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


  • 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



Adenocarcinoma, Colorectal, Carcinoma, Colonoscopy, Retrospective


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.


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.






Original Research Articles