***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background and aims Doppler-guided hemorrhoid artery ligation is a new approach for treating hemorrhoids . Early and 1-year follow-up results of the procedure are presented and compared with those of closed scissors hemorrhoidectomy in a prospect i ve r and omized study . Patients and methods Sixty consecutively recruited patients were r and omized into two groups : group A ( n=30 ) was treated with st and ardized closed scissors hemorrhoidectomy and group B ( n=30 ) with Doppler-guided hemorrhoid artery ligation . The follow-up period was 11.7±4.6 months . Results The average need for minor analgesics was 11.7±12.6 doses in group A and 2.9±7.7 in group B. Patients in group A spent 62.9±29.0 hours in hospital postoperatively and those in group B 19.8±41.8 hours . Return to normal daily activities took 24.9±24.5 days in group A and 3.0±5.5 days in group B. Neither the disappearance ( 26 vs. 25 patients ) nor the recurrence of preoperative symptoms ( 5 vs. 6 patients ) differed significantly between the two groups . Conclusion Both procedures were effective in treating  hemorrhoids . The 1-year results of Doppler-guided hemorrhoid artery ligation do not differ from those of closed scissors hemorrhoidectomy . Doppler-guided hemorrhoid artery ligation seems to be ideal for 1-day surgery , and it fulfills the requirements of minimally invasive surgery BACKGROUND : Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of  symptomatic hemorrhoids  that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids . Development of a special proctoscope enabled the combination of hemorrhoidal artery ligation with transanal rectoanal repair ( mucopexy ) , which serves to lift and then secure the protruding hemorrhoids in place . OBJECTIVE : The purpose of this study was to describe our experience with this combined procedure in the treatment of grade IV hemorrhoids . DESIGN : Prospect i ve observational study . SETTING : Outpatient colorectal surgery unit . PATIENTS : Consecutive patients with grade IV hemorrhoids treated from April 2006 to December 2008 . INTERVENTION : Hemorrhoidal artery ligation – rectoanal repair . MAIN OUTCOME MEASURES : Operating time , number of ligations , number of mucopexies and associated procedures , and postoperative symptoms were recorded . Pain was grade d on a visual analog scale . Follow-up was at 2 , 6 , and 12 months after surgery , and then annually . RESULTS : A total of 100 consecutive patients ( 64 women , 36 men ) with grade IV hemorrhoids were included . Preoperative symptoms were bleeding in 80 and pain in 71 patients ; 19 patients had undergone previous surgical treatment for the disease . The mean operative time was 35 ( range , 17–60 ) minutes , with a mean of 9 ( range , 4–14 ) ligations placed per patient . Eighty-four patients were discharged on the day of the operation . Nine patients developed early postoperative complications : pain in 6 , bleeding in 4 , dyschezia in 1 , and thrombosis of residual hemorrhoids in 3 . Late complications occurred in 4 patients and were managed conservatively . Recurrence was observed in 9 patients ( 9 % ) , with a mean follow-up of 34 ( range , 14–42 ) months . LIMITATIONS : The 2 main weaknesses of the study were the lack of very long-term follow-up and the absence of a comparison with hemorrhoidectomy or hemorrhoidopexy . CONCLUSION : Doppler-guided hemorrhoidal artery ligation with rectoanal repair is safe , easy to perform , and should be considered as an effective option for the treatment of grade IV hemorrhoids Purpose Haemorrhoidal disease is a frequently occurring entity in the western world . The Procedure for prolapse and haemorrhoids ( PPH ) and transanal haemorrhoidal dearterialisation ( THD ) are the most important surgical treatments that respect normal anal anatomy . This is the first r and omized trial that compares both techniques in the treatment of grade III and IV haemorrhoids . Methods Patients with grade III or IV haemorrhoids were r and omized between PPH and THD . Patients were seen after 1 week , 3 weeks and 6 weeks postoperatively . Primary endpoint was resolved symptoms 6 weeks postoperatively . Secondary endpoints were pain , measured with a visual analogue scale ( VAS ) after 1 day , 1 week and 3 weeks , and complications Results Eighteen patients were allocated to PPH versus 23 to THD . Success rates after 6 weeks were 83 % in the PPH group versus 78 % in the THD group . VAS scores were significantly lower after 1 day and 1 week in the THD group , but equalled out after 3 weeks . Twelve percent of the patients after PPH and 4 % after THD needed an urgent readmission to treat an acute bleeding . Overall complication rates did not differ significantly . Conclusion Both PPH and THD are safe treatments for grade III and IV haemorrhoids with acceptable complication rates and good short-term results . THD might be the preferred treatment because it carries the similar complication rate and short-term results , but results in less postoperative pain when compared with PPH . Moreover , it is a less invasive , more easily learned and less costly procedure Background In the past decade , several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain . Among these radiofrequency ( RF ) , excisional surgery seems to be safe , fast , and accompanied by less postoperative pain . The aim of this study was to evaluate and compare RF ( ligasure TM ) to conventional diathermy Milligan-Morgan hemorrhoidectomy ( MMH ) . Patients and methods Between January 2003 and July 2009 , 210 symptomatic patients were r and omized to undergo RF ( 118 patients ) or diathermy MMH ( 92 patients ) . Mean follow-up was 39 ± 16 months . Clinical outcome was assessed by vali date d question naire on postoperative symptoms and satisfaction . Primary endpoints were pain and wound healing . Secondary endpoints were operative time , early and late complications ( including recurrences ) , and patient satisfaction . Data was analyzed using chi-squared test and Fisher ’s exact test . Results Despite postoperative pain was less after RF , this difference was significant only for severe pain ( expressed as VAS score > 7 ) . Significant differences were observed in terms of wound healing . The two techniques were similar in terms of early and late complications . Conclusions RF hemorrhoidectomy is followed by reduced severe pain and better wound healing . However , in our experience , this is not followed by earlier return to daily activities Background and aims Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology . Patients and methods We carried out a r and omised prospect i ve study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy ( group A ) versus 100 patients undergoing Ferguson haemorrhoidectomy ( group B ) for symptomatic haemorrhoids , in whom medical treatment or rubber b and ligation had failed . Results Characteristics of the population were : mean age 43.5 years , with predominance of males , 123 vs. 77 ; 88 % ASA I-II . Clinical presentation : 95 % rectal bleeding ; 87.5 % third-fourth degree . The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients ( 90 % ) . Length of surgery : 24 min ( group A ) and 30 min ( group B ) ( p = n.s . ) . Resection of three haemorrhoidal cushions was done in 87.5 % of cases . There were no re-operations or re-admissions after discharge . Symptomatic recurrence , stenosis and incontinence were not found during the follow-up of the first year . Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group , but the difference was statistically significant ( p<0.05 ) only during bowel movements . There was complete healing in 40 % of the patients in group A and 90 % of those in group B ( p<0.05 ) after 1 month . After 1 year , the results and complications were similar in both groups ( p = n.s . ) . Conclusions Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy , whereas recurrence and complications are similar after 1 year Purpose This study was undertaken to determine the incidence of and risk factors for urinary retention after surgery for benign anorectal disease . Methods We review ed 2,011 consecutive surgeries performed under spinal anesthesia for benign anorectal disease from January through June 2003 to identify potential risk factors for postoperative urinary retention . In addition , we prospect ively investigated the preventive effect of perioperative fluid restriction and pain control by prophylactic analgesics on postoperative urinary retention . Results The number of procedures and the urinary retention rates were as follows :  hemorrhoidectomy  , 1,243 , 21.9 % ; fistulectomy , 349 , 6.3 % ; incision/drainage , 177 , 2.3 % ; and sliding skin graft/lateral subcutaneous internal sphincterotomy , 64 , 17.2 % . The overall urinary retention rate was 16.7 % . With hemorrhoidectomy , female sex , presence of preoperative urinary symptoms , diabetes mellitus , need for postoperative analgesics , and more than three hemorrhoids resected were independent risk factors for urinary retention as assessed by multivariate analysis . With fistulectomy , female sex , diabetes mellitus , and intravenous fluids > 1,000 ml were independent risk factors for urinary retention . Perioperative fluid restriction , including limiting the administration of intravenous fluids , significantly decreased the incidence of urinary retention ( 7.9 vs 16.7 % , P<0.0001 ) . Furthermore , prophylactic analgesic treatment significantly decreased the incidence of urinary retention ( 7.9 vs 25.6 % , P=0.0005 ) . Conclusions Urinary retention is a common complication after anorectal surgery . It is linked to several risk factors , including increased intravenous fluids and postoperative pain . Perioperative fluid restriction and adequate pain relief appear to be effective in preventing urinary retention in a significant number of patients after anorectal surgery PURPOSE Stapled hemorrhoidectomy may be associated with less pain and faster recovery than conventional hemorrhoidectomy for prolapsing hemorrhoids . Therefore , the outcome of stapled hemorrhoidectomy was compared with that of diathermy hemorrhoidectomy in a r and omized , controlled trial . METHODS Sixty patients with third-degree hemorrhoids were r and omly assigned to stapled hemorrhoidectomy ( n = 30 ) or to diathermy hemorrhoidectomy in a day-case setting . Visual analog scale was used for postoperative pain scoring . Surgical and functional outcome was assessed at six weeks and one year after surgery . RESULTS Operation time was a median of 21 ( range , 11–59 ) minutes in the stapled group vs. 22 ( range , 14–40 ) minutes in the diathermy group . Day-case surgery was successful in 24 patients ( 80 percent ) in the stapled group vs. 29 patients ( 97 percent ) in the diathermy group . Average pain in the stapled group was significantly lower than in the diathermy group ( median , 1.8 ( 0.1–4.8 ) vs. 4.3 ( 1.4–6.2 ) , 95 percent confidence interval difference medians , 1.15–3.85 , P = 0.0002 , Mann-Whitney U test ) as was the average pain expected by the patients ( median −2.7 ( −0.15–0.8 ) vs. 0.006 ( −4.05–0.5 ) respectively , 95 percent confidence interval difference medians , 0.5–3.55 , P = 0.0018 , Mann-Whitney U test ) . Postoperative morbidity and time off work were not significantly different between the diathermy and stapled groups . Seven treatment failures in the stapled group and one in the diathermy group necessitated other treatments at a later date . Patient satisfaction scores in the stapled and diathermy group were similar . Symptoms attributed to difficult rectal evacuation decreased significantly after surgery . CONCLUSIONS Stapled hemorrhoidectomy is a significantly less painful operation than diathermy hemorrhoidectomy , but does not seem to offer significant advantages in terms of hospital stay or symptom control in the long term . Hemorrhoidectomy may improve symptoms of difficult rectal evacuation OBJECTIVE To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure . DESIGN Prospect i ve non-r and omised study . SETTING University affiliated hospitals , Hong Kong . SUBJECTS AND METHODS Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study . Twenty-four patients had the procedure in an ambulatory setting and 
    Output:
    
The main reasons for failure were urinary retention , postoperative haemorrhage and unsatisfactory pain control .
Spinal anaesthesia was associated with the highest rates of urinary retention .
Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy .
However , the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management .
Conclusion Day-case haemorrhoidal surgery can be performed whatever the surgical procedure .
Urinary retention is a common issue that can be responsible for failure ; it requires a preventive strategy including short duration spinal anaesthesia .