Comparison of the Short-term Outcomes of Using DST and PPH Staplers in the Treatment of Grade III and IV Hemorrhoids
Comparison of the Short-term Outcomes of Using DST and PPH Staplers in the Treatment of Grade III and IV Hemorrhoids
The hemorrhoidal disease affects approximately 4.4%-36% of the general population, and it has
 been estimated that >50% of the population aged >50 years experiences hemorrhoidal problems .
 Traditional hemorrhoidectomy, including Milligan-Morgan, Ferguson, and Whitehead procedures ,
 are known to cause significant postoperative pain and discomfort and result in a poor quality
 of life after operation. Since the first introduction of the novel procedure hemorrhoidopexy
 by Longo in 1998, it has been considered as a safe procedure causing less postoperative pain
 and resulting in earlier recovery; furthermore, the patients are able to resume their normal
 daily life and work. The PPH stapler (Ethicon Endo-Surgery, Inc. Cincinnati, OH, USA) was
 also first introduced in 1998 as a device to perform this procedure. Subsequently, a new
 device, the DST stapler (Covidien, Mansfield, MA, USA), was introduced in 2008 with some
 structural differences, including a detachable anvil, three anchor points over different
 levels, a larger case, and different agraffe sizes.

 However, the majority of current studies have been focusing on the use of PPH stapler for
 hemorrhoidopexy, and comparison with the DST stapler has been rarely discussed. One
 randomized controlled trial that compared between the PPH stapler and the DST stapler
 reported that the DST stapler demonstrated a better hemostatic ability and allowed the
 resection of a larger area of mucosal prolapse; however, that trial focused only on bleeding
 among the postoperative complications. Currently, only a limited number of studies have
 compared these two devices in terms of pain, complications, and anorectal stricture incidence
 rate. The present investigation is a matched cohort-control study aimed to compare the
 postoperative short-term outcomes among patients with grade III and IV hemorrhoids who were
 treated with either the PPH or the DST stapler. The specimen surface area and the
 relationships with complications were also analyzed.
Inclusion Criteria:

 -  Grade III and grade IV hemorrhoid

 Exclusion Criteria:

 -  Anal fistula, rectal polyo\p