Stapled hemorrhoidopexy is associated with a higher long-term risk of hemorrhoid recurrence and the symptom of prolapse. It is also associated with a higher likelihood of long-term symptom recurrence and the need for additional operations compared to conventional excisional hemorrhoid surgeries. Patients should be informed of these risks when being offered the stapled hemorrhoidopexy as surgical therapy. If hemorrhoid recurrence and prolapse are the most important clinical outcomes, then conventional excisional surgery remains the "gold standard" in the surgical treatment of internal hemorrhoids.
Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial.
We compared the safety and clinical outcome between stapled rectal mucosectomy and closed hemorrhoidectomy for the surgical treatment of noncomplicated hemorrhoidal disease.
                Eighty-four patients with Grade III and IV hemorrhoidal disease were randomly assigned to two groups: 1) stapled rectal mucosectomy group (n = 42) and 2) closed hemorrhoidectomy group (n = 42). Postoperative pain, analgesic use, symptoms, disability, early and late complications, and patient satisfaction were evaluated, among others. Follow-up was six months.
                Eighty-four patients, averaging 45 +/- 9 years of age, underwent surgery. Two were lost to follow-up. Length of surgery and disability, postoperative pain, and use of analgesics were significantly less for patients in the stapled rectal mucosectomy group. In the closed hemorrhoidectomy group early complications were more frequent but not statistically significant, and there were no statistically significant differences regarding the frequency of late complications. No serious complications were reported in either group. Closed hemorrhoidectomy proved to be superior for bleeding control (95.1 percent closed hemorrhoidectomy 80.5 percent stapled rectal mucosectomy; P= 0.04). Patient satisfaction was similar in the two groups, but stapled rectal mucosectomy patients were more willing to undergo the same procedure (P = 0.02).
                Both stapled rectal mucosectomy and closed hemorrhoidectomy are safe procedures. Closed hemorrhoidectomy was superior for bleeding control in Grade III and IV hemorrhoidal disease, but more painful and disabling than stapled rectal mucosectomy.