Comparison of the outcomes of ruiyun procedure for hemorrhoids and PPH in the treatment of grade Ⅱ-Ⅳ hemorrhoids

Comparison of the outcomes of ruiyun procedure for hemorrhoids and PPH in the treatment of grade Ⅱ-Ⅳ hemorrhoids | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (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;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Comparison of the outcomes of ruiyun procedure for hemorrhoids and PPH in the treatment of grade Ⅱ-Ⅳ hemorrhoids Shoulian Wang, Chunpeng Pan, Haibo Wang, Xiaochun Ni, Chihao Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6570958/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To compare the clinical effect of ruiyun procedure for hemorrhoids (RPH) and procedure for prolapse and hemorrhoids (PPH) for the treatment of mixed hemorrhoids with grade Ⅱ-Ⅳ. Methods: Total 192 patients with hemorrhoids of grade Ⅱ-Ⅳ were retrospectively reviewed in Ninth People’s Hospital (North) Affiliated to Shanghai Jiao Tong University School of Medicine, 80 cases were assigned to RPH group, and 112 cases in PPH group. The primary efficacy outcome was rate of curative at 3 month after operation, and the 1-year recurrence rate. Secondary efficacy outcomes included operation time, operative blood loss, time of hospitalizationand required to resume normal work, patients’ satisfaction, and pain post operation was also evaluated. The safety outcome included postoperative complications. Results: The were no significant differences between the two groups regarding patient demographics. No significant difference between the 2 groups in clinical efficacy, 1-year recurrence, patients’ satisfaction, anal anal pain on the 7th day after operation, and postoperative complications (urinary retention, urgent defecation, postoperative bleeding, and so on) ( p >0.05). RPH can markedly improve postoperative anal pain on the 1st, 3rd day( p ＜0.01). The operation time, operative blood loss sore, time of hospitalization and required to resume normal work were decreased significantly in the RPH group compared with the PPH group ( p ＜0.05). Conclusion RPH is effective and safety in the treatment of grades Ⅱ-Ⅳhemorrhoids, with a better advantage in operation time, operative blood loss sore, postoperative complications and recovery than PPH, which is worthy of clinical application. Hemorrhoids Ruiyun procedure for hemorrhoids (RPH) Procedure for prolapse and hemorrhoids (PPH) Postoperative complications Figures Figure 1 Introduction Hemorrhoids is a very common anorectal disease, with an overall prevalence of about 39% worldwide [ 1 ] . However, the exact incidence of hemorrhoids is likely to be much higher because so many patients turn away because of the embarrassment of the site. Hemorrhoids has a great impact on the quality of daily life. Therefore, in clinical practice, it is particularly important to formulate and implement scientific and effective treatment plans in time [ 2 , 3 ] . Currently, although there are many treatment options for hemorrhoids, surgery is still the most effective treatment. With the development of new technologies and equipment, minimally invasive surgery provides more options for the treatment of hemorrhoids [ 4 , 5 ] . PPH was first reported by Longo first reported the application of PPH in the treatment of hemorrhoids in 1998 [ 6 ] . Compared with traditional MMH surgery, PPH has the advantages of less bleeding, less pain, faster recovery, fewer complications [ 7 , 8 ] , and has been widely used in clinical practice. RPH (Ruiyun procedure for Hemorrhoids) is an emerging hemorrhoid surgery method based on (Rubber band ligation, RBL) [ 9 ] . Studies have shown that RPH has reliable postoperative efficacy and reduces the incidence of postoperative complications [ 10 ] . In this study, a retrospective case-control study was conducted to investigate the efficacy and safety of RPH in the treatment of hemorrhoids with grade Ⅱ-Ⅳ. The clinical efficacy of RPH and PPH was compared in a single-center experience for the clinical application of the 2 operations. Methods Participants A total of 1922 patients with hemorrhoids of grade Ⅱ-Ⅳ were retrospectively reviewed in Ninth People’s Hospital (North) Affiliated to Shanghai Jiao Tong University School of Medicine from June 2018 to Juner 2021. The inclusion criteria were as follows: (1) met the criteria of Ⅱ-Ⅳ degree hemorrhoids and underwent RPH or PPH surgery; (2) aged ≥ 18 years; (3) patients or family members were informed of the study and signed the consent form. Exclusion criteria include the following: (1) prior history of any anorectal surgery; (2) combined with other anorectal diseases, such as anal fissure, anal fistula, perianal abscess, inflammatory bowel disease, colorectal cancer, etc.; (3) pregnant or nursing women; (4) coagulation dysfunction or other important organ dysfunction (heart, lung, kidney, etc. ); (5) mental illness or cognitive impairment; (6) incomplete clinical data or loss of follow-up. Surgical procedures and postoperative care All patients underwent mechanical bowel preparation before surgery. A general anesthesia was given, and the patient was positioned in a lithotomy position. RPH surgery (1) Perineal skin and intestinal cavity was disinfected with iodophor, then anoscope was used to expose the anal canal and rectum; (2) Carefully check the number and size of hemorrhoids; (3) After confirming the ligation point, suction aiming at internal hemorrhoids or loose mucosa; (4) Sucking the hemorrhoids into the automatic stretch wire ligation device; (5) When the negative pressure reaches − 0.08 ~ -0.1mpa, releases the elastic ligation wire by firing the device, closes the negative pressure and cuts the elastic wire 1.0cm away from the ligation point; (6) Avoiding ligation points in the same plane if there are many ligation sites; (7) After confirmation of no active bleeding, anoscope is withdrawn, and simplified external stripping and internal ligation was used to remove the remaining incompletely retracted hemorrhoids. PPH surgery (1) Preoperative preparation is similar as RPH; (2) Submucosal purse suture is carried out at 3.0 ~ 4.0 cm above the dentate line with 2 − 0 sliding wire from 3 o 'clock position, and a traction line was pierced through the purse suture at 9 o 'clock; (3) After the staples was inserted above the suture position, the purse suture was tightened and ligated, pulling out the