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Stapled Hemorrhoidopexy and Milligan Morgan Hemorrhoidectomy in the Cure of Fourth-Degree Hemorrhoids: Long-Term Evaluation and Clinical Results

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Diseases of the Colon & Rectum

Purpose

The long-term results after stapled hemorrhoidopexy compared with Milligan-Morgan procedure are discussed.

Methods

The clinical data of 100 patients treated by Milligan-Morgan procedure or stapled hemorrhoidopexy for fourth-degree hemorrhoids have been reviewed. All patients were visited and submitted to a questionnaire to evaluate resumption of symptoms, functional results, and recurrence rate.

Results

The mean follow-up was 54 months for stapled hemorrhoidopexy and 92 months for the Milligan-Morgan procedure. Postoperative pain and return to normal activity were worse in the Milligan-Morgan procedure (Visual Analog Scale 8.56 vs. 5.46, P-lt;-.001; and 2.4 vs. 2 weeks, P value--.018). Eight percent of patients who had stapled hemorrhoidopexy complained of spontaneous pain or pain during defecation vs. 0 percent of patients who underwent the Milligan-Morgan procedure. We noted that there was bleeding in 14 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P-lt;-.006), tenesmus in 32 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P-lt;-.001), and pruritus in 4 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure. Minor leakage was similar in the two groups. Flatus impaired control was less frequent in Milligan-Morgan. The relative risk of recurrence for stapled hemorrhoidopexy compared with Milligan-Morgan procedure was 1.18 (95 percent confidence interval 1< relative risk < 1.4). No statistical difference was noted in patients-satisfaction after the procedures.

Conclusions

Long follow-up seems to indicate more favorable results in Milligan-Morgan procedure in terms of resumption of symptoms and risk of recurrence.

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Authors and Affiliations

  1. Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Claudio Mattana M.D., Claudio Coco M.D., Alberto Manno M.D., Alessandro Verbo M.D., Gianluca Rizzo M.D., Luigi Petito M.D. & Daniel Sermoneta M.D.

  2. Istituto di Patologia Chirurgica, Policlinico Gemelli, Largo Gemelli, 8, Rome, 00168, Italy

    Claudio Mattana M.D.

Authors
  1. Claudio Mattana M.D.
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  2. Claudio Coco M.D.
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  3. Alberto Manno M.D.
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  4. Alessandro Verbo M.D.
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  5. Gianluca Rizzo M.D.
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  6. Luigi Petito M.D.
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  7. Daniel Sermoneta M.D.
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Mattana, C., Coco, C., Manno, A. et al. Stapled Hemorrhoidopexy and Milligan Morgan Hemorrhoidectomy in the Cure of Fourth-Degree Hemorrhoids: Long-Term Evaluation and Clinical Results. Dis Colon Rectum 50, 1770–1775 (2007). https://doi.org/10.1007/s10350-007-0294-6

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  • DOI: https://doi.org/10.1007/s10350-007-0294-6

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