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Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy
  1. Mohamed Adhnan Thaha (m.a.thaha{at}
  1. University of Dundee, United Kingdom
    1. Kenneth L Campbell
    1. Ninewells Hospital & Medical School, United Kingdom
      1. Syed A Kazmi
      1. Ninewells Hospital & Medical School, United Kingdom
        1. Lesley A Irvine
        1. Ninewells Hospital & Medical School, United Kingdom
          1. Ahmed Khalil
          1. University of Dundee, United Kingdom
            1. Norman R Binnie
            1. Aberdeen Royal Infirmary, United Kingdom
              1. Wilson S Hendry
              1. Stirling Royal Infirmary, United Kingdom
                1. Andrew Walker
                1. University of Glasgow, United Kingdom
                  1. Harry J Staines
                  1. University of Abertay Dundee, United Kingdom
                    1. Robert JC Steele
                    1. University of Dundee, United Kingdom


                      Objective: Unlike excisional haemorrhoidectomy, stapled anopexy (SA) which does not involve radical excision has theoretical advantages, thus offering potential patient benefits. We compared the clinical efficacy, safety, and patient acceptability of SA, with closed haemorrhoidectomy (CH).

                      Patients & Methods: 182 patients with symptomatic haemorrhoids (grades II, III, IV) were randomly assigned to receive SA or CH and were followed for up to one-year (6, 12, 24, 48 weeks) after operation. Postoperative pain, symptom control, complications, re-treatment rates, patient satisfaction, and quality of life were compared on an intention-to-treat basis.

                      Results: Postoperative pain in the SA group (n=91) was significantly lower (p=0.004, MWU-test). At one-year there were no significant differences in the symptom load, symptom severity or the disease severity between the two groups. Overall complication rates were similar but faecal urgency was reported more frequently following SA (p=0.093, Fisher’s exact test). Despite a similar rate of residual symptoms, prolapse control was better with CH (p=0.087, Fisher’s exact test), and more patients in the SA group required re-treatment for residual prolapse at one-year (p=0.037, Fisher’s exact test). However, more patients rated SA as an excellent operation at 6 and 12 weeks (p=0.008 and 0.033, binary logistic regression) and were willing to undergo a repeat procedure if required (p=0.018 Fisher’s exact test).

                      Conclusion: Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability. Although the overall symptom control and safety are similar in the majority of the patients, the re-treatment rate for recurrent prolapse at one-year is higher following SA when compared to CH.

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