Single purse string with four-point traction for better haemorrhoid retraction

Area of Science:

• Colorectal Surgery
• Surgical Techniques
• Hemorrhoid Treatment

Background:

• Traction method significantly impacts stapled hemorrhoidopexy (SH) outcomes.
• Current single purse string with two-point traction may lead to irregular mucosal doughnuts and inadequate prolapse reduction.
• Four-point traction is hypothesized to offer more balanced control for increased doughnut height.

Purpose of the Study:

• To evaluate the effectiveness of single purse string with four-point traction compared to two-point traction in SH.
• To assess the impact of traction method on mucosal doughnut height and regularity.
• To determine the optimal traction technique for improved hemorrhoid prolapse reduction.

Main Methods:

• Randomized controlled trial comparing two-point and four-point traction in SH for symptomatic grade III hemorrhoids.
• Sixty patients were allocated to either two-point (G1) or four-point (G2) traction groups.
• Preoperative, intraoperative, and postoperative characteristics were evaluated.

Main Results:

• Four-point traction (G2) significantly increased mucosectomy specimen height (P < 0.01).
• Variation in mucosal doughnut height significantly decreased in the four-point traction group (P < 0.01).
• Anatomy scores after SH were significantly lower in the four-point traction group (P = 0.029), with no difference in complications.

Conclusions:

• Single purse string with four-point traction yields a taller and more regular mucosal doughnut during SH.
• This technique results in more satisfactory hemorrhoid retraction.
• Four-point traction represents an advancement in SH for improved prolapse reduction.