title: Prospective, randomized trial comparing a 3- versus 6-stitch purse-string suture in stapled hemorrhoidopexy.
abstract: OBJECTIVE
  The purse-string suture is the most important part of the procedure in stapled hemorrhoidopexy affecting resection of an ideal mucosal rectal ring. We designed a prospective, randomized study to evaluate the safety and clinical outcome of a 6-stitch purse-string suture compared with a more simple 3-stitch purse-string suture intended to achieve certain interruption of the hemorrhoidal artery.
  
  
  METHODS
  Ninety patients were randomly assigned to undergo stapled hemorrhoidopexy with either a 6-stitch (n = 45) or a 3-stitch (n = 45) purse-string suture. Operative data and postoperative complications were compared between the 2 groups. The ring of excised rectal mucosa was examined histologically. Anal physiology was also assessed.
  
  
  RESULTS
  Although there were no statistically significant differences in postoperative complication rates, histological analysis of the excised mucosa, or anorectal function between the 2 groups, the 3-stitch procedure was significantly superior to the 6-stitch procedure in terms of intraoperative hemostasis and operative time, especially in advanced surgery.
  
  
  CONCLUSIONS
  Once the learning curve has been completed, a 3-stitch purse-string suture in stapled hemorrhoidopexy could be an alternative to the 6-stitch suture, with effective hemostasis and a shorter operative time.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Minako
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Yoshiyama
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hiro
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohi
authors.forename: Chikao
authors.initials: C
authors.lastname: Miki
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D005260:Female; D006484:Hemorrhoids / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology; D017792:Surgical Stapling; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome