Single purse string with four-point traction for better haemorrhoid retraction

Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment

OBJECTIVES

To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids.

DESIGN

Simple randomized double-blind controlled clinical trial. Randomization with closed-envelope technique in two groups with two different SLH.

SETTING

Colorectal Surgery Unit. Department of General Surgery. Hospital de Mataró (Barcelona, Spain).

PARTICIPANTS

119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included.

INTERVENTION

SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge. Postoperative disturbances were evaluated by a colorectal surgeon who was blind for the randomization and pain was measured (visual analogic scale) one week and 3 months after surgery. Mean operative time, number of hemostatic stitches performed and resected mucosal area were considered as well. Mean follow-up was 11.05 ± 1.6 years.

RESULTS

Differences between the operative time and resected mucosa-submucosa area were not found. The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line. We did not found differences between both groups in terms of postoperative pain neither anorectal disturbances. At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance. Neither mortality nor undesirable effects occurred in the series.

CONCLUSIONS

SLH do not influence the recurrence rate neither the postoperative evolution in SA.

TRIAL REGISTRATION

Clinical Trials NCT03383926.