Evaluation of the learning curve of stapled hemorrhoidopexy

Abstract

Introduction: There is limited evidence regarding the learning curve of stapled hemorroidhopexy (PPH). The aim of this study is to determine the learning curve of PPH and its impact on outcomes.

Materials and Methods: A retrospective multicenter case-control study was conducted, including patients who underwent PPH surgery between 2013 and 2021 in 3 surgical centers. Data was collected from medical records and telephone or electronic surveys. Each surgery was assigned an order number in the learning curve. Pre, intra and postoperative variables were evaluated. Multivariate analysis was performed to assess which variables were modified based on the order number and determine the cutoff point. The sample was divided into two groups, "initial" and "advanced," according to the previous determined order number. Variables were compared between the two groups.

Results: A total of 75 patients were included. A significant difference in surgical time was found between the initial 20 cases and the subsequent ones, which was used to divide the sample. Initial group included 26 patients, while advanced group had 49. The mean surgical time was 46.9 minutes in initial group vs. 27.6 minutes in advanced group (p<0.001). The duration of analgesics was 6.7 vs. 8.6 days (p=0.28), complication rate was 7.7 vs. 8.2% (p=1), symptom recurrence was 35.6 vs. 26.5% (p=0.46), and high satisfaction rate was 96.2 vs. 91.8% (p=0.43) in initial and advanced groups, respectively. There was a difference in hospital stay of 0.57 vs. 0.29 days (p=0.011); however, the multivariate analysis of hospital stay showed that the difference was due to the attending surgeon.

Conclusion: PPH technique could be safely performed for patients from the first cases.