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A Prospective, Randomized, Controlled Multicenter Trial Comparing Stapled Hemorrhoidopexy and Ferguson Hemorrhoidectomy: Perioperative and One-Year Results

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Diseases of the Colon & Rectum

PURPOSE

There is a growing body of evidence supporting the lesser degrees of pain with stapled hemorrhoidopexy, also called the procedure for prolapse and hemorrhoids. However, there have been few randomized comparisons assessing both perioperative and long-term outcomes of the procedure for prolapse and hemorrhoids and Ferguson hemorrhoidectomy. Results are presented here from the first prospective, randomized, multicenter trial comparing these hemorrhoid procedures in the United States.

METHODS

Patients with prolapsing hemorrhoids (Grade III) were randomized to undergo the procedure for prolapse and hemorrhoids or Ferguson hemorrhoidectomy by colorectal surgeons who had training in using the stapling technique. Primary end points were acute postoperative pain, and hemorrhoid symptom recurrence requiring additional treatment at one-year follow-up from surgery.

RESULTS

A total of 156 patients (procedure for prolapse and hemorrhoids, 77; Ferguson, 79) completed randomization and the surgical procedure, 18 (procedure for prolapse and hemorrhoids, 12; Ferguson, 6) had significant protocol violations. One hundred seventeen patients (procedure for prolapse and hemorrhoids, 59; Ferguson, 58) returned for one-year follow-up. Demographic parameters, hemorrhoid symptoms, preoperative pain scores, and bowel habits were similar between groups. There were a similar number of patients with adverse events in each group (procedure for prolapse and hemorrhoids, 28 (36.4 percent) vs. Ferguson, 38 (48.1 percent); P = 0.138). Reoperation for an adverse effect was required in six (7.6 percent) Ferguson patients and in 0 patients having the procedure for prolapse and hemorrhoids (P = 0.028). Postoperative pain during the first 14 days, pain at first bowel movement, and need for postoperative analgesics were significantly less in the procedure for prolapse and hemorrhoids group. Control of hemorrhoid symptoms was similar between groups; however, significantly fewer patients having the procedure for prolapse and hemorrhoids required additional anorectal procedures during one-year follow-up (procedure for prolapse and hemorrhoids, 2 (2.6 percent), vs. Ferguson, 11 (13.9 percent); P = 0.01). Only four of the Ferguson patients (5 interventions) required additional procedures more than 30 days after surgery.

CONCLUSIONS

These data demonstrate that stapled hemorrhoidopexy offers the benefits of less postoperative pain, less requirement for analgesics, and less pain at first bowel movement, while providing similar control of symptoms and need for additional hemorrhoid treatment at one-year follow-up from surgery.

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ACKNOWLEDGMENT

The authors thank Dr. Ty McClure for his assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio

    A. J. Senagore M.D., M.S. & M. Singer M.D.

  2. Department of Colon and Rectal Surgery, University of Illinois, Chicago, Illinois

    H. Abcarian M.D.

  3. Department of Colon and Rectal Surgery, Washington University, St. Louis, Missouri

    J. Fleshman M.D.

  4. Department of Surgery, Division of Colon and Rectal Surgery, Long Island Jewish Medical Center, New Hyde Park, New York

    M. Corman M.D.

  5. Department of Colon and Rectal Surgery, University of Southern California, Los Angeles, California

    M. Corman M.D.

  6. Department of Colon and Rectal Surgery, Cleveland Clinic, Florida, Weston, Florida

    S. Wexner M.D.

  7. Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

    S. Nivatvongs M.D.

  8. For the Procedure for Prolapse and Hemmorrhoids (PPH) Multicenter Study Group, (see Appendix)

    A. J. Senagore M.D., M.S., M. Singer M.D., H. Abcarian M.D., J. Fleshman M.D., M. Corman M.D., S. Wexner M.D. & S. Nivatvongs M.D.

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  1. A. J. Senagore M.D., M.S.
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  2. M. Singer M.D.
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  3. H. Abcarian M.D.
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  4. J. Fleshman M.D.
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  5. M. Corman M.D.
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  6. S. Wexner M.D.
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  7. S. Nivatvongs M.D.
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Correspondence to A. J. Senagore M.D., M.S..

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Supported by Ethicon Endo-Surgery, Cincinnati, Ohio.

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Senagore, A., Singer, M., Abcarian, H. et al. A Prospective, Randomized, Controlled Multicenter Trial Comparing Stapled Hemorrhoidopexy and Ferguson Hemorrhoidectomy: Perioperative and One-Year Results. Dis Colon Rectum 47, 1824–1836 (2004). https://doi.org/10.1007/s10350-004-0694-9

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