الفهرس 
SURGICAL ANATOMY OF THE RECTUM, ANAL CANAL, AND PERINEUMOnly 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
H
emorrhoids are one of the commonest benign anorectal problems worldwide. Hemorrhoids are usually considered the most troublesome anal diseases. They can slide down, prolapse, dilate, and bleed occasionally.
Millions of people are affected around the world. It is a major medical and socioeconomic problem. The etiology of hemorrhoids includes many factors such as constipation and prolonged straining.
Hemorrhoids are classified into four degrees. The first and second degrees require conservative or semiconservative methods. The third and fourth degrees include severe prolapse and usually require surgical intervention.
Milligan-Morgan hemorrhoidectomy has been the most popular among the various surgical techniques performed .And the traditional surgical operation was excision according to Milligan-Morgan technique. Till 1990s, this operation was considered the gold standard treatment
Surgical hemorrhoidectomy has been reputed as being a painful procedure for a benign disease, and causes postoperative pain which needs about 2-3 days hospital stay and a convalescence of at least one month.
The major considerations accompanying open hemorrhoidectomy are the significant postoperative pain and the protracted recovery time (a minimum of 4 weeks with the MMH). A postoperative plan for pain relief devised in alliance with the patient is very important for better recovery. Other possible short-term complications include urinary retention, bleeding and infection. Long-term concerns include anal stenosis, fecal incontinence, anal fissure and fistula.
Stapled hemorrhoidopexy is a newer modality that represents a paradigm change in the treatment of hemorrhoids. However it has been met with both skepticism and interest.
The avoidance of an anodermal wound has been attributed to the reduced post-operative pain and earlier return to normal activities reported in some randomised trials.
Stapled hemorrhoidectomy has better short-term outcomes, including shorter operating times, less postoperative pain, early return to work and greater patient satisfaction.
This study was conducted on 50 patients. The patients included in the study was divided in a randomized way into two groups. 25 patients underwent Milligan Morgan technique of open hemorrhoidectomy and 25 underwent stapled hemorroidopexy.
We compared between the outcomes of stapled hemorrhoidopexy with Milligan-Morgan open hemorrhoidectomy in terms of duration of surgery, post-operative pain, duration of hospital stay, post-operative complications, anorectal physiological functions, and recurrence.
from this study we concluded that stapled hemorroidectomy (SH) is superior to Milligan-Morgan (MM) technique in treatment of third and fourth degree circumferential piles, as SH had significant decrease in intra operative blood loss and significant decrease in the recurrence rate with no effect on fecal continence. The complication rate showed statistically nonsignificant difference with respect to the postoperative complications, such as post operative bleeding , urinary retention, anal stenosis.
Considering the recurrence rate, cost of stapling device and potential serious complications including recto-vaginal fistula and stricture, SH is generally reserved for patients with circumferential prolapsing hemorrhoids and having ≥ 3 lesions of advanced internal hemorrhoids.
CONCLUSION
F
rom this study we concluded that stapled hemorroidectomy (SH) is superior to Milligan-Morgan (MM) technique in treatment of third and fourth degree circumferential piles, as SH had significant decrease in intra operative blood loss and significant decrease in the recurrence rate with no effect on fecal continence. The complication rate showed statistically nonsignificant difference with respect to the postoperative complications, such as post operative bleeding, urinary retention, anal stenosis.
Considering the recurrence rate, cost of stapling device and potential serious complications including recto-vaginal fistula and stricture, SH is generally reserved for patients with circumferential prolapsing hemorrhoids and having ≥ 3 lesions of advanced internal hemorrhoids.