A comparative study of short term results of open haemorrhoidectomy and stapler haemorrhoidopexy

Chandrasekhar S. Neeralagi, Yogesh Kumar, Surag K. R., Lakkanna Suggaiah, Preetham Raj


Background: Haemorrhoids are the most common benign anorectal problems worldwide. Treatments of third and fourth degree hemorrhoids include surgical haemorrhoidectomy. Milligan Morgan haemorrhoidectomy (MMH) as described in 1937 has remained the most popular among many techniques proposed. In order to avoid the postoperative drawbacks of Milligan Morgan haemorrhoidectomy, a new surgical treatment for prolapsing haemorrhoids has been described by Longo in 1995, procedure called stapled haemorrhoidopexy which is associated with less postoperative pain and a quicker recovery. The objective of this study was to compare the short-term outcome between stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.

Methods: Prospective randomized study of 120 patients with grade 3 and grade 4 haemorrhoids requiring surgical treatment either MMH or SH, 60 in each group for the period of 18 months from June 2014 to November 2015. Post-operative pain, duration of surgery, duration of hospital stays, post-operative complications and time taken to return to work were compared with mean follow up period of 6 months.

Results: Duration of surgery is significantly low in stapled group with P <0.001, duration of hospital stay is significantly low in stapled group with P <0.001, post-operative pain low in staple group with P <0.05, time taken to return to work is significantly early in stapled group with P <0.001. Post-operative complications incontinence not found in the present study but recurrence of two cases in each group noted.

Conclusion: Stapled hemorrhoidopexy is associated with less postoperative pain, shorter duration of surgery and hospital stay, earlier return to work as compared with Milligan-Morgan open hemorrhoidectomy. The procedure is not associated with major post-operative complications.


Hemorrhoids, MMH, Procedure for prolapse

Full Text:



Sabiston textbook of surgery. Elsevier: Courtney m. Townsend, R. Daniel Beauchamp, B mark Evers and Kenneth L. Mattox. first South Asia edition: RELX India private limited; 2016:1387.

Brunicardi FC, Anderson DK, Billar TR, Dunn DL, Hunter JG, Matthews JB, et al. Schwartz’s principles of surgery. Tenth edition: Mc Graw Hill; 2015:1222.

Fischer, Josef E. Mastery of surgery. 5th edition: Lippincott Williams and Wilkins; 2007:1616.

Kim JS, Vashist YK, Thieltges S, Zehler O, Gawad KA, Yekebas EF, et al. Stapled hemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy in circumferential third-degree haemorrhoids: long-term results of a randomized controlled trial. J Gastrointest Surg. 2013;17(7):122-8.

Moin AJ, Ahmed S. Comparison of stapled versus open haemorrhoidectomy in the management of 3 and 4-degree haemorrhoids. Annals of King Edward Medical University. 2012;18(3):276-8.

Ellabban GM. Stapled haemorrhoidectomy versus traditional haemorrhoidectomy for the treatment of haemorrhoids. World J Colorectal Surg. 2010;2(1):1-25.

Longo A. Mechanical haemorrhoidectomy using a circular stapler. Refresher course in hemorrhoidal disease therapy. Presented at the 24th International Congress of Latin Mediterranean Palmero, Italy, September 29 to October 1; 1995.

Longo A. Treatment of haemorrhoids disease by the reduction of mucosa and haemmorhoidal prolapsed with circular suturing device: a novel procedure. 6th World Congress of Endoscopic Surgery, Rome; 1998.

Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet. 2000;355(9206):779-81.

Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet. 2000;355(9206):782-5.

Khalil KH, O'Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg. 2000;87:1352-5.

Bikhchandani J, Agarwal PN, Kant R, Malik VK. Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg. 2005;189(1):56-60.

Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy. Dis Colon Rectum. 2007;50(6):878-92.

Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, et al. Treatment of haemorrhoids in day surgery: stapled hemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. J Gastrointest Surg. 2008;12(5):795-801.

Cheetham MJ, Mortensen NJM, Nystom PO, Kamm MA, Phillips RKS. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet. 2000;356:730-3.

Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled versus excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002;137:337-40.