Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy

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Abstract
Background: Stapled haemorrhoidectomy does not involve dissection, with its attendant potential morbidity, required to perform closed haemorrhoidectomy. This study compared haemorrhoidectomy with (sutured) and without (stapled) preliminary dissection. Methods: Forty patients with prolapsed symptomatic haemorrhoids were randomly assigned to sutured (n = 20) or stapled (n = 20) haemorrhoidectomy. Preoperative assessment was by proctoscopy, sigmoidoscopy and anal manometry. Stapled and diathermy haemorrhoidectomies with wound suture were performed, and excised tissue was examined histologically. Pain scores, complications, wound healing and patient satisfaction were recorded. Follow-up was weekly for 4 weeks, and at 3 and 6 months; anal manometry was repeated at the last two visits. Results: Postoperative resting and squeeze pressures were reduced by the stapled method at 3 months (P = 0·02 and P = 0·03 respectively), returning to baseline by 6 months. Stapled haemorrhoidectomy was quicker but initial access into the anus was hampered by the bulky stapler. Isolated muscle fibres were identified equally in both groups, but incontinence did not occur. The stapled technique resulted in less postoperative pain (P = 0·04), a greater degree of satisfaction (P = 0·01) and faster wound healing (P < 0·001), but was more expensive. There was no significant difference in complications. Conclusion: Despite the higher cost and difficult access, stapled haemorhoidectomy results in less postoperative pain, faster wound healing and greater patient satisfaction than the sutured technique.