The comparative study of conventional vs stapled haemorrhoidectomy

Abstract

Background: Several comparative studies are reported in Literature to define a standard for ideal treatment of hemorrhoidal disease. Radical surgery is the only therapeutic option in case of III and IV stage haemorrhoids. Hemorrhoids surgical techniques are classified as Open, Closed and Stapled ones. This study was done to compare the postoperative recovery and complications of PPH and conventional MMH. Materials & Methods: 30 patients with haemorrhoids were managed with surgical ligation and excision of haemorrhoids i.e. by the Milligan-Morgan technique (Group I) and the remaining 30 were managed with stapled haemorrhoidectomy, which was performed by Longo’s technique (Group II). Postoperatively, the patients were properly assessed for the degree of pain according to VAS pain scale, number of analgesics consumed, any urinary retention, first bowel action postoperatively, any haemorrhage or urinary or faecal incontinence. Results: The maximum number of patients were seen in the age group 30-40 years i.e. 18 (30%), of which 14 (23.33%) were male and 4 (6.66%) were female. Analgesics required during hospitalization was 12.33 in group I and 4 in group II, acute urine retention was seen in 8 in group I and 4 in group II, pain (vas) on day 1 was 8.6 in group I and 6.6 in group II, D2 was 6.8 in group I and 3.2 in group III and on day 3 was 5.5 in group I and 2.6 in group II. Hospital stay was 4.37 days in group I and 1.9 days in group II. Post- operative complications was reactionary haemorrhage 2 in group I, secondary haemorrhage 1 in group I and faecal Incontinence 2 in group I and 1 in group II. The difference was significant (P< 0.05). Stapler technique has significantly less requirement of analgesics on day 21, 6 weeks and 3 months compared to conventional technique. More satisfaction in the stapled haemorrhoidectomy group patients indicates that the merits of the stapled technique outweigh those of the conventional technique. Conclusion: Authors found stapled haemorrhoidectomy make it a better technique than the conventional haemorrhoidectomy for managing grade II and grade III hemorrhoids such as lesser operating time, postoperative pain, analgesics required, complications like postoperative urinary retention, postoperative hemorrhage and urinary or faecal incontinence.