Does a more extensive mucosal excision prevent haemorrhoidal recurrence after stapled haemorrhoidopexy? Long-term outcome of a randomised controlled trial.

AIM: The study aimed in a multicentric randomised controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with stage III haemorrhoids undergoing stapled haemorrhoidopexy . METHOD: 135 patients were randomised to treatment with PPH01/03 or an EEA stapler. They were reviewed after a minimum follow-up of four years to determine the rate of recurrent mucosal prolapse, and general condition (Wellness evaluation score). Postoperative bowel dysfunction was assessed using the Rome III criteria. RESULTS: 87 (65%) of the 135 patients (48 in the EEA stapler group and 37 in the PPH group) were available for long-term follow-up. The two groups were comparable for age, gender and duration of follow-up (mean 49.3±5.4 months and 49.0±5.3 months respectively). In the EEA-group, 11 (23%) patients had some degree of recurrent prolapse compared with 12 (32%) in the PPH-group (p=0.409). Persistence of anal bleeding was significantly higher in the PPH-group (p=0.04) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA-group (1.73±1.65 vs 3.17±1.94, p<0.001). The wellness evaluation score was significantly better in the EEA-group (1.2±1.27 vs 0.6±1.0, p=0.028). Furthermore, seven (15%) of the patients in EEA-group complained of some evacuation disturbance compared with 13 (36%) in the PPH-group (p = 0.021). CONCLUSION: The study failed to demonstrate any significant difference in the long-term recurrence rate of stage III haemorrhoids using EEA or PPH. Nevertheless, the use of the larger volume EEA provides better symptom resolution compared with PPH. This article is protected by copyright. All rights reserved.