title: Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes.
abstract: BACKGROUND
  The aim of the study was to compare short- and medium-term outcomes of transanal haemorrhoidal dearterialisation (THD) versus stapled haemorrhoidopexy (SH) for the treatment of second- and third-degree haemorrhoids.
  
  
  METHODS
  Patients with second- or third-degree haemorrhoids who failed conservative treatment were randomly allocated to THD or SH. Preoperative and postoperative symptoms, postoperative pain, time until return to normal activities, complications, patient satisfaction and recurrence rates were all assessed prospectively. Patients were followed up at 2, 8 months and when the study was completed.
  
  
  RESULTS
  Twenty-eight patients (43% third degree) underwent THD and 24 (38% third degree) underwent SH. There were no significant differences in terms of postoperative pain, expected pain and analgesia requirements, but more THD patients returned to work within 4 days (P < 0.05). One THD patient developed a sub-mucosal haematoma after surgery, one SH patient occlusion of the rectal lumen and two rectal bleeding. At 8-month follow-up, two SH patients complained of faecal urgency. At 38-month follow-up (range 33-48 months), all short-term complications resolved. Patient satisfaction ("excellent/good outcome", THD 89 vs. SH 87%) and recurrence rate (THD 14 vs. SH 13%) were similar in the two groups.
  
  
  CONCLUSIONS
  Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD. Medium-term results demonstrate that THD and SH have similar effectiveness.
authors.affiliation: Department of Colorectal Surgery, Whipps Cross University Hospital, Whipps Cross Road, London E11 1NR, UK. pasquale.giordano@whippsx.nhs.uk
authors.forename: P
authors.initials: P
authors.lastname: Giordano
authors.forename: P
authors.initials: P
authors.lastname: Nastro
authors.forename: A
authors.initials: A
authors.lastname: Davies
authors.forename: G
authors.initials: G
authors.lastname: Gravante
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011446:Prospective Studies; D012007:Rectum / Q000098:blood supply*; D017792:Surgical Stapling; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult