Safety and short term effectiveness of EEA stapler vs PPH stapler in the treatment of III degree haemorrhoids. Prospective randomised controlled trial.

Abstract Introduction:  Stapled hemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. A new stapler device has been designed to overcome these side effects . Patients and Methods:  135 patients (71 males, mean age 42) with III degree haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH(®) 01/03 stapler (Ethicon EndoSurgery) (63 patients) or with EEA(®) stapler (Covidien) (72 patients) in 4 referral colorectal centers. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in cm(2) ), and any postoperative bleeding within 30-days were recorded. Results:  The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35,75 ± 17,51 vs 28,05 ± 10,23 cm(2) , p=0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median values 1, interquantile range 0-2, vs 3, interquantile range 2-5, p<0.0001). Intraoperative haemostasis was better in the EEA group compared both to PPH 01 and PPH 03 groups. Postoperative bleeding occurred only in 2 PPH patients. Discussion:  Data suggest that the EEA stapler has better haemostatic properties in comparison with PPH and allows resection of larger area of mucosal prolapsed with potential benefits over the recurrence rate of haemorrhoid prolapse.