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document
Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles : a prospective randomized comparison with conventional haemorrhoidectomy . OBJECTIVE Stapled mucosectomy has been developed as an alternative to conventional haemorrhoidectomy for the elective treatment of haemorrhoids , but has not been assessed in the emergency setting . The aim of this study was to compare this technique with a conventional procedure for acute thrombosed circumferential prolapsed haemorrhoids . PATIENTS AND METHODS A prospective randomized comparison of conventional Milligan-Morgan haemorrhoidectomy and stapled mucosectomy was carried out on 35 consecutive patients presenting with acute thrombosed circumferential prolapsed haemorrhoids . Operative data , postoperative stay , pain assessment and persistent symptoms were compared at discharge and at 2 week and 6 week review . Additionally at 6 week review the time to return to work was recorded and an endoanal ultrasound was carried out . RESULTS Thirty patients were randomized and followed up for six weeks . Although postoperative stay and in-hospital analgesia were the same , patients from the stapled group reported significantly more pain at discharge . However , by 2 weeks the conventional group reported significantly higher pain scores particularly on passing stool . By this stage over half the stapled group patients reported no pain at all . More patients in the conventional group complained of persistent symptoms of pain , bleeding and discharge at 2 week and 6 week review with 20 % requiring readmission compared with none in the stapled group . The median return to work was significantly shorter for the stapled group ( 14 days vs 28 days , P < 0.05 ) . Although all patients claimed to be continent , two patients from each group had ultrasonic evidence of internal sphincter damage . CONCLUSION Stapled mucosectomy for acute thrombosed circumferential piles is feasible and may result in less pain , a more rapid resolution of symptoms and an earlier return to work compared with a conventional procedure .
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Intervention_Physical
Stapled mucosectomy
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Intervention_Physical
conventional haemorrhoidectomy
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Intervention_Physical
conventional procedure
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Intervention_Physical
conventional Milligan-Morgan haemorrhoidectomy and stapled mucosectomy
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Intervention_Surgical
endoanal ultrasound
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Intervention_Educational
conventional group
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Outcome_Other
Operative data
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Outcome_Other
postoperative stay
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Outcome_Pain
pain assessment
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Outcome_Pain
persistent symptoms
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Outcome_Other
endoanal ultrasound
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Outcome_Other
postoperative stay
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Outcome_Other
in-hospital analgesia
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Outcome_Pain
higher pain scores
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Outcome_Pain
no pain
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Outcome_Pain
persistent symptoms of pain
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Outcome_Physical
bleeding
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Outcome_Physical
discharge
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Outcome_Other
median return to work was significantly shorter
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Outcome_Physical
internal sphincter damage
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Outcome_Pain
less pain
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Participant_Sample-size
35
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Participant_Condition
acute thrombosed circumferential prolapsed haemorrhoids
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Participant_Sample-size
Thirty
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Participant_Sample-size
stapled group
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Participant_Condition
conventional group