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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.
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).
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.
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.