Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

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

Objective

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.

Settings

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.

Results

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.

Limitations

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

Conclusions

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.

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. Giordano P, Gravante G, Sorge R et al. Long-term outcomes of stapled hemorrhoidopexy vs. conventional hemorrhoidectomy. A meta-analysis of randomized controlled studies. Arch Surg 2009;144(3):266–272.

    Article  PubMed  Google Scholar 

  2. Nisar PJ, Acheson AG, Neal KR et al. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled studies. Dis Colon Rectum 2004;47(11):1837–1845.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  4. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional haemorrhoid surgery. Dis Colon Rectum 2007;50:1297–1305.

    Article  PubMed  Google Scholar 

  5. Zacharakis E, Kanellos D, Pramateftakis MG et al. Long-term results after stapled haemorrhoidopexy for fourth-degree haemorrhoids: a prospective study with median follow-up of 6 years. Tech Coloproctol 2007;11(2):144–147.

    Article  PubMed  CAS  Google Scholar 

  6. Finco C, Sarzo G, Savastano S et al. Stapled haemorrhoidopexy in fourth-degree haemorrhoidal prolapse: is it worthwhile? Colorectal Dis 2006;8(2): 130–134.

    Article  PubMed  CAS  Google Scholar 

  7. Ortiz H, Marzo J, Armendáriz P et al. Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized clinical trial and review of the literature. Dis Colon Rectum 2005;48:809–815.

    Article  PubMed  Google Scholar 

  8. Ceci F, Picchio M, Palimento D et al. Long-term outcome of stapled hemorrhoidopexy for grade III and grade IV hemorrhoids. Dis Colon Rectum 2008;51:1107–1112.

    Article  PubMed  Google Scholar 

  9. Van de Stadt J, D'Hoore A, Duinslaeger M et al. Long-term results after excision haemorrhoidectomy versus stapled haemorrhoidopexy for prolapsing haemorrhoids: a Belgian prospective randomized trial. Acta Chir Belg 2005; 105(1):44–52.

    PubMed  Google Scholar 

  10. Ganio E, Altomare DF, Milito G et al. Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan–Morgan haemorrhoidectomy. Br J Surg 2007;94(8):1033–1037.

    Article  PubMed  CAS  Google Scholar 

  11. Picchio M, Palimento D, Attanasio U et al. Stapled vs. open hemorrhoidectomy: long-term outcome of a randomized controlled trial. Int J Colorectal Dis 2006 Oct;21(7):668–669.

  12. Racalbuto A, Aliotta I, Corsaro G et al. Haemorrhoidal stapler prolapsectomy vs. Milligan–Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis 2004; 19(3):239–244.

    Article  PubMed  CAS  Google Scholar 

  13. Smyth EF, Baker RP, Wilken BJ et al. Stapled versus excision haemorrhoidectomy: long-term follow-up of a randomised controlled trial. Lancet 2003;361(9367):1437–1438.

    Article  PubMed  Google Scholar 

  14. Gravie JF, Lehur PA, Huten N et al. Stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 2005;242(1):29–35.

    Article  PubMed  Google Scholar 

  15. Au-Yong I, Rowsell M, Hemmingway DM. Randomised controlled clinical trial of stapled haemorrhoidopexy vs. conventional haemorrhoidectomy: a three and a half year follow up. Colorectal Dis 2004;6(1):37–38.

    Article  PubMed  CAS  Google Scholar 

  16. Longo A. Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with a circumferential suturing device: a new procedure. Monduzzi Editore, 6th World Congress of Endoscopic Surgery, Bologna, 1998:777–784.

  17. Delbos A. Management of post-operative pain on surgical wards. Ann Fr Anesth Reanim 1998;17:649–662.

    Article  PubMed  CAS  Google Scholar 

  18. Kairaluoma M, Nuorva K, Kellokumpu I. Day-case stapled (circumferential) vs. diathermy hemorrhoidectomy. A randomised, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 2003;46:93–99.

    Article  PubMed  Google Scholar 

  19. Boccasanta P, Capretti PG, Venturi M et al. Randomized controlled trial between stapled circumferential mucosectomy and conventional circumferential hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapsed. Am J Surg 2001;182: 64–68.

    Article  PubMed  CAS  Google Scholar 

  20. Boccasanta P, Venturi M, Roviaro G. Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial. Int J Colorectal Dis 2007;22:245–251.

    Article  PubMed  Google Scholar 

  21. Ortiz H, Marzo J, Armendáriz P, De Miguel M. Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 2005; 48(4):809–815. Review.

    Article  Google Scholar 

  22. Schmidt J, Dogan N, Langenbach R et al. Fecal urge incontinence after stapled anopexia for prolapse and hemorrhoids: a prospective, observational study. World J Surg 2009; 33:355–364.

    Article  PubMed  Google Scholar 

  23. Ho YH, Seow-Choen F, Tsang C et al. Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy. Br J Surg 2001;88:1449–1455.

    Article  PubMed  CAS  Google Scholar 

  24. Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: one-year results of the European STARR Registry. Dis Colon Rectum 2009;52(7):1205–1212.

    Article  PubMed  CAS  Google Scholar 

  25. Hetzer FH, Demartines N, Handschin AE et al. Stapled vs. excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg 2002;137(3):337–340.

    Article  PubMed  Google Scholar 

  26. Naldini G, Martellucci J, Moraldi L. Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 2009;24(5):537–541.

    Article  PubMed  Google Scholar 

  27. Kam MH Mathur P, Peng XH et al. Correlation of histology with anorectal function following stapled hemorrhoidectomy. Dis Colon Rectum 2005;48(7):1437–1441.

    Article  PubMed  CAS  Google Scholar 

  28. Calomino N Martellucci J, Fontani A et al. Care with regard to details improves the outcome of Longo mucoprolapsectomy: long-term follow up. Updates Surg 2011;63(3):151–149.

    Article  PubMed  Google Scholar 

  29. Panarese A, Pironi D, Vendettuoli M et al. Stapled and conventional Milligan–Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 2012;27(4):483–487. Epub 2011 Nov 4.

    Article  PubMed  Google Scholar 

  30. Manfredelli S, Montalto G, Leonetti G et al. Conventional (CH) vs. stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years experience. Ann Ital Chir 2012;83(2):129–134.

    PubMed  Google Scholar 

  31. Arslani N, Patrlj L, Rajković Z, Papeš D et al. A randomized clinical trial comparing Ligasure versus stapled hemorrhoidectomy. Surg Laparosc Endosc Percutan Tech 2012;22(1):58–61.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

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

Authors
  1. Jong-Sun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yogesh K. Vashist
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabrina Thieltges
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oliver Zehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karim A. Gawad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emre F. Yekebas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jakob R. Izbicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Asad Kutup
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asad Kutup.

Additional information

Jong-Sun Kim and Yogesh K. Vashist contributed equally to this work

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, JS., Vashist, Y.K., Thieltges, S. et al. Stapled Hemorrhoidopexy Versus Milligan–Morgan Hemorrhoidectomy in Circumferential Third-Degree Hemorrhoids: Long-Term Results of a Randomized Controlled Trial. J Gastrointest Surg 17, 1292–1298 (2013). https://doi.org/10.1007/s11605-013-2220-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2220-7

Keywords

Search

Navigation