Title: Comparative Study of Stapled and Open Hemorroidectomy
Authors: Sourav Baur, P.G.Chougule, Nitin Nagre, Hrishikesh Deka, S.R.Kulkarni
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.88
Abstract
Background and Objectives: Stapled Hemorroidectomy has rapidly become established as the popular alternative to open Hemorroidectomy, it has a safety profile better than open procedure.
Objectives:
To compare the short term outcome of Stapled Hemorroidectomy, with Open haemorrhoidectomy (Milligan-Morgan) in terms of
Duration of surgery
Post operative pain and analgesia
Safety and efficacy of the procedure
Procedure time
Intra-op complication
Duration of hospital stay
Post operative complications
Days taken for Return to Work
Anorectal physiological functions and recurrence
Patient satisfaction
Methods: Prospective study from Oct 2014 to June 2016, involved 90 patients undergoing surgery for haemorrhoid at Krishna Institute of Medical Sciences, Karad who fulfilled the criteria were included in the study. Forty five underwent Milligan Morgan technique of open haemorrhoidectomy and forty five underwent Longo technique of Stapled hemorroidopexy.
Descriptive statistical analysis has been carried out in the present study. Significance is assessed at 5 % level of significance, Student t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale in parametric condition between two groups Inter group analysis) and Mann Whitney U test (two tailed, dependent) has been used to find the significance of study parameters on continuous scale in non-parametric condition with in each group. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two groups.
Results: stapledhemorrhoidopexy is associated with shorter duration of surgery, less postoperative pain and need for analgesia, shorter duration of hospital stay and a quicker recovery, earlier return to work and a high patient satisfaction as compared with Conventional hemorrhoidectomy (Milligan Morgan technique) of Open Hemorrhoidectomy.
Conclusions: The findings of our study confirm that stapled hemorrhoidopexy is associated with shorter duration of surgery, less postoperative pain and need for analgesia, shorter duration of hospital stay and a quicker recovery, earlier return to work and a high patient satisfaction as compared with Conventional hemorrhoidectomy (Milligan Morgan technique) of Open Hemorrhoidectomy. The procedure is not associated with major post operative complications. There is no recurrence, residual prolapse or incontinence in the follow up period of six months.
We conclude that stapled hemorrhoidopexy is safe with many short-term benefits. It is a novel technique and has emerged as an alternative to open hemorrhoidectomy , long considered the “gold standard”.
References
1. Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg. 2001Jul;234(1):21-4.
2. Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg. 2001 Aug;88(8):1049-53
3. Milligan ETC,Morgan CN, Jones LE, Officer R. Surgical Anatomy of the anal Canal and the operative treatment of hemorrhoids. Lancet 1937; 2:119-1124
4. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoide-ctomy: randomised controlled trial. Lancet. 2000 Mar 4; 355(9206):782-5.
5. Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised control-ed trial. Lancet. 2000 Mar 4; 355 (9206):779-81.
6. Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg. 2001 May;88(5):669-74.
7. Fazio VW. Early promise of stapling technique for haemorrhoidectomy. Lancet. 2000 Mar 4;355(9206):768-9
8. Longo A. Treatment of haemorrhoids disease by the reduction of mucosa and haemmorhoidal prolapsed with circular suturing device: a novel procedure. 6th World Congress of Endoscopic Surgery, Rome. 1998
9. Longo A. Mechanical hemorrhoidectomy using a circular stapler. Refresher course in hemorrhoidal disease therapy. Presented at the 24th International Congress of Latin Mediterranean. Palmero, Italy; September 29 to October 1, 1995.
10. Correa-Rovelo JM, Tellez O, Obregon L, et al. Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized clinical trial. Dis Colon Rectum 2002;45:1367–75.
11. Hetzer FH, Demartines N, Handschin AE, et al. Stapled vs. excisional hemorrhoid-dectomy: long-term results of a prospective randomized trial. Arch Surg 2002;137:337– 4.
12. Singer MA, Cintron JR, Fleshman JW, et al. Early experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 2002;45:3609.
13. Bikhchandani J, Agarwal PN, Kant R, et al. Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 2005; 189(1):56–60.
14. Khalil KH, O'Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg. 2000;87:1352-1355.
15. Franc H. Hetzer, MD; Nicolas Demartines, MD; Alexander E. Handschin, MD; Pierre-Alain Clavien, MD, PhD Stapled vs Excision Hemorrhoidectomy :Long-term Results of a Prospective Randomized Trial Arch Surg. 2002;137:337-340.
16. Ng KH, Ho KS, Ooi BS, et al. Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg 2006;93:226–230
17. Cheetham MJ, Mortensen NJM, Nystom PO, Kamm MA, Phillips RKS. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet. 2000;356: 730-733.
18. Jayaraman S, Colquhoun PH, Malthaner RA.Stapled versus conventional surgery for hemorrhoids Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005393.