Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites

Purpose: Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids. A common complication of SH is SH site stricture (SHsS), which negatively affects quality of life. This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS.Methods: Between 2020 and 2023, 1,023 patients underwent SH, with an average of 3.3 external hemorrhoids being excised per patient. The fluid mixture contained 40 mg of TA per 100 mL (0.4 mg/mL), with 5 mL (2 mg of TA) injected at the SH site and 2–3 mL (1.2 mg of TA) at each excisional hemorrhoidectomy site. The TA group (n=554; propensity score matching [PSM]-adjusted, n=375) received TA injections, whereas the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections. PSM was adjusted for age, sex, concurrent surgeries, botulinum toxin injection, and excisional hemorrhoidectomy frequency. Logistic regression models were used to analyze SHsS and reoperation rates.Results: SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%).Conclusion: Low-dose TA injections effectively prevent SHsS and reduce reoperation rates without increasing the risk of infection, providing a safe, cost-effective approach to improving surgical outcomes.