Abstract
Purpose
Haemorrhoidal disease is one of the most common anorectal disorders. The aim of this study is to compare the results, over the last 10 years, of stapled haemorrhoidopexy (SH) with those of standard Milligan–Morgan haemorrhoidectomy (M&M). Furthermore, we discuss the proper indications for each technique in terms of the lowest rate of complications and long-term results.
Methods
Three hundred forty-three patients with different degrees of symptomatic haemorrhoids underwent SH or M&M from January 2005 to December 2007. Patients were divided into two groups, age and sex matched. The administration of painkillers drugs, antibiotics and laxatives, complication symptoms and hospital stay in all the patients were recorded after surgical treatment.
Results
The mean operative time was shorter in the stapled group compared to that in the open group (31 min versus 40 min). Postoperative pain, hospital stay and return to full activity were shorter in the stapled group. There was a significant difference in the wound healing time between the two groups. We noticed a higher rate of recurrence in patients treated with stapled haemorrhoidectomy for fourth-degree haemorrhoids.
Conclusions
According to our experience, the Longo technique is indicated for the treatment of haemorrhoids of second- and third degree. In the latter grades of prolapse, the Milligan–Morgan haemorrhoidectomy can also be applied with good outcomes. We believe that, in case of irreducible prolapse, the M&M is to be preferred. However, operative management varies according to surgeon's interest and is tailored to meet the individual patient's need.
Similar content being viewed by others
References
Bikhchandani J, Agarwal PN, Kant R, Malik VK (2005) Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 189(1):56–60
Sneider EB, Maykel JA (2010) Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am 90(1):17–32
Moesgaard F, Nielsen ML, Hansen JB, Knudsen JT (1982) High-fiber diet reduces bleeding and pain in patients with hemorrhoids: a double-blind trial of Vi-Siblin. Dis Colon Rectum 25:454–456
Haas PA, Fox TA, Haas GP (1984) The pathogenesis of hemorrhoids. Dis Colon Rectum 27:442–450
Ba-Bai-Ke-Re MM, Huang HG, Re WN, Fan K, Chu H, Ai EH, Li-Mu MM, Wang YR, Wen H (2011) How we can improve patients' comfort after Milligan–Morgan open haemorrhoidectomy. World J Gastroenterol 17(11):1448–1456
Burch J, Epstein D, Baba-Akbari A, Weatherly H, Fox D, Golder S, Jayne D, Drummond M, Woolacott N (2008) Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation. Health Technol Assess 12(8):iii–iv, ix–x, 1–193
Longo A (1998) Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Monduzzi Editore, Bologna, pp. 777–784
Sultan S, Rabahi N, Etienney I, Atienza P (2010) Stapled haemorrhoidopexy: 6 years' experience of a referral centre. Colorectal Dis 12(9):921–926
Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A (2003) Stapled and open hemorrhoidectomy: randomized controlled trial of early results. World J Surg 27(2):203–207
Correa-Rovelo JM, Tellez O, Obregón L, Miranda-Gomez A, Moran S (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45(10):1367–1374
Ortiz H, Marzo J, Armendáriz P, De Miguel M (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48(4):809–815
Kairaluoma M, Nuorva K, Kellokumpu I (2003) Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 46(1):93–99
Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88(8):1049–1053
Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182(1):64–68
Pavlidis T, Papaziogas B, Souparis A, Patsas A, Koutelidakis I, Papaziogas T (2002) Modern stapled Longo procedure vs. conventional Milligan–Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 17(1):50–53
Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan–Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355(9206):782–785
Cheetham MJ, Cohen CR, Kamm MA, Phillips RK (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 46(4):491–497
Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S (2001) Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 88(5):669–674
Chen JS, You JF (2010) Current status of surgical treatment for hemorrhoids—systematic review and meta-analysis. Chang Gung Med J 33(5):488–500
Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow-Choen F (2000) Stapled hemorrhoidectomy cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43(12):1666–1675
Nisar PJ, Scholefield JH (2003) Managing haemorrhoids. BMJ 327:847–851
Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89(11):1376–1381
Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50(9):1297–1305
Lan P, Wu X, Zhou X, Wang J, Zhang L (2006) The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 21(2):172–178
Mattana C, Coco C, Manno A, Verbo A, Rizzo G, Petito L, Sermoneta D (2007) Stapled hemorrhoidopexy and Milligan–Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: long-term evaluation and clinical results. Dis Colon Rectum 50(11):1770–1775
Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 95(2):147–160
Nisar PJ, Acheson AG, Neal KR, Scholefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47(11):1837–1845
Kam MH, Ng KH, Lim JF, Ho KS, Ooi BS, Tang CL, Eu KW (2011) Results of 7302 stapled haemorrhoidectomy operations in a single centre: a seven-year review and follow-up questionnaire survey. ANZ J Surg 81(4):253–256
Ommer A, Hinrichs J, Möllenberg H, Marla B, Walz MK (2011) Long-term results after stapled hemorrhoidopexy: a prospective study with a 6-year follow-up. Dis Colon Rectum 54(5):601–608
Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, Rossi P, Falchetti A, Gaspari A (2008) Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan–Morgan hemorrhoidectomy. J Gastrointest Surg 12(5):795–801
Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50(6):878–892
Conflict of interest
None to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Panarese, A., Pironi, D., Vendettuoli, M. et al. Stapled and conventional Milligan–Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 27, 483–487 (2012). https://doi.org/10.1007/s00384-011-1342-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1342-1