Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial.
OBJECTIVE
This trial compares stapled anopexy with open hemorrhoidectomy in patients with prolapsing (Grade 3) hemorrhoids. Particular attention was paid to changes in anorectal physiology, nature of tissue resected, quality-of-life assessments, and cost implications of the treatments studied.


METHODS
An initial pilot study was followed by a randomized, controlled trial in a District General Hospital in the United Kingdom. All patients had Grade 3 hemorrhoids. Nineteen patients were studied in the pilot study, with 99 patients in the randomized, controlled trial. All patients in the pilot study and 59 in the randomized, controlled trial underwent stapled anopexy. Thirty patients in the randomized, controlled trial underwent open hemorrhoidectomy. Of the 59 patients in the stapled group, 32 were treated with the Ethicon PPH stapling device, and 27 received stapling with a reusable Autosuture stapling device. The following variables were measured: demographic details, quality of life (Medical Outcomes Study Short Form 36 and directed questions), anorectal manometry, and histology.


RESULTS
There was no difference in the case mix within or between the groups. The stapled anopexy groups showed a significant reduction in operative time (P < 0.001) and blood loss (P < 0.001) compared with open hemorrhoidectomy. Open hemorrhoidectomy resulted in significantly greater usage of protective pads postoperatively (P < 0.001) and longer rehabilitation (P < 0.006).


CONCLUSIONS
Stapled anopexy is an effective alternative treatment for prolapsing hemorrhoids that allows reduced operative time and shorter rehabilitation. It does not appear to affect continence or overall quality of life.
Wilson
M S
MS
Department of Surgery, Christie Hospital, Wilmslow Road, Withington, Manchester M20 4BX, United Kingdom.
Pope
V
V
Doran
H E
HE
Fearn
S J
SJ
Brough
W A
WA
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D004180:Direct Service Costs; D006484:Hemorrhoids / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008365:Manometry; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D011788:Quality of Life; D017792:Surgical Stapling / Q000191:economics / Q000379:methods*; D013536:Suture Techniques