Stapling procedure for hemorrhoids versus conventional haemorrhoidectomy

Forty patients admitted at the Saudi German Hospital were randomly assigned to Milligan-Morgan haemorrhoidectomy (n = 20) or the circular stapled procedure. Under general anesthesia patients underwent standardized haemorrhoidectomy or had a circumferential doughnut of rectal mucosa and submucosa above the dentate line excised and closed with a standard circular end to end stapling device. All patients received the same preoperative and postoperative analgesic and laxative regimens. Patients completed linear analogue pain charts each day and were interviewed at 1, 3, and 12 weeks postoperatively. Summary measures of average pain experience were calculated from 10 cm linear analogue pain scores and were used as the primary outcome measure. The stapled group was found to have shorter anesthesia time (9-25 minutes, median 18) versus (15-35 minutes, median 22). Average pain in the stapled group was significantly lower than it was in the Milligan-Morgan group (0.2-7.6, median 2.1) versus (3.1-8.5, median 6.5). Hospital stay and time to first bowel motion were not significantly different between both groups. Return to normal activity was significantly shorter in the stapled group (3-60 days, median 17) versus (14-90 days, median 34). Early and late complications, patient assessed symptom control, and functional outcome appear to be similar after short term follow up.