PPH vs Milligan-Morgan: early and late complications in the treatment of haemorrhoidal disease with circumferential prolapse.

BACKGROUND

The aim of this study was to assess the early and late complications of haemorrhoidectomy according to Milligan-Morgan (Milligan-Morgan laser optical fibers variant) vs haemorrhoidopexy with PPH-stapler and to assess the long-term results in terms of recurrences in circumferential prolapse patients classified P4-E4 (PATE 2000).

METHODS

Onehundredsixty patients, with haemorrhoidal disease classified P4-E4, who underwent surgery between 2001 and 2007, were included in an retrospective observational study. Group A (M-M laser fibre) 80 patients (50%) (50 Male, 30 Female; median age 39 years, range 23-57 years). Group B (PPH-Stapler) 80 patients (50%) (58 Male, 22 Female; median age 40 years, range 23-60 years).

RESULT: Early complications were thrombosis (6 cases in M-M vs 1 in PPH) and urinary retention (13 M-M vs 5 PPH). There weren't cases of sepsis. Late complications have been: occasional bleeding 13.5 % in the M-M-group vs 10 % in the PPH-group; defecatory urgency 2.5 % (M-M-group) vs 5% (PPH-group) with p < 0.1; persistent pain 2.5 % (M-M) vs 5 % (PPH) with p < 0.1; soiling 18.75 % (M-M) vs 0 % (PPH) with p < 0.001; recurrences 5 % in PPH-group vs 0 % in M-M (p < 0.05); residual disease 7.5 % in M-M-group vs 0 % in PPH p < 0.01.

CONCLUSIONS

PPH-stapler procedure for treatment of haemorrhoidal prolapse is an important improvement, but may be followed by severe complications. We think that it has a clear indication in the treatment of haemorrhoidary disease with circumferential prolapse classified P4-E4.