Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire

Introduction

Dear Editor,

We read the article entitled ‘Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire’ by Erdoğdu and friends published in the last issue of Ulusal Cerrahi Dergisi ( Ulusal Cer Der 2013; 29: 59-62) with great interest [1]. We presume that the author thinks “stapled hemorrhoidectomy” process is the same process as “stapled hemorrhoidopexy“. The procedure is named as stapled hemorrhoidectomy in the title, as “stapled hemorrhoidopexy” in the introduction, and as “stapled hemorrhoidectomy “ in material and methods section. In fact, these two definitions describing different surgical procedures also have different meanings according to their terminology (Hemorrhoidectomy; excision of hemorrhoids - hemorrhoidopexy ; hanging of hemorrhoids), and we see that they are used as synonyms in the literature. The aim of this letter is to correct this misperception and emphasize that the term that best describes the procedure is “stapled hemorrhoidopexy”.

Koblandin and Schalkow from Kazakhstan, first described excision of hemorrhoids with circular stapler in 1981 [2]. First publication on this subject from Europe was by Allegra in 1990, where he described anal purse-string stitches by finger retraction of the anal region followed by hemorrhoidectomy with circular stapler [3]. In both studies, the methods described stapled excision of hemorrhoids, thus stapled hemorrhoidectomy [4].

However, in stapled hemorrhoidopexy a hemorrhoidectomy is not performed, instead an annular tissue containing mucosa and submucosa layers from the proximal of internal hemorrhoids is removed. In this way, both hemorrhoidal arterial and venous devascularization and fixation of hemorrhoids to their anatomical location are provided. The purpose of this procedure is to hang the hemorrhoids to their original location and to reduce their blood supply, rather than removing them [4].

The literature published in the first five years following implementation of this surgery, various terms like stapled hemorrhoidectomy, stapled anopexy, the Longo procedure has been extensively used in addition to “stapled hemorrhoidopexy”. In order to prevent using different names for the same surgery the consensus study published in 2003 suggested that the method should be defined as “stapled hemorrhoidopexy” [5].

Currently this recognition is mostly complied. We believe preferring this terminology in publications originating from Turkey is important to avoid any further confusion and to show that we carry the correct point-of-view.

Dear Editor,

We read the comments by Mr. Bozdağ and Mr. Sayım regarding our manuscript entitled ‘Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire’ published in Ulusal Cer Derg 2013;29:59-62, with great interest.

The procedure performed in this publication is “Hemorrhoidopexy with circular stapler (Longo)”.
We apologize from the readers for this unintentional confusion in definition and thank our colleagues for their acuity.

Dr. Nurver Turfaner Sipahioğlu
Department of Family Medicine, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey

References

1. Erdoğdu A, Sipahioğlu NT, Erginöz E, Apaydın B, Sipahioğlu F. Stapler hemoroidektominin yaşam kalitesine etkisinin SF-36 ölçeği ile değerlendirilmesi. Ulusal Cer Derg 2013; 29: 59-62.
2. Hetzer FH, Senagore A. The evidence for stapled hemorrhoidopexy and starr. In Jayne D, Stuto A, eds. Transanal Stapling Techniques for Anorectal Prolapse. 1st ed. Springer-Verlag London Limited; 2009.p.95-115.
3. Allegra G. [Experiences with medical staplers: hemorrhoidectomy using a circular stapler]. G Chir 1990; 11: 95-97.
4. Bozdağ AD. Stapler ile hemoroidopeksi. Turkiye Klinikleri J Gen Surg-Special Topics 2012; 5: 73-77.
5. Corman ML, Gravié JF, Hager T, Loudon MA, Mascagni D, Nyström PO, et al. Stapled haemorrhoidopexy: a consensus position paper by an international working party-indications, contra-indications and technique. Colorectal Dis 2003; 5: 304-310.