Plication of Haemorrhoids [haemorrhoidorrhaphy] versus milligan-morgan haemorrhoidectomy

ABSTRACT

Excision of advanced haemorrhoids involving most of the anal circumference is associated with excessive bleeding, extensive raw area and anal stenosis. On the other h and, incomplete eradication means recurrence. Plication of haemorrhoids or haemorrhoidorrhaphy obliterates any degree of haemorrhoids without leaving raw areas. This r and omized study compared plication with Milligan-Morgan haemorrhoidectomy. A total of 120 patients having advanced 3rd or 4th degree haemorrhoidal disease were r and omized to undergo haemorrhoidorrhaphy [73 cases forming Group A] or conventional haemorrhoidectomy [47 cases forming Group B]. The two methods showed no significant difference as regards the operative time, cost of surgery and postoperative care, amount of pain on days 1 and 7 and on first evacuation, length of postoperative hospital stay and patients' overall satisfaction score after 6 months. However, haemorrhoidorrhaphy was associated with a significantly smaller amount of bleeding. Conventional haemorrhoidectomy was associated with temporary incontinence to flatus in 5 cases, a persistent painful raw area beyond 6 weeks postoperatively in 4 cases, anal stenosis in 2 cases and recurrence in 2 cases, while none of the cases of haemorrhoidorrhaphy had such complications. Postoperatrive retention of urine that needed catheterization was noted in 6 cases of Group A and 7 cases of Group B.A peri-anal abscess was also reported in 2 cases of group A and 3 cases of group B within the first postoperative month and were completely cured by urgent drainage. Plication of haemorrhoids gives better results in comparison to conventional haemorrhoidectomy in advanced cases although it is applicable to all grades of the disease. Such advanced cases will have the advantage of minimization of bleeding, complete avoidance of leaving raw areas which precipitate anal stenosis and complete eradication of the disease that prevents recurrence, together with preservation of the normal anal cushions