Source: Neuroimaging Clin N Am  |  Posted 6 years ago

By Crystal Phend

SAN FRANCISCO, CA -- October 20, 2005 -- Stapled hemorrhoidectomy results in less early pain compared to Ferguson hemorrhoid surgery, but the long-term results of the two procedures are similar, according to a study presented here at the American College of Surgeon (ACS) annual meeting.

Stapled hemorrhoidectomy, also called the procedure for prolapse and hemorrhoids (PPH), pins the excess tissue back to reduce bloodflow and hemorrhoid size. The Ferguson technique surgically removes the tissue and closes the wound with a suture.

"Both procedures give comparable long-term relief from hemorrhoidal symptoms over at least 1 year," said Anthony J. Senagore, MD, Professor and Chairman, Department of Surgery, Medical University of Ohio, Toledo, Ohio, United States, during his presentation here on October 18[^]th[].

Dr. Senagore and colleagues randomized 118 patients to PPH and 122 patients to Ferguson hemorrhoidectomy and followed outcomes for approximately 1 year. Patients kept pain diaries for 2 weeks after surgery.

There were no significant differences in patient demographics between the groups. More than 90% of patients had hemorrhoid prolapse in which tissue protrudes from the anus.

The researchers found a significant difference in the need for concomitant procedures: 25% of patients in the PPH group had at least one concomitant procedure compared to 43% of patients in the Ferguson group. Dr. Senagore suggested that this could be due to the removal of excess tissue, called skin tags, in the Ferguson procedure. Wound complications were likewise higher in the Ferguson group but not significantly so (6% PPH versus 13%).

Although there was a trend for less pain at first bowel movement in the PPH group, the difference was not quite statistically significant. Pain scores, analgesic usage and change from baseline pain also indicated a lower pain severity at each time point for PPH compared to Ferguson.

At 1 year there was no difference between the two procedures in fecal incontinence or control of symptoms.

At 30 days there was no difference in reinterventions, although rubber band ligation of hemorrhoids was required in 5% of the PPH group and in none of the Ferguson group.

Discussant Bruce G. Wolff, MD, Professor of Surgery, Mayo College of Medicine, Rochester, Minnesota, United States, said, "While the results were positive for PPH, the procedure is not yet the gold standard in part because in practice it is tricky to perform and somewhat more expensive."

Dr. Senagore is on the advisory board for Ethicon Endo-Surgery, makers of a PPH device. The company provided an unrestricted grant to the trial group.

[Presentation title: Long-Term Effectiveness of Procedure and Prolapse for Hemorrhoids. Abstract GS42]