penetrating leads from the side hole of the stapler. The surgeon used the index finger to hook the traction line and pulled the line continuously with moderate force when the stapler was screwed tight. (4) Firing the stapler and maintaining in the firing state for 40s, then the stapler was unscrewed and pulled out; (5) Checking the anastomosis, it was sutured in an “8” shape to stop bleeding if there was active bleeding; (6) Simplified external stripping and internal ligation was used to remove the remaining incompletely retracted hemorrhoids. Patients in both groups were administered cefazolin as perioperative antibiotics for 2 ~ 3 days. Postoperative analgesics were routinely provided on the first day. The patient began a semifluid diet 6 h after surgery and gradually increased to a semifluid diet. Avoidance of dry and hard stools contributed to the healing of the surgical incision. A warm sitz bath with kangfuxin liquid was started after the first postoperative day. Data collection and follow-up Clinical data and perioperative variables were abstracted from patients' medical records. Postoperative complications, efficacy outcome and patients’ satisfaction were obtained through outpatient review. All patients received three follow-up visits. The follow-up was scheduled a week, 3 months and one year respectively after surgery at the outpatient clinic. For a small number of patients who unable to participate in outpatient review, follow-up was completed by telephone until June 2022. Primary efficacy outcome The primary efficacy outcome including the rate of curative at 3 month after operation and the 1-year recurrence rate. According to “Traditional Chinese Medicine Syndrome Diagnosis and Efficacy Standards” [ 11 ] , the clinical efficacy was divided into 3 grades ( Curative: no postoperative blood in stool, no anal discomfort and prolapse; Effective: hemorrhoids shrunk, clinical symptoms and signs improved; Ineffective: the clinical symptoms and signs were not relieved). Secondary efficacy outcome The secondary efficacy outcome included: (1) Operativing time; (2) Intraoperative blood loss (No matter RPH or PPH surgery, intraoperative blood loss is relatively little. Numerical measurement is used to evaluate the blood loss as follows: 1, ≤ 5ml; 2, ˃5ml and ≤ 10ml; 3, ˃10ml and ≤ 15ml; etc. (3) Postoperative anal pain, the severity of postoperative pain on the 1st, 3rd and 7th day was measured by a visual analog scale (VAS) score 0 (no pain) to 10 (worst pain) at 1 and 3 days after operation [ 12 ] . (4) Time required to resume normal work; (5) Evaluation of Patient Satisfaction, patients evaluated the surgical effect according to their subjective feelings, which was divided into four grades: "excellent", "good", "general" and "poor". Safety measurement The safety assessment included the following postoperative complications. (1) Postoperative bleeding, which required hemostasis; (2) Urinary retention; (3) Urgent defecation; (4) Anal distension; (5) Anorectal stenosis and (6) Rectovaginal fistula. Statistical analysis Statistical analysis was conducted by SPSS 22.0 software. Measurement data was expressed as mean ± standard deviation, and comparison between the two groups was performed by t-test. Countable data was represented with their frequency (%), and the comparison between the two groups was performed with chi-square test or Fisher exact test. A value of P < 0.05 was considered statistically significant. Results A total of 192 patients with hemorrhoids of grade Ⅱ-Ⅳ were eligible for inclusion. 80 cases were assigned to RPH group, and 112 cases in PPH group. There were no statistically difference between the two groups in age, gender, course, BMI, grade of hemorrhoids, Symptoms, and skin tags (all P > 0.05, Table 1 ). Table 1 Demographic characteristics of hemorrhoids patients at baseline visit RPH (n = 80) PPH (n = 112) χ 2 / t P value Age (years) 46.75 ± 12.59 48.16 ± 11.50 0.805 0.422 Gender (male/ female) 46/34 60/52 0.291 0.589 Course (years) 7.34 ± 5.61 7.34 ± 5.00 0.002 0.998 BMI (kg/m 2 ) 23.68 ± 2.38 23.67 ± 2.33 0.029 0.977 Hemorrhoid degree, n(%) 0.274 0.872 II 12(15.0%) 15(13.4%) III 26(32.5%) 34(30.4%) IV 42(52.5%) 63(56.3) Symptoms, n(%) Hematochezia 56(70.0%) 74(68.8%) 0.329 0.566 Prolapse 22(27.5%) 35(31.3%) 0.314 0.575 Pain 21(26.3%) 21(18.8%) 1.536 0.215 Skin tags n(%) 28(35.0%) 42(37.5%) 0.126 0.723 Primary efficacy measurements The curative rate was 85.0% and 87.5% respectively in RPH group and PPH group, no significant difference was found between the two groups ( P = 0.475, Table 2 ). Combined with external stripping and internal ligation, RPH can achieve a similar appearance to PPH (Fig. 1 ). The recurrence rate of 1 year after surgery in both groups was 6.3%, with no statistical difference ( P = 1.000, Table 2 ). Table 2 Comparison of efficacy and patients’ satisfaction between two groups RPH (n = 80) PPH (n = 112) χ 2 / t P value Clinical efficacy 1.490 0.475 Curative, n (%) 68(85.0%) 98(87.5%) 0.249 0.618 Effective, n (%) 11(13.8%) 14(12.5%) Ineffective, n (%) 1(1.3%) 0 (0) Recurrence, n (%) 5(6.3%) 7(6.3%) 0.000 1.000 Patients’ satisfaction 1.893 0.595 Excellent 58(72.5%) 71(63.4%) Good 12(15.0%) 22(19.6%) General 8(10.0%) 14(12.5) Poor 2(2.5%) 5(4.5%) Secondary efficacy measurements The operative time was significantly shorter in RPH group than that in PPH group (P < 0.001). The time of hospitalization and required to resume normal work in the RP group was significantly shorter than PPH group (all P < 0.001). The intraoperative bleeding sore of RPH group was significantly than that of PPH group ( P < 0.001) (Table 3 ). The anal pain score on the 1st and 3rd day postoperative was markedly improved in the RPH group and was markedly lower than that in the PPH group (all P < 0.001), but there was no significant difference on the 7th day postoperative ( P = 0.068) (Table 4 ). In terms of patients’ satisfaction, the proportions of "excellent", "good", "general" and "poor" in RPH group were 72.5%, 15%, 10% and 2.5%, and there was no statistical difference ( P = 0.595) compared with the PPH group (63.4%, 19.6%, 12.5% and 4.5%) (Table 2 ). Table 3 Comparison of perioperative parameters between the two groups RPH (n = 80) PPH (n = 112) χ 2 / t P value Operativing time (min) 16.05 ± 3.98 20.84 ± 4.27 -7.878 < 0.001 Intraoperative blood loss sore 1.53 ± 0.81 2.05 ± 0.84 -4.372 < 0.001 Postoperative hospital stay (day) 1.64 ± 