Study to compare stapled haemorrhoidectomy with conventional haemorrhoidectomy in terms of outcome variables

Abstract

Aims: The aim of the study to compare stapled haemorrhoidectomy with conventional haemorrhoidectomy in terms of outcome variables. Material and methods: It was a prospective study comparing Milligan Morgan open hemorrhoidectomy and Stapled hemorrhoidopexy for the management of grade 3 and 4 hemorrhoids, in the Department of General Surgery, PMCH, Bihar, India for 8 month. The patients included in the study were divided into two groups. 60 patients underwent Milligan Morgan technique of open hemorrhoidectomy and 60 underwent longo technique of stapled hemorroidopexy. Post-operative pain was managed according to the guidelines of French Anaesthesia Society. Pain was assessed using a visual analog scale (VAS) where a score of 0 represented no pain and a score of 10 represented the worst pain ever. Results: In stapled hemorrhoidopexy group, 53.33% were males and 46.67% were females. In open hemorrhoidectomy group 63.33% were males and 36.67% were females. Mean age of the patients was 38.60±9.69 years and 41.05±10.5 years in the stapled hemorrhoidopexy and open hemorrhoidectomy groups respectively. 46.67% patients had Grade 3 hemorrhoids in stapled hemorrhoidopexy and 41.67% in open hemorrhoidectomy groups, and 53.33% had grade 4 hemorrhoids in stapled hemorrhoidopexy and 58.33% in open hemorrhoidectomy groups.The mean duration of surgery was 35 min, ranging from 24 to 58 minutes. In the open hemorrhoidectomy group, mean duration was 47 minutes, ranging from 26 to 60 minutes. Complete circumferential donut of the stapler line at the end of procedure was 90%. Bleeding was seen in 15% of patients in stapled hemorrhoidopexy group and 23.33% of patients in open hemorrhoidectomy group. Residual prolapse was seen in 53.33% of patients in open hemorrhoidectomy group and none in stapled hemorrhoidopexy group. The mean duration of hospital stay was 2.2 days in the stapled group as compared to 4.5 days in the open group. 85 % were discharged within 2 days in the stapled group, whereas only 3 % in the open group. 77% were discharged at the end of 4 days in the open group. The pain scores were significantly higher in the open group at 6 hours, 12 hours, 24 hours and at first defecation. Conclusion: we conclude that stapled hemorrhoidopexy is associated with shorter duration of surgery, less postoperative pain and need for analgesia, shorter duration of hospital stay and a quicker recovery, earlier return to work and a high patient satisfaction as compared with Milligan-Morgan open hemorrhoidectomy

Keywords: hemorrhoids, hemorrhoidopexy, study.