title: Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy.
abstract: BACKGROUND
  Recently, it has been demonstrated that surgical treatment of hemorrhoids in a day-care basis is possible and safe. The aim of this study was to compare the Longo stapled hemorrhoidopexy (SH) and the Milligan-Morgan hemorrhoidectomy (MMH).
  
  
  METHODS
  One hundred seventy one patients (95 cases in SH group and 76 cases in MMH group) entered the study: 83 cases were III degree hemorrhoids, 88 IV degree. A priori and a post hoc power analysis were performed. Results, prospectively collected, were compared using chi squared test and student t test. Visual analog scale was used for pain evaluation. Postoperative pain, duration of pain, wound secretion, bleeding, resumption of a normal lifestyle, and postoperative complication were evaluated.
  
  
  RESULTS
  Surgical time was 28.41+/-10.78 for MMH and 28.30+/-13.28 min in SH (P=0.94). Postoperative pain was not different between MMH and SH during the first two postoperative days (4.73+/-2.91 vs 5.1+/-3.048; P=0.4), during the following 6 days, patients treated with SH had less pain (4.63+/-2.04 in MMH vs 3.60+/-2.35 in SH; P=0.006). In the SH group, seven patients needed further hospital stay for complicated course. SH showed higher incidence of anal fissure compared with MMH (6.3% vs 0%; P=0.025) but no differences in urinary retention, anal stricture, urgency, or anal hemorrhage.
  
  
  CONCLUSIONS
  This study confirms that SH is associated with less postoperative pain and shorter postoperative symptoms, compared with MMH. SH may be a viable addition to the therapy for hemorrhoids with some advantages in early postoperative pain and some disadvantages in postoperative complications and costs.
authors.affiliation: Department of Surgery, Università Tor Vergata, Rome, Italy. vito.stolfi@tiscali.it
authors.forename: Vito Maria
authors.initials: VM
authors.lastname: Stolfi
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Chiara
authors.initials: C
authors.lastname: Micossi
authors.forename: Isabella
authors.initials: I
authors.lastname: Carbonaro
authors.forename: Marco
authors.initials: M
authors.lastname: Venza
authors.forename: Paolo
authors.initials: P
authors.lastname: Gentileschi
authors.forename: Piero
authors.initials: P
authors.lastname: Rossi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Falchetti
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspari
mesh_terms: D000556:Ambulatory Surgical Procedures; D004724:Endoscopy; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain; D017792:Surgical Stapling