0.68 2.20 ± 0.95 -4.510 < 0.001 Time required to resume normal work (days) 7.18 ± 3.13 11.21 ± 3.89 -7.671 < 0.001 Safety measurements A comparison of incidence of postoperative complications showed in the Table 4 , there was no difference on the urinary retention, urgent defecation and Postoperative bleeding between the two groups (all P > 0.05, Table 4 ). No anorectal stenosis or rectovaginal fistula occurred in both groups (Table 4 ). Table 4 Comparison of postoperative complications between two groups RPH (n = 80) PPH (n = 112) χ 2 / t P value Postoperative pain 1st day 2.78 ± 1.25 3,89 ± 1.54 -5.339 < 0.001 3rd day 1.93 ± 0.69 2.46 ± 0.87 -4.534 < 0.001 7th day 1.34 ± 0.86 1.58 ± 0.94 -1.836 0.068 Urinary retention 5(6.3%) 11(9.8%) 0.779 0.377 Urgent defecation 3(3.8%) 10(8.9%) 1.983 0.159 Postoperative bleeding 3(3.8%) 8(7.1%) 0.995 0.319 Anorectal stenosis 0(0) 0(0) — — Rectovaginal fistula 0(0) 0(0) — — Discussion Modern surgical treatment of hemorrhoids has put forward higher requirements for the protection of anal function. Reasonable protection of the dentate line area is a key step that must be paid attention to duiring hemorrhoids surgery. Although PPH is considered to be a relatively quick and minimally invasive surgery [ 7 , 8 ] , the incidence of postoperative complications such as bleeding, urinary retention and pain is still high [ 13 , 14 ] . Because RPH surgery ligates the mucosa and the hemorrhoid artery located in the submucosa, the blood supply to the rectum and anal canal is reduced. The wound surface is minimal the ligation tissue fall off, and the rectal mucosa is smooth after healing. unlike PPH, which is stimulated by anastomotic nails. Especially combined with simplified external incision and internal ligation, symptoms and signs can be eliminated to a greater extent, the incidence of postoperative complications and postoperative recurrence rate can be reduced significantly [ 15 – 17 ] . In our study, it was also found that there was no significant difference in cure rate and 1-year recurrence rate between the two groups, and no occurrence of anal stenosis, anal incontinence amd rectovaginal fistula in the two groups. RPH surgery is simple and convenient, so the operation time is significantly shorter than PPH surgery. In addition, RPH surgery has obvious advantages over PPH surgery in postoperative pain, bleeding, constipation, urinary retention, recovery time and other aspects, all of which bring better subjective experience to patients, which may be the reasons for the higher satisfaction of patients in the RPH group. After PPH, one patient suffered haemorrhoid artery hemorrhage due to the fall off of anastomotic nail a week after surgery, and hemostasis was performed by surgical suture. In the RPH group, one patient suffered from hemorrhage caused by ligation thread shedding, which was improved after compression and hemostasis. The presence of anastomosis after PPH surgery and the stimulation of anorectal by anastomotic nail may be the important reasons for the above results. The anastomosis of PPH surgery is in the same plane and the level is relatively fixed, while the RPH surgery can be targeted at different levels, different sites of hemorrhoids, the uplift of anal cushions is more efferent, the residual external piles that need additional sMMH is relatively less, these may be the reasons of the low incidence of complications and the rapid recovery. Urinary retention is one of the more common complications after anorectal diseases, and the reasons are mostly related to anesthesia, anal pain, visceral nerve pulling reflex and patient psychology [ 18 ] . Conclusions RPH combined with simplified external incision and internal ligation in the treatment of Ⅱ~Ⅳ degree hemorrhoids is safe, rapid and effective. Compared with PPH, the anal cushion is better protected, which can effectively reduce the occurrence of anorectal complications in patients, and has obvious advantages in postoperative pain, recovery time and patient satisfaction. Declarations Originality statement I hereby declare that the paper submitted is the result of our team's independent work. Except for the quoted content, the research results of this paper do not contain any copyrighted content. The individuals who contributed to the research work involved in this paper have been clearly identified in the text. This article provides a new theoretical basis for the application of RPH in hemorrhoids surgery. Ethics approval and consent to participate The study was approved by ethics committee of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (No. 2019-30-K24). Informed consent was obtained in all cases. Authors’Contribution Shoulian Wang conducted the study and wrote the article. Jiwei Yu and Xin Xu are co-corresponding authors, responsible for the study design. Chunpeng Pan, Haibo Wang, Xiaochun Ni, Chihao Zhang and Linhai Zheng were responsible for data collection. All authors read and approved the final manuscript. Competing Interests All authors declared that they had no conflict of interests regarding the publication of this paper. Availability of data and materials Data collected and analyzed during this study are included in this study and are available from the corresponding author on reasonable request. Consent for publication Not applicable. Acknowledgements Not applicable. Funding There was no funding available for this systematic review. Authors met all operational costs. References Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, Stift A. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215– 20. https://doi.org/10.1007/s00384-011-1316-3. Hollingshead JR, Phillips RK. Haemorrhoids: modern diagnosis and treatment. Postgrad Med J 2016;92:4–8. Jin L, Yang H, Qin K, et al. Efficacy of modified rubber band ligation in the treatment of grade III internal hemorrhoids. Ann Palliat Med 2021;10:1191–7. Johanson JF. Nonsurgical treatment of hemorrhoids. J Gastrointest Surg 2002;6:290–4. Yeo D, Tan KY. Hemorrhoidectomy – making sense of the surgical options. World J Gastroenterol 2014;20:16976–83. LONGOA, Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoids prolapse with a circular suturing device: a new procedure. Rome, Italy, in: Proceedings of the 6th World Congress of Endoscopic Surgery, 1998, p. 3. A.J. Senagore, M. Singer, H. Abcarian, Stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy. a prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results, Dis. Colon Rectum 47 (2004) 1824e1836. E. Ganio, F. Altomare, G. Milito, F. Gabrielli, S. Canuti, Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy, Br. J. Sur 94 (2007) 1033e1037. Wei G, Hua X, Zhao Y, et al. Clinical study of Ruiyun procedure for hemorrhoids combined with Xiaozhiling injections in treatment of hemorrhoids complicated with human immunodefciency virus infection. Zhonghua Wei Chang Wai Ke Za Zhi. 2014;17:1201–4. https://doi.org/10.3760/cma.j. issn.1671-0274.2014.12.012. He YH, Tang ZJ, Xu XT, Huang DQ, Zhang LS, Tang QZ, Fan ZM, Zou XJ, Zou GJ, Zhang CY, Hu F, Xie B, Li YH, Tong Y, Liu HC, Li K, Luo YL, Liu F, Situ GW, Liu ZL. A randomized multicenter clinical trial of RPH with the simplifed Milligan–Morgan hemorrhoidectomy in the treatment of mixed hemorrhoids. Surg Innov. 