DOI: http://dx.doi.org/10.18203/2349-2902.isj20183733

Randomized comparison of stapled haemorrhoidopexy and open haemorrhoidectomy

Suresh Kumar Rulaniya, Soumitra Chandra

Abstract


Background: Surgical management of haemorrhoids is reserved for stage III and IV haemorrhoids. Both Milligan-Morgan technique (CH-Conventional Haemorrhoidectomy) and stapled haemorrhoidopexy technique are used as surgical therapy. Our prospective, comparative study of conventional haemorrhoidectomy versus stapled haemorrhoidectomy was designed in present institution.

Methods: This prospective randomised comparative study was carried out in present Surgery Dept from July 2016 to December 2017 with total 60 sample size. All data were analysed according to applicable statistical methods. The results were compared to previous studies so as to arrive at a conclusion.

Results: The mean duration of surgery with stapled method was 30.76±3.13 minutes and with conventional method was 49.36±4.08 minutes which was significantly high in conventional method. VAS scores for pain at 12 hours, 24 hours, 72 hours and 7 days for stapled group were 2.63±0.76, 1.66±0.88, 0.90±0.71 and 0.50±0.43 while that for the conventional group were 5.63±0.72, 4.56±1.22, 3.26±1.25 and 2.00±0.69. At all points of time the VAS was significantly lower in stapled group. The mean duration of hospital stay of the patients with stapled method was 3.10±0.75 days and with conventional method was 6.06±0.94 days, which was significantly high in conventional method. The mean time to return to normal activities of the patients with stapled method was 8.16±1.93 days and with conventional method was 12.60±1.67 days, which also significantly high in conventional method.

Conclusions: Present study inferred that stapled haemorrhoidopexy is faster, minimally invasive for treatment of haemorrhoids as compared to Conventional haemorrhoidectomy. It is associated less pain and provides a more satisfactory alternative to Conventional surgery because of reduced hospitalisation and earlier return of patient to daily activities, with no significant differences in short term follow up.


Keywords


Hemorrhoids, Open (Milligan-Morgan) hemorrhoidectomy, Stapled hemorrhoidopexy

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References


Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterol. 1990;98:380-6.

Williams NS. Anus and anal canal. In R.C.G. Russell, Norman S. Williams and Christopher J. K. Bulstrode (eds): Baileyand Love’s Short Practice of Surgery. 24th ed. London: Edward Arnold Ltd.; 2004.

Gass OC, Adams J. Haemorrhoids: etiology and pthology. Am J Surg. 1950;79(1):40-3.

Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: A new procedure. Proceedings of the 6th World Congress of Endoscopic surgery. Rome, Italy: Bologna Monduzzi Publishing. 1998:777-84.

Nivatvongs S, Gordon PH. Principles and Practice of Surgery for the Colon, Rectum, and Anus. 3rd ed. USA: Informa Healthcare USA, Inc.; 2007.

Hiremath B, Gupta S. Stapled haemorrhoidoexy for haemorrhoids: a review of our early experience. Indian J Surg. 2012;74(2):163-5.

Bikhchandani J, Agarwal PN, Kant R, Malik VK. Randomized controlled trial to compare the early and mid-term results of stapled versus open haemorrhoidectomy. Am J Surg. 2005;189:56.

Boccasanta P, Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, et al. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular haemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg. 2001;182:64-8.

Hetzer FH, Demartines N, Handschin AE, Clavien P. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002;137:337-40.

Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, et al. Stapled haemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum. 2001;44(8):1224.

Ortiz H, Marzo J, Armendáriz P, De Miguel M. Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Br J Surg. 2002;89:1376-81.

Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet. 2000 Mar;355(9206):782-5.

Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Review. 2006;18(4):CD005393.

Similis C, Thoukididou SN, Slesser AAP, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg. 2015;102:1603-18.