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Erschienen in: European Surgery 3/2015

01.06.2015 | Original Article

Stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy: a short-term follow-up on 640 consecutive patients

verfasst von: A. Cariati, MD

Erschienen in: European Surgery | Ausgabe 3/2015

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Summary

Background

The aim of the present study is to report our data on the treatment of third-and fourth-degree hemorrhoids with stapled technique and Milligan–Morgan operation in terms of postoperative results, costs, and recurrence.

Methods

From 2008 to 2011, 640 consecutive patients with third- and fourth-degree hemorrhoids underwent hemorrhoidectomy or hemorrhoidopexy. Patients have been randomly assigned to Milligan–Morgan or stapled treatment according to the possibility of use 60 staplers/year. In all, 400 patients have been treated by Milligan–Morgan procedure: 357 in one-day surgery; 240 patients underwent stapled hemorrhoidopexy: 197 in one-day surgery (p = 0.011).

Results

Immediate readmissions have been: 5 cases among Milligan–Morgan group and of 9 cases among stapled group (p two-tailed = 0.049). Acute postoperative rectal bleeding with readmission have been: 4 cases among Milligan–Morgan group (1 %) and 8 cases among stapled group (3.33 %) (p = 0.037). Recurrence have been: 2 patients after Milligan–Morgan procedure (0.5 %) and 20 patients after stapled operation (8.33) (p < 0.0000011). Total direct costs have been 668 € higher for each stapled patient.

