Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes

Stapled Versus Conventional Hemorrhoidectomy: A... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/14-601" }, "headline": "Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes", "datePublished": "2025-06-19T15:47:05", "dateModified": "2025-06-19T15:47:05", "author": [ { "@type": "Person", "name": "Mohammedsadeq A. Shweliya" }, { "@type": "Person", "name": "Arkan Shubber AbdulKhaliq Al-Hamdany" }, { "@type": "Person", "name": "Marafi Jammaa Ismail Ahmed" }, { "@type": "Person", "name": "Aya Ahmed Shimal" }, { "@type": "Person", "name": "Khadeeja Ali Hamzah" }, { "@type": "Person", "name": "Hassan H. Eladl" }, { "@type": "Person", "name": "Lina Hemmeda" }, { "@type": "Person", "name": "Mustafa Haleem Alsaadi" }, { "@type": "Person", "name": "Abdulhadi M. A. Mahgoub" }, { "@type": "Person", "name": "Yusur Aamer" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Anorectal hemorrhoids are a common condition that frequently needs surgery in more challenging situations. Both stapled hemorrhoidectomy and conventional hemorrhoidectomy are standard surgical procedures, each one with various advantages and disadvantages as well. The purpose of this study is to compare the outcomes of these two operations concerning patient satisfaction, complications, recovery time and postoperative pain. Method This retrospective cohort analysis was conducted in Karbala, Iraq, at AL-Kafeel Hospital and AL-Safeer Hospital. Information has been collected from patients who had stapled hemorrhoidectomy in 2023–2024 and those who had conventional hemorrhoidectomy from 2015–2018. To account for baseline variations, especially those related to the kind of anesthetic and extent of hemorrhoids, propensity score matching (caliper = 0.05) was employed. SPSS version 29.0 was used for statistical analysis, and comparisons were made by using t-tests, chi-square tests, and correlation analyses. Statistical significance was defined as a p-value of less than 0.05. Results Out of 114 patients (50 conventional, 64 stapled), the stapled group had a higher percentage of fourth-degree hemorrhoids, postoperative pain and bleeding were significantly lower in the stapled group (p < 0.001), and only the conventional group had wound infections and anal stenosis (p < 0.05). The stapled group also showed better postoperative outcomes. Conclusion Stapled hemorrhoidectomy is linked to less pain, fewer complications, and faster recovery than conventional hemorrhoidectomy, but the risk of recurrent hemorrhoidectomy is still a concern. These findings support that surgical decision-making in hemorrhoid management can be optimized. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-601", "name": "Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study..." } } ] } Home Browse Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Shweliya MA, Al-Hamdany ASA, Ahmed MJI et al. Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.12688/f1000research.163191.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] Mohammedsadeq A. Shweliya https://orcid.org/0009-0000-2832-6270 1 , Arkan Shubber AbdulKhaliq Al-Hamdany 2 , Marafi Jammaa Ismail Ahmed https://orcid.org/0009-0000-5032-8627 3 , [...] Aya Ahmed Shimal https://orcid.org/0009-0002-0268-236X 1 , Khadeeja Ali Hamzah https://orcid.org/0009-0009-2674-4829 4 , Hassan H. Eladl https://orcid.org/0009-0005-2003-1159 5 , Lina Hemmeda https://orcid.org/0000-0003-4636-9471 6 , Mustafa Haleem Alsaadi 7 , Abdulhadi M. A. Mahgoub https://orcid.org/0009-0004-5008-940X 8 , Yusur Aamer https://orcid.org/0009-0000-2832-6270 9 Mohammedsadeq A. Shweliya https://orcid.org/0009-0000-2832-6270 1 , Arkan Shubber AbdulKhaliq Al-Hamdany 2 , [...] Marafi Jammaa Ismail Ahmed https://orcid.org/0009-0000-5032-8627 3 , Aya Ahmed Shimal https://orcid.org/0009-0002-0268-236X 1 , Khadeeja Ali Hamzah https://orcid.org/0009-0009-2674-4829 4 , Hassan H. Eladl https://orcid.org/0009-0005-2003-1159 5 , Lina Hemmeda https://orcid.org/0000-0003-4636-9471 6 , Mustafa Haleem Alsaadi 7 , Abdulhadi M. A. Mahgoub https://orcid.org/0009-0004-5008-940X 8 , Yusur Aamer https://orcid.org/0009-0000-2832-6270 9 PUBLISHED 19 Jun 2025 Author details Author details 1 University of Baghdad, Baghdad, Baghdad Governorate, Iraq 2 Iraqi Ministry of Health, Karbala Health Directorate, General and Laparoscopic Surgeon, Karbala, Iraq 3 Bahri University, Khartoum, Sudan 4 University of Baghdad Al-Kindy College Of Medicine, Baghdad, Iraq 5 Ain Shams University, Cairo, Cairo Governorate, Egypt 6 University of Khartoum, Khartoum, Khartoum, Sudan 7 Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences, Najaf, Iraq 8 University of Gezira, Wad Madani, Al Jazirah, Sudan 9 Mustansiriyah University, Baghdad, Baghdad Governorate, Iraq Mohammedsadeq A. Shweliya Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation Arkan Shubber AbdulKhaliq Al-Hamdany Roles: Conceptualization, Resources, Writing – Review & Editing Marafi Jammaa Ismail Ahmed Roles: Writing – Review & Editing Aya Ahmed Shimal Roles: Writing – Original Draft Preparation Khadeeja Ali Hamzah Roles: Validation, Writing – Original Draft Preparation Hassan H. Eladl Roles: Writing – Original Draft Preparation, Writing – Review & Editing Lina Hemmeda Roles: Writing – Original Draft Preparation, Writing – Review & Editing Mustafa Haleem Alsaadi Roles: Formal Analysis, Writing – Review & Editing Abdulhadi M. A. Mahgoub Roles: Validation, Writing – Original Draft Preparation, Writing – Review & Editing Yusur Aamer Roles: Methodology, Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Anorectal hemorrhoids are a common condition that frequently needs surgery in more challenging situations. Both stapled hemorrhoidectomy and conventional hemorrhoidectomy are standard surgical procedures, each one with various advantages and disadvantages as well. The purpose of this study is to compare the outcomes of these two operations concerning patient satisfaction, complications, recovery time and postoperative pain. Method This retrospective cohort analysis was conducted in Karbala, Iraq, at AL-Kafeel Hospital and AL-Safeer Hospital. Information has been collected from patients who had stapled hemorrhoidectomy in 2023–2024 and those who had conventional hemorrhoidectomy from 2015–2018. To account for baseline variations, especially those related to the kind of anesthetic and extent of