Open versus primary repair following hemorrhoidectomy for Grade III hemorrhoids: a prospective comparative study

Abdul Ghader Barazandeh Moghadam; Shoaibuddin Mohammad; Bushra Khan

doi:10.18203/2349-2902.isj20184092

Authors

Abdul Ghader Barazandeh Moghadam Department of General Surgery, Princess Esra Hospital, Deccan College of Medical sciences, Hyderabad, Telangana, India
Shoaibuddin Mohammad Department of General Surgery, Princess Esra Hospital, Deccan College of Medical sciences, Hyderabad, Telangana, India
Bushra Khan Department of General Surgery, Princess Esra Hospital, Deccan College of Medical sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184092

Keywords:

Adenocarcinoma, Colorectal, Carcinoma, Colonoscopy, Retrospective

Abstract

Background: The debate on open versus primary closure following haemorrhoidectomy continues to be active. Despite other methods like doppler guided haemorrhoidal artery ligation, sclerotherapy, cryotherapy, banding; open haemorrhoidectomy is performed at many places. The never-ending discussion on the better choice between open versus primary repair led to the initiation of this work.

Methods: This is a prospective comparative study of a contiguous and continuous cohort of 105 cases. Alternate cases were assigned for either of the procedures. Only grade III haemorrhoids were included. Grade I and II haemorrhoids, cases treated earlier and recurrent haemorrhoids were excluded. Multiple parameters like duration of surgery, intraoperative and post-operative bleeding, pain duration and severity, time taken to return to work, use of dressings and sitz bath, wound healing time and stenosis were studied. A blinded statistical analysis was done by a third-party statistician.

Results: Primary haemorrhoidectomy took a significantly longer time (P value- 0.0043). Pain was significantly less with open haemorrhoidecomy (P value- 0.0023). Post-operative pain was significant in primary repair. Pain was assessed using visual analogue scale and verbal rating scale. Open haemorrhoidectomy took a significantly longer time to heal (P value: 0.0004) and return to work (P value: 0.0001). Primary repair had stenosis requiring dilatation in a few cases. Statistical analysis was done in all cases.

Conclusions: Primary repair seems to be preferred because of shorter duration of recovery despite more pain and occasional anal stenosis.

Metrics

Metrics Loading ...

References

Courtney M. Townsend. Sabiston Textbook of Surgery. 20th edition. Elsevier; 2017(2):1400.

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

Arbman G, Krook H, Haapaniemi S. Closed versus open hemorrhoidectomy: is there any difference? Dis Colon Rectum. 2000;43:31-4.

You SY, Kim SH, Chung CS, Lee DK. Open versus closed hemorrhoidectomy. Dis Colon Rectum. 2005;48:108-13.

Gencosmanoglu R, Sad O, Koc D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum. 2002;45:70-5.

Khalil-ur-Rehman, Hasan A, Taimur M, Imran M. A comparison between open and closed hemorrhoidectomy. J Ayub Med Coll Abbottabad. 2011;23:114-6.

Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg. 2016;4(6):1509-19.

Borse H, Dhake S. A comparative study of open (Millign-morgan) versus closed (Ferguson) hemorrhoidectomy. MVP J Med Sci. 2016;3:7-10.

Rajasekar M, Jasmine. Comparative study of outcume of open vs closed hemorrhoidectomy vERSUs rubber band ligation in third degree haemorrhoids. IOSR-JDMS. 2017;16:29-34.

Ahsan M, Hussain SN. Stapled haemorrhoidopexy versus conventional (open) haemorrhoidectomy: a comparative study. JMSCR. 2017;05:232, 629-74.

Kumar M, Sinha K. Open haemorrhoidectomy versus closed haemorrhoidectomy: a comparative study. JMSCR. 2017;05:21698-701.