human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background The aim of the study was to compare ligation anopexy ( LA ) and conventional hemorrhoidectomy ( CH ) in treatment of second- and third-degree hemorrhoids . Methods A prospect i ve controlled r and omized clinical trial included 100 patients who underwent CH ( CH group ) and 100 patients who underwent LA ( LA group ) . A detailed history was taken from all the patients . The effectiveness , safety , postoperative complications , operative time , length of hospital stay , time until first bowel movement , time until return to work , and postoperative pain score were assessed . Results There was no significant difference between groups regarding age , sex , and preoperative symptoms . The LA group had significantly shorter operative times , earlier first bowel movement , and an earlier return to work/activities . The postoperative pain score in the LA group was significantly lower than that in the CH group on days 1 , 3 , 7 , and 14 after surgery . There was no significant difference between groups as regards postoperative complications . Conclusions LA is safe , and as effective as CH in the treatment of grade II and grade III hemorrhoids , with shorter operative times , earlier mobilization , and lower postoperative pain scores The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement aims to improve the reporting of r and omized controlled trials ( RCTs ) ; however , it lacks guidance on the reporting of patient-reported outcomes ( PROs ) , which are often inadequately reported in trials , thus limiting the value of these data . In this article , we describe the development of the CONSORT PRO extension based on the method ological framework for guideline development proposed by the Enhancing the Quality and Transparency of Health Research ( EQUATOR ) Network . Five CONSORT PRO checklist items are recommended for RCTs in which PROs are primary or important secondary end points . These recommendations urge that the PROs be identified as a primary or secondary outcome in the abstract , that a description of the hypothesis of the PROs and relevant domains be provided ( ie , if a multidimensional PRO tool has been used ) , that evidence of the PRO instrument 's validity and reliability be provided or cited , that the statistical approaches for dealing with missing data be explicitly stated , and that PRO-specific limitations of study findings and generalizability of results to other population s and clinical practice be discussed . Examples and an up date d CONSORT flow diagram with PRO items are provided . It is recommended that the CONSORT PRO guidance supplement the st and ard CONSORT guidelines for reporting RCTs with PROs as primary or secondary outcomes . Improved reporting of PRO data should facilitate robust interpretation of the results from RCTs and inform patient care This multicentre r and omized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids AIM The study aim ed in a multicentric r and omized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy .  METHOD In all , 135 patients were r and omized to treatment with a PPH-01/03 ( Ethicon EndoSurgery ) or an EEA ( Covidien ) stapler .  They were review ed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition ( wellness evaluation score ) . Postoperative bowel dysfunction was assessed using the Rome III criteria . RESULTS Eighty-seven ( 65 % ) of the 135 patients ( 48 in the EEA stapler group and 37 in the PPH group ) were available for long-term follow-up . The two groups were comparable for age , gender and duration of follow-up ( mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively ) . In the EEA group , 11 ( 23 % ) patients had some degree of recurrent prolapse compared with 12 ( 32 % ) in the PPH group ( P = 0.409 ) . Persistence of anal bleeding was significantly higher in the PPH group ( P = 0.04 ) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group ( 1.73 ± 1.65 vs 3.17 ± 1.94 , P < 0.001 ) . The wellness evaluation score was significantly better in the EEA group ( 1.2 ± 1.27 vs 0.6 ± 1.0 , P = 0.028 ) . Furthermore , 7 ( 15 % ) of the patients in the EEA group complained of some evacuation disturbance compared with 13 ( 36 % ) in the PPH group ( P = 0.021 ) . CONCLUSION The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH . Nevertheless , use of the larger volume EEA provides better symptom resolution compared with PPH Objective : Unlike excisional haemorrhoidectomy , stapled anopexy ( SA ) , which does not involve radical excision , has theoretical advantages , thus offering potential patient benefits . We compared the clinical efficacy , safety and patient acceptability of SA , with closed haemorrhoidectomy ( CH ) . Patients and methods : 182 patients with symptomatic haemorrhoids ( grade s II , III , IV ) were r and omly assigned to receive SA or  CH  and were followed for up to 1 year ( 6 , 12 , 24 , 48 weeks ) after operation . Postoperative pain , symptom control , complications , re-treatment rates , patient satisfaction , and quality of life were compared on an intention-to-treat basis . Results : Postoperative pain in the SA group ( n = 91 ) was significantly lower ( p = 0.004 , Mann – Whitney U test ) . At 1 year there were no significant differences in the symptom load , symptom severity or the disease severity between the two groups . Overall complication rates were similar but faecal urgency was reported more frequently following SA ( p = 0.093 , Fisher ’s exact test ) . Despite a similar rate of residual symptoms , prolapse control was better with CH ( p = 0.087 , Fisher ’s exact test ) , and more patients in the SA group required re-treatment for residual prolapse at 1 year ( p = 0.037 , Fisher ’s exact test ) . However , more patients rated SA as an excellent operation at 6 and 12 weeks ( p = 0.008 and 0.033 , binary logistic regression ) and were willing to undergo a repeat procedure if required ( p = 0.018 , Fisher ’s exact test ) . Conclusion : Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability . Although the overall symptom control and safety are similar in the majority of the patients , the re-treatment rate for recurrent prolapse at 1 year is higher following SA when compared to CH Summary Background Two commonly performed surgical interventions are available for severe ( grade II – IV ) haemorrhoids ;  traditional excisional surgery and stapled haemorrhoidopexy . Uncertainty exists as to which is most effective . The eTHoS trial was design ed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery . Methods The eTHoS trial was a large , open-label , multicentre , parallel-group , pragmatic r and omised controlled trial done in adult participants ( aged 18 years or older ) referred to hospital for surgical treatment for grade II – IV haemorrhoids . Participants were r and omly assigned ( 1:1 ) to receive either traditional excisional surgery or stapled haemorrhoidopexy . R and omisation was minimised according to baseline EuroQol 5 dimensions 3 level score ( EQ-5D-3L ) , haemorrhoid grade , sex , and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery . The primary outcome was area under the quality of life curve ( AUC ) measured with the EQ-5D-3L descriptive system over 24 months , assessed according to the r and omised groups . The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables . This trial is registered with the IS RCT N registry , number IS RCT N80061723 . Findings Between Jan 13 , 2011 , and Aug 1 , 2014 , 777 patients were r and omised ( 389 to receive  stapled haemorrhoidopexy and 388 to receive  traditional excisional surgery ) . Stapled haemorrhoidopexy was less painful  than traditional excisional surgery in the short term and surgical complication rates were similar between groups . The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months ; mean difference −0·073 ( 95 % CI −0·140 to −0·006 ; p=0·0342 ) . EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery , the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group . 24 ( 7 % ) of 338 participants who received stapled haemorrhoidopexy and 33 ( 9 % ) of 352 participants who received traditional excisional surgery  had serious adverse events . Interpretation As part of a tailored management plan for haemorrhoids , traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice . Funding National Institute for Health Research Health Technology Assessment programme Introduction The aim of the study was to compare short- and medium-term outcomes of transanal haemorrhoidal dearterialisation ( THD ) versus stapled haemorrhoidopexy ( SH ) for the treatment of second- and third-degree haemorrhoids . Methods Patients with second- or third-degree haemorrhoids who failed conservative treatment were r and omly allocated to THD or SH .  Preoperative and postoperative symptoms , postoperative pain , time until return to normal activities , complications , patient satisfaction and recurrence rates were all assessed prospect ively . Patients were followed up at 2 , 8 months and when the study was completed . Results Twenty-eight patients ( 43 % third degree ) underwent THD and 24 ( 38 % third degree ) underwent SH . There were no significant differences in terms of postoperative pain , expected pain and analgesia requirements , but more THD patients returned to work within 4 days ( P < 0.05 ) . One THD patient developed a sub-mucosal haematoma after surgery , one SH patient occlusion of the rectal lumen and two rectal bleeding . At 8-month follow-up , two SH patients complained of faecal urgency . At 38-month follow-up ( range 33–48 months ) , all short-term complications resolved . Patient satisfaction ( “ excellent/good outcome ” , THD 89 vs. SH 87 % ) and recurrence rate ( THD 14 vs. SH 13 % ) were similar in the two groups . Conclusions Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD . Medium-term results demonstrate that THD and SH have similar effectiveness PURPOSE To evaluate efficacy and safety of superior rectal artery embolization of hemorrhoidal disease as a first-line invasive treatment . MATERIAL