[Transfixed stitches technique versus open haemorrhoidectomy. Results of a randomised trial]

Nowadays different surgical techniques are available for the treatment of haemorrhoids even if a general, international consensus is still lacking. The authors, through a personal interpretation of haemorrhoids based on the PATE 2000 Sorrento classification, report on a comparative trial of haemorrhoidectomy by the transfixed stitches technique versus an open surgical technique (Milligan-Morgan). Particular attention was devoted in this prospective randomised trial to analysing the early postoperative side effects (bleeding, urinary retention), the time taken to return to active life and wound healing. Patients with grade III-IV haemorrhoids were enrolled in our study and divided into two groups: one treated by the transfixed stitches technique and the other by the Milligan-Morgan procedure. The main outcome measures such as analgesic use during the first week, early side effects, wound healing and the time taken to return to active life were evaluated. Patients were followed for 6 months after surgery. A total of 160 patients were enrolled, 80 in each group. The pain score after surgery was significantly lower in the transfixed stitches group than in the Milligan-Morgan group (p < 0.01). 30% of the transfixed stitches patients took analgesics in comparison with 90% of the Milligan-Morgan patients (p < 0.01). Postoperative pain after the start of bowel movements in the transfixed stitches group was lower than in the Milligan-Morgan group. Wound healing was immediate in the transfixed stitches patients and was obtained after one month in the open surgery group. Haemorrhoidectomy by the transfixed stitches technique is more advantageous in comparison with the Milligan-Morgan procedure because of its lesser discomfort for the patient, earlier wound healing, milder side effects, shorter surgical time and earlier return to active life.