Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse.
BACKGROUND
: This multicentre randomized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids.


METHODS
: The study involved 18 hospitals in Sweden, Denmark and the UK. Some 207 patients were randomized to either anopexy or Milligan-Morgan haemorrhoidectomy, of whom 90 in each group were operated on. Patients reported symptoms before surgery and after 1 year. Daily postoperative pain scores were recorded in a patient diary. Surgeons evaluated the anal anatomy before surgery and after 1 year.


RESULTS
: Correction of prolapse in the anopexy and haemorrhoidectomy groups was similar at 1 year (88 and 90 per cent respectively; P = 0.80). Freedom from symptoms was obtained in 44 and 69 per cent respectively (P = 0.002). Stapled anopexy was associated with less postoperative pain, which resolved more quickly (P = 0.004). Significant improvements were noted in anal continence and well-being 1 year after both operations (P < 0.001). Excessive pain was the most common complication after diathermy excision and disturbed bowel function after stapled anopexy.


CONCLUSIONS
: Haemorrhoidal prolapse was corrected equally by either operation. Diathermy haemorrhoidectomy gave better symptom relief but was more painful. Neither operation provided complete cure but well-being was greatly improved.


BACKGROUND
ISRCTN68315343 (http://www.controlled-trials.com).
Nyström
P-O
PO
Department of Clinical Sciences, Intervention and Technology, CLINTEC, Karolinska Institute, and Department of Gastrointestinal Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden. per-olof.nystrom@karolinska.se
Qvist
N
N
Raahave
D
D
Lindsey
I
I
Mortensen
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D004564:Electrocoagulation / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012005:Rectal Prolapse / Q000601:surgery*; D017792:Surgical Stapling; D016896:Treatment Outcome; D055815:Young Adult