Stapled hemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy: a paradigm shift in the management of 3rd and 4th degree hemorrhoids

Authors

  • Sudhir Kumar Panigrahi Department of Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Chinmaya Ranjan Behera Department of Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Subrajit Mishra Department of Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Abinash Kanungo Department of Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175897

Keywords:

Hemorrhoid surgery, stapled hemorrhoidopexy, Miligan-Morgan hemorrhoidectomy

Abstract

Background: Hemorrhoids being a common anorectal problem with its well known morbidity and complications is treated since long by conservative measures, injection sclerotherapy or rubber banding for 1st and 2nd degree and by open Miligan Morgan hemorrhoidectomy or closed Fergusson hemorrhoidectomy for 3rd and 4th degree. However, since 1998, the adoption of Stapled Hemorrhoidopexy has proved over time to be a better alternative in terms of lesser postoperative complication and an overall patient satisfaction.

Methods: A prospective study conducted on 114 patients at Department of General Surgery, Kalinga institute of Medical Sciences, Bhubaneswar, Odisha from May 2014 to December 2016.

Results: Our study showed stapled hemorrhoidopexy, significantly reduced the time taken for the operative procedure (p <0.001), post operative pain (p <0.01), hospital stay along with early return to work and a better patient satisfaction.

Conclusions: Stapled hemorrhoidopexy is an effective alternative to open Miligan-Morgan procedure in treating 3rd and 4th degree hemorrhoids, in terms of lesser time taken for the operative procedure, post operative pain, use of analgesics, hospital stay and early return to work, better post operative patient’s satisfaction and reduced procedure related complication.

References

Corman ML. Hemorrhoids. In: Corman ML, editor. Colon and rectal surgery. 4th edition. Philadelphia: Lippincott-Raven; 1998:147-205.

Nivatvongs S. Hemorrhoids. In: Gordon PH, Nivatvongs S, editors. Principles and practice of surgery for the colon, rectum, and anus. 2nd edition. St. Louis: Quality Medical Publishing Inc.; 1999:193-215.

Standards Task Force. American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of hemorrhoids. Dis Colon Rectum. 1993;36:1118.

Konsten J, Beaten CGMI. Hemorrhoidectomy vs. Lord's method: 17-year, follow-up of a prospective, randomized trial. Dis Colon Rectum. 2000;43:503.

Cintron JR, Abcarian H. Benign anorectal: Hemorrhoids. The ASCRS textbook of colon and rectal surgery. Springer; 2007:156-177.

Hayssen TK, Luchtefeld MA, Senagore AJ. Limited hemorrhoidectomy: results and long-term follow up. Dis Colon Rectum. 1999;42:909-15.

MEllabban G.Stapled Hemorrhoidectomy versus traditional hemorrhoidectomy for the treatment of hemorrhoids. World J Colorect Surg. 2010;2(1).

Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. In: Mundozzi, editor. 6th World Congress of Endoscopic Surgery. Rome; 1998:777-784.

Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL et al. Stapled hemorrhoidectomy - cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum. 2000;43:1666-75.

Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001;88:1049-53.

Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, et al. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg. 2001;182(l):64-8.

Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg. 2001;88:669-74.

Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled hemorrhoidectomy. Lancet. 2000;355:810.

Beck DE. Hemorrhoidal disease. In: Beck DE, Wexner SD, editors. Fundamentals of anorectal surgery. 2nd editon. London: W.B. Saunders Co.; 1998:237-53.

Kohlstadt CM, Weber J, Prohm P. Stapler hemorrhoidectomy. A new alternative to conventional methods. Zentralbl Chir. 1999;124:238-43.

Baliga K, Chetty DV. Stapler hemorrhoidectomy versus open hemorrhoidectomy. Int Surg J. 2016 Nov;3(4):1001-905.

Ashwani K, Manisha A, Lal RS, Tarun K, Sunita GOpen (Miligan Morgan) hemorrhoidectomy versus stapled hemorrhoidopexy: A comparative study. Br J Med Med Res. 2017;21(12):1-7.

Ng KH, Ho KS, Ooi BS, Tang CL, Eu KW. Experience of 3711 stapled Haemorrhoidectomy operations. Br J Surg. 2006;93:226-230.

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

Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: A systemic review and meta analysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172-8.

Kirsch JJ, Staude G, Herold A. The Longo and Milligan-Morgan hemorrhoidectomy. A prospective comparative study of 300 patients. Chirurg. 2001;72:180-5.

Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomized controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet. 1998; 351:169-72.

Seow-Choen F. Stapled hemorrhoidectomy; pain or gain. Br J Surg. 2001;88:1-3.

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

Chalkoo, M, Ahangar S, Awan N, Dogra V, Mushtaq U, Makhdoomi H. An early experience of stapled hemorrhoidectomy in a medical college setting. Surgic Sci. 2015;6:214-20.

Chalkoo M, Okumura K, Otieno ES. Open (Miligan Morgan) haemorrhoidectomy versus stapled haemorrhoidepexy: a comparative study. Br J Medic Med Res. 2017;21(12):1-7.

Atomizing Hemorrhoids. Available at: www.proctology.us/atomizing.php. Accessed on 10th July 2010.

Downloads

Published

2017-12-26

Issue

Section

Original Research Articles