Publication:

Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy for grade III and IV hemorrhoids – a prospective randomized comparative study

Background Surgical management of grade III and IV hemorrhoids is associated with postoperative pain and delayed recovery. Stapled hemorrhoidopexy offers a tissue-preserving alternative to conventional excisional hemorrhoidectomy. This study compared perioperative and early postoperative outcomes of stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy.

Methods This prospective randomized comparative study was conducted over two years at a tertiary care centre. One hundred and twenty patients aged 18-80 years with symptomatic grade III or IV hemorrhoids were randomized equally into two groups: open Milligan-Morgan hemorrhoidectomy (n=60) and stapled hemorrhoidopexy (n=60). Operative time, intraoperative blood loss, postoperative pain assessed using the visual analogue scale (VAS), hospital stay, and early postoperative complications were evaluated. A p value <0.05 was considered statistically significant.

Results Stapled hemorrhoidopexy demonstrated significantly shorter operative time than Milligan-Morgan hemorrhoidectomy (26.41±7.25 versus 37.51±8.16 min; p<0.0001) and lower intraoperative blood loss (10.56±2.89 versus 38.80±8.48 ml; p<0.0001). Postoperative VAS pain scores were significantly lower in the stapled group at 6, 12, 24 and 48 hours and on postoperative day 7 (p<0.0001). Hospital stay was also significantly shorter (1.60±0.73 versus 2.29±0.93 days; p<0.0001). Postoperative bleeding occurred significantly less frequently after stapled hemorrhoidopexy (21.7% versus 53.3%; p=0.0004). Urinary retention was observed in 5.0% versus 15.0%, while anal discharge occurred in 3.3% versus 13.3% of patients in the stapled and open groups, respectively.

Conclusions Stapled hemorrhoidopexy provides significant short-term advantages over Milligan-Morgan hemorrhoidectomy, with reduced operative time, blood loss, postoperative pain, hospital stay, and early morbidity. It represents an effective option for appropriately selected patients with grade III and IV hemorrhoids; however, longer-term studies are required to determine recurrence, functional outcomes, quality of life, and cost-effectiveness.