title: The use of bioabsorbable staple-line reinforcement performing stapled hemorrhoidopexy to decrease the risk of postoperative bleeding.
abstract: Postoperative staple-line bleeding after stapled hemorrhoidopexy represents a major issue of this procedure, especially in the day surgery setting. In this study we assess the possible benefit of using circular bioabsorbable staple-line reinforcement to reduce the risk of hemorrhage  when performing stapled hemorrhoidopexy in a day surgery setting. Patients with symptomatic II to III grade hemorrhoidal disease were randomly assigned into two groups. In Group A we performed a stapled hemorrhoidopexy using PPH33-03(®) with Seamguard(®), a bioabsorbable  staple-line reinforcement; in Group B, we used only a PPH33-03(®) stapler. We evaluated the intraoperative and postoperative staple-line bleeding and, secondarily, the duration of surgery, need for additional hemostatic stitches, and presence of postoperative complications. One  hundred patients were enrolled in the study. Group A patients showed a statistically significant decrease of intraoperative bleeding (4 vs 42% in Group B) and hemostatic stitch placement (5.7 vs 42%) with the consequent reduction in mean operative time, postoperative pain, and  tenesmus. There were no differences between the two groups in hemorrhoidal disease control or postoperative late complications. The use of bioabsorbable staple-line reinforcement while performing stapled hemorrhoidopexy may allow improvement of the safety of this procedure, especially in a  day surgery setting.
authors.affiliation: Unit of Oneday-Day Surgery, Department of Surgery of Sant'Andrea Hospital, University Sapienza of Rome, Rome, Italy. frasavmari@yahoo.it
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Luigi
authors.initials: L
authors.lastname: Masoni
authors.forename: Umile Michele
authors.initials: UM
authors.lastname: Cosenza
authors.forename: Francesco
authors.initials: F
authors.lastname: Favi
authors.forename: Giammauro
authors.initials: G
authors.lastname: Berardi
authors.forename: Anna
authors.initials: A
authors.lastname: Dall'Oglio
authors.forename: Fioralba
authors.initials: F
authors.lastname: Pindozzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D013505:Digestive System Surgical Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D017792:Surgical Stapling / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods
chemical_list: D001672:Biocompatible Materials