A comparative study of modern techniques of stapled versus enseal haemorrhoidectomy: a prospective randomized trial on 240 cases
Keywords:Circular stapler, Enseal, Haemorrhoids, Haemorrhoidectomy
Background:Increasing incidence of haemorrhoids in population consuming diet rich in calories, low in fibre, spicy food, tropical climate and other known factors has led to development of new techniques for haemorrhoid treatment. The aim of study is to compare pros and cons of haemorrhoidectomy with stapler v/s enseal.
Methods: A prospective randomized trial was conducted on a total of 240 patients having 3rd and 4th degree haemorrhoids, divided into two groups of 120 each during 2012-2014 at NIMS Medical College and Hospital, Jaipur, India. Pre-operative complaints (bleeding P/R, rectal/perianal pain, mass coming out of anus), operative and post-operative outcomes, operative time, post-operative pain, bleeding, urinary retention, faecal/flatus incontinence, thrombosis of external haemorrhoids/perianal hematoma, anal/rectal stenosis, wound problems and recurrence were assessed.
Results:Average operating time was 1.5 times in Stapler Haemorrhoidectomy(SH) v/s Enseal Haemorrhoidectomy (EH), average hospital stay, recovery time and total analgesics required during 5 POD was almost 0.5 in SH v/s EH. Post-operative complications like bleeding, urinary retention, faecal/flatus incontinence, anal discomfort, rectal/anal stenosis and wound infection were found significantly less in SH v/s EH. Residual skin tags prolapse and recurrence was almost three times in SH v/s EH.
Conclusions:Both SH and EH are probably equally valuable techniques in modern haemorrhoid surgery. However Enseal has an advantage because ease of technique, but SH is a better technique with over all better outcomes.