S AND METHODS This prospect i ve study was conducted between 2014 and 2015 on 25 consecutive patients ( 16 men and 9 women with a mean age of 53 y [ range , 30 - 76 y ] ) with grade II-III hemorrhoids refractory to medical treatment . A transfemoral superselective superior rectal artery branch embolization was performed using 2- and 3-mm diameter microcoils . Over the following 12 months , clinical outcomes were evaluated using the French bleeding score , Goligher prolapse score , visual analog scale ( VAS ) score for pain , quality -of-life score . The primary endpoint was relief of symptoms by 12 months based on a 2-point minimum improvement on VAS score and bleeding score . RESULTS At 12 months after embolization , clinical success was obtained in 18 patients ( 72 % ) , 8 of whom had 2 embolizations . VAS score decreased from 4.6 to 2.3 ( P < .01 ) , and bleeding score decreased from 5.5 to 2.3 ( P < .01 ) . Quality -of-life and prolapse scores also showed improvement ( P < .05 ) , and no patients experienced any early or late complications . Complete clinical failure was observed in 7 patients . After coil embolization , the collateral supply to the hemorrhoidal cushions was significantly related to any recurrence ( P = .001 ) . CONCLUSIONS Hemorrhoidal artery coil embolization was found to be a safe and effective treatment for grade II-III hemorrhoids Objective An improved underst and ing of the pathophysiology of haemorrhoids has result ed in the introduction of new surgical techniques including stapled haemorrhoidopexy ( SH ) . This r and omized controlled trial compared the long‐term effectiveness of SH with rubber b and ligation ( RBL ) in the treatment of grade II circumferential symptomatic haemorrhoids Introduction Exact data on the prevalence of hemorrhoids are rare . Therefore , we design ed a study to investigate the prevalence of hemorrhoids and associated risk factors in an adult general population . Methods Between 2008 and 2009 , consecutive patients were included in a prospect i ve study . They attended the Austrian national wide health care program for colorectal cancer screening at four medical institutions . A flexible colonoscopy and detailed examination were conducted in all patients . Hemorrhoids were defined according to a st and ardized grading 
    Output:
    
agent
Scores values tended to decrease postoperatively .
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Background The aim of the study was to compare ligation anopexy ( LA ) and conventional hemorrhoidectomy ( CH ) in treatment of second- and third-degree hemorrhoids . Methods A prospect i ve controlled r and omized clinical trial included 100 patients who underwent CH ( CH group ) and 100 patients who underwent LA ( LA group ) . A detailed history was taken from all the patients . The effectiveness , safety , postoperative complications , operative time , length of hospital stay , time until first bowel movement , time until return to work , and postoperative pain score were assessed . Results There was no significant difference between groups regarding age , sex , and preoperative symptoms . The LA group had significantly shorter operative times , earlier first bowel movement , and an earlier return to work/activities . The postoperative pain score in the LA group was significantly lower than that in the CH group on days 1 , 3 , 7 , and 14 after surgery . There was no significant difference between groups as regards postoperative complications . Conclusions LA is safe , and as effective as CH in the treatment of grade II and grade III hemorrhoids , with shorter operative times , earlier mobilization , and lower postoperative pain scores The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement aims to improve the reporting of r and omized controlled trials ( RCTs ) ; however , it lacks guidance on the reporting of patient-reported outcomes ( PROs ) , which are often inadequately reported in trials , thus limiting the value of these data . In this article , we describe the development of the CONSORT PRO extension based on the method ological framework for guideline development proposed by the Enhancing the Quality and Transparency of Health Research ( EQUATOR ) Network . Five CONSORT PRO checklist items are recommended for RCTs in which PROs are primary or important secondary end points . These recommendations urge that the PROs be identified as a primary or secondary outcome in the abstract , that a description of the hypothesis of the PROs and relevant domains be provided ( ie , if a multidimensional PRO tool has been used ) , that evidence of the PRO instrument 's validity and reliability be provided or cited , that the statistical approaches for dealing with missing data be explicitly stated , and that PRO-specific limitations of study findings and generalizability of results to other population s and clinical practice be discussed . Examples and an up date d CONSORT flow diagram with PRO items are provided . It is recommended that the CONSORT PRO guidance supplement the st and ard CONSORT guidelines for reporting RCTs with PROs as primary or secondary outcomes . Improved reporting of PRO data should facilitate robust interpretation of the results from RCTs and inform patient care This multicentre r and omized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids AIM The study aim ed in a multicentric r and omized controlled trial to define the role of a more extensive mucosal resection on recurrence of mucosal prolapse in patients with Stage III haemorrhoids undergoing stapled haemorrhoidopexy .  