Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial

Background Surgical haemorrhoidectomy has a reputation for being a painful procedure for a fairly-benign disorder. The circular transanal stapled tech nique for the treatment of haemorrhoids has the potential to offer a less p ainful rectal procedure in place of ablative perianal surgery. We compared the short-term outcome of the circular stapled procedure for haemorrhoids w ith current standard surgery in a randomised controlled trial. Methods 40 patients admitted for surgical treatment of prolapsing haemorrho ids were randomly assigned to Milligan-Morgan haemorrhoidectomy (n=20) or t he circular stapled procedure. Under general anaesthesia patients underwent standardised diathermy excision haemorrhoidectomy or had a circumferential doughnut of rectal mucosa and submucosa above the dentate line excised and closed with a standard circular end-to-end stapling device. All patients r eceived standardised preoperative and postoperative analgesic and laxative regimens. Patients completed linear analogue pain charts each day and were interviewed at 1, 3, and 6-10 weeks postoperatively. Summary measures of av erage pain experience were calculated from 10 cm linear analogue pain score s and were used as the primary outcome measure. Findings The stapled group had shorter anaesthesia time (median 18 [range 9 -25] vs 22 [15-35] mins). Average pain in the stapled group was significant ly lower than it was in the Milligan-Morgan group (2.1[0.2-7.6] vs 6.5 [3.1 -8.5], 95.1% CI difference medians 1.9-4.7, p<0.0001. Mann-Whitney U test). Average pain relative to what the patient expected was also significantly less in the stapled group (-2.8 [-4.4 to 1.3] vs 0.7 [-1.8 to 3.4]. Hospita l stay and time to first bowel motion were not significantly different betw een groups. Return to normal activity was significantly shorter in the stap led group (1.7 [3-60] vs 34 [14-90]. Early and late complications, patient- assessed symptom control, and functional outcome appear similar after short -term follow-up Interpretation The circular stapled technique offers a significantly less p ainful alternative to Milligan-Morgan haemorrhoidectomy and is associated w ith an earlier return to normal activity. Early symptom control and functio nal outcome appear similar. However, long-term symptomatic and functional o utcome need further study.