Conclusion

In conclusion, Milligan–Morgan hemorrhoidectomy for third- and fourth-degree hemorrhoids is superior to stapled operation when comparing hospital stay, major postoperative bleeding, hospital cost, and recurrence.
Literatur
1.
Zurück zum Zitat Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98:380–86.PubMed Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98:380–86.PubMed
3.
Zurück zum Zitat Goligher J, Duthie H, Nixon H. Surgery of the anus, rectum and colon. 5th ed. London: Balliere Tindall; 1984. Goligher J, Duthie H, Nixon H. Surgery of the anus, rectum and colon. 5th ed. London: Balliere Tindall; 1984.
4.
Zurück zum Zitat Ba-bai-ke-re MM, Huang HG, Re WN, et al. How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol. 2011;17:1448–56.PubMedCentralPubMedCrossRef Ba-bai-ke-re MM, Huang HG, Re WN, et al. How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol. 2011;17:1448–56.PubMedCentralPubMedCrossRef
5.
Zurück zum Zitat Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;18(4):CD005393. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006;18(4):CD005393.
6.
Zurück zum Zitat Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet. 2000;355:782–85.PubMedCrossRef Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet. 2000;355:782–85.PubMedCrossRef
7.
Zurück zum Zitat Kirsch JJ, Staude G, Herold A. The Longo and Milligan-Morgan hemorrhoidectomy. A prospective comparative study of 300 patients. Chirurg. 2001;72:180–85.PubMedCrossRef Kirsch JJ, Staude G, Herold A. The Longo and Milligan-Morgan hemorrhoidectomy. A prospective comparative study of 300 patients. Chirurg. 2001;72:180–85.PubMedCrossRef
8.
Zurück zum Zitat Nisar PJ, Acheson AG, Neal KR, Sholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum. 2004;47:1837–45.PubMedCrossRef Nisar PJ, Acheson AG, Neal KR, Sholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum. 2004;47:1837–45.PubMedCrossRef
9.
Zurück zum Zitat Cariati A, Piromalli E, Copello F, Torelli I. Anal stretch for chronic anal fissure: an old operation that stood the test of time. Langenbecks Arch Surg. 2012. doi:10.1007/s00423-012-0969-x Cariati A, Piromalli E, Copello F, Torelli I. Anal stretch for chronic anal fissure: an old operation that stood the test of time. Langenbecks Arch Surg. 2012. doi:10.1007/s00423-012-0969-x
10.
Zurück zum Zitat Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2007;50:878–92.PubMedCrossRef Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2007;50:878–92.PubMedCrossRef
11.
Zurück zum Zitat Slawik S, Kenefick N, Greenslade GL, Dixon AR. A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the management of 3rd and 4th degree haemorrhoids. Colorectal Dis. 2007;9:352–6.PubMedCrossRef Slawik S, Kenefick N, Greenslade GL, Dixon AR. A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the management of 3rd and 4th degree haemorrhoids. Colorectal Dis. 2007;9:352–6.PubMedCrossRef
12.
Zurück zum Zitat Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50:1297–305.PubMedCrossRef Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50:1297–305.PubMedCrossRef
13.
Zurück zum Zitat Giordano P, Bradley BM, Peiris L. Obliteration of the rectal lumen after stapled hemorrhoidectomy: report of a case. Dis Colon Rectum. 2008;51:1574–6.PubMedCrossRef Giordano P, Bradley BM, Peiris L. Obliteration of the rectal lumen after stapled hemorrhoidectomy: report of a case. Dis Colon Rectum. 2008;51:1574–6.PubMedCrossRef
14.
Zurück zum Zitat Brown S, Baraza W, Shorthouse A. Total rectal lumen obliteration after stapled hemorrhoidopexy: a cautionary tale. Tech Coloproctol. 2007;11:357–8.PubMedCrossRef Brown S, Baraza W, Shorthouse A. Total rectal lumen obliteration after stapled hemorrhoidopexy: a cautionary tale. Tech Coloproctol. 2007;11:357–8.PubMedCrossRef
15.
Zurück zum Zitat Cipriani S, Pescatori M. Acute rectal obstruction after PPH stapled hemorrhoidectomy. Colorectal Dis. 2002;4:367–70.PubMedCrossRef Cipriani S, Pescatori M. Acute rectal obstruction after PPH stapled hemorrhoidectomy. Colorectal Dis. 2002;4:367–70.PubMedCrossRef
16.
Zurück zum Zitat Cirocco WC. Life threatening sepsis and mortality following stapled hemorrhoidopexy. Surgery. 2008;143:824–9.PubMedCrossRef Cirocco WC. Life threatening sepsis and mortality following stapled hemorrhoidopexy. Surgery. 2008;143:824–9.PubMedCrossRef
17.
Zurück zum Zitat Kornaros S, Dalamangas K, Zisi-Sermpetzoglou A. Fulminant intra-abdominal sepsis after stapled hemorrhoidectomy. Surg Infect. 2001;12:145–8.CrossRef Kornaros S, Dalamangas K, Zisi-Sermpetzoglou A. Fulminant intra-abdominal sepsis after stapled hemorrhoidectomy. Surg Infect. 2001;12:145–8.CrossRef
18.
Zurück zum Zitat Milligan ETC, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet. 1937;230:1119–24.CrossRef Milligan ETC, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet. 1937;230:1119–24.CrossRef
19.
Zurück zum Zitat Cariati A. Hospital costs of conventional and stapled 1-day hemorrhoidectomy. Arch Surg. 2009;144:979–80.PubMedCrossRef Cariati A. Hospital costs of conventional and stapled 1-day hemorrhoidectomy. Arch Surg. 2009;144:979–80.PubMedCrossRef
20.
Zurück zum Zitat Sultan S, Rabahi N, Etienney I, Atienza P. Stapled haemorrhoidopexy: 6 years’ experience of a referral centre. Colorectal Dis. 2010;12(9):921–6.PubMedCrossRef Sultan S, Rabahi N, Etienney I, Atienza P. Stapled haemorrhoidopexy: 6 years’ experience of a referral centre. Colorectal Dis. 2010;12(9):921–6.PubMedCrossRef
21.
Zurück zum Zitat Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A. Stapled and open hemorrhoidectomy: randomized controlled trial of early results. World J Surg. 2003;27(2):203–7.PubMed Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A. Stapled and open hemorrhoidectomy: randomized controlled trial of early results. World J Surg. 2003;27(2):203–7.PubMed
22.
Zurück zum Zitat Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001;88(8):1049–53.PubMedCrossRef Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001;88(8):1049–53.PubMedCrossRef
23.
Zurück zum Zitat Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: a randomized controlled trial. Lancet. 2000;355(9206):782–5.PubMedCrossRef Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: a randomized controlled trial. Lancet. 2000;355(9206):782–5.PubMedCrossRef
24.
Zurück zum Zitat Cheetham MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoidectomy vs stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum. 2003;46(4):491–7.PubMedCrossRef Cheetham MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoidectomy vs stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum. 2003;46(4):491–7.PubMedCrossRef
25.
Zurück zum Zitat Panarese A, Pironi D, Vendettuoli M, Pontone S, Arcieri S, Conversi A, Romani AM, Filippini A. Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis. 2012;27:483–7.PubMedCrossRef Panarese A, Pironi D, Vendettuoli M, Pontone S, Arcieri S, Conversi A, Romani AM, Filippini A. Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis. 2012;27:483–7.PubMedCrossRef
26.
Zurück zum Zitat Ammaturo C, Tufano A, Spiniello E, Sodano B, Iervolino EM, Brillantino A, Braccio B. Stapled haemorrhoidopexy vs Milligam-Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial. G Chir. 2012;33(10):346–51.PubMed Ammaturo C, Tufano A, Spiniello E, Sodano B, Iervolino EM, Brillantino A, Braccio B. Stapled haemorrhoidopexy vs Milligam-Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial. G Chir. 2012;33(10):346–51.PubMed
Metadaten
Titel
Stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy: a short-term follow-up on 640 consecutive patients
verfasst von
A. Cariati, MD
Publikationsdatum
01.06.2015
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 3/2015
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-015-0316-x

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