METHOD In all , 135 patients were r and omized to treatment with a PPH-01/03 ( Ethicon EndoSurgery ) or an EEA ( Covidien ) stapler .  They were review ed after a minimum follow-up of 4 years to determine the rate of recurrent mucosal prolapse and general condition ( wellness evaluation score ) . Postoperative bowel dysfunction was assessed using the Rome III criteria . RESULTS Eighty-seven ( 65 % ) of the 135 patients ( 48 in the EEA stapler group and 37 in the PPH group ) were available for long-term follow-up . The two groups were comparable for age , gender and duration of follow-up ( mean 49.3 ± 5.4 months and 49.0 ± 5.3 months respectively ) . In the EEA group , 11 ( 23 % ) patients had some degree of recurrent prolapse compared with 12 ( 32 % ) in the PPH group ( P = 0.409 ) . Persistence of anal bleeding was significantly higher in the PPH group ( P = 0.04 ) while the postoperative Haemorrhoid Symptom Score was significantly better in the EEA group ( 1.73 ± 1.65 vs 3.17 ± 1.94 , P < 0.001 ) . The wellness evaluation score was significantly better in the EEA group ( 1.2 ± 1.27 vs 0.6 ± 1.0 , P = 0.028 ) . Furthermore , 7 ( 15 % ) of the patients in the EEA group complained of some evacuation disturbance compared with 13 ( 36 % ) in the PPH group ( P = 0.021 ) . CONCLUSION The study failed to demonstrate any significant difference in the long-term recurrence rate of Stage III haemorrhoids using EEA or PPH . Nevertheless , use of the larger volume EEA provides better symptom resolution compared with PPH Objective : Unlike excisional haemorrhoidectomy , stapled anopexy ( SA ) , which does not involve radical excision , has theoretical advantages , thus offering potential patient benefits . We compared the clinical efficacy , safety and patient acceptability of SA , with closed haemorrhoidectomy ( CH ) . Patients and methods : 182 patients with symptomatic haemorrhoids ( grade s II , III , IV ) were r and omly assigned to receive SA or  CH  and were followed for up to 1 year ( 6 , 12 , 24 , 48 weeks ) after operation . Postoperative pain , symptom control , complications , re-treatment rates , patient satisfaction , and quality of life were compared on an intention-to-treat basis . Results : Postoperative pain in the SA group ( n = 91 ) was significantly lower ( p = 0.004 , Mann – Whitney U test ) . At 1 year there were no significant differences in the symptom load , symptom severity or the disease severity between the two groups . Overall complication rates were similar but faecal urgency was reported more frequently following SA ( p = 0.093 , Fisher ’s exact test ) . Despite a similar rate of residual symptoms , prolapse control was better with CH ( p = 0.087 , Fisher ’s exact test ) , and more patients in the SA group required re-treatment for residual prolapse at 1 year ( p = 0.037 , Fisher ’s exact test ) . However , more patients rated SA as an excellent operation at 6 and 12 weeks ( p = 0.008 and 0.033 , binary logistic regression ) and were willing to undergo a repeat procedure if required ( p = 0.018 , Fisher ’s exact test ) . Conclusion : Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability . Although the overall symptom control and safety are similar in the majority of the patients , the re-treatment rate for recurrent prolapse at 1 year is higher following SA when compared to CH Summary Background Two commonly performed surgical interventions are available for severe ( grade II – IV ) haemorrhoids ;  traditional excisional surgery and stapled haemorrhoidopexy . Uncertainty exists as to which is most effective . The eTHoS trial was design ed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery . Methods The eTHoS trial was a large , open-label , multicentre , parallel-group , pragmatic r and omised controlled trial done in adult participants ( aged 18 years or older ) referred to hospital for surgical treatment for grade II – IV haemorrhoids . Participants were r and omly assigned ( 1:1 ) to receive either traditional excisional surgery or stapled haemorrhoidopexy . R and omisation was minimised according to baseline EuroQol 5 dimensions 3 level score ( EQ-5D-3L ) , haemorrhoid grade , sex , and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery . The primary outcome was area under the quality of life curve ( AUC ) measured with the EQ-5D-3L descriptive system over 24 months , assessed according to the r and omised groups . The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables . This trial is registered with the IS RCT N registry , number IS RCT N80061723 . Findings Between Jan 13 , 2011 , and Aug 1 , 2014 , 777 patients were r and omised ( 389 to receive  stapled haemorrhoidopexy and 388 to receive  traditional excisional surgery ) . Stapled haemorrhoidopexy was less painful  than traditional excisional surgery in the short term and surgical complication rates were similar between groups . The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months ; mean difference −0·073 ( 95 % CI −0·140 to −0·006 ; p=0·0342 ) . EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery , the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group . 