title: A Randomized Trial Comparing Stapled Rectal Mucosectomy Versus Open and Semiclosed Hemorrhoidectomy.
abstract: BACKGROUND
  Different results have been reported concerning the postoperative outcomes of different surgical approaches for hemorrhoids.
  
  
  OBJECTIVE
  We aimed to determine the postoperative outcome following 3 main surgical techniques.
  
  
  METHODS
  A prospective, randomized trial was designed with 180 patients in 3 arms of 60 patients each.
  
  
  METHODS
  The study was conducted from April 1999 to January 2007 at the University Hospital "Campus Bio-Medico di Roma."
  
  
  METHODS
  All of the patients who were referred for hemorrhoid surgery were enrolled according to inclusion and exclusion criteria (ISRCTN12040297).
  
  
  METHODS
  Treatments according to the open, semiclosed, and stapled techniques were compared.
  
  
  METHODS
  Sample size was calculated to determine a difference in terms of the intensity of postoperative pain at the first week and the days required for return to work activity.
  
  
  RESULTS
  After 1 week, patients who underwent semiclosed hemorrhoidectomy reported significantly less pain (p < 0.01) and a significant decrease in analgesic intake from the third postoperative day (p < 0.01) than after the other 2 techniques. The patients resumed work ≈11 days after semiclosed and stapled techniques (11.8 and 11.6 days), which was earlier compared with 21.3 days in the open group (p < 0.05).
  
  
  CONCLUSIONS
  The high number of patients excluded might be considered a limitation of the study, but our selection criteria including patients living within 50 km of the hospital allowed for a low rate (9.4%) of patients lost to follow-up.
  
  
  CONCLUSIONS
  This study found an earlier resumption of work and less pain in patients who underwent the stapled and semiclosed procedures rather than open, which was associated with more complications, particularly because of a higher rate of stenosis (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A196).
authors.affiliation: Department of General Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Ripetti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: La Vaccara
authors.forename: Santi
authors.initials: S
authors.lastname: Greco
authors.forename: Augusto
authors.initials: A
authors.lastname: Arullani
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D012007:Rectum / Q000601:surgery*; D062707:Return to Work / Q000706:statistics & numerical data*; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics