Comparing Skin-Sparing Hemorrhoidectomy and PExy SHAPE to Milligan-Morgan Hemorrhoidectomy for Treating Advanced Hemorrhoids

What this Trial Is About

Researchers are evaluating two surgical methods for treating third- and fourth-degree hemorrhoids in adults over 18 years old. This randomized controlled trial takes place at the General Surgery Department of Kasr Al-Ainy Teaching Hospital, Cairo University. It compares Skin-Sparing Hemorrhoidectomy and PExy SHAPE with conventional Milligan-Morgan hemorrhoidectomy, aiming to understand differences in outcomes such as pain and recovery. Patients with inflammatory bowel disease, anal stenosis, colorectal cancer, or fecal incontinence are not eligible. Participants are randomly assigned to one of two groups. Group A undergoes the SHAPE procedure, which selectively removes hemorrhoidal tissue above the dentate line, preserving anoderm and including mucopexy using Vicryl sutures to lift prolapsed mucosa. Group B has the Milligan-Morgan hemorrhoidectomy, involving excision and ligation of hemorrhoids with skin bridges left to prevent stenosis. After surgery, patients start oral fluids after 2 hours and resume normal diet as tolerated, typically discharged the next day unless complications arise. During the study, patients receive detailed preoperative assessments including history, symptom evaluation, anorectal and digital rectal exams, and routine labs. Follow-up visits occur twice weekly in the first week, weekly for a month, then monthly to monitor pain using a Visual Analog Scale, wound healing, complications, and surgical outcomes. Main outcomes include postoperative pain intensity measured on days 1, 7, and 30. Secondary outcomes include operative time, infection rates, urine retention, anal stenosis, hemorrhoid recurrence, bleeding, and return to normal activity, all followed up to 3 months after surgery.

SHAPE Versus Milligan-Morgan Hemorrhoidectomy for Hemorrhoidal Disease