Die Klammernahtresektion bei Hämorrhoiden: eine Bestandsaufnahme nach zweijähriger Anwendung Vergleich der Ergebnisse mit der Technik nach Milligan-Morgan

The aim of this investigation was to demonstrate possible advantages of stapler hemorrhoidectomy in comparison to the Milligan-Morgan procedure. 96 patients with an average age of 54 years were treated in a two year period (7/1998-8/2000) by stapler hemorrhoidectomy. The complication rate was 12.5% and included one mechanical stapler defect, two cases of bleeding, five cases of urinary retention and four of perianal edema. The use of analgesics was small with 70% requiring no medication at all. Hospitalisation post-operatively was 3.3 days with patients under 65 years old and 4.7 days in those over 65 years. These data were compared retrospectively to that of Milligan-Morgan hemorrhoidectomy (214 patients) performed between January 1990-December 1997. The stapler patients had less pain, fewer complications and shorter hospitalisation. Using a questionnaire, all stapler patients and 50 Milligan-Morgan controls were evaluated. 78% responded at 13.8 months after stapler hemorrhoidectomy, 63 % 54.1 months after Milligan-Morgan. The degree of satisfaction was high in both groups (93 vs 94%). One patient in the Milligan-Morgan group suffered a recurrence. No further symptoms had been experienced by 57% after stapler, 68% after Milligan-Morgan procedure. Faecal continence represents a problem in the stapler group. Stapler hemorrhoidectomy is an effective treatment for IIIrd degree hemorrhoids. In comparison to the Milligan-Morgan procedure, it has advantages in the early post-operative period. Defecation problems can occur with an unkown prognosis. Without long-term results and because of the comparatively high cost of the procedure the indication for stapler hemorrhoidectomy should be carefully made.