title: Single purse string with four-point traction for better haemorrhoid retraction.
abstract: BACKGROUND
  Traction method is important to stapled haemorrhoidopexy (SH) for its impact on haemorrhoidal prolapse reduction. Single purse string with one-point traction is most commonly used in SH. This traction method often results in an irregular mucosal doughnut with inadequate height, which leads to insignificant and uneven haemorrhoidal prolapse reduction. Single purse string with two-point traction is a modified traction method. According to some authors, it has significantly improved the height and regularity of the mucosal doughnut in SH. However, the reduction of haemorrhoidal prolapse is not always satisfactory, especially in patients with large prolapse. Our assumption is that single purse string with four-point traction, a more balanced traction method, will provide better control to increase the doughnut height using the same amount of traction. This study was designed to evaluate the outcomes of single purse string with four-point traction as compared with two-point traction in SH.
  
  
  METHODS
  Consecutive patients with symptomatic grade III haemorrhoids were randomized to two groups: Group 1, G(1) ; Group 2, G(2) . Each group underwent SH by colorectal surgeons. The patients in G(1) underwent single purse string with two-point traction. The patients in G(2) underwent SH using single purse string with four-point traction. Preoperative, intraoperative and post-operative patient characteristics were evaluated.
  
  
  RESULTS
  Sixty patients with a median age of 44 (range, 21-78) years were identified. Patient demographic and clinical characteristics were similar in the two groups. The height of the mucosectomy specimens significantly increased in patients of G(2) (P < 0.01, t-test). The variation in mucosal doughnut height significantly decreased in patients of G(2) (P < 0.01, t-test). The anatomy score after SH also significantly decreased in patients of G (2) (P = 0.029, Mann-Whitney U-test). No significant difference in complications was observed between the two groups. Median follow-up was 14 (range, 6-22) months. No haemorrhoidal symptoms were found in these patients.
  
  
  CONCLUSIONS
  Single purse string with four-point traction ensures a taller and more regular mucosal doughnut during SH, thus it brings a more satisfactory haemorrhoid retraction.
authors.affiliation: Department of General Surgery, PLA General Hospital, Beijing, China.
authors.forename: Shao-Quan
authors.initials: SQ
authors.lastname: Chen
authors.forename: Ai-Zhen
authors.initials: AZ
authors.lastname: Cai
authors.forename: Ning
authors.initials: N
authors.lastname: Wang
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016037:Single-Blind Method; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques; D016896:Treatment Outcome