22448
document
Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy : a prospective , randomized , multicenter trial with 2-year postoperative follow up . PURPOSE The purpose of this study was to compare the outcome of stapled hemorrhoidopexy ( SH group ) performed using a circular stapler with that of the Milligan-Morgan technique ( MM group ) . The goals of the study were to evaluate the efficacy and reproducibility of stapled hemorrhoidopexy and define its place among conventional techniques . METHODS A series of 134 patients were included at 7 hospital centers . They were randomized according to a single-masked design and stratified by center ( with balancing every 4 patients ) . Patients were clinically evaluated preoperatively and at 6 weeks , 1 year , and a minimum of 2 years after treatment . Patients completed a questionnaire before and 1 year after surgery to evaluate symptoms , function , and overall satisfaction . RESULTS The mean follow-up period was 2.21 years +/- 0.26 ( 1.89-3.07 ) . Nine patients ( 7 % ) could not be monitored at 1 or 2 years , but 4 of these 9 nevertheless filled in the 1-year questionnaire . The patients in the SH group experienced less postoperative pain/discomfort as scored by pain during bowel movement ( P < 0.001 ) , total analgesic requirement over the first 3 days ( according to the World Health Organization [ WHO ] class II analgesics [ P = 0.002 ] ; class III [ P = 0.066 ] ) , and per-patient consumption frequency of class III analgesics ( P = 0.089 ) . A clear difference in morphine requirement became evident after 24 hours ( P = 0.010 ) . Hospital stay was significantly shorter in the SH group ( SH 2.2 +/- 1.2 [ 0 ; 5.0 ] versus MM 3.1 +/- 1.7 [ 1 ; 8.0 ] P < 0.001 ) . At 1 year , no differences in the resolution of symptoms were observed between the 2 groups , and over 2 years , the overall incidence of complications was the same , specifically fecaloma ( P = 0.003 ) in the MM group and external hemorrhoidal thrombosis ( P = 0.006 ) in the SH group . Impaired sphincter function was observed at 1 year with no significant difference between the groups for urgency ( 12 % ) , continence problems ( 10 % ) , or tenesmus ( 3 % ) . No patient needed a second procedure for recurrence within 2 years , although partial residual prolapse was detected in 4 SH patients ( 7.5 % ) versus 1 MM patient ( 1.8 % ) ( P = 0.194 ) . CONCLUSION Stapled hemorrhoidopexy causes significantly less postoperative pain . The technique is reproducible and can achieve comparable outcomes as those of the MM technique as long as the well-described steps of the technique are followed . Like with conventional surgery , anorectal dysfunction can occur after stapled hemorrhoidopexy in some patients . Its effectiveness in relieving symptoms is equivalent to conventional surgery , and the number of hemorrhoidal prolapse recurrences at 2 years is not significantly different . Hemorroidopexy is applicable for treating reducible hemorrhoidal prolapse .
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Intervention_Surgical
Stapled hemorrhoidopexy
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Intervention_Surgical
milligan-morgan hemorrhoidectomy
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Intervention_Surgical
stapled hemorrhoidopexy ( SH group )
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Intervention_Surgical
Milligan-Morgan technique ( MM group )
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Intervention_Surgical
stapled hemorrhoidopexy
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Intervention_Educational
questionnaire
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Intervention_Surgical
SH
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Intervention_Surgical
SH
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Intervention_Surgical
MM
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Intervention_Surgical
MM
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Intervention_Surgical
SH
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Intervention_Surgical
SH
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Intervention_Surgical
MM
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Intervention_Surgical
Stapled hemorrhoidopexy
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Intervention_Surgical
MM
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Intervention_Surgical
surgery
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Intervention_Surgical
stapled hemorrhoidopexy
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Intervention_Surgical
Hemorroidopexy
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Outcome_Other
Stapled hemorrhoidopexy
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Outcome_Other
milligan-morgan hemorrhoidectomy
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Outcome_Other
stapled hemorrhoidopexy
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Outcome_Other
efficacy and reproducibility
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Outcome_Pain
postoperative pain/discomfort
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Outcome_Pain
pain during bowel movement
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Outcome_Other
total analgesic requirement over the first 3 days
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Outcome_Other
morphine requirement
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Outcome_Other
Hospital stay
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Outcome_Other
resolution of symptoms
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Outcome_Adverse-effects
overall incidence of complications
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Outcome_Adverse-effects
fecaloma
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Outcome_Adverse-effects
external hemorrhoidal thrombosis
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Outcome_Adverse-effects
Impaired sphincter function
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Outcome_Adverse-effects
partial residual prolapse
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Outcome_Pain
postoperative pain
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Outcome_Adverse-effects
anorectal dysfunction
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Outcome_Other
effectiveness
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Outcome_Adverse-effects
number of hemorrhoidal prolapse recurrences at 2 years
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Participant_Condition
hemorrhoidectomy
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Participant_Sample-size
134