hemorrhoids, propensity score matching (caliper = 0.05) was employed. SPSS version 29.0 was used for statistical analysis, and comparisons were made by using t-tests, chi-square tests, and correlation analyses. Statistical significance was defined as a p-value of less than 0.05. Results Out of 114 patients (50 conventional, 64 stapled), the stapled group had a higher percentage of fourth-degree hemorrhoids, postoperative pain and bleeding were significantly lower in the stapled group (p < 0.001), and only the conventional group had wound infections and anal stenosis (p < 0.05). The stapled group also showed better postoperative outcomes. Conclusion Stapled hemorrhoidectomy is linked to less pain, fewer complications, and faster recovery than conventional hemorrhoidectomy, but the risk of recurrent hemorrhoidectomy is still a concern. These findings support that surgical decision-making in hemorrhoid management can be optimized. READ ALL READ LESS Keywords Hemorrhoidectomy; Stapled hemorrhoidectomy; Conventional hemorrhoidectomy; Surgical outcomes; Complications; Postoperative pain Corresponding Author(s) Lina Hemmeda ( [email protected] ) Close Corresponding author: Lina Hemmeda Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Shweliya MA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Shweliya MA, Al-Hamdany ASA, Ahmed MJI et al. Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.12688/f1000research.163191.1 ) First published: 19 Jun 2025, 14 :601 ( https://doi.org/10.12688/f1000research.163191.1 ) Latest published: 19 Jun 2025, 14 :601 ( https://doi.org/10.12688/f1000research.163191.1 ) Introduction Hemorrhoids, commonly known as piles, are severely swollen veins that have formed in the lower rectum or the anus. They are of two types: internal and external. Internal ones develop within the rectum and are usually painless. They can lead to rectal bleeding. They may also prolapse, which is when the hemorrhoids come out through the anus. On the other hand, the skin beneath the anus is home to external hemorrhoids, which can cause swelling, pain, and itching. 1 , 2 Risk factors include pregnancy, family history, aging, obesity, low-fiber diet, sedentary lifestyle, heavy lifting, and chronic constipation or diarrhea. 3 , 4 Studies show that nearly 5% of the global population suffers from symptomatic hemorrhoids, with higher prevalences in developed countries. 5 People suffering from hemorrhoids complain of factors such as pain, discomfort, itching, and even bleeding, which makes it difficult for them to carry out their daily activities as well as social life. This may lead to physical and psychological problems such as anxiety and depression because they tend to feel embarrassed. 6 The Goligher grading system classifies internal hemorrhoids into four grades based on prolapse severity. Grade I is asymptomatic, while Grade II prolapses after bowel movements but reduces spontaneously. Grade III requires manual reduction, and Grade IV remains prolapsed. 7 Treatment varies by severity. Early-stage cases are managed with lifestyle modifications and analgesics. 8 Minimally invasive procedures like sclerotherapy, infrared photocoagulation, and rubber band ligation are options for advanced cases. 9 Severe or chronic hemorrhoids often require surgery, primarily conventional or stapled hemorrhoidectomy. 10 In conventional hemorrhoidectomy, the hemorrhagic tissues are removed under local, regional, or general anesthesia during the surgery. It may be done using a laser or a scalpel with the wound either sutured or left open. It’s found to be effective for Grade III and IV hemorrhoids but is associated with significant postoperative pain and a lengthy recovery period of two to six weeks. 11 In contrast, stapled hemorrhoidectomy, which uses a circular stapler to remove extra tissue and realign hemorrhoids while under general anesthesia, has a greater recurrence rate but is less painful and heals more quickly. 12 , 13 The classical technique, introduced in 1993, treats hemorrhoidal disease through stapled hemorrhoidopexy, a less invasive alternative to traditional hemorrhoidectomy. It offers better pain control and patient comfort but carries risks of complications like bleeding and sepsis. Since 2002, over 130 studies have reported these risks, emphasizing the need for careful comparison with conventional hemorrhoidectomy. 14 The choice between conventional and stapled hemorrhoidectomy remains challenging due to variations in pain levels, recovery time. Limited and mostly outdated studies have explored this topic, with none conducted in Iraq, leaving a gap in understanding patient outcomes and long-term effectiveness in our clinical setting. This research aims to compare the outcomes between stapled and conventional hemorrhoidectomy techniques by evaluating postoperative pain, recovery time, and complications. The study seeks to provide evidence-based data to guide surgical decision-making and optimize treatment selection for patients requiring hemorrhoid surgery in our clinical setting. Methods This study is a retrospective analysis of prospectively collected data from two centers: AL-Kafeel Hospital and Safeer Al-Hussain Hospital in Karbala, Iraq. The aim was to compare the outcomes and complications of conventional hemorrhoidectomy and stapled hemorrhoidectomy. Patients These data were collected by teams of two surgeons for their patients between September 2015 and January 2024. We included patients older than 18 years old, with grade three or four hemorrhoids, complete medical records, and who underwent surgical intervention at Al-Kafeel Hospital and Al-Safeer Hospital in Karbala, Iraq. Exclusion criteria included patients with incomplete records, missing data or those for whom baseline characteristics or postoperative outcomes were unavailable, those who underwent surgery for acute cause, or those with a history of hemorrhoidectomy. Written informed consent was obtained from each patient at time of data collection. Propensity score matching To reduce the bias in selection, propensity score matching was carried using a caliper width of 0.05. Matching was performed based on the type of anesthesia and degree of hemorrhoids to ensure that the two surgical groups would have comparable baseline characteristics. Statistical analysis Data were analyzed using SPSS version 29.0 ( https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-29 ). Descriptive statistics were used to summarize the data, including mean, standard deviation, and percentages. An independent samples t-test was applied for continuous variables, while categorical variables were compared using the chi-square test. Pearson’s and Spearman’s correlation coefficients were calculated to assess relationships among variables. Statistical significance was established at p < 0.05. Results In this retrospective study involving 114 participants, 50 (43%) were in the classical group, while 64 (56%) were in the stapled group. Among both groups, 35 participants (30%) were female, and 79 (69%) were male. The mean age of the classical group was 42 years, while the mean age of the stapled group was 43 years. The age distribution among the study groups followed a normal distribution, and there was no statistically significant difference in age between the groups, see Table 1 . Age was categorized into multiple groups for analytical purposes. At baseline, the stapled group exhibited a higher proportion of fourth-degree cases than those with third-degree cases, as can be seen in Table 2 and Figure 1 . Table 1. Age distribution of unmatched cohort. Age in Years Classical, n = 50 % Stapled, n = 64 % Total, n = 114 18-21 2 4 4 6 6 22-29 6 12 10 15 16 30-49 30 60 28 43 58 50-59 7 14 16 25 23 60-69 4 8 6 9 10 70-79 1 2 0 0 1 Total 50 100 64 100 114 Mean ± SD 42.52 ± 11.56 43.55 ± 13.89 43.1 ± 14.35 Table 2. Baseline characteristics of unmatched cohort. Parameter Classical n = 50 (%) Stapled n = 64 (%) p-value Gender <0.001 Female (%) 24 (48) 11 (17) Male (%) 26 (52) 53 (82) Hemorrhoids degree (%) <0.001 Third (%) 46 (92) 41 (64) Fourth (%) 4 (8) 23 (35) Preoperative pain (%) 33 (66) 34 (53) 0.166 Preoperative bleeding (%) 23 (46) 39 (60) 0.112 Preoperative mass (%) 47 (94) 59 (92) 0.707 Figure 1. Showing hemorrhoid degree at presentation among the stapled and classical groups. Regarding the preoperative presentations, the preoperative mass was the predominant feature in the clinical presentation for both groups. This mass may be associated with bleeding or pain. The proportions of hemorrhoid severity varied between the two groups. The majority of participants presented with third-degree hemorrhoids, with 92% in the classical group compared to 64% in the stapled group, see Figure 2 . While in postoperative complications, a significant difference was observed in postoperative pain, bleeding (p = 0.001), and wound infection (p = 0.01). In the classical group, additional complications included anal stenosis. Notably, all cases of postoperative wound infection occurred in females (n = 5). In contrast, no such complications were observed in the stapled group, see Table 3 , Figure 3 and Table 4 . All instances of postoperative bleeding in the stapled group were reported in males ( Table 5 ). Figure 2. Preoperative presentation of the two study groups. Table 3. Showing the type of anesthesia, operation time, and postoperative complications in the unmatched cohort. Unmatched cohort Classical n = 50 (%) Stapled n = 64 (%) p-value Type of anesthesia (%) Spinal 27 (54) 5 (7) <0.001 General 23 (46) 59 (92) Operation time (minutes) (Mean ± SD) 28.1 ± 11.72 29.3 ± 7.82 0.489 Postoperative bleeding (%) 19 (38) 4 (6) 0.001 Postoperative pain (%) 50 (100) 4 (6) 0.001 Wound infection (%) 5 (10) 0 (0) 0.01 Residual mass (%) 10 (20) 4 (6) 0.02 Anal stenosis (%) 8 (16) 0 (0) 0.001 Figure 3. Postoperative complications in the classical and stapled groups. Table 4. Showing the type of anesthesia, operation time, and postoperative complications in the matched cohort. Matched cohort Classical n = 25 (%) Stapled n = 64 (%) p-value Type of anesthesia (%) 0.26 Spinal 4 (16) 5 (7) General 21 (84) 59 (92) Operation time (minutes) (Mean ± SD) 25 ± 10.3 29 ± 7.8 0.07 Postoperative bleeding (%) 11 (44) 4 (6) < 0.001 Postoperative pain (%) 25 (100) 4 (6) < 0.001 Wound infection (%) 3 (12) 0 (0) 0.02 Residual mass (%) 4 (16) 4 (6) 0.21 Anal stenosis (%) 5 (20) 0 (0) 0.001 Table 5. Postoperative complications according to the biological sex of unmatched cohort. Female, n = 35 (%) Male, n = 79 (%) p-value Postoperative bleeding Classical 11 (31) 8 (10) 0.27 Stapled 0 (0) 4 (5) 0.34 Wound infection Classical 5 (14) 0 (0) 0.02 Stapled 0 (0) 0 (0) Postoperative pain Classical 23 (65) 26 (32) Stapled 0 (0) 4 (5) 0.34 Operation time (mean ± SD) Classical 33.69 ± 14.29 22.69 ± 4.23 <0.001 Stapled 30.36 ± 6.91 29.06 ± 8.07 0.620 Residual mass (%) Classical 5 (14) 5 (6) 1 Stapled 0 (0) 4 (5) 0.34 Anal stenosis (%) Classical 0 (0) 8 (10) 0.004 Stapled 0 (0) 0 (0) Discussion Our findings show differences in results between stapled and conventional hemorrhoidectomy operations. The results showed less postoperative pain and fewer complications. The mean (SD) of age in our cohort was 42.52 (11.56) and 43.55 (13.89) in the classical and stapled groups, respectively, which is slightly higher than the mean age reported in a prior cohort, 40.05 years (SD = 10.88) and 39.5 years (SD = 9.82) in the classical and stapled groups, respectively. 15 Regarding gender distribution, our classical group had a relatively balanced composition (52% male, 48% female), whereas the stapled group had a significantly higher proportion of males (82% male, 17% female). This differs from the findings of Sachin et al. (2017), where the male-to-female ratios were 66% male, 34% female in the conventional group and 54% male and 46% female in the stapled group. 15 The type of anesthesia used was spinal in 54% of patients who underwent classical hemorrhoidectomy and general anesthesia in 92% of stapled hemorrhoidectomy patients. However, the significantly lower postoperative pain in the stapled hemorrhoidectomy group (p < 0.001) aligns with previous studies, which attribute this to the preservation of the anoderm and perianal skin innervation. 12 , 13 Conventional hemorrhoidectomy involves excising hemorrhoidal tissue, leading to an open wound that remains exposed to irritation from stool passage, causing prolonged discomfort. 11 In contrast, stapled hemorrhoidectomy repositions rather than removes tissue. 12 , 13 This could be due to minimized nerve disruption and inflammatory response, which may explain the shorter recovery period observed in our cohort. In contrast, studies reported severe postoperative pain as one of the most common complications, 14 , 16 , 17 Still, it was powerfully explained by the incorrect indication for surgery or surgical technique or pre-existing comorbidities. 