Journal of Gastrointestinal Surgery

, Volume 17, Issue 7, pp 1292–1298 | Cite as

Stapled Hemorrhoidopexy Versus Milligan–Morgan Hemorrhoidectomy in Circumferential Third-Degree Hemorrhoids: Long-Term Results of a Randomized Controlled Trial

  • Jong-Sun Kim
  • Yogesh K. Vashist
  • Sabrina Thieltges
  • Oliver Zehler
  • Karim A. Gawad
  • Emre F. Yekebas
  • Jakob R. Izbicki
  • Asad Kutup
Original Article



The literature indicates higher recurrence rates for stapled hemorrhoidopexy than for conventional techniques. This could be due to inappropriate patient selection.


The aim of this study was to evaluate the short- and long-term outcome after stapled hemorrhoidopexy compared with the Milligan–Morgan procedure in a homogeneous patient population with circumferential third-degree hemorrhoids.

Design and Patients

One hundred thirty patients were enrolled into a randomized controlled study, of which 122 were clinically evaluated at weeks 1, 2, and 4, and thereafter each year for a minimum of 3 years. Patients completed a questionnaire for symptoms, function, and pain. Pain was assessed using a visual analog scale. Recurrences were determined by anoscopy and self-report.


The study was performed at the University Hospital Hamburg.

Main Outcome Measures

Endpoints were pain, recurrence, bleeding, itching/burning, urinary retention, incontinence symptoms, and prolonged rate of wound healing.


The cumulative recurrence rates after 5 years were 18 % (n = 11) in the stapled hemorrhoidopexy group and 23 % (n = 14) in the Milligan–Morgan group (p = 0.65). Patients who underwent stapled hemorrhoidopexy had significantly less postoperative pain with mean VAS scores at week 1: 3.1 vs. 6.2; week 2: 0.5 vs. 3; week 4: 0.05 vs. 0.6 (p < 0.001), and demonstrated less burning/itching sensation 4 weeks after surgery compared with the Milligan–Morgan group (4.9 vs. 19.7 %; p < 0.001). The postoperative bleeding rate was 4.9 % in both groups and the rate of urinary retention did not differ significantly (4.9 % vs. 1.6 %; p = 0.309). Postoperative incontinence symptoms (6.6 % versus 3.3 %; p = 0.40) resolved within the first 6 months.


Detailed measurement of incontinence was not possible because postoperative symptoms resolved between consultations, and pathological results were examined retrospectively.


The results show a similar rate of recurrence in the long term and suggest increased patient comfort in the early postoperative course after stapled hemorrhoidopexy. In patients with circumferential third-degree hemorrhoids, stapled hemorrhoidopexy is as effective as the Milligan–Morgan procedure.


Hemorrhoids Stapled hemorrhoidopexy Milligan–Morgan Recurrence Long-term outcome Pain 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Jong-Sun Kim
    • 1
  • Yogesh K. Vashist
    • 1
  • Sabrina Thieltges
    • 1
  • Oliver Zehler
    • 1
  • Karim A. Gawad
    • 1
  • Emre F. Yekebas
    • 1
  • Jakob R. Izbicki
    • 1
  • Asad Kutup
    • 1
  1. 1.Department of General, Visceral and Thoracic SurgeryUniversity Medical Center of Hamburg-EppendorfHamburgGermany

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