Bleeding Clinical Trial
Official title:
Taipei Medical University Shuang-Ho Hospital
The hemorrhoidal disease affects approximately 4.4%-36% of the general population, and it has
been estimated that >50% of the population aged >50 years experiences hemorrhoidal problems .
Traditional hemorrhoidectomy, including Milligan-Morgan, Ferguson, and Whitehead procedures ,
are known to cause significant postoperative pain and discomfort and result in a poor quality
of life after operation. Since the first introduction of the novel procedure hemorrhoidopexy
by Longo in 1998, it has been considered as a safe procedure causing less postoperative pain
and resulting in earlier recovery; furthermore, the patients are able to resume their normal
daily life and work. The PPH stapler (Ethicon Endo-Surgery, Inc. Cincinnati, OH, USA) was
also first introduced in 1998 as a device to perform this procedure. Subsequently, a new
device, the DST stapler (Covidien, Mansfield, MA, USA), was introduced in 2008 with some
structural differences, including a detachable anvil, three anchor points over different
levels, a larger case, and different agraffe sizes.
However, the majority of current studies have been focusing on the use of PPH stapler for
hemorrhoidopexy, and comparison with the DST stapler has been rarely discussed. One
randomized controlled trial that compared between the PPH stapler and the DST stapler
reported that the DST stapler demonstrated a better hemostatic ability and allowed the
resection of a larger area of mucosal prolapse; however, that trial focused only on bleeding
among the postoperative complications. Currently, only a limited number of studies have
compared these two devices in terms of pain, complications, and anorectal stricture incidence
rate. The present investigation is a matched cohort-control study aimed to compare the
postoperative short-term outcomes among patients with grade III and IV hemorrhoids who were
treated with either the PPH or the DST stapler. The specimen surface area and the
relationships with complications were also analyzed.
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