title: Outcome of stapled haemorrhoidectomy versus Milligan Morgan's haemorrhoidectomy.
abstract: OBJECTIVE
  To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan's open haemorrhoidectomy.
  
  
  METHODS
  Comparative study.
  
  
  METHODS
  Surgical Unit 1, Ward-3, Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi, from March to September 2006.
  
  
  METHODS
  Sixty patients of late 2nd, 3rd and 4th degree haemorrhoids were selected for admission from the outpatient department after taking informed consent. Patients with concomitant anal disease (e.g. fissure, abscess, fistula, ano-rectal cancer etc.) were excluded. Two groups of thirty each were made, one for Milligan-Morgan open haemorrhoidectomy and another for stapled haemorrhoidectomy, in which excision of a ring of mucosa proximal to the haemorrhoid(s) was done thus, interrupting the blood supply but maintaining continuity of the rectal mucosa. The operative time was measured in minutes. Postoperative pain was assessed through VAS. Bleeding was measured as no, mild, profuse. Other post-operative complications during hospital stay like urinary retention, anal stenosis etc. were noted. Student t-test, chi-square test and repeated measured analysis of variance were applied to compare the variables.
  
  
  RESULTS
  The mean age was 40.7+/-11.6 years. A majority (53.3%) of patients (combined % in both groups) had third degree haemorrhoid. The mean length of operative time was found statistically insignificant between open and stapled groups (19.6+/-5.9 vs. 22.4+/-7.2 minutes, p=0.974). However, the mean length of postoperative hospital stay was significantly less in the stapled than open haemorrhoidectomy group (3.37+/-2.2 vs. 2.03+/-0.81 days, p=0.003. Mean postoperative pain (observed by VAS) in the stapled group was significantly less than the open haemorrhoidectomy group (4.43+/-1.25 vs. 7.37+/-0.72). The proportion of postoperative bleeding, infection, anal tag, urinary retention, tenderness on digital rectal examination and wound discharge was higher in open than stapled haemorrhoidectomy group, but statistically insignificant (p < 0.05).
  
  
  CONCLUSIONS
  There was a significant difference between Milligan Morgan's and stapled haemorrhoidectomy for postoperative pain and hospital stay. However the mean length of operative time was insignificantly different.
authors.affiliation: Department of Genral Surgery, Jinnah Postgraduate Medical Centre, Karachi. nawaidfk@yahoo.com
authors.forename: Nawaid Farooque
authors.initials: NF
authors.lastname: Khan
authors.forename: Syed Sagheer
authors.initials: SS
authors.lastname: Hussain Shah
authors.forename: Iram
authors.initials: I
authors.lastname: Bokhari
authors.forename: Samreen
authors.initials: S
authors.lastname: Mahboob
authors.forename: Mansoor Akhtar
authors.initials: MA
authors.lastname: Gulfam
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ghayasuddin
authors.forename: Asadullah
authors.initials: A
authors.lastname: Khan
authors.forename: Shahid
authors.initials: S
authors.lastname: Rasul
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000704:Analysis of Variance; D051517:Digital Rectal Examination; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome