Comparative study between Milligan-Morgan hemorrhoidectomy, stapled hemorrhoidopexy, and laser hemorrhoidoplasty in patients with third degree hemorrhoids: a prospective study

Abstract

Context Hemorrhoids are dilated blood vessels under the anal mucosa. Hemorrhoids are classified into four degrees. The third and fourth include severe prolapse requiring surgical intervention. Many methods of treatment are available. Aim This study aimed to compare Milligan-Morgan hemorrhoidectomy, stapling hemorrhoidopexy, and laser hemorrhoidoplasty (LHP) in patients with third degree hemorrhoids. Settings and design This is a prospective randomized comparative study. Materials and methods A total of 120 patients were included. The study took place from April 2017 till October 2019. The patients were allocated into three groups, with 40 patients each: groups A (Milligan-Morgan hemorrhoidectomy), B (stapling hemorrhoidopexy), and C (LHP). Operative time, hospital stay, return to daily activities, postoperative pain, urinary retention, postoperative hemorrhage, recurrence, and anal stenosis were assessed. Statistical analysis Continuous variables were expressed as mean and SD. Categorical variables were expressed as frequencies and percentage. Results The operative time was 27.5±5.3, 25.9±4.7, and 22.8±3.9 min in groups A, B, and C, respectively; the hospital stay was 2.1±0.6, 1.1±0.3, and 0.7±0.3 days, respectively; and time to return to activity was 26.2±4.3, 17.2±4.5, and 11.3±2.4 days, respectively. Postoperative pain (visual analog scale) on day 1 was 6.9±1.1, 4.5±0.8, and 2.8±0.5 in groups A, B, and C, respectively; on week 1 was 5.2±0.9, 2.5±0.8, and 0.8±0.5, respectively in groups A, B, and C, respectively; and on week 2 was 4.1±0.8 and 0.7±0.6 in groups A and B, respectively. On week 3, it was 2.9±0.7, on week 4 was 1.2±0.7, and on week 8 was 0.4±0.5 in group A. On week 1, postoperative bleeding occurred in 27, eight, and three patients in groups A, B, and C, respectively. On week 2, postoperative bleeding was seen in 15 and two patients in groups A and B, respectively. On week 3, postoperative bleeding was seen in 12 patients and on week 4 in one patient in group A. Urine retention occurred in three and two patients in groups A and B, respectively. Recurrence occurred in one, three, and four patients in groups A, B, and C, respectively. Anal stenosis occurred in two patients in group A. Conclusions This study clarified that LHP is the most suitable technique for primary third degree hemorrhoids. However, a large-scale study has to be carried out for clarification of the minor differences.