Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial.
BACKGROUND
We compared the safety and clinical outcome between stapled rectal mucosectomy and closed hemorrhoidectomy for the surgical treatment of noncomplicated hemorrhoidal disease.


METHODS
Eighty-four patients with Grade III and IV hemorrhoidal disease were randomly assigned to two groups: 1) stapled rectal mucosectomy group (n = 42) and 2) closed hemorrhoidectomy group (n = 42). Postoperative pain, analgesic use, symptoms, disability, early and late complications, and patient satisfaction were evaluated, among others. Follow-up was six months.


RESULTS
Eighty-four patients, averaging 45 +/- 9 years of age, underwent surgery. Two were lost to follow-up. Length of surgery and disability, postoperative pain, and use of analgesics were significantly less for patients in the stapled rectal mucosectomy group. In the closed hemorrhoidectomy group early complications were more frequent but not statistically significant, and there were no statistically significant differences regarding the frequency of late complications. No serious complications were reported in either group. Closed hemorrhoidectomy proved to be superior for bleeding control (95.1 percent closed hemorrhoidectomy 80.5 percent stapled rectal mucosectomy; P= 0.04). Patient satisfaction was similar in the two groups, but stapled rectal mucosectomy patients were more willing to undergo the same procedure (P = 0.02).


CONCLUSIONS
Both stapled rectal mucosectomy and closed hemorrhoidectomy are safe procedures. Closed hemorrhoidectomy was superior for bleeding control in Grade III and IV hemorrhoidal disease, but more painful and disabling than stapled rectal mucosectomy.
Correa-Rovelo
José Manuel
JM
Colon and Rectum Clinic, Médica Sur Hospital, Mexico City, Mexico.
Tellez
Oscar
O
Obregón
Leoncio
L
Miranda-Gomez
Adriana
A
Moran
Segundo
S
D000328:Adult; D006484:Hemorrhoids / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome