OBJECTIVE: An improved understanding of the pathophysiology of haemorrhoids has resulted in the introduction of new surgical techniques including stapled haemorrhoidopexy (SH). This randomized controlled trial compared the long-term effectiveness of SH with rubber band ligation (RBL) in the treatment of grade II circumferential symptomatic haemorrhoids. METHOD: A consecutive cohort of patients was randomly allocated to either SH or RBL. Data on haemorrhoidal symptoms, Cleveland continence scores, sphincter assessment, SF-36, EQ-5D, HAD score and prior treatment history were assessed at enrollment and reassessed by long-term postal questionnaire. The details were analysed using spss 12.0 from Microsoft Access. RESULTS:Sixty patients were allocated by computer block randomization. Both groups were balanced for age, sex and symptoms. Recurrence favoured SH [3 vs 11; OR 0.18, 95% CI (0.03 to 0.86), P = 0.028] at 1 year and, at a mean of 40.67 (31-47) months [4 vs 12; OR 0.23, 95% CI (0.05, 0.95); P = 0.039]. SH patients experienced prolonged pain [Median (IQR) = 7 (5,7) vs 3 (1,7), P = 0.008] and took a longer time to return to work [6 (3,7) vs 3 (1,6) days, P = 0.018]. This was no significant difference in quality of life. CONCLUSION:Stapled haemorrhoidopexy achieved better disease control at 1 year without any major complication. This was sustained in the long-term. Further studies with greater patient numbers are needed to confirm this study.
RCT Entities:
OBJECTIVE: An improved understanding of the pathophysiology of haemorrhoids has resulted in the introduction of new surgical techniques including stapled haemorrhoidopexy (SH). This randomized controlled trial compared the long-term effectiveness of SH with rubber band ligation (RBL) in the treatment of grade II circumferential symptomatic haemorrhoids. METHOD: A consecutive cohort of patients was randomly allocated to either SH or RBL. Data on haemorrhoidal symptoms, Cleveland continence scores, sphincter assessment, SF-36, EQ-5D, HAD score and prior treatment history were assessed at enrollment and reassessed by long-term postal questionnaire. The details were analysed using spss 12.0 from Microsoft Access. RESULTS: Sixty patients were allocated by computer block randomization. Both groups were balanced for age, sex and symptoms. Recurrence favoured SH [3 vs 11; OR 0.18, 95% CI (0.03 to 0.86), P = 0.028] at 1 year and, at a mean of 40.67 (31-47) months [4 vs 12; OR 0.23, 95% CI (0.05, 0.95); P = 0.039]. SH patients experienced prolonged pain [Median (IQR) = 7 (5,7) vs 3 (1,7), P = 0.008] and took a longer time to return to work [6 (3,7) vs 3 (1,6) days, P = 0.018]. This was no significant difference in quality of life. CONCLUSION: Stapled haemorrhoidopexy achieved better disease control at 1 year without any major complication. This was sustained in the long-term. Further studies with greater patient numbers are needed to confirm this study.
Authors: Angus J M Watson; Hanne Bruhn; Kathleen MacLeod; Alison McDonald; Gladys McPherson; Mary Kilonzo; John Norrie; Malcolm A Loudon; Kirsty McCormack; Brian Buckley; Steven Brown; Finlay Curran; David Jayne; Ramesh Rajagopal; Jonathan A Cook Journal: Trials Date: 2014-11-11 Impact factor: 2.279
Authors: Angus J M Watson; Jemma Hudson; Jessica Wood; Mary Kilonzo; Steven R Brown; Alison McDonald; John Norrie; Hanne Bruhn; Jonathan A Cook Journal: Lancet Date: 2016-10-07 Impact factor: 79.321
Authors: Jim Tiernan; Daniel Hind; Angus Watson; Allan J Wailoo; Michael Bradburn; Neil Shephard; Katie Biggs; Steven Brown Journal: BMC Gastroenterol Date: 2012-10-25 Impact factor: 3.067
Authors: Steven R Brown; James P Tiernan; Angus J M Watson; Katie Biggs; Neil Shephard; Allan J Wailoo; Mike Bradburn; Abualbishr Alshreef; Daniel Hind Journal: Lancet Date: 2016-05-25 Impact factor: 79.321
Authors: Robin R van Tol; Marieke P A Bruijnen; Jarno Melenhorst; Sander M J van Kuijk; Laurents P S Stassen; Stéphanie O Breukink Journal: Int J Colorectal Dis Date: 2018-03-15 Impact factor: 2.571