Skip to main content

Advertisement

SpringerLink
Log in

Stapled and conventional Milligan–Morgan haemorrhoidectomy: different solutions for different targets

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  2. Sneider EB, Maykel JA (2010) Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am 90(1):17–32

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  CAS  Google Scholar 

  4. Haas PA, Fox TA, Haas GP (1984) The pathogenesis of hemorrhoids. Dis Colon Rectum 27:442–450

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Google Scholar 

  7. 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

  8. Sultan S, Rabahi N, Etienney I, Atienza P (2010) Stapled haemorrhoidopexy: 6 years' experience of a referral centre. Colorectal Dis 12(9):921–926

    Article  PubMed  CAS  Google Scholar 

  9. 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

    PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88(8):1049–1053

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  CAS  Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan–Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355(9206):782–785

    Article  PubMed  CAS  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. 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

    PubMed  Google Scholar 

  20. 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

    Article  PubMed  CAS  Google Scholar 

  21. Nisar PJ, Scholefield JH (2003) Managing haemorrhoids. BMJ 327:847–851

    Article  PubMed  Google Scholar 

  22. Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89(11):1376–1381

    Article  PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50(6):878–892

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None to declare.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, “Sapienza” University of Rome, V.le Regina Elena 324, 00161, Rome, Italy

    Alessandra Panarese, Daniele Pironi, Maurizio Vendettuoli, Stefano Pontone, Stefano Arcieri, Andrea Conversi, Anna Maria Romani & Angelo Filippini

Authors
  1. Alessandra Panarese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniele Pironi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Vendettuoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Pontone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Arcieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Conversi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anna Maria Romani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Angelo Filippini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefano Pontone.

Rights and permissions

Reprints 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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1342-1

Keywords

Search

Navigation