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Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse
P-O Nyström1, N Qvist, D Raahave
1Department of Clinical Sciences, Intervention and Technology, CLINTEC, Karolinska Institute, and Department of Gastrointestinal Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden. per-olof.nystrom@karolinska.se
Background:
: This multicentre randomized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids.
Methods:
: The study involved 18 hospitals in Sweden, Denmark and the UK. Some 207 patients were randomized to either anopexy or Milligan-Morgan haemorrhoidectomy, of whom 90 in each group were operated on. Patients reported symptoms before surgery and after 1 year. Daily postoperative pain scores were recorded in a patient diary. Surgeons evaluated the anal anatomy before surgery and after 1 year.
Results:
: Correction of prolapse in the anopexy and haemorrhoidectomy groups was similar at 1 year (88 and 90 per cent respectively; P = 0.80). Freedom from symptoms was obtained in 44 and 69 per cent respectively (P = 0.002). Stapled anopexy was associated with less postoperative pain, which resolved more quickly (P = 0.004). Significant improvements were noted in anal continence and well-being 1 year after both operations (P < 0.001). Excessive pain was the most common complication after diathermy excision and disturbed bowel function after stapled anopexy.
Conclusion:
: Haemorrhoidal prolapse was corrected equally by either operation. Diathermy haemorrhoidectomy gave better symptom relief but was more painful. Neither operation provided complete cure but well-being was greatly improved.
Registration Number:
ISRCTN68315343 (http://www.controlled-trials.com).
