6/28/23, 11:19 PM MoLish Pathway Feedback Search Clinical Topics Home Studies MoLish MoLish Disease Hemorrhoids Trial question Is modified ligation procedure superior to stapled hemorrhoidectomy in patients with symptomatic hemorrhoids? Study design Single center Single blinded RCT Population Characteristics of study participants 53.0% female N = 130 47.0% male 130 patients (69 female, 61 male) Inclusion criteria: patients with symptomatic hemorrhoids Key exclusion criteria: acute hemorrhoidal edema; infection; bleeding; IBD, acute or chronic diarrhea; anal fistula; perianal sepsis; colorectal malignancy Interventions N=64 modified ligation procedure (application of a rubber band and a silk loop to each ligation site via a proctoscope) N=66 stapled hemorrhoidectomy (performed with a PaH32 stapler) Primary outcome https://web.pathway.md/studies/recWEw4TbJjZwWCog 1/2 6/28/23, 11:19 PM MoLish Pathway Cure rate at 6 months 90.6 % 90.6 69.7 67.9 % 45.3 % Significant increase 22.6 % NNH = 5 0.0 % Modified ligation procedure Stapled hemorrhoidectomy Significant increase in cure rate at 6 months (90.6% vs. 69.7%; AD 20.9%, 95% CI 7.12 to 34.68) Secondary outcomes Significant decrease in median hemorrhoid symptom severity score at 6 months (MD -1, 95% CI -1.66 to -0.34) Significant decrease in Wexner incontinence score at 1 month (AD -1, 95% CI -1.94 to -0.06) Significant decrease in median postoperative pain score at day 7 (1 vs. 2; AD -1, 95% CI -1.79 to -0.21) Safety outcomes No significant differences in urinary retention, perianal haematoma. Significant differences in cutaneous bridge edema (32.8% vs. 6.1%), anal distension (37.5% vs. 54.5%). Conclusion In patients with symptomatic hemorrhoids, modified ligation procedure was superior to stapled hemorrhoidectomy with respect to cure rate at 6 months. Reference Haibo Yang, Zhan Shi, Wei Chen et al. Modified ligation procedure for prolapsed haemorrhoids versus stapled haemorrhoidectomy for the management of symptomatic haemorrhoids (MoLish): randomized clinical trial. BJS Open. 2022 May 2;6(3):zrac064. Open reference URL https://web.pathway.md/studies/recWEw4TbJjZwWCog 2/2