14 , 17 However, other studies have shown that stapled hemorrhoidectomy reduces hospitalization length and lowers the need for postoperative analgesics. 18 – 20 Our study confirmed that wound infection anal stenosis were exclusively seen in the conventional hemorrhoidectomy group (p < 0.05), which are common complications known to be associated with conventional hemorrhoidectomy. 21 , 22 This may be due to open wounds being prone to bacterial colonization, tissue fibrosis, and subsequent scarring. 23 There were no notable distinctions between males and females in most of the postoperative complications. Interestingly, our results showed a higher rate of wound infections in females (p = 0.02) and anal stenosis in males (p = 0.004). The reason for this disparity is unclear but may be linked to anatomical variations in pelvic floor structure, wound healing response, and hormonal influences. In our study, the mean surgical duration was 28.1 ± 11.72 minutes in the classical group and 29.3 ± 7.82 minutes in the stapled group, with significantly longer times in females (P < 0.001). Similarly, there was no significant difference in operative time (P = 0.082) or blood loss (P = 0.117), but shorter hospital stays in the stapled group (P < 0.001) (19). Conversely, Toppo et al. (2023) found shorter operative times for stapled (28.71 ± 7.25 min) vs. open hemorrhoidectomy (36.51 ± 9.16 min) 24 gender disparity in our classical group underscores the importance of considering patient demographics when evaluating surgical outcomes. Although the stapled hemorrhoidectomy technique is generally considered safer with a lower complication rate, It has been linked to a higher chance of incontinence and higher recurrence rates, as confirmed by previous studies. 19 , 25 , 26 This suggests that while the stapled technique may offer short-term benefits in terms of safety, long-term outcomes should be carefully considered, particularly in high-risk populations. A national study, for instance, found that advanced age combined with comorbidities significantly increased postoperative risks in hemorrhoidectomy patients. 27 Further, a study linked complications like pain, bleeding, and stricture to pre-existing conditions, highlighting the need for careful patient assessment. 17 Limitations The analysis is limited by its retrospective observational design and the small sample size, which could affect the data’s generalizability. Complication assessment was restricted to admission duration without long-term follow-up to evaluate recurrence rates or patient satisfaction. While longer follow-ups would provide more detailed information, logistical issues with patient attrition in retrospective studies usually limit long-term data. Lastly, while the research emphasizes safety outcomes, efficacy measures of functional recovery and recurrence prevention were not exhaustively examined. Prospective design studies with extended follow-ups must be done in the future to address these deficiencies. Strength One of the biggest strengths of this study is the simple comparison between two prevalent surgical techniques, which will prove to be very helpful in clinical practice. Patients from two hospitals provide more generalizability of the findings to various populations. The study also collects a lot of preoperative, postoperative, and demographic data. Propensity score matching also enhances reliable outcome measurements and removes some selection bias. Future implications Additional research should evaluate both procedures’ long-term efficacy, particularly for recurrence and patient satisfaction. Cost-effectiveness analysis of stapled vs. conventional hemorrhoidectomy would help establish optimized resource utilization. From high-risk groups, including those with significant comorbidities, more targeted surgical recommendations can be developed. More extensive research with longer follow-up is needed to refine the treatment further and improve patients’ outcomes. Conclusion This study demonstrates that stapled hemorrhoidectomy is better than conventional hemorrhoidectomy in that it causes less postoperative pain, fewer complications, and faster recovery. The high recurrence rate is problematic. These findings suggest that surgical management should be tailored based on disease severity and patient preference. Further studies with more extensive series and longer follow-ups are required to validate these observations and guide the optimal surgical treatment for hemorrhoidal disease. Ethical considerations Ethical approval was taken from the “Research Unite at Karbala Health Directorate” in February 2025. No approval number was provided. Patient confidentiality was maintained throughout the study. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Consent Written informed consent was obtained from each patient at time of data collection. Preregistered data analysis This retrospective study has not been preregistered at any site previously, as retrospective registration is not permitted. Data availability Underlying data Zenodo: stapled vs classical.xlsx. https://doi.org/10.5281/zenodo.15380704 . 28 This project contains the following underlying data: • stapled vs classical.xlsx. (This contains values of stapled and classical surgeries) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Zenodo: stapled vs classical.xlsx. https://doi.org/10.5281/zenodo.15380704 . 28 This project contains the following underlying data: • Age as a continous Variable (2).xlsx. (This contains the age variable as a continuous data variable) • STROBE-checklist-v4-combined.doc (This contains STROBE checklist) • sheet.pdf (This contains participants information sheet) • patient consent form sample.pdf (This contains blank consent form) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments Not applicable. References 1. Bernstein WC: What are hemorrhoids and what is their relationship to the portal venous system? Dis. Colon Rectum. 