Hemorrhoidal disease is a common pathology affecting 5 percent of the general population.
Hemorrhoidectomy is the most effective approach for hemorrhoidal disease, especially for
Grade III and IV hemorrhoids, and is one of the most frequently performed general
surgeries. For patients with circumferential prolapsed hemorrhoids, the standard
three-quadrant hemorrhoidectomy (Milligan-Morgan or Ferguson method) may leave behind too
much hemorrhoid-bearing mucosa and skin tags, which are the main complaints of patients
as incomplete resection or recurrence. Since its first description in 1882, the Whitehead
hemorrhoidectomy has earned a reputation as a radical procedure for circumferential
prolapsed hemorrhoids. However, this procedure has been criticized because it is
time-consuming and causes considerable blood loss, disturbed continence, ectropion of the
rectal mucosa, and stricture formation, and it has been used rarely by surgeons. More
recent modifications, such as a circular incision, anodermal flap graft, or sliding skin
flap graft, reduce the risk of complications associated with the primary method, but the
results remain unsatisfactory. Some colorectal surgeons have used a modified Ferguson
method with various degrees of anoplasty and an anodermal flap to treat circumferential
hemorrhoids during the past 20 years,8 but unsatisfactory results were still experienced,
including occasional flap necrosis, which causes skin defects and anal stenosis.
Furthermore, the loss of most cushioning effect of the anus, which results in varying
degrees of incontinence, also is a problem. Stapled hemorrhoidopexy was presented as a
procedure for prolapsed hemorrhoids (PPH) in 1998 by Longo. From the viewpoints of lesser
post operative pain and short recuperation period after PPH, it was later adapted for
grade III and grade IV hemorrhoids gradually. However, PPH had several drawbacks and
long-term sequelae, such as residual skin tags, anal stenosis and even chronic anal pain
after surgery. Therefore, the Milligan- Morgan hemorrhoidectomy (MMH) or modified
Ferguson method is still the most popular method for hemorrhoids. The explanation for
residual skin tags is probably that the external components remained untreated by
stapling in most of the studies. Therefore, we have been routinely adding an anoplasty
for the prominent skin tag after the stapling hemorrhoidopexy procedure. Moreover,
previous studies have demonstrated a reduction of rectal distensibility and volume
thresholds for sensations in patients treated with stapled hemorrhoidopexy, and a
possible correlation between rectal functional alterations and postoperative disorders
was postulated. The present study aimed to compare the short- and long-term outcomes of
PPH with anoplasty and traditional Ferguson hemorrhoidectomy.