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Radiofrequency Versus Milligan Morgan Hemorrhoidectomy: a Prospective, Randomized Study
Pierpaolo Sileri, Luana Franceschilli*, Vito M. Stolfi, Alessandra Di Giorgio, Giulio P. Angelucci, Stefano D' Ugo, Achille Gaspari
Surgery, University of Rome Tor Vergata, Rome, Italy

In the past decade, several new surgical tools have revived the hope for an improved technique to treat radicallly haemorrhoids with less postoperative pain. Among these radiofrequency (RF) excisional surgery seems to be safe, fast and accompanied by less postoperative pain. The aim of this study was to evaluate and compare RF to Milligan Morgan (MM) hemorrhoidectomy.Patients and Methods: Between 01/03 and 07/09, 210 symptomatic patients were randomized to RF (118 patients) or MM hemorrhoidectomy (92 patients). Mean follow-up was 39+/-16 months. Patients were seen after 1 week after Day Surgery and pain assessed using a 10cm linear visual analogue scale (VAS). Further controls were at 1, 3, 6 and 12 months. Patients were contacted annually thereafter.Clinical outcome was assessed by validated questionnaire on postoperative symptoms and satisfaction. Primary endpoints were pain and wound healing. Secondary endpoints were operative time, morbidity (early and late complications), and patients satisfaction. Data was analysed using chi-squared test and Fisher's exact test. Overall results are resumed in tables 1 and 2. Despite postoperative pain was less after RF this difference was significative only for severe pain (VAS>7). Significant differences were observed in terms of wound healing. The two techniques were similar in terms of early and late complications.Conclusions: RF hemorrhoidectomy is followed by reduced severe pain, better wound healing, despite this, in our experience, is not followed by an earlier return daily activities.
Pain, Healing and Return to work after MM and RF Hemorrhoidectomy.

PARAMETER RADIOFREQUENCY MILLIGAN MORGAN P VALUE
Postoperative pain VAS 1st week 4.6±2.4 5.2±1.9 NS
Patients with VAS>7 (%) 17 (14.4%) 25 (26%) P 0.04
Pain duration (days) 15.8±10.2 18.3±7.4 NS
Secretion time (days) 17.6±12.3 21.2±11.6 NS
Bleeding duration (days) 11.6±8.2 18.9±11 P 0.05
Itching (days) 9.6±6.4 21±13.7 P 0.04
Return to work (days) 18.0±12.0 17.1±10.1 NS
Hospitalizations 1 (0.8%) 1 (1.1%) NS
ER admission and Readmissions 5 (4.2%) 1 (1.1%) NS

ER: emergency room admissions
Early and Late Complications Resume'.

RADIOFREQUENCY MILLIGAN MORGAN P VALUE
Urinary retention 2 (1.7%) 1 (1.1%) NS
Bleeding 6 (5.1%) 2 (2.2%) NS
Faecal retention 1 (0.8%) 1 (1.1%) NS
Transitory Incontinence 5 (4.2%) 0 P= 0,04
Skin tags 15 (12.7%) 16 (17.4%) NS
Anal fissure 5 (4.2%) 1 (1.1%) NS
Anal stricture 6 (5.1%) 3 (3.3%) NS
Abscess/fistula 1 (0.8%) 0 NS
Recurrence 0 2 (2.2%) NS


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