[Haemorrhoidectomy: conventional excision versus resection with the circular stapler. Prospective, randomized study].
OBJECTIVE
The goal of this study was to compare two surgical methods of treating for haemorrhoids that aim at closure of the wound: resection with a circular stapler and a conventional, closed haemorrhoidectomy.


METHODS
80 patients (41 males, mean age 47,1 years) with haemorrhoids stage 3 were randomized and treated with stapler haemorrhoidectomy (test group; n = 40) or had an haemorrhoidectomy according to Fansler and Anderson (control group; n = 40). Following a standardized study protocol we compared postoperative results on the operating day and one week, six weeks, six months and one year afterwards uni- and multivariate analysis and we also calculated the costs.


RESULTS
The stapler haemorrhoidectomy proved to be the method causing significantly reduced pain in the early postoperative period so that the patients needed less pain relief. They were able to return to work earlier. One year after stapler haemorrhoidectomy there were three episodes of postoperative bleedings that required intervention, one in the control group. Six patients still had haemorrhoids stage 3, six patients over the age of 65 had persistent anal incontinence (I degrees according to Parks) with proven sphincter dysfunction and disturbances in voiding their bowel with resulting deterioration of quality of life, significantly more frequent than in the control group.


CONCLUSIONS
Stapler haemorrhoidectomy cures stage 3 haemorrhoids on a long term basis in 84.2 % of patients, costing less than all alternative treatments. In some cases, it can be associated with postoperative complications.
Hasse
C
C
Klinik für Visceral-, Thorax- und Gefässchirurgie, Philipps-Universität Marburg. coloproktologie@t-online.de
Sitter
H
H
Brune
M
M
Wollenteit
I
I
Lorenz
W
W
Rothmund
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D013528:Surgical Staplers / Q000191:economics / Q000592:standards*; D017792:Surgical Stapling / Q000191:economics / Q000592:standards*; D013997:Time Factors