2017;24(6):574–81. https://doi.org/10.1177/ 1553350617731205. State Administration of Traditional Chinese Medicine. Criteria for diagnostic and efficacy of traditional Chinese medicine [M]. Beijing: China Medical Science and Technology Press, 2012: 53-54. P.L. Ritter, V.M. Gonzalez, D.D. Laurent, K.R. Lorig, Measurement of pain using the visual numeric scale, J. Rheumatol. 33 (2006) 574–580 2006; 33(3): 574-580, PubMed PMID: 16511926. T.C. Sardinha, M.L. Corman, Hemorrhoids, Surg. Clin. North Am. 82 (2002) 1153e1167. B. Ravo, A. Amato, V. Bianco, et al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech. Coloproctol. 6 (2002) 83e88. De Nardi P，Tamburini AM，Gazzetta PG，et al. Hemorrhoid laser procedure for second-and third-degree hemorrhoids: results from a multicenter prospective study [J]. Tech Coloproctol, 2016, 20(7): 455-459. Bjelanovic Z, Draskovic M, Veljovic M, et al. Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease [J]. Cir Esp, 2016, 94( 10) : 588-594. Kersting S, Herold A, Jung KP, et al. Complication management following hemorrhoid operations [J]. Chirurg, 2015, 86( 8): 726-733. Izadpanah A, Hosseini S, Mahjoob M. Comparison of electrotherapy，rubber band ligation and hemorrhoidectomy in the treatment of hemorrhoids: a clinical and manometric study [J]. Middle East J Dig Dis, 2010, 2(1) : 9-13. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6570958","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":458921704,"identity":"c224f69c-d4b8-4fe6-bbb6-e30f47df4d43","order_by":0,"name":"Shoulian Wang","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Shoulian","middleName":"","lastName":"Wang","suffix":""},{"id":458921705,"identity":"a9b3157a-62a3-4d92-987c-5382d35edcfd","order_by":1,"name":"Chunpeng Pan","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Chunpeng","middleName":"","lastName":"Pan","suffix":""},{"id":458921706,"identity":"3dd5b297-f2bf-468a-8cee-91ac9a8990b1","order_by":2,"name":"Haibo Wang","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Haibo","middleName":"","lastName":"Wang","suffix":""},{"id":458921707,"identity":"bbc0bcd3-75d7-4930-9e00-c393f1dafd13","order_by":3,"name":"Xiaochun Ni","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Xiaochun","middleName":"","lastName":"Ni","suffix":""},{"id":458921708,"identity":"fd79cc22-ca3f-4158-badd-f4bd364efc76","order_by":4,"name":"Chihao Zhang","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Chihao","middleName":"","lastName":"Zhang","suffix":""},{"id":458921709,"identity":"e7034dfe-de9e-4f33-bdfd-655b05844f6f","order_by":5,"name":"Linhai Zheng","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Linhai","middleName":"","lastName":"Zheng","suffix":""},{"id":458921710,"identity":"bc4c72ec-a47c-4394-8c0b-820bc3fd0d47","order_by":6,"name":"Xin Xu","email":"","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Xu","suffix":""},{"id":458921711,"identity":"8763f642-30f8-4514-80a0-e7d5cc1aba1e","order_by":7,"name":"Jiwei Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBACxgYgkWADYjIfOPChQkKOnzgtaSAmW+LBGWcsjCUbiLILrIXH+DBvW0XiBkJamNt7jz14kGCTb3Ajx+Aw7zwJxg0MzA8f3cDnsJ5z6QYJCWmWG26kFRycu02C2ZyBzdg4B5+WGTlmEok/DhsY3EjecODtNgk2ywYeNmm8Wua/MZNISPgP1JJgcIB3jgSPwQFCWmbwgLQcAGpJMTjI2yAhQVhLTw5IS7KB5JlnCQdnHJMwkGwm4BfD9jNmkj8S7Az4jicf/vChpq6+n7354WO8WhqgDIUDMCFmPMpBQB7OaMCjahSMglEwCkY2AABQnVGp+tIvBAAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai Jiao Tong University","correspondingAuthor":true,"prefix":"","firstName":"Jiwei","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2025-05-01 09:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6570958/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6570958/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83299654,"identity":"74d7629c-6696-47bb-8741-9c599cfaf29d","added_by":"auto","created_at":"2025-05-22 14:40:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":248155,"visible":true,"origin":"","legend":"\u003cp\u003eAppearance changes after RPH and PPH. A. Preoperative RPH; B. The 1st\u003csup\u003e \u003c/sup\u003eday after RPH; C. Preoperative PPH; D. The 1st\u003csup\u003e \u003c/sup\u003eday after PPH.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6570958/v1/71e3f2f0e310651d00180213.png"},{"id":104423468,"identity":"cd5fab99-bbb4-4683-a5f8-199fab353e7c","added_by":"auto","created_at":"2026-03-11 14:13:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1144106,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6570958/v1/461e5682-1cb8-4c09-b326-fc2943d9d9ef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of the outcomes of ruiyun procedure for hemorrhoids and PPH in the treatment of grade Ⅱ-Ⅳ hemorrhoids","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHemorrhoids is a very common anorectal disease, with an overall prevalence of about 39% worldwide \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. However, the exact incidence of hemorrhoids is likely to be much higher because so many patients turn away because of the embarrassment of the site. Hemorrhoids has a great impact on the quality of daily life. Therefore, in clinical practice, it is particularly important to formulate and implement scientific and effective treatment plans in time \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Currently, although there are many treatment options for hemorrhoids, surgery is still the most effective treatment. With the development of new technologies and equipment, minimally invasive surgery provides more options for the treatment of hemorrhoids \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. PPH was first reported