Conventional hemorrhoidectomy and stapled hemorrhoidectomy: A clinical comparative study

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Conventional hemorrhoidectomy and stapled hemorrhoidectomy: A clinical comparative study

Journal Title: Medpulse International Journal of Surgery - Year 2019, Vol 9, Issue 3

Abstract

Background: Though hemorrhoid disease is one of the most common causes of anal pathology usually the patients are embarrassed to seek medical help. Various studies have estimated that symptomatic hemorrhoids affect more than 1 million individuals in the western world per year. Because of its high incidence and social cost of treatment the management strategies have evoked immense interest amongst surgeons particularly colorectal surgeons. The surgical management of hemorrhoids may be divided into open, closed and stapled hemorrhoidectomy. The choice of surgery depends on factors such as availability of facilities, experience of surgeon and stage of hemorrhoids. There are no standardized recommendations for choice of surgery in these cases and Very few studies have compared stapled hemorrhoidopexy with open hemorrhoidectomy. This study was therefore undertaken in a tertiary care hospital to compare the outcomes of stapled hemorrhoidopexy and open conventional hemorrhoidectomy on a set of predetermined parameters Materials and Methods: This was a prospective randomized clinical study in which 90 patients with grade-III and grade- IV hemorrhoids were included on the basis of a predefined inclusion and exclusion criteria. All 90 patients were subjected to detailed history taking, clinical examination, inspection during straining, digital rectal examination, proctoscopic examination. Routine lab investigations like blood and urine examination and screening of chest was done for preoperative evaluation. Alternate patients were subjected to stapled procedure and performed according to technique described by Longo and other group underwent conventional open hemorrhoidectomy procedure. The outcome of both the procedures was assessed by considering the factors such as duration of surgery, pain, incidence of complications and duration of hospital stay. Results: Patients were divided into 2 groups on the basis of whether they were treated by stapled hemorrhoidopexy (Group SH) or open hemorrhoidectomy (Group CH). Mean age of patients in group A was 47.22 years while in group B it was 49.46 years. The mean age was comparable and there was no statistically significant difference between the mean ages of 2 groups. Males were found to be predominantly affected with a M:F ratio being 1:0.21. Grade III and Grade IV hemorrhoids were seen in 51 (56.66%) and 39 (43.33%) respectively. The average duration of surgery in Stapled hemorrhoidectomy and conventional hemorrhoidectomy was 29.48 minutes and 43.62 minutes respectively and the difference was found to be statistically highly significant. Post-operative pain, post-operative analgesia requirement, postoperative bleeding and mean duration of hospital stay was found to be statistically significantly less (P<0.05) in patients who had undergone stapled hemorrhoidopexy. There was no significant difference in recurrence rates of both the groups. Conclusion: stapled hemorrhoidectomy is preferable over conventional hemorrhoidectomy in patients with grade III and IV hemorrhoids because of its significantly low duration of surgery and comparatively better outcome in terms of post-operative pain, post-operative analgesia requirement and postoperative bleeding, but its cost effectiveness is less as compared to conventional hemorrhoidectomy.

Authors and Affiliations

Arti Mitra, Archana Kamble, Unmed Chandak

Keywords

EP ID EP526705
DOI 10.26611/1069313
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