Stapler hemorrhoidectomy versus open hemorrhoidectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20163120Keywords:
Stapler hemorrhoidectomy, Open hemorrhoidectomy, Milligan Morgan hemorrhoidectomyAbstract
Background: Hemorrhoidal disease is a painful concern to the sufferer and the treating surgeon. Several methods are available for treatment of hemorrhoids. Milligan Morgan hemorrhoidectomy is the most widely practiced Gold standard surgical technique for the management of 3rd and 4th degree hemorrhoids. Staplers are novel methods known for its simplicity, ease and standardization to an anastomosis.
Methods: A prospective randomized control study was done including 60 consecutive patients. The patients were divided into two groups viz. Stapler hemorrhoidectomy group (SH) and Open (Milligan Morgan) hemorrhoidectomy group (OH). Randomization of the patient and assigning them to either of the group was done by the sealed envelope technique on the morning of the surgery. Pain score data sheet was filled out by the patients postoperatively. Data was analysed using SPSS. Significant difference was estimated using Chi Square test and Student’s ‘t’ independent test. Level of significance was taken as 0.05.
Results: Sixty patients in two equal groups were studied. Mean age of the two groups was similar. The male: female ratio was 6.5:1 for the stapled group and 9:1 for the open group. The mean operating time for open group was significantly higher than the stapled group (P = 0.0001). The SH group returned to normal activity significantly early. There was no significant difference in pain score on day one. Pain score was significantly lower for the SH group on days 2 and 3. There was no significant difference in complication between the two groups.
Conclusions: Operative time, duration of hospital stay and return to normal activity were satisfactory with stapler hemorrhoidectomy than the open method. Hence those who can afford the cost of surgery will definitely benefit, though it cannot be prescribed to all patients due to economic constraints. We still suggest long-term follow-up of all stapler hemorrhoidectomy patients.
References
Jayaram S, Colguhoun PH, Malthaner RA. Stapled Versus Conventional Surgery for Hemorrhoids. Cochrane Database Syst Rev. 2006;18(4):CD005393.
Milligan ETC, Morgan CN, Jones CE, Officer R. Surgical anatomy of the anal canal and operative treatment of haemorrhoids. Lancet. 1937;ii:1119-24.
Beattie GC, Lam JPH, London MA. A prospective evaluation of the introduction of circumferential stapled anoplasty in the management of hemorrhoids and mucosal prolapse. Colorectal Dis. 1999;2:137-42.
Thomson WH. The nature of haemorrhoids. Br J Surg. 1975;62:542-52.
Harvrylenko SP. Results of hemorrhoidectomy with the use of Staplers. Klin Khir. 1998;6:9-10.
Kohlstadt CM, Weber J, Prohm P. Stapler hemorrhoidectomy. A new alternative to conventional methods. Zentralbl Chir. 1999;124:238-43.
Pernice LM, Bartalucci B, Bencini L, Borri A, Catarzi S, Kroning K. Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum. 2001;44:836-41.
Kirsch JJ, Staude G, Herold A. The Longo and Milligan-Morgan hemorrhoidectomy. A prospective comparative study of 300 patients. Chirurg. 2001;72:180-5.
Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomized controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet. 1998;351:169-72.
Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002;137:337-40.
Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001;88:1049-53.
Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet. 2000;355:782-5.
Ortiz H, Marzo J, Armendaniz P. Randomized controlled trial of stapled haemorrhoidopexy versus conventional diathermy hemorrhoidectomy. Br J Surg. 2002;89:1376-81.
Seow-Choen F. Stapled hemorrhoidectomy; pain or gain. Br J Surg. 2001;88:1-3.
Plocek MD, Kondylis LA, Floyd ND, Reilly JC, Geisler DP, Kondylis PD. Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum. 2006;49:1905-9.
Bikhchandani J, Agarwal PN, Kant R, Malik VK. Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg. 2005;189:56-60.
Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: A systemic review and meta analysis of ten randomized control trials. Int J Colorectal Dis. 2006;21:172-8.
Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy- Systematic review of randomized controlled trials. Dis Colon Rectum. 2004;47:1837-45.
Pescatori M. Transanal stapled excision of rectal mucosal prolapse. Tech Coloproctol. 1997;1:96-8.
Molloy RG, Kingsmore D. Life-threatening pelvic sepsis after stapled hemorrhoidectomy. Lancet. 2000;355:810.
Wong LY, Jiang JK, Chang SC, Lin JK. Rectal perforation: a life-threatening complication of stapled hemorrhoidectomy. Dis Colon Rectum. 2003;46:116-7.
Cipriani S, Pescatori M. Acute rectal obstruction following PPH hemorrhoidectomy. Colorectal Disease. 2002;4:367-70.
