A Pragmatic Study of Management of Grade 3 and Grade 4 Haemorrhoids

Authors

  • Niranjan Moharana Assistant Professor, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Chinmaya Ranjan Behera Assistant Professor, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Abinash Kanungo Assistant Professor, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Indrani Roy PG Resident, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Amaresh Mishra Professor, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
  • Subrat Kumar Mohanty Professor, Department of Surgery, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

Keywords:

Haemorrhoids, Stapled haemorrhoidectomy, Conventional Haemorrhoidectomy.

Abstract

Introduction: The word ‘Hemorrhoids’ is derived from Greek word Haima (bleed) + Rhoos (flowering), means bleeding. Hemorrhoids consist of vascular cushions that are intimately involved in the maintenance of continence and discrimination between flatus and faeces. Material and Methods: It is a hospital based prospective observational study conducted at Department of Surgery at a Tertiary care teaching hospital over a period of 2 years from September 2018 to August 2020. Minimum 100 consecutive cases of Grade 3 and Grade 4 hemmorhoids were considered. A detailed history taking and a thorough clinical examination, which included digital rectal examination and proctoscopy was carried out after admission. Apart from routine preoperative investigations sigmoidoscopy or colonoscopy were carried out if it was indicated. Results: There was a significant difference between the 3 groups in terms of Duration of Surgery (Minutes) (χ2 = 80.776, p = <0.001), with the median Duration of 76 minutes being highest in the Stapler group, next being with harmonic scalpel and then conventional hemorrhoidectomy in our study. There was a significant difference between the various groups in terms of distribution of intra-operative bleeding (χ2 = 175.460, p = <0.001). Participants in the Stapler group had the largest proportion of mild intra-operative bleeding. Participants in the Harmonic group had the largest proportion of moderate intra-operative bleeding. Participants in the Conventional group had the largest proportion of severe intra-operative bleeding. Conclusion: Amongst the three procedures, Stapled hemorrhoidectomy was superior to others as it has shown lower postoperative pain severity, less secondary bleeding, less urinary retention and led to earlier return to work in patients with hemorrhoids, based on telephone interviews over follow-up period.

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Published

2021-04-14

How to Cite

Moharana, N., Behera, C. R., Kanungo, A., Roy, I., Mishra, A., & Mohanty, S. K. (2021). A Pragmatic Study of Management of Grade 3 and Grade 4 Haemorrhoids. International Journal of Health and Clinical Research, 4(7), 25–29. Retrieved from https://ijhcr.com/index.php/ijhcr/article/view/1291