by Longo first reported the application of PPH in the treatment of hemorrhoids in 1998 \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Compared with traditional MMH surgery, PPH has the advantages of less bleeding, less pain, faster recovery, fewer complications \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, and has been widely used in clinical practice. RPH (Ruiyun procedure for Hemorrhoids) is an emerging hemorrhoid surgery method based on (Rubber band ligation, RBL) \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that RPH has reliable postoperative efficacy and reduces the incidence of postoperative complications \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, a retrospective case-control study was conducted to investigate the efficacy and safety of RPH in the treatment of hemorrhoids with grade Ⅱ-Ⅳ. The clinical efficacy of RPH and PPH was compared in a single-center experience for the clinical application of the 2 operations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003e A total of 1922 patients with hemorrhoids of grade Ⅱ-Ⅳ were retrospectively reviewed in Ninth People\u0026rsquo;s Hospital (North) Affiliated to Shanghai Jiao Tong University School of Medicine from June 2018 to Juner 2021. The inclusion criteria were as follows: (1) met the criteria of Ⅱ-Ⅳ degree hemorrhoids and underwent RPH or PPH surgery; (2) aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (3) patients or family members were informed of the study and signed the consent form. Exclusion criteria include the following: (1) prior history of any anorectal surgery; (2) combined with other anorectal diseases, such as anal fissure, anal fistula, perianal abscess, inflammatory bowel disease, colorectal cancer, etc.; (3) pregnant or nursing women; (4) coagulation dysfunction or other important organ dysfunction (heart, lung, kidney, etc. ); (5) mental illness or cognitive impairment; (6) incomplete clinical data or loss of follow-up.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical procedures and postoperative care\u003c/h3\u003e\n\u003cp\u003eAll patients underwent mechanical bowel preparation before surgery. A general anesthesia was given, and the patient was positioned in a lithotomy position.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRPH surgery\u003c/b\u003e (1) Perineal skin and intestinal cavity was disinfected with iodophor, then anoscope was used to expose the anal canal and rectum; (2) Carefully check the number and size of hemorrhoids; (3) After confirming the ligation point, suction aiming at internal hemorrhoids or loose mucosa; (4) Sucking the hemorrhoids into the automatic stretch wire ligation device; (5) When the negative pressure reaches \u0026minus;\u0026thinsp;0.08 ~ -0.1mpa, releases the elastic ligation wire by firing the device, closes the negative pressure and cuts the elastic wire 1.0cm away from the ligation point; (6) Avoiding ligation points in the same plane if there are many ligation sites; (7) After confirmation of no active bleeding, anoscope is withdrawn, and simplified external stripping and internal ligation was used to remove the remaining incompletely retracted hemorrhoids.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePPH surgery\u003c/b\u003e (1) Preoperative preparation is similar as RPH; (2) Submucosal purse suture is carried out at 3.0\u0026thinsp;~\u0026thinsp;4.0 cm above the dentate line with 2\u0026thinsp;\u0026minus;\u0026thinsp;0 sliding wire from 3 o 'clock position, and a traction line was pierced through the purse suture at 9 o 'clock; (3) After the staples was inserted above the suture position, the purse suture was tightened and ligated, pulling out the penetrating leads from the side hole of the stapler. The surgeon used the index finger to hook the traction line and pulled the line continuously with moderate force when the stapler was screwed tight. (4) Firing the stapler and maintaining in the firing state for 40s, then the stapler was unscrewed and pulled out; (5) Checking the anastomosis, it was sutured in an \u0026ldquo;8\u0026rdquo; shape to stop bleeding if there was active bleeding; (6) Simplified external stripping and internal ligation was used to remove the remaining incompletely retracted hemorrhoids.\u003c/p\u003e \u003cp\u003ePatients in both groups were administered cefazolin as perioperative antibiotics for 2\u0026thinsp;~\u0026thinsp;3 days. Postoperative analgesics were routinely provided on the first day. The patient began a semifluid diet 6 h after surgery and gradually increased to a semifluid diet. Avoidance of dry and hard stools contributed to the healing of the surgical incision. A warm sitz bath with kangfuxin liquid was started after the first postoperative day.\u003c/p\u003e\n\u003ch3\u003eData collection and follow-up\u003c/h3\u003e\n\u003cp\u003eClinical data and perioperative variables were abstracted from patients' medical records. Postoperative complications, efficacy outcome and patients\u0026rsquo; satisfaction were obtained through outpatient review. All patients received three follow-up visits. The follow-up was scheduled a week, 3 months and one year respectively after surgery at the outpatient clinic. For a small number of patients who unable to participate in outpatient review, follow-up was completed by telephone until June 2022.\u003c/p\u003e\n\u003ch3\u003ePrimary efficacy outcome\u003c/h3\u003e\n\u003cp\u003eThe primary efficacy outcome including the rate of curative at 3 month after operation and the 1-year recurrence rate. According to \u0026ldquo;Traditional Chinese Medicine Syndrome Diagnosis and Efficacy Standards\u0026rdquo; \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, the clinical efficacy was divided into 3 grades ( Curative: no postoperative blood in stool, no anal discomfort and prolapse; Effective: hemorrhoids shrunk, clinical symptoms and signs improved; Ineffective: the clinical symptoms and signs were not relieved).\u003c/p\u003e\n\u003ch3\u003eSecondary efficacy outcome\u003c/h3\u003e\n\u003cp\u003eThe secondary efficacy outcome included: (1) Operativing time; (2) Intraoperative blood loss (No matter RPH or PPH surgery, intraoperative blood loss is relatively little. Numerical measurement is used to evaluate the blood loss as follows: 1, \u0026le; 5ml; 2, ˃5ml and \u0026le;\u0026thinsp;10ml; 3, ˃10ml and \u0026le;\u0026thinsp;15ml; etc. (3) Postoperative anal pain, the severity of postoperative pain on the 1st, 3rd and 7th day was measured by a visual analog scale (VAS) score 0 (no pain) to 10 (worst pain) at 1 and 3 days after operation \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. (4) Time required to resume normal work; (5) Evaluation of Patient Satisfaction, patients evaluated the surgical effect according to their subjective feelings, which was divided into four grades: \"excellent\", \"good\", \"general\" and \"poor\".