EP776 - Outcomes of Stapled Hemorrhoidopexy (PPH) Compared to Excisional Hemorrhoidectomy and Transanal Hemorrhoidal Dearterialization: A Single Institution Retrospective Cohort Study

Purpose/Background: Hemorrhoidal disease is common, with up to 60% of patients developing prolapsing internal hemorrhoids causing bleeding and discomfort. Excisional hemorrhoidectomy (Ferguson or Milligan-Morgan) and transanal hemorrhoidal dearterialization (THD) remain standard surgical approaches, while stapled hemorrhoidopexy (Procedure for Prolapse and Hemorrhoids, PPH) was developed to minimize postoperative pain and recovery time. Despite these advantages, its use in the United States has declined due to concerns of serious complications including recurrence and infections. This study compares postoperative outcomes and recurrence rates of PPH, excisional hemorrhoidectomy, and THD performed by a single surgeon at Orlando Health.

Methods/Interventions: This retrospective cohort study included adult patients (≥18 years) who underwent surgery for prolapsed internal hemorrhoids by a single surgeon between January 2021 and October 2025. Patients treated with excisional hemorrhoidectomy (n=25), PPH (n=70), or THD (n=43) were identified from the institutional database. Demographic, operative, and postoperative data were collected from electronic medical records.

All patients were routinely followed up at 10-14 days postoperatively and subsequently as needed for up to 1 year. Outcomes analyzed included hemorrhoid recurrence, acute bleeding, constipation, infection, urinary retention, urinary tract infection, fecal urgency, fecal incontinence, chronic anal pain, and anal stenosis. Fisher's exact test was used for categorical comparisons among surgical groups.

Results/Outcomes: Significant differences were found among surgical groups for 4 of 10 chosen outcomes. The PPH group had the fewest acute bleeding events compared with THD and excisional hemorrhoidectomy (p < 0.001). Chronic anal pain was also lowest in the PPH group (p < 0.001). The excisional hemorrhoidectomy group experienced more anal stenosis than PPH and THD (p < 0.05). Fecal urgency was least frequent in the PPH group (p < 0.05). No significant differences were observed for recurrence, constipation, infection, urinary retention, urinary tract infection, or incontinence. Overall, PPH demonstrated comparable or superior outcomes relative to traditional techniques.

Conclusion/Discussion: This analysis represents one of the largest contemporary single-institution evaluations of stapled hemorrhoidopexy outcomes in the United States. In this 4-year cohort, PPH demonstrated similar or improved complication rates compared to traditional hemorrhoidectomy techniques, supporting its safety and ongoing relevance when performed by experienced surgeons. Importantly, our institution's overall experience with PPH spans more than a decade and includes several hundred additional patients. A forthcoming expanded analysis of this full dataset will provide the most comprehensive U.S. evaluation to date comparing PPH with excisional hemorrhoidectomy and THD. The present results offer an early preview of these findings and underscore the value of reassessing the role of PPH in modern hemorrhoid surgery.