Abstract
Purpose: The aim of this study was to compare, postoperative complications and effects on healing duration of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy.
Materials and Method: This trial was a prospective randomized study. 30 patients, in two groups, were included in this study who underwent stapled haemorrhoidopexy (16 patients) and Milligan-Morgan haemorrhoidectomy (14 patients).
Results: There were 9 male and 7 female patients in stapled haemorrhoidopexy group and the mean age was 44.6 (range 25-64). The Milligan-Morgan haemorrhoidectomy group had 9 male and 5 female patients and the mean age was 40.07 (range 22-61). Patients in both groups have 3rd and 4th degree haemorrhoidal disease. Preoperative faecal continence scoring was assessed and rectoscopy was performed in all patients. Postoperatively pain scores measured by visual analoge scale (=VAS) at 1st, 3rd and 7th days and urinary retention, bleeding, postoperative continence and pain scoring was assessed. In stapled haemorrhoidopexy group; postoperative pain scores at all times were lower ( day 1; 2,56 vs 4,5 day 3; 2,56 vs 4,92 day 7; 1,75 vs 2,71). Bleeding was higher at 1st-3rd days in Milligan-Morgan group (6 vs 11). There were no statistical differences for other complications.
Conclusion: Stapled haemorrhoidopexy is a safe and effective method that is associated with reduced postoperative pain and bleeding.
Keywords:
Haemorrhoidal disease, stapled haemorrhoidopexy, Milligan-Morgan haemorrhoidectomy, heamorrhoidectomy
References
1Thomson WH. The nature of hemorroids. Br J Surg, 1975;62:542-552.
2Dixon MR, Stamos MJ, Grant SR, et al. Stapled hemorrhoidectomy: a review of our early experience. Am Surg, 2003;69:862-865.
3Vanheuverzwyn R, Colin JF, Van Wymersch T, et al. Hemorrhoids. Review. Acta Gastroenterol Belg 1995;58:452-464.
4Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. 6th World Congress of Endoscopic Surgery, 1998; 777-784.
5Carol E. H. Scott-Conner. Chassin'in Genel Cerrahide Ameliyat Stratejileri Genişletilmiş Teknik Atlas (Çeviri Editörleri: Özmen MM, Sayek İ.) Üçüncü Baskı. Ankara. Güneş Kitabevi, 2005:528-535.
6Pigot F, Siproudhis L, Allaert FA. Risk factors associated with haemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol, 2005; 29:1270-1274.
7Boccasanta P, Venturi M, Orio A, et al. Circular hemorrhoidectomy in advanced hemorrhoidal disease. Hepatogastroenterology, 1998;45:969-972.
8Kohlstadt CM, Weber J, Prohm P. Stapled hemorrhoidectomy. A new alternative conventional method. Zentralbl Chir, 1999;124:238-243.
9Terzi C, Füzün M. Anorektumun Benign Hastalıkları. Sayek İ. Temel Cerrahi 3. Baskı. Ankara: Güneş Kitabevi, 2004:1256-1268.
10Seow-Choen F. Stapled hemorrhoidectomy: pain or gain. Br J Surg, 2001;88:1-3.
11Hetzer FH, Demartines N, Handschin AE, et al. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg, 2002;137:337-340.
12Pavlidis T, Papaziogas B, Souparis A, et al. Modern stapled Longo procedure vs conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis, 2002;17:50-53.
13O'Bichere A, Laniado M, Sellu D. Stapled haemorrhoidectomy: a feasible day-case procedure. Br J Surg, 1998;85:377-378.
14Carapeti EA, Kamm MA, McDonald PJ, et al. Randomized trial open versus closed day-case haemorrhoidectomy. Br J Surg, 1999;86:612-613.
15Sutherland LM, Burchard AK, Matsuda K,et al, A systematic review of stapled hemorrhoidectomy. Arch Surg, 2002;137:1395-1406.
16Fantin AC, Hetzer FH, Christ AD, et al. Influence of stapler haemorrhoidectomy on anorectal function and on patients' acceptance. Swiss Med Wkly, 2002;132:38-42.
17Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy. Cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry and endoanal ultrasound assesments at up to three months. Dis Colon Rectum, 2000;43:1666-1675.
18Pescatori M. Stapled rectal prolapsectomy. Dis Colon Rectum, 2000;43:867-877.
19Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet, 2000;355:810-813.
20Cheetham MJ, Mortensen NJ, Nystrom PO,et al. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet, 2000;356:730-733.
21Demirbaş S, Aktaş O, Öğün İ ve ark. Grade 3-4 Hemoroidlerde sirküler stapler kullanımı ile yapılan hemoroidektomi. Türkiye Klinikleri J Med Sci, 2002;22:36-41.