Milligan Morgan open hemorrhoidectomy versus Longo’s stapled hemorrhoidopexy in treating symptomatic hemorrhoids: A prospective comparative study

Abstract

Background: Milligan Morgan hemorrhoidectomy (open hemorrhoidectomy [OH]) once considered the gold standard surgical technique for hemorrhoids is challenged by stapled hemorrhoidopexy (SH) which claims a better postoperative outcome. The purpose of this study was to compare the outcomes of OH and SH in the Indian context. Materials and Methods: This prospective comparative study included 50 consecutive patients who underwent OH (n = 30) and SH (n = 20) from June 2018 to May 2020 at our institute. The primary outcomes were intra-operative time, postoperative pain assessed by the visual analog scoring system, and duration of stay at the hospital. Patients were clinically assessed at 1 week and 3 months postdischarge, and telephonically interviewed at 3 and 6 months for complications and time taken to resume normal activities. Student t test and chi-square test were used to test the statistical significance of the difference in mean of continuous variables and the difference in the proportion of categorical variables respectively. Results: The mean pain score postOH was found to be significantly higher than post-SH, measured after 3 h (3.47 ± 1.16 vs. 1.90 ± 0.968; P < 0.001), 6 h (5.8 ± 1.4 vs. 3.55 ± 0.99; P < 0.001), and 12 h (5.2 ± 1.7 vs. 1.85 ± 1.387; P < 0.001). The duration of hospital stay post-procedure was higher for OH by 24 h on average (3.1 ± 1.08 days vs. 2.10 ± 1.02 days; P < 0.001). The time that is, taken to resume work after OH was significantly higher (28.3 ± 14.5 vs. 10.85 ± 4.082; P < 0.001). Conclusion: SH has lower post-procedure pain, shorter hospitalization, and faster return to work compared to OH. The incidence of complications was comparable between both groups.

Keywords

• internal hemorrhoids
• open hemorrhoidectomy
• stapled hemorrhoidopexy