A Prospective Study of Stapled Versus Open Haemorrhoidectomy

Abstract

Introduction: Hemorrhoids are one of the commonest benign anorectal problems worldwide. The management of third and fourth degree hemorrhoids is usually surgical. The most commonly performed operation is hemorrhoidectomy. Milligan-Morgan hemorrhoidectomy has been the most popular among the various surgical techniques performed.Materials and Methods: A hospital based prospective comparative study was done among hemorrhoids patients undergoing surgical intervention for haemorrhoids in Department of General Surgery, Maheshwara Medical College & Hospital, Isnapur, Hyderabad. The study was conducted during October 2018 to March 2020. All patients with grade III and IV hemorrhoids and both sexes were included in the study. Written informed consent was gathered from the study participants before conducting the study. Participants who underwent Stapled Hemorrhoidectomy were considered as group A (n=40) and Open Hemorrhoidectomy (n=40) as group B. Patients were evaluated for socio economic characteristics, clinical presentation, and surgical outcome in terms of pain, operating time, hospital stay and complications. Postoperative pain measured by Visual Analog Scale (VAS) was used as the primary outcome measure. Secondary outcome measures studies are operative time, postoperative complications, hospital stay duration, time to first bowel motion, and return to normal activity. All clinical variables were obtained through an interview schedule. Results: In this present study there were 40 patients in Group A (Stapled method) and 40 patients in Group B (Open method). There were 47.5% and 42.5% patients below the age group of 40 years in group A and Group B respectively. 15% of the patients were above the age of 50 years in both the groups. It was found that hemorrhoids were more common in males in both of the groups, 82.5% in Group A and 85% in Group B. Most of the patients (62.5%) in Group A presented with grade IV hemorrhoids and 70% of the patients from Group B.Conclusion: Stapled haemorrhoidectomy reported less pain when compared to the conventional open method and allows early return to work. However, long-term complications are still unknown, operative time, duration of hospital stay and return to normal activity were satisfactory with stapler hemorrhoidectomy.