***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: HYPOTHESIS Stapled hemorrhoidectomy offers several advantages over excision hemorrhoidectomy , including reduced postoperative pain , a reduced hospital stay , and an earlier recovery time . Furthermore , stapled hemorrhoidectomy is associated with lower hemorrhoidal recurrence on long-term follow-up . DESIGN A r and omized prospect i ve trial . Patients were blinded to the operation technique used . Follow-up occurred at 1 and 3 weeks and 12 months postoperatively . SETTING A university hospital providing primary , secondary , and tertiary care . PATIENTS Forty patients with second- and third-degree hemorrhoid disease were r and omized to undergo either  stapled or excision hemorrhoidectomy .  Two patients were excluded . All patients were subject to a follow-up examination . INTERVENTIONS Stapled hemorrhoidectomy ( Longo technique ) vs excision hemorrhoidectomy ( Ferguson technique ) . MAIN OUTCOME MEASURES Operating time , postoperative pain ( measured by the visual analog scale ) , hospital stay , histologic features , morbidity , defecation habit , continence , recovery time ( return to work ) , and hemorrhoid recurrence at 1 year . RESULTS Stapled vs excision hemorrhoidectomy was associated with a significantly reduced operating time ( 30 vs 43.25 minutes ; P<.001 ) , reduced postoperative pain scores ( visual analog score ) on the first 4 postoperative days ( day 1 : 2.7 vs 6.3 ; day 2 : 1.7 vs 6.3 ; day 3 : 0.8 vs 5.4 ; and day 4 : 0.5 vs 4.8 , where 0 indicates no pain , and 10 , maximum pain ; P < or = .001 ) , and an earlier return to work ( 6.7 vs 20.7 days;P = .001 ) . There were no differences for stapled vs excision hemorrhoidectomy in length of hospital stay ( 2.4 vs 2.1 days ) , complications ( 3 [ 15 % ] of 20 patients vs 5 [ 25 % ] of 20 patients ) , and recurrence rate ( 1 [ 5 % ] of 20 patients vs 1 [ 5 % ] of 20 patients ) . CONCLUSIONS Stapled hemorrhoidectomy is associated with reduced postoperative pain , earlier recovery time and return to work , and a similar recurrence rate compared with the excision technique . Provided further clinical trials confirm these findings , stapled hemorrhoidectomy may become a future gold st and ard Abstract Purpose : To compare the postoperative evolution and the long-term efficacy after  stapled haemorrhoidopexy ( PPH )  and Milligan-Morgan haemorrhoidectomy ( MM ) . Methods : In a prospect i ve r and omized study , 40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III were assigned to either MM or PPH ( 20 each ) . Postoperative pain , wound healing were evaluated , as well as anal pressures and sphincter anatomy . Mean follow-up is 46 months . Results : Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated ( P < 0.0001 ) . Healing time was shorter after PPH ( P < 0.0001 ) . Endoanal ultrasound remained unchanged postoperatively . Resting and squeeze pressures decreased after MM , but not after PPH ( P < 0.01 ) . After a mean follow-up of 46 months ( 12 - 56 ) , persistent or recurrent symptoms , mostly mild and temporary , were observed after both MM and PPH , in 7 and 11 patients respectively ( NS ) . After PPH , five patients ( 25 % ) complained of recurrent external swelling and /or prolapse ( P = 0.047 vs. MM ) requiring redo surgery in four of them , after 10 , 13 , 14 and 21 months . No redo-surgery was required after MM . Long term patient satisfaction after PPH was not better than after MM . Conclusions : Postoperative pain is less important after PPH . This advantage disappears if any resection is associated with the stapling . At medium to long-term follow-up , PPH seems to carry a higher risk of symptomatic external haem-orrhoidal disease , needing further surgery PURPOSE It has been shown that for hemorrhoidal surgery both LigaSure ™ and stapler cause less pain than diathermy or scissor dissection . This study has attempted to establish which of the less painful alternatives proves best in an unselected series of patients with hemorrhoidal disease . METHODS Fifty patients were r and omized to undergo stapling hemorrhoidopexy or LigaSure ™ hemorrhoidectomy .  Parameters investigated were pain ( primary parameter ) , patient satisfaction with treatment , and recovery of personal activity . Other factors investigated were operative result , ease of h and ling , analgesic requirements , and postoperative course . RESULTS Both methods were found to be equivalent in all major aspects analyzed . Postoperative pain scores ( P = 0.99 ) , patient satisfaction ( P = 1 ) , and self- assessment of activity ( P = 0.99 ) were almost identical in both groups of patients . Significant differences were found in none of the numerous factors investigated . CONCLUSION Both methods can be used safely and without major disadvantage for the patient regardless of stage and extent of hemorrhoidal disease Background and aims Stapled hemorrhoidectomy is a relatively new procedure , and studies on long-term outcomes are few . We present the results of a 5-year follow-up on patients recruited to a r and omized controlled trial comparing stapled and Milligan – Morgan hemorrhoidectomy .  Patients and methods We performed telephone interviews and office visits between May and July 2005 on patients who had taken part in a r and omized controlled trial from May 1999 to December 2000 . Results Occasional pain and bleeding were referred by the patients with no difference between the two groups . The patients were also equally satisfied with both procedures . No recurrent hemorrhoidal prolapse or stenosis was detected at anorectal exploration and rigid sigmoidoscopy . Conclusion Both stapled and Milligan – Morgan techniques guarantee satisfactory long-term results . Larger studies are needed to assess the durability of stapled hemorrhoidectomy Advantages of the stapling procedure for haemorrhoids  include reduced postoperative pain and shortened convalescence ; however , there are few data with respect to functional and symptomatic outcome . At a dedicated clinic , we review ed patients between Dec , 2001 , and March , 2002 , who had taken part in a r and omised controlled trial undertaken at the unit in 1999 , which compared outcomes after open or stapled haemorrhoidectomy .  We noted the presence or absence of haemorrhoid specific symptoms , and assessed overall satisfaction , continence , and quality of life .  Rigid sigmoidoscopy and an anorectal examination were also used to examine symptomatic recurrence and disease activity . At minimum follow-up of 33 months since surgery , both techniques seem to be equally effective PURPOSE A r and omized trial was undertaken to evaluate and compare stapled hemorrhoidopexy with excisional hemorrhoidectomy in which the Harmonic Scalpel ™ was used . METHODS Patients with Grade III hemorrhoids who were employed during the trial period were recruited and r and omized into two groups : ( 1 ) Harmonic Scalpel ™ hemorrhoidectomy , and ( 2 ) stapled hemorrhoidopexy . All operations were performed by a single surgeon . In the stapled group , the doughnut obtained was sent for histopathologic examination to determine whether smooth muscles were included in the specimen . Operative data and complications were recorded , and patients were followed up through a structured pro forma protocol . An independent assessor was assigned to obtain postoperative pain scores and satisfaction scores at six-month follow-up . Patients were also administered a simple question naire at follow-up to assess continence functions . RESULTS Over a 20-month period , 88 patients were recruited . The two groups were matched for age and gender distribution . No significant difference was identified between the two groups in terms of operation time , blood loss , day of first bowel movement after surgery , and complication rates . Despite a similar parenteral and oral analgesic requirement , the stapled group had a significantly better pain score ( P = 0.002 ) ; these patients also had a significantly shorter length of stay ( P = 0.02 ) , and on average resumed work nine days earlier than the group treated with the Harmonic Scalpel ™ ( 6.7 vs. 15.6 , P = 0.002 ) . Although 88 percent of doughnuts obtained in the stapled group contained some smooth muscle fibers , no association was found between smooth muscle incorporation and postoperative continence function , and as a whole the continence outcomes of the stapled group were similar to those after Harmonic Scalpel ™ hemorrhoidectomy . Finally , at six-month follow-up , patients who underwent the stapled procedure had significantly better satisfaction scores ( P = 0.001 ) . CONCLUSIONS tapled hemorrhoidopexy is a safe and effective procedure for Grade III hemorrhoidal disease . Patients derive greater short-term benefits of reduced pain , shorter length of stay , and earlier resumption to work . Long-term follow-up is necessary to determine whether these initial results are lasting The aim of this study was to assess the short- and long-term results of treatment for haemorrhoids by prospect ively comparing two techniques , namely , stapled rectal prolapse mucosectomy according to Longo and open hemorrhoidectomy .  One hundred consecutive patients were r and omised to stapled ( 50 patients ) or manual hemorrhoidectomy ( 50 patients ) . We analysed  postoperative pain , preoperative and postoperative anorectal function , intraoperative and postoperative complications , time needed to return to work and to normal social activities , and costs . Long-term follow data were obtained by means of an outpatient visit . The operative time of the stapled technique was less than that of open haemorrhoidectomy ( 22 vs 35 minutes ) . Two cases of early postoperative bleeding occurred after the stapled technique . The mean pain score on a visual scale was significantly less in patients undergoing the stapled technique . In addition , the time needed to return to work and to normal social activities was significantly less after the stapled technique , which , however , proved to be a more expensive procedure . Stapled mucosectomy of the prolapsed rectal mucosa is a safe , rapid , and relatively painless technique , which has a low incidence of complications . It can be performed in a day surgery unit . Patient satisfaction , early return to normal activities and good long-term results counterbalance the high cost of the procedure 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 PURPOSE : Stapled hemorrhoidectomy is performed without leaving painful perianal wounds . The aim of this study was to assess any benefits , compared with a conventional open diathermy technique . METHODS : A total of 119 consecutive patients with prolapsed irreducible hemorrhoids were r and omly assigned ( conventional open diathermy technique=62 ; stapled hemorrhoidectomy=57 ) . Preoperative fecal incontinence scoring , anorectal manometry , and endoanal ultrasound were performed . Postoperatively , these were repeated at up to three months with pain scores , analgesic requirements , quality of life assessment , and total related medical costs . RESULTS : Conventional open diathermy technique was 
    Output:
    
No significant difference was noted between the two techniques in terms of the total incidence of complications .
Stapled haemorrhoidopexy offers some short-term benefits over conventional operation but the total complication rates are similar for both techniques .
Stapled haemorrhoidopexy is associated with a higher rate of recurrent disease