Comparison Of Surgical Treatment Of Hemorrhoids - Stapled Versus Open And Closed Hemorrhoidectomy

Aim: To make a comparative assessment of the following procedures for haemorrhoids: a) Stapled haemorrhoidectomy b) Open haemorrhoidectomy and c) Closed haemorrhoidectomy, in terms of operating time, postoperative pain, postoperative complications (immediate and late), hospital stay, time to return to work, and cost of the procedure.Materials and Methods: This non-randomised prospective study included 50 patients (stapled haemorrhoidectomy (n=20), open haemorrhoidectomy (n=20) and closed haemorrhoidectomy (n=10). Pain was assessed using the visual analogue scale. The patients were followed up for 6 months.Results: The mean age was 45 years; the majority of the patients were males. Mass per anus, pain during defecation and constipation were the predominant symptoms. In the study, 22 patients had grade II and 28 patients had grade III haemorrhoids. The average time taken for a stapled haemorrhoidectomy was 45.75 minutes and for an open one it was 38.75 minutes. Closed haemorrhoidectomy took an average of 62 minutes (45-80min.). The average pain scores on postoperative day 1, day 2 and day 3 in the stapled group were 3.8, 2.4 and 1.6 as against 5.6, 4.6 and 4.1 in the open group and 5.4, 4.3 and 3.9 in the closed group, respectively. Pain during the passage of stools was considerably less in the stapled group. The average duration of hospital stay for the stapled group was 1.5 days and for the open and the closed group it was 5.8 days and 6.2 days, respectively. The average time to return to work in the stapled group was 5.3 days as against 13.2 in the open group and 13.1 days in the closed group. None of the patients in any of the groups had any postoperative wound infection. Two patients in the stapled group had recurrence of the symptoms. One patient in stapled group developed fecal urgency. No major late complications were noted in the closed group. Conventional procedures were cost-effective in our setting.Conclusion: Stapled haemorrhoidectomy offers much less pain when compared to the conventional methods and allows early return to work. However, long-term complications are still unknown with most of the surgeons still in the learning curve. It is up to the treating surgeon to use his experience, skill and acumen in selecting the procedure for treating his patient with haemorrhoids which is suitable to the patient economically, socially and curatively.