24 ( 7 % ) of 338 participants who received stapled haemorrhoidopexy and 33 ( 9 % ) of 352 participants who received traditional excisional surgery  had serious adverse events . Interpretation As part of a tailored management plan for haemorrhoids , traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice . Funding National Institute for Health Research Health Technology Assessment programme Introduction The aim of the study was to compare short- and medium-term outcomes of transanal haemorrhoidal dearterialisation ( THD ) versus stapled haemorrhoidopexy ( SH ) for the treatment of second- and third-degree haemorrhoids . Methods Patients with second- or third-degree haemorrhoids who failed conservative treatment were r and omly allocated to THD or SH .  Preoperative and postoperative symptoms , postoperative pain , time until return to normal activities , complications , patient satisfaction and recurrence rates were all assessed prospect ively . Patients were followed up at 2 , 8 months and when the study was completed . Results Twenty-eight patients ( 43 % third degree ) underwent THD and 24 ( 38 % third degree ) underwent SH . There were no significant differences in terms of postoperative pain , expected pain and analgesia requirements , but more THD patients returned to work within 4 days ( P < 0.05 ) . One THD patient developed a sub-mucosal haematoma after surgery , one SH patient occlusion of the rectal lumen and two rectal bleeding . At 8-month follow-up , two SH patients complained of faecal urgency . At 38-month follow-up ( range 33–48 months ) , all short-term complications resolved . Patient satisfaction ( “ excellent/good outcome ” , THD 89 vs. SH 87 % ) and recurrence rate ( THD 14 vs. SH 13 % ) were similar in the two groups . Conclusions Short-term results although similar seem to suggest SH may result in increased morbidity while return to work is quicker after THD . Medium-term results demonstrate that THD and SH have similar effectiveness PURPOSE To evaluate efficacy and safety of superior rectal artery embolization of hemorrhoidal disease as a first-line invasive treatment . MATERIAL S AND METHODS This prospect i ve study was conducted between 2014 and 2015 on 25 consecutive patients ( 16 men and 9 women with a mean age of 53 y [ range , 30 - 76 y ] ) with grade II-III hemorrhoids refractory to medical treatment . A transfemoral superselective superior rectal artery branch embolization was performed using 2- and 3-mm diameter microcoils . Over the following 12 months , clinical outcomes were evaluated using the French bleeding score , Goligher prolapse score , visual analog scale ( VAS ) score for pain , quality -of-life score . The primary endpoint was relief of symptoms by 12 months based on a 2-point minimum improvement on VAS score and bleeding score . RESULTS At 12 months after embolization , clinical success was obtained in 18 patients ( 72 % ) , 8 of whom had 2 embolizations . VAS score decreased from 4.6 to 2.3 ( P < .01 ) , and bleeding score decreased from 5.5 to 2.3 ( P < .01 ) . Quality -of-life and prolapse scores also showed improvement ( P < .05 ) , and no patients experienced any early or late complications . Complete clinical failure was observed in 7 patients . After coil embolization , the collateral supply to the hemorrhoidal cushions was significantly related to any recurrence ( P = .001 ) . CONCLUSIONS Hemorrhoidal artery coil embolization was found to be a safe and effective treatment for grade II-III hemorrhoids Objective An improved underst and ing of the pathophysiology of haemorrhoids has result ed in the introduction of new surgical techniques including stapled haemorrhoidopexy ( SH ) . This r and omized controlled trial compared the long‐term effectiveness of SH with rubber b and ligation ( RBL ) in the treatment of grade II circumferential symptomatic haemorrhoids Introduction Exact data on the prevalence of hemorrhoids are rare . Therefore , we design ed a study to investigate the prevalence of hemorrhoids and associated risk factors in an adult general population . Methods Between 2008 and 2009 , consecutive patients were included in a prospect i ve study . They attended the Austrian national wide health care program for colorectal cancer screening at four medical institutions . A flexible colonoscopy and detailed examination were conducted in all patients . Hemorrhoids were defined according to a st and ardized grading 
    Output:
    