Stapler hemorrhoidectomy versus Milligan Morgan hemorrhoidectomy in hemorrhoids in terms of post-operative pain and hospital stay - A prospective randomized control trial

Background: Haemorrhoidectomy remains the treatment of choice for symptomatic grade-III and IV hemorrhoids. Milligan and Morgan's haemorrhoidectomy is the most widely used procedure in the surgical management of hemorrhoids. Aim: This study was done to evaluate and analyze statistically whether stapler haemorrhoidectomy is better than Milligan Morgan haemorrhoidectomy in terms of Post operative pain, Duration of Hospital stay. Materials and methods: Prospective analytical study of 124 patients of haemorrhoids Grade II to Grade IV admitted , all adults aged 18 to 75 years with grade II to grade IV haemorrhoids admitted with ASA GRADE < III were included in our study. Two groups were constituted a stapled haemorrhoidectomy group and a Milligan Morgan group operated using standard open haemorrhoidectomy. Pain was assessed and recorded at 0, 15, 30, 45, 60 minutes after the patient attains a score of 4/4 on Bromage scale. Pain was assessed using visual analogue scale (VAS). Results: It was observed that at 0 minutes out of 62 patients in Milligan Morgan group 47 patients had moderate pain, 15 had mild pain. (mean VAS score was 4.242), at 15 minutes out of 62 patients in Milligan Morgan group 38 patients had moderate pain, 24 had mild pain (mean VAS score was 3.82). At 30 minutes out of 62 patients in Milligan Morgan group 25 patients had moderate pain 37 had mild pain (mean VAS score was 3.50).At 45 minutes out of 62 patients in Milligan Morgan group 19 patients had moderate pain 43 had mild pain (mean VAS score 3.342). At 60 minutes out of 62 patients in Milligan Morgan group 14 patients had moderate pain 48 had mild pain.(mean VAS score 3.016)/ In the stapler group the VAS scale at the same intervals were 1.712, 1.06, 0.966, 0.647, and 0.407 respectively. At all the intervals the P value was <0.005. Thus establishing the fact that stapler haemorrhoidectomy is less painful procedure than Milligan Morgan hemorrhoidectomy. The mean duration of hospital stay in the Milligan Morgan group was 2.532 days and stapler haemorrhoidectomy was 1.136 days with a P value <0.005. Conclusion: The circular stapled procedure for haemorrhoids is superior in terms of postoperative pain, discomfort, anaesthesia time and return to normal activity.