Stapled versus open haemorrhoidectomy: a prospective study


  • Serbin Mohammed Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
  • Kavitha Jayanthi Balachandran Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
  • S. Vineed Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India
  • Meer M. Chisthi Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India



Milligan Morgan haemorrhoidectomy, Open haemorrhoidectomy, Stapler haemorrhoidectomy, Stapler haemorrhoidopexy


Background: In this era of staplers and advanced techniques in surgery Milligan Morgan technique of open haemorrhoidectomy is still considered as gold standard procedure for symptomatic haemorrhoids. Stapler haemorrhoidectomy, even though it is practiced in many centres has not become common due to various factors. The present study was done to compare the efficacy, safety and advantages, if any, of the stapled haemorrhoidectomy to open procedure.

Methods: This prospective study was performed in the department of general surgery, Government medical college, Thiruvananthapuram, Kerala over a period of 12 months from March 2015 to March 2016. Symptomatic patients with grade 3 and4 haemorrhoids were selected for the study. The patients were randomized into two equal groups of 20 each. Group A underwent conventional open haemorrhoidectomy and group B, stapled haemorrhoidectomy.

Results: Mean operative time period for group A was 39.25 ±5.5 minutes and group B was 26.75±4.7 minutes. There was significant difference in the pain score between these procedures on first 3 post-operative days. There was also significant difference in group A and group B which was 6.55±1.099 and 3.55±0.759 days respectively for mean hospital stay and 9.90±1.651 and 5.70±0.865 days respectively for return to normal work.

Conclusions: Stapler haemorrhoidectomy is associated with lower pain scores postoperatively and shorter duration of hospital stay with early return to work when compared to conventional open haemorrhoidectomy.

Author Biography

Serbin Mohammed, Department of General Surgery, Government Medical College, Thiruvananthapuram, Kerala, India

Assistant Professor

Department Of General Surgery

Government Medical college,Trivandrum-11



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

Sayfan J, Becker A, Koltun L. Suture less closed haemorrhoidectomy: a new technique. Ann Surg. 2001;234(1):21-4.

Picchio M, Greco E, Di Filippo A, Marino G, Stipa F, Spaziani E. Clinical Outcome Following Haemorrhoid Surgery: a Narrative Review. Indian J Surg. 2015;77(3):1301-7.

Milligan ETC, Morgan CN, Jones CE, Officer R. Surgical anatomy of the anal canal and operative treatment of haemorrhoids. Lancet. 1937;2:1119-24.

Jayaram S, Colguhoun PH, Malthaner RA. Stapled Versus Conventional Surgery for Haemorrhoids. Cochrane Database Syst Rev. 2006;18(4):CD005393.

Ho YH, Seow-Cheon F, Tan M, Leong AFPK. Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg. 1997;84:1729-30.

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

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

Cheetham MJ, Mortensen NJM, Nystom PO, Kamm MA, Phillips RKS. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet. 2000;356:730-3.

Ho YH, Tsang C, Tang CL, Nyam D, Eu KW, Seow-Choen F. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry. Dis Colon Rectum. 2000;43:169-73.

Maria G, Brisinda G, Civello IM. Anoplasty for the treatment of anal stenosis. Am J Surg. 1998;175(2):158-60.

Beattie GC, Lam JPH, London MA. A prospective evaluation of the introduction of circumferential stapled anoplasty in the management of hemorrhoids and mucosal prolapse. Colorectal Dis.1999;2:137-42.

Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision Hemorrhoidectomy: longterm results of a prospective randomized trial. Arch Surg. 2002;137:337-40.

Plocek MD, Kondylis LA, Floyd ND, Reilly JC, Geisler DP, Kondylis PD. Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum. 2006;49:1905-9.

Wani MD, Mir SA, Javaid S, Watali Y. Open hemorrhoidectomy versus stapler hemorrhoidopexy: A prospective study. Arch Clin Exp Surg. 2017;6:66-73.

Pescatori M. Transanal stapled excision of rectal mucosal prolapse. Tech Coloproctol. 1997;1:96-8.

Wong LY, Jiang JK, Chang SC, Lin JK. Rectal perforation: a life-threatening complication of stapled hemorrhoidectomy. Dis Colon Rectum. 2003;46:116-7.

Cipriani S, Pescatori M. Acute rectal obstruction following PPH hemorrhoidectomy. Colorectal Dis. 2002;4:367-70.

Molloy RG, Kingsmore D. Life-threatening pelvic sepsis after stapled hemorrhoidectomy. Lancet. 2000;355:810.

Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum. 2004;47(11):1837-45.






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