Evaluation of outcome in open and stapler haemorrhoidectomy in grade III/IV haemorrhoids

Manju Singh, Amit Agarwal, Kush Pandey


Background: Haemorrhoids are one of most common benign anorectal malformation worldwide. There are various surgical treatment modalities for 3rd and 4th degree haemorrhoids. Open haemorrhoidectomy was the most widely practiced and is considered the current gold standard. In search of a newer surgical technique, stapler has been introduced for haemorrhoidectomy and has revolutionised operative procedures over the last decade world-wide due to its ease and simplicity and lesser post-operative complications. The following study was done to evaluate the outcome of open versus stapled haemorrhoidectomy in terms of post-operative pain, postoperative bleeding, duration of surgery, duration of hospital stays in a medical college hospital at Raipur, Chhattisgarh.

Methods: This was a prospective follow-up study, in patients undergoing surgery for grade III/IV haemorrhoids conducted in the Department of Surgery, Dr BRAM Hospital, Raipur, from August 2017 to July 2018. Fourteen patients underwent stapled haemorrhoidopexy and eighteen underwent open haemorrhoidectomy. All patients were reviewed immediately after surgery, at discharge and at 1, 3 and 10 weeks post-operatively. The two groups were compared for post-operative outcomes and complications.

Results: The majority of patients in the study were males and had grade 4 haemorrhoids. Stapled haemorrhoidopexy group had shorter duration of surgery, less postoperative pain, shorter duration of hospital stays as compared with open haemorrhoidectomy group. There were no major post-operative complications in the follow up period of 10 weeks in the stapled group.

Conclusions: Stapled haemorrhoidopexy is a safer alternative to open haemorrhoidectomy with many short-term benefits.  


Haemorrhoids, Open haemorrhoidectomy, Stapled haemorrhoidopexy

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Welling DR, Wolff BG, Dozois RR. Piles of defeat. Napoleon at Waterloo. Dis Colon Rectum. 1988;31(4):303-5.

Hulme-Moir M, Bartolo DC: Haemorrhoids. Gastro enterol Clin North Am. 2001;30(1):183-197.

Gan SG. Haemorrhoids. In: Diseases of the rectum, anus, and colon. 1st ed. Philadelphia and London: WB Saunders Company. 1923:419-531.

Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterol. 2009;136(2):376-86.

Thomson WH. The nature of haemorrhoids. Br J Surg. 1975;62(7):542-52.

Lunniss PJ, Phillips RK. Anatomy and function of the anal longitudinal muscle. Br J Surg. 1992;79(9):882-4.

Haas PA, Fox TA, Jr., Haas GP. The pathogenesis of haemorrhoids. Dis Colon Rectum. 1984;27(7):442-50.

Khan NF, Hussain Shah SS, Bokhari I. Outcome of stapled haemorrhoidectomy versus Milligan Morgan's haemorrhoidectomy. J Coll Physicians Surg Pak. 2009;19(9):561-5.

Sachin ID, Muruganathan OP. Stapled haaemorrhoidopexy versus open hemorrhoidectomy: a comparative study of short term results. Int Surg J. 2017;4(2):472-8.

Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled haemorrhoidopexy. Dis Colon Rectum. 2007;50(6):878-92.

Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P, et al. Treatment of hemorrhoids in day surgery: stapled haemorrhoidopexy vs MilliganMorgan haemorrhoidectomy. J Gastrointest Surg. 2008;12(5):795-801.

Hetzer FH, Demartines N, Handschin AE. Stapled vs. excisional hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002;137(3):337-4.

Ng KH, Ho KS, Ooi BS. Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg. 2006;93(2):226-30.

Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL et al. Stapled hemorrhoidectomy- cost and effectiveness. Randomized, controlled trial including incontinence scoring, ano-rectal manometry and endo-anal ultrasound assessments at up to three months. Dis Colon rectum. 2000;43(12):1666-75.

Picchio M, Palimento D, Attanasio U, Renda A. Stapled vs open hemorrhoidectomy: long-term outcome of a randomized controlled trial. International journal of colorectal disease. 2006;21(7):668-9.

Ascanelli S, Gregorio C, Tonini G, Baccarini M, Azzena G. Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short-and long-term results of a randomised, controlled, prospective trial. Chirurgia italiana. 2005;57(4):439-47.

Manfredelli S, Montalto G, Leonetti G, Covotta M, Amatucci C, Covotta A et al. Conventional (CH) vs. stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years’ experience. Ann Ital Chir. 2012;83(2):129-34.