1983 Dec [cited 2025 Feb 23]; 26 (12): 829–834. PubMed Abstract | Publisher Full Text 2. Aigner F, Gruber H, Conrad F, et al. : Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int. J. Color. Dis. 2009 [cited 2025 Feb 23]; 24 (1): 105–113. PubMed Abstract | Publisher Full Text 3. Pigot F, Siproudhis L, Allaert FA: Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol. Clin. Biol. 2005 [cited 2025 Feb 23]; 29 (12): 1270–1274. Publisher Full Text Reference Source 4. De Marco S, Tiso D: Lifestyle and Risk Factors in Hemorrhoidal Disease. Front. Surg. 2021 Aug 18 [cited 2025 Feb 23]; 8 . PubMed Abstract | Publisher Full Text | Free Full Text 5. Kibret AA, Oumer M, Moges AM: Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One. 2021 Apr 1 [cited 2025 Feb 23]; 16 (4): e0249736. PubMed Abstract | Publisher Full Text | Free Full Text 6. Rørvik HD, Davidsen M, Gierløff MC, et al. : Quality of life in patients with hemorrhoidal disease. Surg. Open Sci. 2023 Mar 1 [cited 2025 Feb 23]; 12 : 22–28. PubMed Abstract | Publisher Full Text | Free Full Text 7. Rubbini M, Ascanelli S: Classification and guidelines of hemorrhoidal disease: Present and future. World. J. Gastrointest. Surg. 2019 Mar 27 [cited 2025 Feb 23]; 11 (3): 117–121. PubMed Abstract | Publisher Full Text | Free Full Text 8. Mott T, Latimer K, Edwards C: Hemorrhoids: Diagnosis and Treatment Options. Am. Fam. Physician. 2018 Feb 1 [cited 2025 Feb 23]; 97 (3): 172–179. PubMed Abstract Reference Source 9. Miyamoto H: Minimally Invasive Treatment for Advanced Hemorrhoids. J. Anus Rectum Colon. 2023 Jan 25 [cited 2025 Feb 23]; 7 (1): 8–16. PubMed Abstract | Publisher Full Text | Free Full Text 10. Hollingshead JRF, Phillips RKS: Haemorrhoids: modern diagnosis and treatment. Postgrad. Med. J. 2016 Jan 1 [cited 2025 Feb 23]; 92 (1083): 4–8. Publisher Full Text Reference Source 11. Yeo D, Tan KY: Hemorrhoidectomy - making sense of the surgical options. World J. Gastroenterol. 2014 Dec 7 [cited 2025 Feb 23]; 20 (45): 16976–16983. PubMed Abstract | Publisher Full Text | Free Full Text 12. Hetzer FH, Demartines N, Handschin AE, et al. : Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch. Surg. 2002 Mar 1 [cited 2025 Feb 23]; 137 (3): 337–340. PubMed Abstract | Publisher Full Text 13. Mascagni D, Zeri KP, Di Matteo FM, et al. : Stapled hemorrhoidectomy: surgical notes and results. Hepato-Gastroenterology. 2003 Nov 1 [cited 2025 Feb 23]; 50 (54): 1878–1882. PubMed Abstract 14. Schiano di Visconte M, Pasquali A, Cipolat Mis T: Main Disadvantages of Stapled Hemorrhoidopexy.2017 [cited 2025 Feb 23]; 1–12. Publisher Full Text 15. Sachin ID, Muruganathan OP: Stapled hemorrhoidopexy versus open hemorrhoidectomy: a comparative study of short term results. Int. Surg. J. 2017 Jan 25 [cited 2025 Feb 25]; 4 (2): 472–478. Publisher Full Text Reference Source 16. Feng J, Cheng J, Xiang F: Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids. Ann. Palliat Med. 2021 [cited 2025 Feb 25]; 10 (1): 479–47483. Publisher Full Text Reference Source 17. Moldovan C, Rusu E, Cochior D, et al. : Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review.2023 Jan 16 [cited 2025 Feb 25]; 11 (2): 366–384. Reference Source Reference Source 18. Salama MM, Hossainy AFE, Rihan M: Comparative study between stapled and open hemorrhoidectomy results with one-year follow-up. Egypt. J. Surg. 2023 Jul [cited 2025 Feb 25]; 42 (3): 627–634. Publisher Full Text Reference Source 19. Mir P, Sadeghi M, Rabiee M, et al. : Short term results of stapled versus conventional hemorrhoidectomy within 1 year follow-up. Int. J. Burns Trauma. 2021 [cited 2025 Feb 25]; 11 (1): 69. Reference Source 20. Shah M, Makwana N, Rathwa A, et al. : Comparative study of the stapled hemorrhoidectomy against conventional hemorrhoidectomy. Int. J. Health Sci. (Qassim). 2022 Jun 25; 2983–2992. Publisher Full Text 21. Barman A, Lama N, Das S, et al. : A prospective study of post-operative complications and its management following open hemorrhoidectomy in a tertiary care hospital. Asian J. Med. Sci. 2024 Apr 1; 15 (4): 248–253. Publisher Full Text 22. Sobrado CW, Mester M, Sobrado L, et al. : Main Disadvantages of Hemorrhoidectomy.2018 [cited 2025 Feb 25]; 243–252. Publisher Full Text 23. Yang Y, Huang J, Zeng A, et al. : The role of the skin microbiome in wound healing. Burns Trauma. 2024 Jan 1 [cited 2025 Feb 25]; 12 . PubMed Abstract | Publisher Full Text | Free Full Text 24. Toppo S, Rani K, Murari K, et al. : A PROSPECTIVE COMPARATIVE STUDY OF STAPLER HEMORRHOIDOPEXY VERSUS OPEN HEMORRHOIDECTOMY OF SHORT-TERM RESULTS IN RIMS RANCHI. Int. J. Acad. Med. Pharm. [cited 2025 Feb 25]. Reference Source 25. Sobrado CW, Sobrado LF, Obregon CA, et al. : STAPLED HEMORRHOIDOPEXY: RESULTS, LATE COMPLICATIONS, AND DEGREE OF SATISFACTION AFTER 16 YEARS OF FOLLOW-UP. Arquivos Brasileiros de Cirurgia Digestiva: ABCD. 2022 [cited 2025 Feb 25]; 35 : e1689. PubMed Abstract | Publisher Full Text | Free Full Text 26. Sturiale A, Fabiani B, Menconi C, et al. : Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years. Tech. Coloproctol. 2018 Sep 1 [cited 2025 Feb 25]; 22 (9): 689–696. PubMed Abstract | Publisher Full Text 27. Colley A, Finlayson E, Zhao S, et al. : High risk of complications after a “low risk” procedure: A national study of nursing home residents and older adults undergoing haemorrhoid surgery. Color. Dis. 2023 Feb 1 [cited 2025 Feb 25]; 25 (2): 298–304. PubMed Abstract | Publisher Full Text 28. Shweliya MA: stapled vs classical.xlsx. [Data set]. Zenodo. 2025. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 University of Baghdad, Baghdad, Baghdad Governorate, Iraq 2 Iraqi Ministry of Health, Karbala Health Directorate, General and Laparoscopic Surgeon, Karbala, Iraq 3 Bahri University, Khartoum, Sudan 4 University of Baghdad Al-Kindy College Of Medicine, Baghdad, Iraq 5 Ain Shams University, Cairo, Cairo Governorate, Egypt 6 University of Khartoum, Khartoum, Khartoum, Sudan 7 Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences, Najaf, Iraq 8 University of Gezira, Wad Madani, Al Jazirah, Sudan 9 Mustansiriyah University, Baghdad, Baghdad Governorate, Iraq Mohammedsadeq A. Shweliya Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Supervision, Writing – Original Draft Preparation Arkan Shubber AbdulKhaliq Al-Hamdany Roles: Conceptualization, Resources, Writing – Review & Editing Marafi Jammaa Ismail Ahmed Roles: Writing – Review & Editing Aya Ahmed Shimal Roles: Writing – Original Draft Preparation Khadeeja Ali Hamzah Roles: Validation, Writing – Original Draft Preparation Hassan H. Eladl Roles: Writing – Original Draft Preparation, Writing – Review & Editing Lina Hemmeda Roles: Writing – Original Draft Preparation, Writing – Review & Editing Mustafa Haleem Alsaadi Roles: Formal Analysis, Writing – Review & Editing Abdulhadi M. A. Mahgoub Roles: Validation, Writing – Original Draft Preparation, Writing – Review & Editing Yusur Aamer Roles: Methodology, Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 19 Jun 2025, 14:601 https://doi.org/10.12688/f1000research.163191.1 Copyright © 2025 Shweliya MA et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Shweliya MA, Al-Hamdany ASA, Ahmed MJI et al. Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.12688/f1000research.163191.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 19 Jun 2025 Views 0 Cite How to cite this report: Gambardella C. Reviewer Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r442172 ) The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-442172 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 01 Feb 2026 Claudio Gambardella , University of Study of Campania “Luigi Vanvitelli”, Naples, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.179498.r442172 The manuscript addresses an important and common problem in colorectal surgery, providing a comparative analysis of different surgical approaches for hemorrhoidal disease. The topic is clinically relevant, and the study has the potential to contribute useful data to daily surgical ... Continue reading READ ALL The manuscript addresses an important and common problem in colorectal surgery, providing a comparative analysis of different surgical approaches for hemorrhoidal disease. The topic is clinically relevant, and the study has the potential to contribute useful data to daily surgical practice. Overall, the manuscript is clearly structured and the results are presented in a comprehensible manner. The conclusions are generally consistent with the reported findings. However, minor revisions are recommended to strengthen the scientific framework of the study, improve the discussion, and better contextualize the results within the current literature on hemorrhoidal disease, pelvic floor function, and minimally invasive techniques. Strengths of the Manuscript Clinical relevance: Hemorrhoidal disease remains a highly prevalent condition, and comparative outcome analyses are valuable for surgical decision-making. Comparative design: The direct comparison between surgical techniques provides practical insights for colorectal surgeons. Clear outcomes: Postoperative pain, complications, and recovery are clinically meaningful endpoints. Minor Revisions Suggested 1. Expansion and Update of the Literature Review The introduction and discussion sections would benefit from a more comprehensive integration of contemporary evidence, particularly regarding: Minimally invasive approaches for hemorrhoidal disease, Postoperative wound management and mid-term outcomes, The role of pelvic floor anatomy and functional integrity in anorectal disorders. In this context, the reviewer strongly recommends citing and discussing the following peer-reviewed articles, which are directly relevant to the manuscript’s topic and would enhance its scientific rigor: Gambardella C et al., Langenbeck’s Archives of Surgery 2023 Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend. This study provides high-quality comparative data on postoperative outcomes and wound management in grade III hemorrhoidal disease and would be particularly valuable for contextualizing the present results within the evolving landscape of minimally invasive techniques. Brusciano L et al., Techniques in Coloproctology 2019 An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. This conceptual work offers an important anatomical and functional perspective on pelvic floor dynamics, which may help interpret postoperative functional outcomes and complication patterns in hemorrhoidal surgery. Brusciano L et al., Diseases of the Colon & Rectum 2023 Rectal Prolapse Pathological Features: Findings in Patients With Outlet Obstruction Treated With Stapled Transanal Rectal Resection. This article provides relevant pathological and functional insights into anorectal disorders and stapled techniques, supporting a broader discussion on tissue remodeling, outlet obstruction, and functional sequelae following anorectal surgery. Incorporating these references would significantly strengthen the discussion and demonstrate awareness of current, high-impact literature in colorectal surgery. 2. Discussion Section The discussion could be moderately expanded to compare the present findings with published data on laser-based and stapled techniques, particularly regarding postoperative pain, wound healing, and mid-term efficacy. A brief consideration of pelvic floor function and its potential influence on postoperative outcomes would improve the interpretative depth of the manuscript. 3. Limitations Although limitations are mentioned, the authors may consider emphasizing the absence of long-term functional follow-up and its potential impact on recurrence rates and quality-of-life outcomes. Language and Style The manuscript is generally well written in clear scientific English. Only minor stylistic and grammatical refinements are suggested, mainly in the discussion section, to improve fluency and precision. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Gambardella C, Brusciano L, Brillantino A, Parisi S, et al.: Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend. Langenbeck's Archives of Surgery . 2023; 408 (1). Publisher Full Text 2. Brusciano L, Gambardella C, Tolone S, del Genio G, et al.: An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. Techniques in Coloproctology . 2019; 23 (6): 603-605 Publisher Full Text 3. Brusciano L, Gambardella C, Falato A, Ronchi A, et al.: Rectal Prolapse Pathological Features: Findings in Patients With Outlet Obstruction Treated With Stapled Transanal Rectal Resection. Diseases of the Colon & Rectum . 