Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: arandomized clinical trial.

Abstract

This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of gradeIII and gradeIV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1year. This was asingle-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50(68.75%) male and 20(31.25%) female patients with third- and fourth-degree piles. The patients were divided into two groups of 35patients each. GroupI underwent SH and groupII underwent HSH. The mean age of groupI was 42.94years and of groupII, 42.20years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in groupI was lower than in groupII during the first 2weeks, but there was persistent mild pain in most patients in groupI at the 2‑week follow-up. In groupII there was significant improvement in pain after 2weeks, with higher patient satisfaction. Wound infection was detected in 3(5%) patients in groupI and no patients in groupII (p = 0.077). Postoperative bleeding occurred in 4(11.4%) patients in groupI in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in groupII (p = 0.039). There were 3(15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7(20%) cases of recurrence at the 1‑year follow-up in groupI and 1(2.9%) case in groupII (p = 0.024). Compared with SH, HSH was safer, easier, and associated with alower incidence of recurrence after 1year and with higher patient satisfaction.