A Comparative Study of Open Haemorrhoidectomy with Minimally Invasive Procedure For Haemorrhoids (M.I.P.H)
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 1
Abstract
Aim: To compare open haemorrhoidectomy with minimally invasive procedure for haemorrhoids with special reference to operative time, post operative pain, post operative bleeding, duration of hospital stay and recurrence. Materials and Methods: This is a prospective study comparing the two types of surgical procedures for haemorrhoids 1. Milligan-Morgan haemorrhoidectomy, Minimally invasive Procedure for haemorrhoids in 45 patients admitted and underwent surgery in with complaints of bleeding per rectum, pain during defecation, mass per rectum, discharge and irritation. Results: Haemorrhoids were common in the age group of 40yrs and above with mean age of presentation 45.8±13.8 years. There are less number of patients above 60 yrs. Male (69%) patients are more in number than female (31%) patients. Bleeding, pain and mass per rectum were the most common complaints as majority of patients operated are grade III and grade IV. In this study, 51% of the patients are grade III and rest are grade II &IV. The operating time in present study for stapler haemorrhoidectomy was 28.76±3.5min and for open haemorrhoidectomy 36.2±6.5min. Stapled haemorrhoidectomy was significantly faster than open haemorrhoidectomy (21min versus 31 min). Mean score of pain for MIPH group is 3.5±2 and for Milligan-Morgan group is 5.7±2.2. Pain usually appeared after weaning off of the spinal anaesthesia for which NSAIDs or Tramadol was used. Bleeding in the post-operative period was in 9.5% of the cases of stapler haemorrhoidectomy where as bleeding was seen in 20.8% of the cases of open haemorrhoidectomy which ranged from dressing soakage to about few drops of blood during defecation. Urinary retention in our study is 9.5% in MIPH group and 12.5% in Milligan-Morgan group which is not differed significantly, with p value > 0.005. Mean post-operative hospital stay in MIPH group is 1.1±0.35 days and 2.3±1.2 days in Milligan-Morgan group, which is statistically significant with p value < 0.005. Patients had been followed for 6months to 24 months, found 1 case of relapse in MIPH and 1 case of relapse in Milligan-Morgan has been identified with 4.76% vs 4.16% with p value of >0.005. 2 patients of anal stenosis has been identified with 8.5% and no cases in stapler haemorrhoidopexy with p value >0.005. Conclusion: Stapler haemorrhoidopexy is thus a viable alternative to to open haemorrhoidectomy in it’s indicated group of patients who can afford the stapler with distinct advantages.
Authors and Affiliations
Varun Raju. Thirumalagiri, Ramachandrer Rao
Keywords
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