title: Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomized controlled trial.
abstract: OBJECTIVE
  The study aimed in a multicentric randomized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy.
  
  
  METHODS
  In all, 135 patients were randomized to treatment with a PPH-01/03 (Ethicon EndoSurgery) or an EEA (Covidien) stapler. They were reviewed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition (wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria.
  
  
  RESULTS
  Eighty-seven (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively). In the EEA group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH group (P = 0.409). Persistence of anal bleeding was significantly higher in the PPH group (P = 0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group (1.73 ± 1.65 vs 3.17 ± 1.94, P < 0.001). The wellness evaluation score was significantly better in the EEA group (1.2 ± 1.27 vs 0.6 ± 1.0, P = 0.028). Furthermore, 7 (15%) of the patients in the EEA group complained of some evacuation disturbance compared with 13 (36%) in the PPH group (P = 0.021).
  
  
  CONCLUSIONS
  The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH. Nevertheless, use of the larger volume EEA provides better symptom resolution compared with PPH.
authors: Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
authors: D F
authors: DF
authors: Altomare
authors: Colorectal Unit, Surgical Clinic, University of Catania, Catania, Italy.
authors: G
authors: G
authors: Pecorella
authors: Colorectal Unit, 'San Camillo' Hospital, Treviso, Italy.
authors: G
authors: G
authors: Tegon
authors: Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
authors: F
authors: F
authors: Aquilino
authors: Colorectal Unit, Surgical Clinic, University of Catania, Catania, Italy.
authors: D
authors: D
authors: Pennisi
authors: Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
authors: M
authors: M
authors: De Fazio
mesh_terms: D000328:Adult; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011184:Postoperative Period; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods*; D017792:Surgical Stapling / Q000379:methods; D016896:Treatment Outcome
keywords: EEA stapler; PPH stapler; Stapled haemorrhoidopexy; prolapse recurrence