الفهرس 
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Abstract
Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to compare of Milligan Morgan (MM) hemorrhoidectomy and stapled hemorrhoidectomy (ST) for patients with grade III and IV Hemorrhoids.
Databases were searched through 2012 until 2020 using combinations of the search terms stapled, hemorrhoidectomy, and Milligan-Morgan: PubMed, For inclusion in this meta-analysis, studies had to meet the following criteria:
1. Designed as randomized clinical trial; include adult patients with grade III or IV hemorrhoids.
2. Compare the out-comes for ST versus MM
3. Two evaluation indicators were included: anal stenosis and incontinence. Records identified through database searching were 1350. Studies included in qualitative synthesis were 9.
The outcome measures postoperative complications extracted were incontinence and anal stenosis. For the assessment of long‐term outcomes, a meta-analysis was conducted to quantify the efficacy of stapled haemorrhoidectomy and conventional haemorrhoidectomy.
The 9 trials contained a total of 2218 patients; the largest study was based on 493 patients the smallest on 60 patients. The total patients number with III and IV degree haemorrhoids were 744 and 1494, respectively. A total of 947 patients were treated using the ST technique, and 1271 underwent MM hemorrhoidectomy.
The percentage of patients who have problem incontinence after surgery with total and mean were 13.7 %, 1.52 % in case stapled technique and 31.1 %, 3.46 % with Milligan-Morgan technique, respectively. However, these differences were non-significant by probability (P) 0.1154.
With respect of the strength of the association between the type of surgery and the incidence of incontinence complication the odds ratio was calculated
The odds ratios were ranged between 0.13 – 1.0 in case of stapled technique and was between 1.18-15.1in case conventional haemorrhoidectomy technique. The mean of odds ratio in case of ST was 0.346 while in case MM the odds ratio was 3.748. This result indicated that a complication of incontinence was associated with the MM technique rather than St.
The percentage of patients who have complication of stenosis after surgery with total and mean were 2.95 %, 0.59 % in case stapled technique and 29.62 %, 3.29 % with Milligan-Morgan technique, respectively. The probability (P) of these differences was 0.00071.
The effect of the type of surgery on the occurrence of the complication of incontinence was done by odds ratios. The odds ratio were ranged between 0.13 – 1.0 in case of stapled technique and was between 1.18-15.1 in case conventional haemorrhoidectomy technique. The mean of odds ratio in case of ST was 0.346 while in case MM the odds ratio was 3.748. This result indicated that a complication of incontinence was associated with the MM technique rather than St.
Finally, it is concluded that ST appeared to be better than MM for grade III and IV hemorrhoids based on the current evidence.