Stapled haemorrhoidectomy compared with Milligan-Morgan excision for the treatment of prolapsing haemorrhoids: a prospective study.
ABSTRACT To compare stapled haemorrhoidectomy with Milligan-Morgan haemorrhoidectomy.
Prospective open study.
Teaching hospital, Greece.
85 patients with prolapsing haemorrhoids were invited to choose between stapled and Milligan-Morgan haemorrhoidectomy. 48 chose the former and 37 the latter.
Operation. Postoperatively, the patients were given analgesics on demand, and were discharged as soon as their condition and particularly their pain had improved.
Patients' symptoms and their opinion about the procedures, which were recorded during their follow-up which lasted for 6 months.
Stapling resulted in a significantly shorter operating time, and less postoperative pain and other symptoms, than Milligan-Morgan excision (p < 0.001). Postoperative complications, and mean time in hospital did not differ significantly between the two groups. During the follow-up period there was no significant difference in the incidence of recurrences between the two groups. Six months after the operation, significantly more patients in the stapled group had residual skin tags-external haemorrhoids than in the Milligan-Morgan group, and all these patients had fourth degree haemorrhoids.
Stapled haemorrhoidectomy is a promising method of treatment for prolapsing third degree haemorrhoids. Its effectiveness is questionable for fourth degree ones. Initially, the results are as good as after Milligan-Morgan haemorrhoidectomy, especially for third degree haemorrhoids. However, more patients and longer follow-up periods are required for its long-term efficacy to be confirmed.
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ABSTRACT: Stapled haemorrhoidopexy (SH) is associated with low postoperative pain but, when performed for advanced piles, carries high recurrence rates. The aim of our study was to assess our long-term results after SH for third-degree haemorrhoids. A total of 126 consecutive patients (67 men and 59 women) with third-degree haemorrhoids underwent SH in our unit between 1998 and 2002. Of these, 120 (95.2%) were followed up in the outpatient department after a median interval of 61.5 months (range, 38-84 months). During the postoperative period, 7 patients (5.8%) experienced pain for 5-12 days, which was treated with oral analgesia. Seven patients (5.8%) experienced gas incontinence and one of them also reported soiling; the incontinence subsided within 2-8 weeks. Recurrence of the haemorrhoidal disease occurred in 8 patients (6.6%). SH is a safe, low-pain and, in the long-term, effective technique for the treatment of third-degree haemorrhoids.Techniques in Coloproctology 04/2006; 10(1):47-9. · 1.29 Impact Factor
Article: Emorroidectomia sec. Milligan-Morgan vs. mucoprolassectomia rettale secondo Longo: tecniche chirurgiche a confronto[show abstract] [hide abstract]
ABSTRACT: Premessa Nel campo della proctologia le emorroidi rappresentano la pa-tologia più comune. Tutti i trattamenti proposti hanno registrato dei miglioramenti nel ridurre la sintomatologia dolorosa e la morbilità. Scopo dello studio Scopo dello studio è confrontare i risultati a breve e a lungo ter-mine delle due tecniche chirurgiche più applicate: l'emorroidecto-mia sec. Milligan-Morgan (MM) e la muco-prolassectomia rettale sec. Longo (RMP). Metodi Sono stati arruolati 170 pazienti consecutivi sottoposti ad inter-vento chirurgico tra il 1998 e il 2000; 70 pazienti sono stati sotto-posti a MM (Gruppo A) e 100 a RMP (Gruppo B). La stadiazione patologica comprendeva nel Gruppo A il 15,7% di pazienti allo sta-dio II, il 58,6% allo stadio III ed il 25,7% allo stadio IV; il Gruppo B comprendeva il 4% di pazienti allo stadio II, il 79% allo stadio III e il 17% allo stadio IV. I pazienti sono stati intervistati telefoni-camente nel luglio del 2003 dopo un follow-up variabile dai 30 ai 65 mesi. Risultati L'incidenza complessiva delle complicanze precoci è risultata maggiore nel Gruppo A (15,7%) rispetto al Gruppo B (8%, p = 0,05). Abbiamo registrato 7 casi (10%) di complicanze tardive nel Gruppo A e 10 (10%) nel Gruppo B. Sintomi residui erano presenti nel 32,8% dei pazienti del Gruppo A e nel 20% dei pazienti del Gruppo B. La recidiva o la persistenza di prolasso emorroidario si è verificata nell'1,4% dei pazienti del Gruppo A e nel 2% nel Gruppo B. Il livello di soddisfazione (soddisfatto o molto soddi-sfatto) per il Gruppo A è stato dell'84,3% e del 90% nel Gruppo B.Ospedali d'Italia - chirurgia 09/2005; 4.
Article: External validation of Cleveland Clinic Foundation colorectal cancer model in a University Clinic in terms of predicting operative mortality.[show abstract] [hide abstract]
ABSTRACT: The aim of this study was to perform an external validation of Cleveland Clinic Foundation colorectal cancer model in a single center. Relevant data of 771 patients who underwent surgery for colorectal cancer between January 1997 and November 2008 were retrospectively collected. The performance of the scoring system was evaluated by discrimination and calibration. Discrimination was evaluated by using the area under the receiver operator characteristics curve and calibration by using the Hosmer-Lemeshow goodness-of-fit test. Mean age was 60.8 (18-91). Forty-four percent of patients were female, and 56% were male. Overall mortality was 3.9%. Cleveland Clinic Foundation colorectal cancer model showed good discrimination but poor calibration. These data suggest that the Cleveland Clinic Foundation colorectal cancer model is a suitable model to be used in our center for patients with colorectal cancer but requires recalibration.Techniques in Coloproctology 12/2009; 14(1):9-12. · 1.29 Impact Factor