The tissue selecting technique (TST) versus the Milligan–Morgan hemorrhoidectomy for prolapsing hemorrhoids: a retrospective case–control study

Abstract

Milligan-Morgan hemorrhoidectomy (MMH) is the procedure of choice in the management of hemorrhoidal disease. However, this procedure is associated with significant postoperative pain. Tissue selecting technique (TST) is a segmental stapled hemorrhoidopexy, which aims to reduce the postoperative pain, rectovaginal fistula (RVF) and rectal stenosis. The aim of the present study was to compare the clinical outcomes between TST and MMH. A case-control study was undertaken to investigate the difference in clinical characteristics between the patients treated with TST and those treated with MMH. Intraoperative and postoperative parameters in both groups were collected and compared. One hundred and ninety-five eligible patients underwent either TST (n=121) or MMH (n=74). The pain score was significantly less in the TST group than that in the MMH group at the first defecation and at 12h, day 3 and day 7 postoperatively (P=0.001). Further analysis revealed that, at the time point of 12h, day 3, day 7 and during first defecation, the pain score in the TST group and TST+STE group was less than that in the MMH group (P=0.001). No patient in either group developed postoperative rectal stenosis. Furthermore, no case of RVF was identified in the TST group. The 1-year recurrence rate was 3.3% (4/121) and 2.7% (2/74), respectively, in TST and MMH groups (P=1.0). The 1-year recurrence rate after TST and MMH for the treatment of patients with grade III-IV hemorrhoids is similar. It is encouraging that TST is associated with less postoperative pain and no RVF or rectal stenosis.