Prospective, randomized trial comparing a 3- versus 6-stitch purse-string suture in stapled hemorrhoidopexy.
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.
Inoue
Yasuhiro
Y
Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan.
Kobayashi
Minako
M
Yoshiyama
Shigeyuki
S
Hiro
Junichiro
J
Ohi
Masaki
M
Miki
Chikao
C
Kusunoki
Masato
M
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