title: Stapled hemorrhoidopexy and Milligan Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: long-term evaluation and clinical results.
abstract: OBJECTIVE
  The long-term results after stapled hemorrhoidopexy compared with Milligan-Morgan procedure are discussed.
  
  
  METHODS
  The clinical data of 100 patients treated by Milligan-Morgan procedure or stapled hemorrhoidopexy for fourth-degree hemorrhoids have been reviewed. All patients were visited and submitted to a questionnaire to evaluate resumption of symptoms, functional results, and recurrence rate.
  
  
  RESULTS
  The mean follow-up was 54 months for stapled hemorrhoidopexy and 92 months for the Milligan-Morgan procedure. Postoperative pain and return to normal activity were worse in the Milligan-Morgan procedure (Visual Analog Scale 8.56 vs. 5.46, P < 0.001; and 2.4 vs. 2 weeks, P value = 0.018). Eight percent of patients who had stapled hemorrhoidopexy complained of spontaneous pain or pain during defecation vs. 0 percent of patients who underwent the Milligan-Morgan procedure. We noted that there was bleeding in 14 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P < 0.006), tenesmus in 32 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure (P < 0.001), and pruritus in 4 percent of stapled hemorrhoidopexy vs. 0 percent of Milligan-Morgan procedure. Minor leakage was similar in the two groups. Flatus impaired control was less frequent in Milligan-Morgan. The relative risk of recurrence for stapled hemorrhoidopexy compared with Milligan-Morgan procedure was 1.18 (95 percent confidence interval 1< relative risk < 1.4). No statistical difference was noted in patients' satisfaction after the procedures.
  
  
  CONCLUSIONS
  Long follow-up seems to indicate more favorable results in Milligan-Morgan procedure in terms of resumption of symptoms and risk of recurrence.
authors: Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
authors: Claudio
authors: C
authors: Mattana
authors: Claudio
authors: C
authors: Coco
authors: Alberto
authors: A
authors: Manno
authors: Alessandro
authors: A
authors: Verbo
authors: Gianluca
authors: G
authors: Rizzo
authors: Luigi
authors: L
authors: Petito
authors: Daniel
authors: D
authors: Sermoneta
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling; D016896:Treatment Outcome