PPH-01 Versus PPH-03 to Perform STARR for the Treatment of Hemorrhoids Associated With Large Internal Rectal Prolapse: A Prospective Multicenter Randomized Trial

Renzi, Adolfo; Brillantino, Antonio; Di Sarno, Giandomenico; D’Aniello, Francesco; Giordano, Alfredo; Stefanuto, Alberto; Aguzzi, Daniele; Daffinà, Antonio; Ceci, Francesco; D’Oriano, Giuseppe; Mercuri, Massimo; Alderisio, Alfonso; Perretta, Luis; Carrino, Francesco; Sernia, Giovanni; Greco, Ettore; Picchio, Marcello; Marino, Giuseppe; Goglia, Angelo; Trombetti, Amilcare
September 2011
Surgical Innovation;Sep2011, Vol. 18 Issue 3, p241
Academic Journal
Purpose. This multicenter randomized study was designed to compare the clinical and functional results of stapled transanal rectal resection (STARR) performed with 2 staplers (PPH-01 vs. PPH-03) in the treatment of hemorrhoidal disease associated with a large internal rectal prolapse. Methods. From a total of 937 patients, referred for hemorrhoidal disease in the 20 centers involved in the study, 425 (45.3%) with prolapsed hemorrhoids associated with a large internal rectal prolapse were randomized to undergo STARR with PPH-01 or PPH-03. Postoperative evaluation was made at 3, 6, and 12 months. Results. The incidence of bleeding at the stapled line was significantly lower in the PPH-03 group than in the PPH-01 group (58/207 [28.0%] vs. 145/201 [72.1%]; P < .0001); the mean number of hemostatic stitches was significantly higher in the PPH-01 than in the PPH-03 group (3.2 ± 0.1 vs. 1.8 ± 0.8; P < .0001). The mean operative time was 25.1 ± 11.5 minutes in the PPH-03 group and 38.1 ± 15.7 minutes in the PPH-01 group (P < .0001). No major complications occurred in either of the groups. At 12-month follow-up, the success rate in the 2 groups was 94.5% in the PPH01 group and 94.2% in the PPH03 group. Conclusion. STARR performed for the treatment of hemorrhoidal disease associated with a large rectal prolapse is a safe and effective procedure. The use of the PPH-03 stapler instead of the PPH-01 guarantees a statistically significant reduction of intraoperative bleeding and a significant decrease of the operative time.


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