Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial

Background Haemorrhoidectomy is commonly an inpatient procedure because it is frequently associated with postoperative pain. Day case haemorrhoidectom y is a similar operation to that used on inpatients but with different stra tegies for managing postoperative pain. Circumferential mucosectomy (staple d haemorrhoidectomy) may be associated with less postoperative pain than co nventional haemorrhoidectomy. We compared stapled haemorrhoidectomy with co nventional haemorrhoidectomy in patients with third degree haemorrhoids, Methods We randomly assigned 22 patients to conventional haemorrhoidectomy by the diathermy dissection or to stapled haemorrhoidectomy with the use of an intraluminal stapling device, Patients were discharged when free of pai n, took cocodamol as required, completed visual analogue charts each day, a nd were assessed at 1 and 6 weeks postoperatively for symptom control. Findings All patients received the assigned treatment. Mean inpatient slay was lower in the group assigned to stapled as opposed to conventional haemo rrhoidectomy (1.09 [0.3] vs 2.82 [0.09] nights, p<0.001), experienced less pain overall (p=0.003), and returned to normal activities sooner (8.1[1.53] vs 16.9 [2.33] days, p<0.005). Stapled haemorrhoidectomy controlled sympto ms of prolapse, discharge and bleeding in all patients. Interpretation Stapled haemorrhoidectomy is an effective treatment for thir d degree haemorrhoids with significant advantages for patients compared wit h conventional haemorrhoidectomy.