2023; 66 (8): e826-e833 Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Coloproctology and general surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Gambardella C. Reviewer Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r442172 ) The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-442172 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Eberspacher C. Reviewer Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r393563 ) The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-393563 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Jul 2025 Chiara Eberspacher , Sapienza University, Rome, Italy Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.179498.r393563 The article is interesting but requires some massive corrections to be acceptable and I'm very perplexed about methods and results. In the abstract do not describe the statistical method used, just use it in the article itself. ... Continue reading READ ALL The article is interesting but requires some massive corrections to be acceptable and I'm very perplexed about methods and results. In the abstract do not describe the statistical method used, just use it in the article itself. In the introduction: - Goligar's classification is not a classification of internal hemorrhoids but of hemorrhoids - Quote number 9 is totally wrong in its contextualization. The techniques mentioned In fact are adapted and used especially in the first grades of hemorrhoids and only in this particular article are they adapted and studied in the more advanced cases. In the methods: Methods are the part of the article that require major revision. In fact, nothing has been cited that could make the study replicable. There is no complete description of the techniques used. - In what position was the patient operated? - the surgeons who performed the operation were experts; they were always the same. - Was the hemorrhoidectomy performed with a monopolar scalpel? Studies over the last 15 years have in fact highlighted how this technique is more effective and less painful when different tools such as radiofrequency or ultrasound are used. - What types of staplers were used, how many were used and with what technique? - What post-operative care has been used? without knowing it is impossible to understand the pain and its evaluation if effective methods have been adopted to reduce it. - How was the evaluation performed during the follow up? when? with which pain scales? we talk about pain but without an objective evaluation with a scale - the outcomes are not evaluated in any reproducible way. Abouts results. - the results mentioned are almost not assessable because it is not clear what kind of scale was adopted especially for pain. Pain assessment cannot be YES or NOT - Bleeding what means? Further operations? - the tables especially table number 3 is clearly not understandable. it is necessary to cite the values ​​adopted. Discussion: - discussion absolutely does not take into consideration all the measures that are adopted in hemorrhoidectomy to reduce post-operative pain from the type of anesthesia to post-operative drugs, to ointments to what could be the type of tools used during the operation. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Surgery. Proctology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Eberspacher C. Reviewer Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r393563 ) The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-393563 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 19 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 19 Jun 25 read read Chiara Eberspacher , Sapienza University, Rome, Italy Claudio Gambardella , University of Study of Campania “Luigi Vanvitelli”, Naples, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Gambardella C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 01 Feb 2026 | for Version 1 Claudio Gambardella , University of Study of Campania “Luigi Vanvitelli”, Naples, Italy 0 Views copyright © 2026 Gambardella C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript addresses an important and common problem in colorectal surgery, providing a comparative analysis of different surgical approaches for hemorrhoidal disease. The topic is clinically relevant, and the study has the potential to contribute useful data to daily surgical practice. Overall, the manuscript is clearly structured and the results are presented in a comprehensible manner. The conclusions are generally consistent with the reported findings. However, minor revisions are recommended to strengthen the scientific framework of the study, improve the discussion, and better contextualize the results within the current literature on hemorrhoidal disease, pelvic floor function, and minimally invasive techniques. Strengths of the Manuscript Clinical relevance: Hemorrhoidal disease remains a highly prevalent condition, and comparative outcome analyses are valuable for surgical decision-making. Comparative design: The direct comparison between surgical techniques provides practical insights for colorectal surgeons. Clear outcomes: Postoperative pain, complications, and recovery are clinically meaningful endpoints. Minor Revisions Suggested 1. Expansion and Update of the Literature Review The introduction and discussion sections would benefit from a more comprehensive integration of contemporary evidence, particularly regarding: Minimally invasive approaches for hemorrhoidal disease, Postoperative wound management and mid-term outcomes, The role of pelvic floor anatomy and functional integrity in anorectal disorders. In this context, the reviewer strongly recommends citing and discussing the following peer-reviewed articles, which are directly relevant to the manuscript’s topic and would enhance its scientific rigor: Gambardella C et al., Langenbeck’s Archives of Surgery 2023 Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend. This study provides high-quality comparative data on postoperative outcomes and wound management in grade III hemorrhoidal disease and would be particularly valuable for contextualizing the present results within the evolving landscape of minimally invasive techniques. Brusciano L et al., Techniques in Coloproctology 2019 An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. This conceptual work offers an important anatomical and functional perspective on pelvic floor dynamics, which may help interpret postoperative functional outcomes and complication patterns in hemorrhoidal surgery. Brusciano L et al., Diseases of the Colon & Rectum 2023 Rectal Prolapse Pathological Features: Findings in Patients With Outlet Obstruction Treated With Stapled Transanal Rectal Resection. This article provides relevant pathological and functional insights into anorectal disorders and stapled techniques, supporting a broader discussion on tissue remodeling, outlet obstruction, and functional sequelae following anorectal surgery. Incorporating these references would significantly strengthen the discussion and demonstrate awareness of current, high-impact literature in colorectal surgery. 