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document
Stapled hemorrhoidopexy vs. Harmonic Scalpel hemorrhoidectomy : a randomized trial . PURPOSE A randomized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel was used . METHODS Patients with Grade III hemorrhoids who were employed during the trial period were recruited and randomized into two groups : ( 1 ) Harmonic Scalpel hemorrhoidectomy , and ( 2 ) stapled hemorrhoidopexy . All operations were performed by a single surgeon . In the stapled group , the doughnut obtained was sent for histopathologic examination to determine whether smooth muscles were included in the specimen . Operative data and complications were recorded , and patients were followed up through a structured pro forma protocol . An independent assessor was assigned to obtain postoperative pain scores and satisfaction scores at six-month follow-up . Patients were also administered a simple questionnaire at follow-up to assess continence functions . RESULTS Over a 20-month period , 88 patients were recruited . The two groups were matched for age and gender distribution . No significant difference was identified between the two groups in terms of operation time , blood loss , day of first bowel movement after surgery , and complication rates . Despite a similar parenteral and oral analgesic requirement , the stapled group had a significantly better pain score ( P = 0.002 ) ; these patients also had a significantly shorter length of stay ( P = 0.02 ) , and on average resumed work nine days earlier than the group treated with the Harmonic Scalpel ( 6.7 vs. 15.6 , P = 0.002 ) . Although 88 percent of doughnuts obtained in the stapled group contained some smooth muscle fibers , no association was found between smooth muscle incorporation and postoperative continence function , and as a whole the continence outcomes of the stapled group were similar to those after Harmonic Scalpel hemorrhoidectomy . Finally , at six-month follow-up , patients who underwent the stapled procedure had significantly better satisfaction scores ( P = 0.001 ) . CONCLUSION Stapled hemorrhoidopexy is a safe and effective procedure for Grade III hemorrhoidal disease . Patients derive greater short-term benefits of reduced pain , shorter length of stay , and earlier resumption to work . Long-term follow-up is necessary to determine whether these initial results are lasting .
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Intervention_Surgical
Stapled hemorrhoidopexy
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Intervention_Surgical
Harmonic Scalpel hemorrhoidectomy
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Intervention_Surgical
stapled hemorrhoidopexy with excisional hemorrhoidectomy
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Intervention_Surgical
Harmonic Scalpel hemorrhoidectomy
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Intervention_Surgical
stapled hemorrhoidopexy
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Intervention_Educational
simple questionnaire
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Intervention_Surgical
stapled
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Intervention_Surgical
Stapled hemorrhoidopexy
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Outcome_Pain
pain scores
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Outcome_Other
satisfaction scores
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Outcome_Other
operation time
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Outcome_Physical
blood loss
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Outcome_Physical
day of first bowel movement after surgery
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Outcome_Adverse-effects
complication rates
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Outcome_Pain
pain score
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Outcome_Other
length of stay
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Outcome_Physical
smooth muscle fibers
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Outcome_Physical
smooth muscle incorporation
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Outcome_Physical
postoperative continence function
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Outcome_Other
satisfaction scores
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Outcome_Other
safe and effective
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Outcome_Pain
pain
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Outcome_Other
shorter length of stay
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Outcome_Physical
earlier resumption to work
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Participant_Condition
Patients with Grade III hemorrhoids who were employed during the trial period