Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long‐term outcome of a randomized controlled trial. (June 2017)

• Record Type: Journal Article
• Authors: Altomare, D. F.; Pecorella, G.; Tegon, G.; Aquilino, F.; Pennisi, D.; De Fazio, M.
• Is Part Of: Colorectal disease. Volume 19:Number 6(2017)
• Page Start: 559
• Page End: 562
• Publication Date: 2017-06
• Subjects: Stapled haemorrhoidopexy -- prolapse recurrence -- PPH stapler -- EEA stapler; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.13549
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: 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. Method: 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). Conclusion: 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.