Randomized Trial of Open Hemorrhoidectomy Versus Stapled Hemorrhoidectomy for Grade II/III Hemorrhoids

Abstract

Hemorrhoids are one of the most common anorectal disorders. Open hemorrhoidectomy (OH) is the gold standard surgical technique while stapled hemorrhoidopexy (SH) [procedure for prolapsed hemorrhoids (PPH)] is a newly developed method for the surgical management of hemorrhoids. A Medline, PubMed, and Cochrane data base search was performed. Relevant papers, e.g., randomized controlled trials, review, and meta-analysis from different parts of the world have shown stapled hemorrhoidopexy is less painful and it is associated with quicker recovery, but SH is associated with higher rates of skin tags, hemorrhoid recurrence, and prolapse recurrence than conventional hemorrhoidectomy. A randomized trial was conducted from March 2014 to March 2016 at M.Y.H. Hospital Indore tertiary care center. The aim of the study was to compare the early results in 100 patients randomly allocated to undergo either stapled or open hemorrhoidectomy. Patients with grade II and III hemorrhoids were randomly allocated to undergo either stapled (50 patients) or open (50 patients) hemorrhoidectomy. Post-operative pain was assessed by means of a visual analog scale (VAS). Recovery evaluation included return to pain-free defecation and normal activities. A 6-month clinical follow-up was obtained in all patients. Operation time for stapled hemorrhoidectomy was shorter (mean 35.8 mins [range 20 to 50] minutes versus 50.2 mins [range 30 to 60] minutes, p < 0.05). Mean (range) VAS scores in the stapled group were significantly lower (VAS score after 7 days: 2.2 [2 to 5] versus 3.3 [2 to 6], p < 0.05). Resumption of routine work was significantly faster in the stapled group (8.08 days versus 16.2 days, p = 0.001). At follow-up, 4 weeks and 4 months recurrence of symptoms and fecal urgency was present in 6/50 (12%) patients in the stapled group and 2/50 (4%) in the OH group (p < 0.05). Our initial results suggest that stapled hemorrhoidectomy is an effective treatment for symptomatic second and third degree hemorrhoids but with significant complication rates on follow-up in patients compared with traditional hemorrhoidectomy.