To date, more than 30 prospective randomized trials have been published, corroborating the positive experiences. Most of the studies reported significantly less postoperative pain and, in many studies, more patient comfort, as well as significantly faster return to work.
There was no significant difference in the complication rate or length of stay in hospital - probably mostly due to the different health care systems.
Several Cochrane analyses have confirmed these outcomes at evidence level 1 compared with open hemorrhoidectomy by Milligan et al.:
Benefits favoring stapler hemorrhoidopexy during the early postoperative course. However, compared with conventional surgical techniques the long-term course demonstrated significantly better outcome regarding freedom of symptoms, recurrent prolapse and reoperation.
When interpreting these data, however, it must be remembered that the studies were conducted between 2000 and 2004 and may have included patients with fourth-degree hemorrhoids and fixed anal prolapse. As it was only after 2005 that randomized clinical trials (RCT) reported a significantly poorer outcome for this indication, the indication may have changed in recent years compared with the above trials.