\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSafety measurement\u003c/h2\u003e \u003cp\u003eThe safety assessment included the following postoperative complications. (1) Postoperative bleeding, which required hemostasis; (2) Urinary retention; (3) Urgent defecation; (4) Anal distension; (5) Anorectal stenosis and (6) Rectovaginal fistula.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted by SPSS 22.0 software. Measurement data was expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and comparison between the two groups was performed by t-test. Countable data was represented with their frequency (%), and the comparison between the two groups was performed with chi-square test or Fisher exact test. A value of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 192 patients with hemorrhoids of grade Ⅱ-Ⅳ were eligible for inclusion. 80 cases were assigned to RPH group, and 112 cases in PPH group. There were no statistically difference between the two groups in age, gender, course, BMI, grade of hemorrhoids, Symptoms, and skin tags (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of hemorrhoids patients at baseline visit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRPH (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePPH (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e / t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.16\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender (male/ female)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46/34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60/52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCourse (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.34\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemorrhoid degree, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(32.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(56.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSymptoms, n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematochezia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74(68.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSkin tags n(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28(35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrimary efficacy measurements\u003c/h2\u003e \u003cp\u003eThe curative rate was 85.0% and 87.5% respectively in RPH group and PPH group, no significant difference was found between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.475, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Combined with external stripping and internal ligation, RPH can achieve a similar appearance to PPH (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The recurrence rate of 1 year after surgery in both groups was 6.3%, with no statistical difference ( \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.000, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of efficacy and patients\u0026rsquo; satisfaction between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRPH (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePPH (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e / t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical efficacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurative, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68(85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98(87.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.249\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.618\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffective, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11(13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIneffective, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRecurrence, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients\u0026rsquo; satisfaction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58(72.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71(63.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(15.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSecondary efficacy measurements\u003c/h2\u003e \u003cp\u003eThe operative time was significantly shorter in RPH group than that in PPH group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The time of hospitalization and required to resume normal work in the RP group was significantly shorter than PPH group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The intraoperative bleeding sore of RPH group was significantly than that of PPH group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The anal pain score on the 1st and 3rd day postoperative was markedly improved in the RPH group and was markedly lower than that in the PPH group (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but there was no significant difference on the 7th day postoperative (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.068) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In terms of patients\u0026rsquo; satisfaction, the proportions of \"excellent\", \"good\", \"general\" and \"poor\" in RPH group were 72.5%, 15%, 10% and 2.5%, and there was no statistical difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.595) compared with the PPH group (63.4%, 19.6%, 12.5% and 4.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of perioperative parameters between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRPH (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePPH (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e / t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOperativing time (min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e20.84\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntraoperative blood loss sore\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative hospital stay (day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime required to resume normal work (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-7.