title: Influence of stapler haemorrhoidectomy on anorectal function and on patients' acceptance.
abstract: BACKGROUND
  Symptomatic haemorrhoids surgery has been shown to be the most successful and definite therapy. Recently a new method using a transanally inserted circular stapler has been presented for treatment of symptomatic prolapsing haemorrhoids. This prospective study investigated the influence of the stapling procedure on the anorectal function and patients' acceptance.
  
  
  METHODS
  Eighteen consecutive patients (10 males, 8 females) mean age 44.7 years (range 18- 66) with symptomatic second (n = 3), third (n = 14), and fourth degree (n = 1) haemorrhoids were included. All patients underwent the day before and 8 weeks after the operation a standardised anal manometry using a water perfused system. Mean resting (MRAP) and mean maximal squeeze anal pressures (MSAP) were recorded. Volumes of initial rectal sensation (VIRS), constant rectal sensation (VCRS), and maximal tolerable volume (MTV) of a rectal balloon were assessed. Anorectal symptoms (bleeding, pain, faecal incontinence) were assessed in a standardised fashion preoperatively and 1, 8, and 12 weeks postoperatively.
  
  
  RESULTS
  The stapling procedure led to no manometric or symptomatic change in anal sphincter function. Pre- and postoperative MRAP (91.7 mm Hg, SD 23.59 / 83.8 mm Hg, SD 14.53, p = 0.053), MSAP (162.6 mm Hg SD 78.68 / 173.9 mm Hg, SD 69.93, p = 0.162), VIRS (55.8 ml, SD 26.12 / 51.7 ml, SD 28.90, p = 0.410), VCRS (109.4 ml SD 41.67/ 96.4 ml, SD 38.44, p = 0.181), and MTV (204.7 ml SD 47.65/ 173.3 ml, SD 43.22, p = 0.053) were similar. No symptoms of rectal pain or faecal incontinence were registered during follow up. Patients' acceptance and satisfaction for the operation were high.
  
  
  CONCLUSIONS
  Stapling haemorrhoidectomy is a safe procedure which does not alter anorectal functions. Patients' acceptance and satisfaction are high.
authors.affiliation: Department of Internal Medicine, University Hospital of Zurich, Switzerland. dracfantin@bluewin.ch
authors.forename: Amedeo C
authors.initials: AC
authors.lastname: Fantin
authors.forename: Franc H
authors.initials: FH
authors.lastname: Hetzer
authors.forename: Andreas D
authors.initials: AD
authors.lastname: Christ
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Werner
authors.initials: W
authors.lastname: Schwizer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D017060:Patient Satisfaction; D011446:Prospective Studies; D012007:Rectum / Q000502:physiology*; D018709:Statistics, Nonparametric; D017792:Surgical Stapling / Q000009:adverse effects; D011795:Surveys and Questionnaires; D016896:Treatment Outcome