title: Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids.
abstract: OBJECTIVE
  The aim of this prospective controlled trial was to evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy performed by expert surgeons in a selected group of patients for the treatment of chronic hemorrhoids.
  
  
  METHODS
  This study took place in the outpatient clinic and at the Day Surgery Unit attached to the University Hospital of Elche.
  
  
  METHODS
  From March 2003 to May 2005, 200 consecutive patients with third-degree hemorrhoids and treated with double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler were included in the study.
  
  
  METHODS
  Demographic, manometric, and clinical features were analyzed, as well as the variables related to surgery, postoperative course, and follow-up. Manometry was repeated at the 6-month, 1-year, and 5-year follow-up.
  
  
  RESULTS
  Median follow-up was 110 months. Four patients (2%) reported daily rectal bleeding. One patient with active rectal bleeding was taken for reoperation within the first 12 postoperative hours. Seventy percent of patients reported pain ≤ 2 on the first postoperative day, 85% on the fourth postoperative day, and 95% on the seventh postoperative day. Pain was measured with a linear analog scale from 0 to 10 (0 = no pain; 10 = unbearable pain). Seventeen patients (8.5%) reported tenesmus during the first week. Eight patients (4%) reported persistent pain: in 5 patients, the pain resolved within the next 6 months; 2 patients presented with anal fissure; and 1 patient required the removal of the staples. Two patients (1%) reported residual soiling at the 5-year revision. Fourteen patients (7%) experienced recurrence with symptomatic prolapse. Six (3%) underwent further surgery: stapled hemorrhoidopexy was indicated again in 2 patients, and 4 patients underwent a Milligan-Morgan open hemorrhoidectomy, because they did not have a uniform prolapse. Six patients required treatment with rubber band ligation. There were no statistically significant differences between preoperative and postoperative manometric values.
  
  
  CONCLUSIONS
  The new PPH33-03 stapler, the learning process of the modified surgical procedure, and the correct selection of patients will overcome the main objections to stapled hemorrhoidopexy.
authors.affiliation: Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Spain. arroyocir@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Arroyo
authors.forename: Juan
authors.initials: J
authors.lastname: Pérez-Legaz
authors.forename: Elena
authors.initials: E
authors.lastname: Miranda
authors.forename: Pedro
authors.initials: P
authors.lastname: Moya
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: Lacueva
authors.forename: Fernando
authors.initials: F
authors.lastname: Candela
authors.forename: Rafael
authors.initials: R
authors.lastname: Calpena
mesh_terms: D002908:Chronic Disease; D003672:Defecation; D004867:Equipment Design; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008365:Manometry; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D017792:Surgical Stapling; D013536:Suture Techniques / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome