***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: This multicentre r and omized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids Background The literature indicates higher recurrence rates for stapled hemorrhoidopexy than for conventional techniques . This could be due to inappropriate patient selection . Objective The aim of this study was to evaluate the short- and long-term outcome after stapled hemorrhoidopexy compared with the Milligan – Morgan procedure in a homogeneous patient population with circumferential third-degree hemorrhoids . Design and Patients One hundred thirty patients were enrolled into a r and omized controlled study , of which 122 were clinical ly evaluated at weeks 1 , 2 , and 4 , and thereafter each year for a minimum of 3 years . Patients completed a question naire for symptoms , function , and pain . Pain was assessed using a visual analog scale . Recurrences were determined by anoscopy and self-report . Setting sThe study was performed at the University Hospital Hamburg . Main Outcome Measures Endpoints were pain , recurrence , bleeding , itching/burning , urinary retention , incontinence symptoms , and prolonged rate of wound healing . Results The cumulative recurrence rates after 5 years were 18 % ( n = 11 ) in the stapled hemorrhoidopexy group and 23 % ( n = 14 ) in the Milligan – Morgan group ( p = 0.65 ) . Patients who underwent stapled hemorrhoidopexy had significantly less postoperative pain with mean VAS scores at week 1 : 3.1 vs. 6.2 ; week 2 : 0.5 vs. 3 ; week 4 : 0.05 vs. 0.6 ( p < 0.001 ) , and demonstrated less burning/itching sensation 4 weeks after surgery compared with the Milligan – Morgan group ( 4.9 vs. 19.7 % ; p < 0.001 ) . The postoperative bleeding rate was 4.9 % in both groups and the rate of urinary retention did not differ significantly ( 4.9 % vs. 1.6 % ; p = 0.309 ) . Postoperative incontinence symptoms ( 6.6 % versus 3.3 % ; p = 0.40 ) resolved within the first 6 months . Limitations Detailed measurement of incontinence was not possible because postoperative symptoms resolved between consultations , and pathological results were examined retrospectively . Conclusions The results show a similar rate of recurrence in the long term and suggest increased patient comfort in the early postoperative course after stapled hemorrhoidopexy . In patients with circumferential third-degree hemorrhoids , stapled hemorrhoidopexy is as effective as the Milligan – Morgan procedure Background Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results . The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results . The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy Methods A prospect i ve clinical trial was conducted . Patients with newly diagnosed haemorrhoids requiring haemorrhoidectomy were r and omized to either LigaSure haemorrhoidectomy or diathermy haemorrhoidectomy . Surgical technique and postoperative care was st and ardized . Outcome measures were operative time and bleeding , postoperative pain ( measured on a visual analogue scale ) and rate of wound healing Results We r and omized 44 patients , 22 to LigaSure and 22 to diathermy ; 43 patients were evaluated . They were aged between 19 and 71 years . There were no differences in patient demographics or type of haemorrhoid being operated on .  LigaSure haemorrhoidectomy had a significantly lower mean operative time and intraoperative bleeding . At 3 weeks after surgery , haemorrhoidectomy performed with LigaSure had an odds ratio for complete epithelialization of 3.1 over diathermy ( 95 % CI 1.2–8.2 ) . There was no difference in postoperative pain Conclusion LigaSure haemorrhoidectomy is superior to diathermy for open 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 There is scepticism regarding anatomical rationale and Doppler guidance for ligation of haemorrhoidal arteries . The null hypothesis of this r and omized controlled trial ( RCT ) was that there is no difference in pain following dearterialization or haemorrhoidectomy  for grade III/IV internal haemorrhoids in a minimum of three quadrants 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 Abstract Background Ferguson hemorrhoidectomy is believed to result in less postoperative pain because of a closed wound . Stapled hemorrhoidopexy , without a perianal wound , should thus have lesser pain . We conducted a prospect i ve r and omized trial to compare stapled hemorrhoidopexy ( SH ) with Ferguson hemorrhoidectomy ( FH ) . Methods Fifty patients with third-degree or early fourthdegree hemorrhoids who required surgery were recruited . Patients were prospect ively r and omized to receive either FH or SH . Data collected include operative time , hospital stay , fecal incontinence and pain scores , morbidity and complications . Results SH patients had less pain in the early postoperative period . There were no significant differences in hospital stay or major complications . One patient after SH required emergency reintervention for thrombosed hemorrhoids distal to the staple line . FH patients had more minor problems of bleeding , wound discharge and pruritus . Fecal incontinence was similar in the 2 groups but two of the three patients with daily incontinence to gas after SH cl aim ed that their lifestyle was affected . Conclusions SH is safe to perform and results in less postoperative pain as well as less minor morbidity . Early reintervention and incontinence to gas compromising lifestyle occurred only after SH 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 OBJECTIVE To investigate and compare the clinical 
    Output:
    
After stapled , LigaSure ™ and Harmonic ® haemorrhoidectomies patients resumed normal daily activities earlier than after open and closed procedures .
THD provided the earliest time to first bowel movement .
The stapled and THD groups had significantly higher haemorrhoid recurrence rates than the open , closed and LigaSure ™ groups .
Recurrence of haemorrhoidal symptoms was more common after stapled haemorrhoidectomy than after open and LigaSure ™ operations .
No significant difference was identified between treatments for anal stenosis , incontinence and perianal skin tags .
CONCLUSION Open and closed haemorrhoidectomies result ed in more postoperative complications and slower recovery , but fewer haemorrhoid recurrences .
THD and stapled haemorrhoidectomies were associated with decreased postoperative pain and faster recovery , but higher recurrence rates .