Comparison between stapler hemorrhoidectomy and open hemorrhoidectomy in the management of grade III and IV hemorrhoids: a prospective randomized study

Shailendra Pal Singh, Somendra Pal Singh, Vipin Gupta, Kutubuddin Quadri, Mohit Gupta


Background: Haemorrhoids are one of the most common anorectal disorders. Haemorrhoids or piles are dilated veins of the anal canal and are more common in obesity, constipation and pregnancy. Classically they occur in the 3, 7 and 11 o'clock position with the patient in lithotomy position. Symptoms of haemorrhoids are per rectal bleeding and prolapse. Bleeding is bright red in colour and which is painless. The aim of the study was to compare the early results in 60 patients randomly allocated to undergo either stapled or open hemorrhoidectomy.

Methods: Out of 60 patients, 30 (50.0%) patients underwent hemorrhoidectomy by Open Milligan-Morgan’s method were classified as Group A while rest 30 (50.0%) patients underwent hemorroidectomy by Stapler method after anal stretching, these patients were classified as Group B.

Results: Pain score of majority of patients of Group A was ≥7 (76.7%), only 6.7% had pain score <3 and rest 16.7% had pain score 3 to 6. On comparing the difference of pain in passage of first stool among patients of Group A and Group B statistically was found to be highly significant. Pain in follow up at 3, 7 and 15th day was also significantly higher in group A in comparison to group B.

Conclusions: Of the 60 patients in the current study, 32 are still in the follow up with the maximum follow up period of 11 months. There was no case of recurrence of haemorrhoids in this study. The factor of cost was not evaluated in the study since the hospital stay as well as stapling instrument was totally free in U.P, UMS, Saifai.


Ferguson, Hemorrhoids, Milligan Morgan, Stapler

Full Text:



Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for haemorrhoids. Cochrane Database Syst Rev. 2006; 18:CD005393.

Mattana C, Coco C, Manno A, Verbo A, Rizzo G, Petito L, et al. Stappled haemorrhoidopexy and Milligan Morgan haemorrhoidectomy in the cure of fourth degree haemorrhoids: long term evaluation and clinical results. Dis Colon Rectum. 2007; 50:1770-7

Senagore AJ, Singer M, Abcarian H. A prospective, randomized, controlled multicenter trial comparing stapled haemorrhoidopexy and Ferguson haemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum. 2004;47:1824-36.

Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg. 2001;88:669-74.

Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with circular suturing device: a new procedure. 6th World Congress Endosco Surg; Rome;1998:777-84.

Corman ML, Gravié JF, Hager T, Arnaud JP, Pessaux P, Huten N, et al. Stapled haemorrhoidopexy: a consensus position paper by an international working party-indications, contraindications and technique. Colorectal Dis. 2001;3:374-9.

Lan P, Wu X, Zhou X,Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172-8.

Mehingan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet.2000;355:782-5.

Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet. 2000;355:779-1.

Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow Choen F. Stapled haemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence score, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum. 2000;43:1666-75.

Halaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001;88:1049-53.

Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, et al. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular haemorrhoidectomy in advanced haemorrhoids with external mucosal prolapse. Am J Surg. 2001; 182:64-8.

Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorroidectomy) versus conventional haemorrhoidectomy: randomized controlled trail Lancet. 2000;355:779-81.

Pavlidis T, Papaziogas B, Souparis A, Patsas A, Koutelidakis I, Papaziogas T. Modern stapled Longo procedure vs conventional millyan-Margan haemorrhoidectomy: a randomized controlled trial. Int J Colorecal Dis 2002;7:50-3.

Sachin ID, Muruganathan OP. Stapled hemorrhoidopexy versus open hemorrhoidectomy: a comparative study of short term results. Int Surg J. 2017;4:472-8.

Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL et al. Stapled haemorrhoidectomy– cost and effectiveness: Randomized controlled trail including incontinence scoring, anorectal manometery, an endoanal ultrasound assessment at up to three months. Dis Colon Rectum 2000;43:1666-75.

P Thejeswi, Laxman, Y Kumar, S Ram.Comparison of surgical treatment of hemorrhoids-Stapled versus Open and Closed hemorrhoidectomy. Internet J Surg.2012;28:2.

Ortiz H, Marzo J, Armenderiz P. Randomized Clinical tral of stapled haemorrhoidopexy versus conventional diatermy haemorrhoidectomy. Br J Surg. 2002;89:1376-81.