Comparison of Surgical Outcomes and Recovery Process Following Milligan–Morgan Hemorrhoidectomy (MMH) and TST-Stapler Circular Stapled Hemorrhoidopexy (TS-CSH): A Retrospective Single-Centre Study

Background and Objectives: Circular stapled hemorrhoidopexy (CSH) is a surgical method to treat patients with hemorrhoidal disease. Compared to conventional hemorrhoidectomy, it is associated with reduced postoperative pain and a shorter recovery time, supporting a quicker return to daily activities. However, in populations treated using this technique performed with first-generation staplers, a higher recurrence rate was observed. Ongoing advancements in stapler technology appear to improve the surgical outcomes of CSH, maintaining its previous advantages. The aim of this study is to compare the surgical outcomes and recovery process between CSH performed with the new-generation TST-36 stapling device (TS-CSH) and the Milligan–Morgan hemorrhoidectomy (MMH). Materials and Methods: Medical records of 48 patients with grade III or higher hemorrhoids treated electively with MMH (n = 24) or TS-CSH (n = 24) between January 2023 and January 2025 were retrospectively reviewed. MMH patients were matched by age, sex, and perioperative risk (American Society of Anesthesiologists Physical Status Classification System, ASA-PS). Those with a history of previous hemorrhoid surgery, fewer than two columns excised, ASA-PS III or higher, patients who underwent urgent surgery, or declining participation were excluded. During the follow-up period, ranging from 3 to 28 months, in the outpatient clinic, patients’ medical records were updated regarding postoperative recovery time, pain (NRS), analgesic use, urinary retention, defecation difficulties, bleeding, complications, satisfaction, and symptom recurrence. Demographic and perioperative data were collected from electronic records. Results: The TS-CSH group experienced significantly lower pain scores at first defecation (p = 0.003), 24 h (p = 0.016), and 7 days postoperatively (p < 0.001). Additionally, time to full recovery was significantly shorter following TS-CSH compared to MMH (14.0 vs. 30.0 days, p < 0.001). No cases of fecal incontinence and anal stenosis were recorded. Three patients were identified as presenting symptoms of recurrence, all in the TS-CSH group; however, this finding did not reach the threshold of statistical significance. Conclusions: CSH performed with the new generation of stapling devices is minimally invasive, feasible, and a safe technique for treating grade III or IV hemorrhoids. TS-CSH should be considered as an alternative to conventional hemorrhoidectomy, associated with a trend toward lower pain and faster return to daily activities while maintaining a comparable satisfaction rate.