Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse




This multicentre randomized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids.


The study involved 18 hospitals in Sweden, Denmark and the UK. Some 207 patients were randomized to either anopexy or Milligan–Morgan haemorrhoidectomy, of whom 90 in each group were operated on. Patients reported symptoms before surgery and after 1 year. Daily postoperative pain scores were recorded in a patient diary. Surgeons evaluated the anal anatomy before surgery and after 1 year.


Correction of prolapse in the anopexy and haemorrhoidectomy groups was similar at 1 year (88 and 90 per cent respectively; P = 0·80). Freedom from symptoms was obtained in 44 and 69 per cent respectively (P = 0·002). Stapled anopexy was associated with less postoperative pain, which resolved more quickly (P = 0·004). Significant improvements were noted in anal continence and well-being 1 year after both operations (P < 0·001). Excessive pain was the most common complication after diathermy excision and disturbed bowel function after stapled anopexy.


Haemorrhoidal prolapse was corrected equally by either operation. Diathermy haemorrhoidectomy gave better symptom relief but was more painful. Neither operation provided complete cure but well-being was greatly improved. Registration number: ISRCTN68315343 (http://www.controlled-trials.com). Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.