Title: A Randomised Comparative Study between Open and Closed Haemorrhoidectomy
Authors: Dr Gopal Sharma, Dr Shyam Gupta, Dr Tariq P Azad, Dr Nivedita Prashar
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.73
Abstract
Background: Haemorrhoids are defined as dilated plexus of superior haemorrhoidal veins in relation to the anal canal. Haemorrhoidectomy can be performed by various techniques as open (Milligan Morgan), sub mucous resection (Park), closed (Ferguson) or by stapled techniques. Various outcomes have been reported with controversy still existing as to which of the techniques has an edge over the other. Aim of this study was to compare operating time, postoperative pain, hospital stay and wound healing in patients undergoing open and closed haemorrhoidectomy.
Method: 60 patients with third or fourth degree haemorrhoids were randomly assigned into two groups. They were randomized into two groups depending upon whether the patient registration number was odd or even. Patients in group A (Milligan-Morgan) were operated by an open method and patients in group B were operated by closed method (Ferguson technique).
Results: The mean age of patients in group A was 44.25±1.80 whereas mean age in group B was 42.60±1.16 years. In group A 60 %(18) of patients were males whereas 40%(12) were females. In group B 56.66 %(17) were males whereas females comprised of 43.33%(13) Demographic and other characteristic of patients in the two groups were comparable. All patients were operated under spinal anaesthesia in both the groups. The mean duration of surgery in group A was 20.66±1.60 minutes whereas in group B it was 26.20±5.90 minutes p value 0.001 (highly significant). In group A, mean VAS score on first post operative day was 4.20±1.60 while it was 3.58±1.10 in group B p value 0.085, (statistically not significant). VAS score on first act of defacation in group A was 3.80±1.48 while it was 3.00±0.98 p value 0.001(highly significant). Mean hospital stay in group A was 2.10±0.40 days while in group B, mean hospital stay was 1.94±1.16 days p value 0.78(statistically not significant) .Healing time in group A patients was 4.40±0.70 weeks while it was 2.90±1.60 weeks in group B p value 0.001(highly significant). Only minor complications were encountered in the present study. There was no recurrence in both groups
Conclusions: The closed technique provides a better outcome in terms of less postoperative pain, shorter duration of surgery, and early wound healing.
Keywords: Haemorrhoids, open, closed, pain, healing time.
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