The current study is an expansion of our recent work comparing the clinical efficacy and safety of the PSH and CSH techniques for patients with symptomatic grade III and grade IV hemorrhoids over a long-term follow-up (5 y).
#STAPLED EVENTS TRIAL#
Our choice of a noninferiority trial design was based on the expectation that the PSH procedure is noninferior to CSH with fewer postoperative complications. 13– 15 However, a head-to-head comparison between PSH and CSH in randomized trial has not been made, and information on long-term outcomes is lacking. 13 Favorable outcomes with PSH have been reported in short-term follow-up case series. 12 The PSH procedure showed little impact on anorectal physiology with low complications, consistent with the finding by Soares et al. Our preliminary data had shown similar clinical efficacy between the PSH and CSH procedures for advanced hemorrhoidal prolapse over a medium-term follow-up with less postoperative pain and fewer cases of initial fecal urgency in the PSH-treated patients. 11 We reported shorter operative time, less postoperative pain, and reduced hospital stay with minimal functional disturbance over a 12-month follow-up with the PSH. Our unit has previously reported similar clinical results with the PSH technique compared with open hemorrhoidectomy in patients with grade III/IV hemorrhoids, 10 a finding recently confirmed by Wang et al. 7, 8 This approach is anticipated to preserve the compliant tissue because fewer staples are deployed, 9 thereby potentially reducing some of the morbidities associated with the conventional CSH procedure, including anastomotic stenosis, rectovaginal fistula, and defecatory dysfunction. 7 Using this technique, PSH was performed by preserving the mucosal bridges. Therefore, it is also referred to as partial stapled hemorrhoidopexy (PSH).
Our group had first reported the safety and feasibility of a new procedure called tissue-selecting technique, which is a partial or segmental stapled hemorrhoidopexy. 5 Rarely, a rectovaginal fistula may develop secondary to the occurrence of hematoma within the rectovaginal septum. 4 Functional issues, including new-onset fecal urgency and difficulty in defecation, are probably a result of the inflammatory response to staple deployment, whereas in some cases a fixed fibrotic element led to significant postoperative anorectal stenosis. 3 It is postulated that excessive fibrosis around the staples may be an important cause of persistent proctalgia. 2Īlthough CSH procedures are associated with less postoperative pain compared with the conventional hemorrhoidectomy, a small but significant number of patients have unrelenting discomfort. 1 Our previous systematic review and meta-analysis had reported that the CSH technique is an effective procedure for reducing the principle hemorrhoidal symptoms, although there is a reported higher rate of symptomatic prolapse over time compared with conventional hemorrhoidectomy. The circumferential stapled hemorrhoidopexy (CSH) technique was first introduced for the management of symptomatic hemorrhoids by Longo in 1998.
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