Purpose: We compared the safety and clinical outcome between stapled hemorrhoidectomy and conventional excision hemorrhoidectomy for treating acute hemorrhoidal crisis.
Methods: Seventy consecutive patients diagnosed with hemorrhoidal crisis were enrolled. Thirty patients underwent stapled hemorrhoidectomy and forty patients underwent conventional excision hemorrhoidectomy. All had the operation within 24 hours of admission under local anesthesia with conscious sedation. Patients were prospectively evaluated for operative data, perioperative pain, analgesic use, disability, complications and satisfaction.
Results: Length of surgery, hospital stay and disability, postoperative pain, and use of analgesics were significant less for patients in the stapled hemorrhoidectomy group. Two early complications (within 7 days of the operation), thrombosed hemorrhoids and fecal urgency, were significantly higher in the stapled hemorrhoidectomy group (p = 0.036). Late complications were more frequent in the stapled hemorrhoidectomy group,,but not statistically significantly. No serious complications were reported in either group. Patient satisfaction was similar in the two groups.
Conclusion: Stapled hemorrhoidectomy is superior in less postoperative pain, shorter operative time, shorter hospital stay and earlier return to normal activity, but more recurrent and thrombosed hemorrhoids than conventional excision procedure. We suggest that stapled hemorrhoidectomy can be used in selected patients with an acute hemorrhoidal crisis.
Demographic data and clinical characteristics

Variable	SH (n=30)	CH (n=40)	P value
Age, years, mean± SD a (range)	48.21 ± 9.50 (32-82)	40.25 ± 14.67 (22-76)	0.064
Gender
Male	20 (66.7)	29 (72.5)	0.598
Female	10 (33.3)	11 (27.5)
Operative time, minutes, mean± SD b	30.50 ± 3.31	49.0 ± 18.37	< 0.001*
Duration of hospital stay, day, mean± SD b	1.27 ± 0.45	2.8 ± 0.94	< 0.001*
Normal activity resumed,day, mean± SD b	7.63 ± 1.22	10.6 ± 4.98	0.001*
Follow-up time, months, mean± SD b	11.37 ± 3.63	14.00 ± 6.65	0.176

SH : stapled hemorrhoidectomy CH : conventional hemorrhoidectomy a : Independent samples T test b : Manny-Whitney U test * : P < 0.05 statistically significant