Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy : A prospective, randomized, multicenter trial with 2-year postoperative follow up

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 plac...

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Bibliographic Details
Published in:Annals of surgery 2005-07, Vol.242 (1), p.29-35
Main Authors: GRAVIE, Jean Francois, LEHUR, Paul-Antoine, HUTEN, Noël, PAPILLON, Marc, FANTOLI, Michel, DESCOTTES, Bernard, PESSAUX, Patrick, ARNAUD, Jean-Pierre
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chi-Square Distribution
Colonoscopy - methods
Female
Follow-Up Studies
General aspects
Hemorrhoids - diagnosis
Hemorrhoids - surgery
Humans
Male
Medical sciences
Minimally Invasive Surgical Procedures - instrumentation
Minimally Invasive Surgical Procedures - methods
Pain Measurement
Pain, Postoperative - physiopathology
Postoperative Complications
Probability
Prospective Studies
Randomized, Controlled Trials
Rectum - surgery
Risk Assessment
Severity of Illness Index
Surgical Stapling - methods
Time Factors
Treatment Outcome
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Summary: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. 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. 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). 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
ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000169570.64579.31