title: Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy.
abstract: BACKGROUND
  The aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2).
  
  
  METHODS
  One hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8-19) months patients were administered a standardized questionnaire by telephone.
  
  
  RESULTS
  Postoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5.3 (range 0-19) days compared with 3.1 (range 0-10) days in group 2 (P = 0.01), while severe pain was present for 2.3 (range 0-24) days in group 1 but only for 1 (range 0-14) day in group 2 (P = 0.03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0.01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0.01), but after 30 days the continence score was better in group 2 (P = 0.04).
  
  
  CONCLUSIONS
  Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.
authors.affiliation: Department of General Surgery, Colorectal Eporediensis Centre, Ivrea, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ganio
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.forename: F
authors.initials: F
authors.lastname: Gabrielli
authors.forename: G
authors.initials: G
authors.lastname: Milito
authors.forename: S
authors.initials: S
authors.lastname: Canuti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006484:Hemorrhoids / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D017792:Surgical Stapling