2. Discussion Section The discussion could be moderately expanded to compare the present findings with published data on laser-based and stapled techniques, particularly regarding postoperative pain, wound healing, and mid-term efficacy. A brief consideration of pelvic floor function and its potential influence on postoperative outcomes would improve the interpretative depth of the manuscript. 3. Limitations Although limitations are mentioned, the authors may consider emphasizing the absence of long-term functional follow-up and its potential impact on recurrence rates and quality-of-life outcomes. Language and Style The manuscript is generally well written in clear scientific English. Only minor stylistic and grammatical refinements are suggested, mainly in the discussion section, to improve fluency and precision. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes References 1. Gambardella C, Brusciano L, Brillantino A, Parisi S, et al.: Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend. Langenbeck's Archives of Surgery . 2023; 408 (1). Publisher Full Text 2. Brusciano L, Gambardella C, Tolone S, del Genio G, et al.: An imaginary cuboid: chest, abdomen, vertebral column and perineum, different parts of the same whole in the harmonic functioning of the pelvic floor. Techniques in Coloproctology . 2019; 23 (6): 603-605 Publisher Full Text 3. Brusciano L, Gambardella C, Falato A, Ronchi A, et al.: Rectal Prolapse Pathological Features: Findings in Patients With Outlet Obstruction Treated With Stapled Transanal Rectal Resection. Diseases of the Colon & Rectum . 2023; 66 (8): e826-e833 Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Coloproctology and general surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Gambardella C. Peer Review Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r442172) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-442172 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Eberspacher C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Jul 2025 | for Version 1 Chiara Eberspacher , Sapienza University, Rome, Italy 0 Views copyright © 2025 Eberspacher C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The article is interesting but requires some massive corrections to be acceptable and I'm very perplexed about methods and results. In the abstract do not describe the statistical method used, just use it in the article itself. In the introduction: - Goligar's classification is not a classification of internal hemorrhoids but of hemorrhoids - Quote number 9 is totally wrong in its contextualization. The techniques mentioned In fact are adapted and used especially in the first grades of hemorrhoids and only in this particular article are they adapted and studied in the more advanced cases. In the methods: Methods are the part of the article that require major revision. In fact, nothing has been cited that could make the study replicable. There is no complete description of the techniques used. - In what position was the patient operated? - the surgeons who performed the operation were experts; they were always the same. - Was the hemorrhoidectomy performed with a monopolar scalpel? Studies over the last 15 years have in fact highlighted how this technique is more effective and less painful when different tools such as radiofrequency or ultrasound are used. - What types of staplers were used, how many were used and with what technique? - What post-operative care has been used? without knowing it is impossible to understand the pain and its evaluation if effective methods have been adopted to reduce it. - How was the evaluation performed during the follow up? when? with which pain scales? we talk about pain but without an objective evaluation with a scale - the outcomes are not evaluated in any reproducible way. Abouts results. - the results mentioned are almost not assessable because it is not clear what kind of scale was adopted especially for pain. Pain assessment cannot be YES or NOT - Bleeding what means? Further operations? - the tables especially table number 3 is clearly not understandable. it is necessary to cite the values ​​adopted. Discussion: - discussion absolutely does not take into consideration all the measures that are adopted in hemorrhoidectomy to reduce post-operative pain from the type of anesthesia to post-operative drugs, to ointments to what could be the type of tools used during the operation. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Surgery. Proctology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Eberspacher C. Peer Review Report For: Stapled Versus Conventional Hemorrhoidectomy: A Retrospective Study and Comparative Analysis of Outcomes [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :601 ( https://doi.org/10.5256/f1000research.179498.r393563) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-601/v1#referee-response-393563 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Stapled Versus Conventional Hemorrhoidectomy:...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/14-601/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/14-601/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/14-601/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Shweliya MA et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/14-601/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/14-601", templates : { twitter : "Stapled Versus Conventional Hemorrhoidectomy: A Retrospective.... Shweliya MA et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/14-601/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/163191/179498") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "179498"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "442176": 0, "414222": 0, "414223": 0, "414220": 0, "414221": 0, "414218": 0, "414219": 0, "414216": 0, "414217": 0, "431958": 0, "393559": 0, "431959": 0, "431956": 0, "431957": 0, "431955": 0, "414224": 0, "414225": 0, "393566": 0, "393567": 0, "393564": 0, "431964": 0, "393565": 0, "393562": 0, "431962": 0, "431963": 0, "393563": 3, "393560": 0, "431960": 0, "393561": 0, "431961": 0, "393568": 0, "442167": 0, "442174": 0, "442175": 0, "442172": 2, "442173": 0, "442170": 0, "442171": 0, "442168": 0, "442169": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "dbfb127b-36e3-4f21-a72d-1fcf16047434"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });