In our set up the only restricting factor is the cost of the stapling gun.

I prefer transanal hemorrhoidal dearterialization, as this procedure seems to be more anatomical. Is minimally invasive, with excelent short and long-term results. 

I found as nice the following two papers about the topic. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807324/

https://www.ncbi.nlm.nih.gov/pubmed/25213152/

The problem concerning  stapled haemorroïdopexy for me is that it does

- too little where there is a bulky prolapsing complex which often requires a number of extra stitches distal to the staple line

- too much  in the area in between complexes, removing a lot of normal rectal wall, often full thickness. 

I switched to Laser haemorroïdoplasty last summer.

I completely agree with Charles A. de Gheldere. I also have to add that we had too much patients with the hemorrhoidal diseases problems as before the operation, in somewhat smaller severity. Also we had one severe complication that we published

https://www.ncbi.nlm.nih.gov/pubmed/?term=augustin+g.+can+j+surg

We went back to Milligan-Morgan due to good long-term results with unfortunately more pronounced pain during first 3-6 weeks. Also the patients do not have residual skin tags and residual fibrosis from partially remained internal hemorroids which were the problem for female patients especially

Main reasons in my view 

1) cost 

2) complications like pelvic abscess and proctalgia fugax which were not that common with the open or closed haemorrhoidectomy. Most of the time the reasons for the complication is something technical (such as taking too much rectal wall)

It might be an easy technique, but is still excisional, with a similar long term complication profile as other excision all methods, including Milligan-Morgan or diathermy excision etc. Management is guided by the symptoms, but, repeated banding and/ vertical rectopexys are more favourable if there is significant bleeding/prolapse/pruritis etc. The addition of targeted arterial ligation is useful for more vascular pedicles. All, commonly done as day case procedures, with minimal pain. There is a feeling of rectal fullness which settles in 10-14 days, particularly if the patients avoid sitting on the commode for long+/- straining, and is improved with anal canal excercises. Easily repeatable; but with life-style modifications, not that commonly required. It is satisfying watching the mucosa being repositioned on lighting the pexies; very few need the usual "tidy-ups". Excessively hard or loose bowel movements postop are equally disadvantageous. Less is definitely more in proctology!