title: PPH vs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse.
abstract: BACKGROUND
  The aim of this study was to assess the early and late complications of haemorrhoidectomy according to Milligan-Morgan (Milligan-Morgan laser optical fibers variant) vs haemorrhoidopexy with PPH-stapler and to assess the long-term results in terms of recurrences in circumferential prolapse patients classified P4-E4 (PATE 2000).
  
  
  METHODS
  Onehundredsixty patients, with haemorrhoidal disease classified P4-E4, who underwent surgery between 2001 and 2007, were included in an retrospective observational study. Group A (M-M laser fibre) 80 patients (50%) (50 Male, 30 Female; median age 39 years, range 23-57 years). Group B (PPH-Stapler) 80 patients (50%) (58 Male, 22 Female; median age 40 years, range 23-60 years).
  
  
  RESULTS
  Early complications were thrombosis (6 cases in M-M vs 1 in PPH) and urinary retention (13 M-M vs 5 PPH). There weren't cases of sepsis. Late complications have been: occasional bleeding 13.5 % in the M-M-group vs 10 % in the PPH-group; defecatory urgency 2.5 % (M-M-group) vs 5% (PPH-group) with p < 0.1; persistent pain 2.5 % (M-M) vs 5 % (PPH) with p < 0.1; soiling 18.75 % (M-M) vs 0 % (PPH) with p < 0.001; recurrences 5 % in PPH-group vs 0 % in M-M (p < 0.05); residual disease 7.5 % in M-M-group vs 0 % in PPH p < 0.01.
  
  
  CONCLUSIONS
  PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement, but may be followed by severe complications. We think that it has a clear indication in the treatment of haemorrhoidary disease with circumferential prolapse classified P4-E4.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sammarco
authors.forename: Francesco
authors.initials: F
authors.lastname: Ferrari
authors.forename: Antonio
authors.initials: A
authors.lastname: Carpino
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Vescio
authors.forename: Michele
authors.initials: M
authors.lastname: Ammendola
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
mesh_terms: D000328:Adult; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012005:Rectal Prolapse / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult