English

Abstract

BACKGROUND AND NEED FOR STUDY: Manual hemorrhoidopexy is a new technique proposed by Tagariello Carlo1 (2011) for the treatment of hemorrhoids especially grade III. In contrast to the conventional excisional hemorrhoidectomy (Milligan-Morgan/ Ferguson) this novel technique, does not involve excision but plication with fixation of the prolapsing hemorrhoid. In the original study the new technique was not compared with any other techniques of treatment for hemorrhoids. This study compares the new method and the traditional Milligan-Morgan hemorrhoidectomy. MATERIAL AND METHODS: A prospective study of patients who have undergone surgery for hemorrhoids over 2 years (from March 2011 to March 2013) was done in College of Medical Sciences Teaching Hospital (COMS-TH), Bharatpur, Chitwan, Department of Surgery. The patients who presented with third degree internal hemorrhoids on a random basis, underwent either conventional MilliganMorgan hemorrhoidectomy (Group A) or Manual hemorrhoidopexy (Group B). The patients who had external hemorrhoids in addition to internal were excluded. Preoperative, intraoperative, and postoperative characteristics were evaluated. RESULTS: Group A included 37 patients (25 males) with mean age group 42 years underwent conventional Milligan-Morgan hemorrhoidectomy. Group B included 33 patients (20 males) with mean age group 40 years underwent manual hemorrhoidopexy. The patients in Group A had longer duration of surgery (42.2 min vs 25.2 min, p=.001), more postoperative pain as compared to Group B (8.18 vs 2.14, as assessed by the visual analogue scale, p=.014) and this was statistically significant. Most of the Group A patients had minimal post-operative bleeding. None of the Group B patient had postoperative bleeding. There was no significant difference among the other post-operative complications (eg. Urinary retention). Mean hospital stay in Group A was 4.06 days as compared to 2.69 days in Group B (p =.002). Median follow up was 3 (1-4) months. None of the patients in either group had recurrence at follow up. CONCLUSION: Manual hemorrhoidopexy scores better then Milligan-Morgan method of hemorrhoidectomy with respect to duration of surgery, post-operative pain and hospital stay. KEYWORD: Manual haemorrhoidopexy, haemorrhoid, Milligan –Morgan, haemorrhoidectomy.