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSafety measurements\u003c/h2\u003e \u003cp\u003eA comparison of incidence of postoperative complications showed in the Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there was no difference on the urinary retention, urgent defecation and Postoperative bleeding between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). No anorectal stenosis or rectovaginal fistula occurred in both groups (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of postoperative complications between two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRPH (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePPH (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e / t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative pain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-4.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7th day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrinary retention\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrgent defecation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(8.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.159\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative bleeding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnorectal stenosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRectovaginal fistula\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026mdash;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eModern surgical treatment of hemorrhoids has put forward higher requirements for the protection of anal function. Reasonable protection of the dentate line area is a key step that must be paid attention to duiring hemorrhoids surgery. Although PPH is considered to be a relatively quick and minimally invasive surgery \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, the incidence of postoperative complications such as bleeding, urinary retention and pain is still high \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBecause RPH surgery ligates the mucosa and the hemorrhoid artery located in the submucosa, the blood supply to the rectum and anal canal is reduced. The wound surface is minimal the ligation tissue fall off, and the rectal mucosa is smooth after healing. unlike PPH, which is stimulated by anastomotic nails. Especially combined with simplified external incision and internal ligation, symptoms and signs can be eliminated to a greater extent, the incidence of postoperative complications and postoperative recurrence rate can be reduced significantly \u003csup\u003e[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, it was also found that there was no significant difference in cure rate and 1-year recurrence rate between the two groups, and no occurrence of anal stenosis, anal incontinence amd rectovaginal fistula in the two groups. RPH surgery is simple and convenient, so the operation time is significantly shorter than PPH surgery. In addition, RPH surgery has obvious advantages over PPH surgery in postoperative pain, bleeding, constipation, urinary retention, recovery time and other aspects, all of which bring better subjective experience to patients, which may be the reasons for the higher satisfaction of patients in the RPH group. After PPH, one patient suffered haemorrhoid artery hemorrhage due to the fall off of anastomotic nail a week after surgery, and hemostasis was performed by surgical suture. In the RPH group, one patient suffered from hemorrhage caused by ligation thread shedding, which was improved after compression and hemostasis.\u003c/p\u003e \u003cp\u003eThe presence of anastomosis after PPH surgery and the stimulation of anorectal by anastomotic nail may be the important reasons for the above results. The anastomosis of PPH surgery is in the same plane and the level is relatively fixed, while the RPH surgery can be targeted at different levels, different sites of hemorrhoids, the uplift of anal cushions is more efferent, the residual external piles that need additional sMMH is relatively less, these may be the reasons of the low incidence of complications and the rapid recovery. Urinary retention is one of the more common complications after anorectal diseases, and the reasons are mostly related to anesthesia, anal pain, visceral nerve pulling reflex and patient psychology \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eRPH combined with simplified external incision and internal ligation in the treatment of Ⅱ~Ⅳ degree hemorrhoids is safe, rapid and effective. Compared with PPH, the anal cushion is better protected, which can effectively reduce the occurrence of anorectal complications in patients, and has obvious advantages in postoperative pain, recovery time and patient satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eOriginality statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI hereby declare that the paper submitted is the result of our team's independent work. Except for the quoted content, the research results of this paper do not contain any copyrighted content. The individuals who contributed to the research work involved in this paper have been clearly identified in the text. This article provides a new theoretical basis for the application of RPH in hemorrhoids surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by ethics committee of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (No. 2019-30-K24). Informed consent was obtained in all cases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShoulian Wang conducted the study and wrote the article. Jiwei Yu and Xin Xu are co-corresponding authors, responsible for the study design. Chunpeng Pan, Haibo Wang, Xiaochun Ni, Chihao Zhang and Linhai Zheng were responsible for data collection.\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declared that they had no conflict of interests regarding the publication of this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collected and analyzed during this study are included in this study and are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no funding available for this systematic review. Authors met all operational costs.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRiss S, Weiser FA, Schwameis K, Riss T, Mittlb\u0026ouml;ck M, Steiner G, Stift A. