Erkek A, Yıldırak MK, Yıldız A, Sevinç B. Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease. World J Gastrointest Surg 2025; 17(8): 107476 [DOI: 10.4240/wjgs.v17.i8.107476]
Corresponding Author of This Article
Barış Sevinç, Associate Professor, Department of General Surgery, Uşak University Faculty of Medicine, Uşak Üniversitesi 1 Eylül Kampüsü, Uşak 64100, Türkiye. drbarissevinc@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Aug 27, 2025; 17(8): 107476 Published online Aug 27, 2025. doi: 10.4240/wjgs.v17.i8.107476
Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease
Ahmet Erkek, Muhammed K Yıldırak, Abdullah Yıldız, Barış Sevinç
Ahmet Erkek, Department of General Surgery, Istinye University, İstanbul 34600, Türkiye
Muhammed K Yıldırak, Abdullah Yıldız, Department of General Surgery, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul 34400, Türkiye
Barış Sevinç, Department of General Surgery, Uşak University Faculty of Medicine, Uşak 64100, Türkiye
Author contributions: Erkek A, Yıldırak MK, and Yıldız A collected the patients’ clinical data; Erkek A and Sevinç B analyzed the data and revised the paper; Yıldırak MK and Yıldız A wrote the paper. All authors read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Ümraniye Training and Research Hospital (No. B.10.1.TKH.4.34.H.GP.0.01/305).
Informed consent statement: Signed written informed consent form was obtained from all patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The anonymized data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Barış Sevinç, Associate Professor, Department of General Surgery, Uşak University Faculty of Medicine, Uşak Üniversitesi 1 Eylül Kampüsü, Uşak 64100, Türkiye. drbarissevinc@gmail.com
Received: March 25, 2025 Revised: March 28, 2025 Accepted: June 11, 2025 Published online: August 27, 2025 Processing time: 154 Days and 7.1 Hours
Abstract
BACKGROUND
Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease, being particularly effective for grade III and IV hemorrhoids. The procedure is associated with better short-term outcomes, including less postoperative pain, shorter operative time, faster return to work, and higher patient satisfaction. However, there is a risk-benefit debate surrounding SH due to significant complications from the procedure, such as anal stenosis, rectovaginal fistula, fecal incontinence, and recurrence.
AIM
To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.
METHODS
This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis. Early (less than 7 days after SH) and late (7 or more days after SH) complications were analyzed. Recurrence rates were calculated as well.
RESULTS
Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups. Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids. Postoperative bleeding, incomplete defecation, urgent defecation, incontinence, skin tags, and anal fissure were complications reported by both groups.
CONCLUSION
Due to the high recurrence rate, SH is not an appropriate treatment option for patients with grade IV hemorrhoids. Open surgery may be a more suitable option for these patients.
Core Tip: Stapled hemorrhoidopexy (SH) is widely used to treat grade III and IV hemorrhoids. While it offers advantages such as reduced postoperative pain and faster recovery, its effectiveness for advanced hemorrhoidal disease remains controversial. In this retrospective, single-center study, we analyzed the clinical outcomes of 77 patients who underwent SH. We focused particularly on recurrence rates after SH. Our observations suggest that SH is an inappropriate treatment for grade IV hemorrhoids due to a significantly higher recurrence rate.
