Severe Inpatient Pain After Stapled Hemorrhoidopexy Versus Milligan–Morgan Hemorrhoidectomy: A Multicenter Overlap-Weighted Cohort Study

Abstract

Background: Stapled hemorrhoidopexy and Milligan–Morgan hemorrhoidectomy are commonly used surgical treatments for hemorrhoidal disease, but comparative evidence on early postoperative recovery in routine multicenter practice remains limited. This study aimed to compare early postoperative outcomes after stapled hemorrhoidopexy and Milligan–Morgan hemorrhoidectomy in routine multicenter practice.

Methods: This was a multicenter retrospective cohort study using standardized records from 13 hospitals. Adults with a classifiable operative technique were included. The primary outcome was severe inpatient pain, defined as pain requiring at least two additional analgesic doses beyond the routine regimen. Propensity-score overlap weighting balanced age, sex, ethnicity, emergency status, presenting symptoms, disease characteristics, comorbidity, and hospital. Hospital-clustered 95% confidence intervals (CIs) were calculated.

Results: Among 514 adults, 321 underwent stapled hemorrhoidopexy and 193 underwent Milligan–Morgan hemorrhoidectomy. Unadjusted severe-pain counts were 5/321 (1.6%) and 39/193 (20.2%), respectively; overlap-weighted risks were 0.8% and 17.4% (risk difference, −16.5 percentage points; 95% CI, −24.1 to −9.0; risk ratio, 0.05; 95% CI, 0.01–0.23). The overlap-weighted risk difference for a stay longer than 10 days was −11.9 percentage points (95% CI, −23.3 to −0.4). Estimates for urinary retention, bleeding, operative time, and mean stay were imprecise. Sensitivity analyses supported the primary association.

Conclusions: Stapled hemorrhoidopexy was associated with less severe inpatient pain, defined by at least two additional analgesic doses beyond the routine regimen, than Milligan–Morgan hemorrhoidectomy. This analgesic-use-based measure was not a validated patient-reported pain score.