Stapled and Open
Hemorrhoidectomy: Randomized Controlled Trial of Early
Results
Domenico Palimento, Marcello Picchio, Ugo Attanasio,
Assunta Lombardi, Chiara Bambini, Andrea Renda
A1 Department of Surgery, Civil Hospital
"San Rocco", Via Sessa Mignana, 81037, Sessa Aurunca, Caserta,
Italy
A2 Institute of Statistics,
University "La Sapienza", P. le Aldo Moro 5, 00185, Rome,
Italy
A3 Department of Surgery, University
"Federico II", Via S. Pansini 5, 80131, Naples, Italy
Abstract:
Abstract
The aim of the study was to compare the early results in 52
patients randomly allocated to undergo either stapled or open
hemorrhoidectomy. Seventy-four patients with grade III and IV
hemorrhoids were randomly allocated to undergo either stapled
(37 patients) or open (37 patients) hemorrhoidectomy. Stapled
hemorrhoidectomy was performed with the use of a circular
stapling device. Open hemorrhoidectomy was accomplished
according to the Milligan-Morgan technique. Postoperative pain
was assessed by means of a visual analogue scale (V.A.S.).
Recovery evaluation included return to pain-free defecation
and normal activities. A 6-month clinical follow-up and a 17.5
(10 to 27)-month median telephone follow-up was obtained in
all patients. Operation time for stapled hemorrhoidectomy was
shorter (median 25 [range 15 to 49] minutes versus 30 [range
20 to 44] minutes, p = 0.041). Median (range)
V.A.S. scores in the stapled group were significantly lower
(V.A.S. score after 4 hours: 4 [2 to 6] versus 5 [2 to 8],
p = 0.001; V.A.S. score after 24 hours: 3 [1 to
6] versus 5 [3 to 7], p = 0.000; V.A.S. score
after first defecation: 5 [3 to 8] versus 7 [3 to 9],
p = 0.000). Resumption of pain-free defecation
was significantly faster in the stapled group (10 [6 to 14]
days vs 12 [9 to 19] days, p = 0.001). At
follow-up 4 weeks and 6 months postoperatively the median
(range) symptom severity score was similar in both groups (1
[0 to 2] versus 0 [0 to 3], p = 0.150 and 0 [0
to 2] versus 0 [0 to 2], p = 0.731). At
long-term follow-up occasional pain was present in 6/37 (16.2)
patients in the stapled group and 7/37 (18.9%) in the
Milligan-Morgan group (p = 1.000); episodes of
bleeding were reported by 8/37 (21.6%) patients in the stapled
group and 5/37 (13.5%) patients in the Milligan-Morgan group
(p = 0.542). No problems related to continence
and defecation were reported in either group. Patients were
satisfied with the operation in 33/37 (89.2%) cases in the
stapled group and 31/37 (83.8%) cases in the Milligan-Morgan
group (p = 0.735). Hemorrhoidectomy with a
circular staple device is easy to perform and achieves better
results than the Milligan-Morgan technique in terms of
postoperative pain and recovery. Comparable results are
obtained at long-term follow-up.
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