Document Detail


Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy.
MedLine Citation:
PMID:  19091821     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 AND METHODS: 182 patients with symptomatic haemorrhoids (grades II, III, IV) were randomly assigned to receive SA or CH and were followed for up to 1 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, Mann-Whitney U test). At 1 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 1 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 1 year is higher following SA when compared to CH.
Authors:
M A Thaha; K L Campbell; S A Kazmi; L A Irvine; A Khalil; N R Binnie; W S Hendry; A Walker; H J Staines; R J C Steele
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-12-17
Journal Detail:
Title:  Gut     Volume:  58     ISSN:  1468-3288     ISO Abbreviation:  Gut     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-10     Completed Date:  2009-06-04     Revised Date:  2009-12-21    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  England    
Other Details:
Languages:  eng     Pagination:  668-78     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery & Molecular Oncology, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK. m.a.thaha@dundee.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Anal Canal / surgery*
Diathermy / adverse effects*
Digestive System Surgical Procedures / instrumentation
Female
Hemorrhoids / complications,  surgery*
Humans
Male
Middle Aged
Pain, Postoperative / etiology
Patient Satisfaction
Prospective Studies
Quality of Life
Surgical Stapling / adverse effects*
Suture Techniques
Treatment Outcome
Comments/Corrections
Comment In:
Gut. 2010 Jan;59(1):137-8; author reply 138   [PMID:  20007961 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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