Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy

Abstract

Objective: Stapled mucosectomy has been developed as an alternative to conventional haemorrhoidectomy for the elective treatment of haemorrhoids, but has not been assessed in the emergency setting. The aim of this study was to compare this technique with a conventional procedure for acute thrombosed circumferential prolapsed haemorrhoids.

Patients and methods: A prospective randomized comparison of conventional Milligan-Morgan haemorrhoidectomy and stapled mucosectomy was carried out on 35 consecutive patients presenting with acute thrombosed circumferential prolapsed haemorrhoids. Operative data, postoperative stay, pain assessment and persistent symptoms were compared at discharge and at 2 week and 6 week review. Additionally at 6 week review the time to return to work was recorded and an endoanal ultrasound was carried out.

Results: Thirty patients were randomized and followed up for six weeks. Although postoperative stay and in-hospital analgesia were the same, patients from the stapled group reported significantly more pain at discharge. However, by 2 weeks the conventional group reported significantly higher pain scores particularly on passing stool. By this stage over half the stapled group patients reported no pain at all. More patients in the conventional group complained of persistent symptoms of pain, bleeding and discharge at 2 week and 6 week review with 20% requiring readmission compared with none in the stapled group. The median return to work was significantly shorter for the stapled group (14 days vs 28 days, P < 0.05). Although all patients claimed to be continent, two patients from each group had ultrasonic evidence of internal sphincter damage.

Conclusion: Stapled mucosectomy for acute thrombosed circumferential piles is feasible and may result in less pain, a more rapid resolution of symptoms and an earlier return to work compared with a conventional procedure.