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11 This prospective randomized study analyzes the outcome of stapled vs excision hemorrhoidectomy in patients with second- or third-degree hemorrhoid disease blinded to the operation technique used, with special regard to the long-term results and recurrence rate.īetween January 1, 1999, and July 31, 2000, 42 patients with symptomatic second- or third-degree hemorrhoid disease, according to the grading of Milles, 12 were included in this prospective randomized study.
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To our knowledge, there are few data comparing the long-term results of stapled vs excision hemorrhoidectomy. These controversial results suggest the need for further prospective evaluation and a randomized comparison of stapled vs conventional hemorrhoidectomy. However, severe complications following stapled hemorrhoidectomy have been reported in 0.12% of the cases these complications include sphincter lesions, persistent postoperative pain, rectal perforations, and even lethal sepsis. 4 Larger studies 5, 6 comparing the 2 techniques confirmed less postoperative pain and an earlier return to work in the stapler group but showed no difference in total hospital stay and overall complications. Faster wound healing and less postoperative pain have also been observed.
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#Stapled hemorrhoidopexy complications series
1 In a small series including 23 patients, 2 it was shown that the stapled hemorrhoidectomy initially described by Longo 3 leads to less postoperative pain, a shorter postoperative hospital stay, and a shorter recovery time in patients with third-degree hemorrhoids compared with conventional hemorrhoidectomy. Furthermore, the patients have to maintain a precise wound dressing to prevent local infection, because local wound exposure may lead to fecal contamination and prolonged wound healing. Provided further clinical trials confirm these findings, stapled hemorrhoidectomy may become a future gold standard.ĮXCISION hemorrhoidectomy is associated with significant postoperative pain because of trauma of the sensitive anal mucosa (anoderm). There were no differences for stapled vs excision hemorrhoidectomy in length of hospital stay (2.4 vs 2.1 days), complications (3 of 20 patients vs 5 of 20 patients), and recurrence rate (1 of 20 patients vs 1 of 20 patients).Ĭonclusions Stapled hemorrhoidectomy is associated with reduced postoperative pain, earlier recovery time and return to work, and a similar recurrence rate compared with the excision technique. Results Stapled vs excision hemorrhoidectomy was associated with a significantly reduced operating time (30 vs 43.25 minutes P<.001), reduced postoperative pain scores (visual analog score) on the first 4 postoperative days (day 1: 2.7 vs 6.3 day 2: 1.7 vs 6.3 day 3: 0.8 vs 5.4 and day 4: 0.5 vs 4.8, where 0 indicates no pain, and 10, maximum pain P≤.001), and an earlier return to work (6.7 vs 20.7 days P =. Main Outcome Measures Operating time, postoperative pain (measured by the visual analog scale), hospital stay, histologic features, morbidity, defecation habit, continence, recovery time (return to work), and hemorrhoid recurrence at 1 year. Interventions Stapled hemorrhoidectomy (Longo technique) vs excision hemorrhoidectomy (Ferguson technique). All patients were subject to a follow-up examination. Patients Forty patients with second- and third-degree hemorrhoid disease were randomized to undergo either stapled or excision hemorrhoidectomy. Setting A university hospital providing primary, secondary, and tertiary care. Follow-up occurred at 1 and 3 weeks and 12 months postoperatively. Patients were blinded to the operation technique used. Furthermore, stapled hemorrhoidectomy is associated with lower hemorrhoidal recurrence on long-term follow-up.ĭesign A randomized prospective trial. Hypothesis Stapled hemorrhoidectomy offers several advantages over excision hemorrhoidectomy, including reduced postoperative pain, a reduced hospital stay, and an earlier recovery time. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.