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215\u0026ndash; 20. https://doi.org/10.1007/s00384-011-1316-3. \u003c/li\u003e\n\u003cli\u003eHollingshead JR, Phillips RK. Haemorrhoids: modern diagnosis and treatment. Postgrad Med J 2016;92:4\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eJin L, Yang H, Qin K, et al. Efficacy of modified rubber band ligation in the treatment of grade III internal hemorrhoids. Ann Palliat Med 2021;10:1191\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eJohanson JF. Nonsurgical treatment of hemorrhoids. J Gastrointest Surg 2002;6:290\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eYeo D, Tan KY. Hemorrhoidectomy \u0026ndash; making sense of the surgical options. World J Gastroenterol 2014;20:16976\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eLONGOA, Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoids prolapse with a circular suturing device: a new procedure. Rome, Italy, in: Proceedings of the 6th World Congress of Endoscopic Surgery, 1998, p. 3. \u003c/li\u003e\n\u003cli\u003eA.J. Senagore, M. Singer, H. Abcarian, Stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy. a prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results, Dis. Colon Rectum 47 (2004) 1824e1836. \u003c/li\u003e\n\u003cli\u003eE. Ganio, F. Altomare, G. Milito, F. Gabrielli, S. Canuti, Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy, Br. J. Sur 94 (2007) 1033e1037. \u003c/li\u003e\n\u003cli\u003eWei G, Hua X, Zhao Y, et al. Clinical study of Ruiyun procedure for hemorrhoids combined with Xiaozhiling injections in treatment of hemorrhoids complicated with human immunodefciency virus infection. Zhonghua Wei Chang Wai Ke Za Zhi. 2014;17:1201\u0026ndash;4. https://doi.org/10.3760/cma.j. issn.1671-0274.2014.12.012. \u003c/li\u003e\n\u003cli\u003eHe YH, Tang ZJ, Xu XT, Huang DQ, Zhang LS, Tang QZ, Fan ZM, Zou XJ, Zou GJ, Zhang CY, Hu F, Xie B, Li YH, Tong Y, Liu HC, Li K, Luo YL, Liu F, Situ GW, Liu ZL. A randomized multicenter clinical trial of RPH with the simplifed Milligan\u0026ndash;Morgan hemorrhoidectomy in the treatment of mixed hemorrhoids. Surg Innov. 2017;24(6):574\u0026ndash;81. https://doi.org/10.1177/ 1553350617731205.\u003c/li\u003e\n\u003cli\u003eState Administration of Traditional Chinese Medicine. Criteria for diagnostic and efficacy of traditional Chinese medicine [M]. Beijing: China Medical Science and Technology Press, 2012: 53-54.\u003c/li\u003e\n\u003cli\u003eP.L. Ritter, V.M. Gonzalez, D.D. Laurent, K.R. Lorig, Measurement of pain using the visual numeric scale, J. Rheumatol. 33 (2006) 574\u0026ndash;580 2006; 33(3): 574-580, PubMed PMID: 16511926.\u003c/li\u003e\n\u003cli\u003eT.C. Sardinha, M.L. Corman, Hemorrhoids, Surg. Clin. North Am. 82 (2002) 1153e1167. \u003c/li\u003e\n\u003cli\u003eB. Ravo, A. Amato, V. Bianco, et al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech. Coloproctol. 6 (2002) 83e88.\u003c/li\u003e\n\u003cli\u003eDe Nardi P，Tamburini AM，Gazzetta PG，et al. Hemorrhoid laser procedure for second-and third-degree hemorrhoids: results from a multicenter prospective study [J]. Tech Coloproctol, 2016, 20(7): 455-459. \u003c/li\u003e\n\u003cli\u003eBjelanovic Z, Draskovic M, Veljovic M, et al. Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease [J]. Cir Esp, 2016, 94( 10) : 588-594. \u003c/li\u003e\n\u003cli\u003eKersting S, Herold A, Jung KP, et al. Complication management following hemorrhoid operations [J]. Chirurg, 2015, 86( 8): 726-733. \u003c/li\u003e\n\u003cli\u003eIzadpanah A, Hosseini S, Mahjoob M. Comparison of electrotherapy，rubber band ligation and hemorrhoidectomy in the treatment of hemorrhoids: a clinical and manometric study [J]. Middle East J Dig Dis, 2010, 2(1) : 9-13.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemorrhoids, Ruiyun procedure for hemorrhoids (RPH), Procedure for prolapse and hemorrhoids (PPH), Postoperative complications ","lastPublishedDoi":"10.21203/rs.3.rs-6570958/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6570958/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo compare the clinical effect of ruiyun procedure for hemorrhoids (RPH) and procedure for prolapse and hemorrhoids (PPH) for the treatment of mixed hemorrhoids with grade Ⅱ-Ⅳ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eTotal 192 patients with hemorrhoids of grade Ⅱ-Ⅳ were retrospectively reviewed in Ninth People’s Hospital (North) Affiliated to Shanghai Jiao Tong University School of Medicine, 80 cases were assigned to RPH group, and 112 cases in PPH group. The primary efficacy outcome was rate of curative at 3 month after operation, and the 1-year recurrence rate. Secondary efficacy outcomes included operation time, operative blood loss, time of hospitalizationand required to resume normal work, patients’ satisfaction, and pain post operation was also evaluated. The safety outcome included postoperative complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe were no significant differences between the two groups regarding patient demographics. No significant difference between the 2 groups in clinical efficacy, 1-year recurrence, patients’ satisfaction, anal anal pain on the 7th day after operation, and postoperative complications (urinary retention, urgent defecation, postoperative bleeding, and so on) ( \u003cem\u003ep \u003c/em\u003e\u0026gt;0.05). RPH can markedly improve postoperative anal pain on the 1st, 3rd day(\u003cem\u003ep\u003c/em\u003e＜0.01). The operation time, operative blood loss sore, time of hospitalization and required to resume normal work were decreased significantly in the RPH group compared with the PPH group (\u003cem\u003ep\u003c/em\u003e＜0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eRPH is effective and safety in the treatment of grades Ⅱ-Ⅳhemorrhoids, with a better advantage in operation time, operative blood loss sore, postoperative complications and recovery than PPH, which is worthy of clinical application.\u003c/p\u003e","manuscriptTitle":"Comparison of the outcomes of ruiyun procedure for hemorrhoids and PPH in the treatment of grade Ⅱ-Ⅳ hemorrhoids","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-22 14:40:42","doi":"10.21203/rs.3.rs-6570958/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcae79f8-107c-4100-87d8-fade330f45b4","owner":[],"postedDate":"May 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T14:11:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-22 14:40:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6570958","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6570958","identity":"rs-6570958","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}