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Indian Journal of Surgery

, Volume 80, Issue 6, pp 574–579 | Cite as

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

  • Sumit Shukla
  • Ankur Maheshwari
  • Brijesh TiwariEmail author
Original Article
  • 90 Downloads

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.

Keywords

Stapled hemorrhoidopexy Open hemorrhoidectomy Hemorrhoids MYH hospital Randomized trial 

Notes

Compliance with Ethical Standards

Conflict of Interest

Authors Dr. Sumit Shukla, Dr. Ankur Maheshwari, and Dr. Brijesh Tiwari declare that they have no conflict of interest.

References

  1. 1.
    Nisar PJ, Acheson AG, Neal KR et al (2004) Stapled haemorrhoidopexy compared with conventional haemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47(11):1837–1845CrossRefGoogle Scholar
  2. 2.
    Thejeswi P, Laxman YK, Ram K (2012) Comparison of surgical treatment of hemorrhoids—stapled versus open and closed hemorrhoidectomy. The Internet Journal of Surgery 28(2)Google Scholar
  3. 3.
    Bikhchandani J, Agarwal PN, Kant R, Malik VK (2005) Randomized controlled trial to compare the early and mid-term results of stapled versus open haemorrhoidectomy. Am J Surg 189(1):56–60CrossRefGoogle Scholar
  4. 4.
    Hiremath B, Gupta S (2012) Stapled haemorrhoidopexy for haemorrhoids: a review of our early experience. Indian J Surg 74(2):163–165. doi: 10.1007/s12262-011-0406-3 CrossRefGoogle Scholar
  5. 5.
    Palimento D, Picchio M, Attanasio U et al (2003) Stapled and open haemorrhoidectomy: randomized controlled trial of early results. World J Surg 27(1):203–207Google Scholar
  6. 6.
    Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and haemorrhoids (stapled haemorrhoidopexy). Dis Colon Rectum 50(6):878–892CrossRefGoogle Scholar
  7. 7.
    Khan NF, Hussain Shah SS, Bokhari I, Mahboob S, Gulfam MA (2009) Outcome of stapled haemorrhoidectomy versus Milligan Morgan’s haemorrhoidectomy. J Coll Physicians Surg Pak 19(9):561–565Google Scholar
  8. 8.
    Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355(9206):728–725CrossRefGoogle Scholar
  9. 9.
    Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL et al (2000) Stapled hemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43(12):1666–1675CrossRefGoogle Scholar
  10. 10.
    Khalil KH, O’Bichere A, Sellu D (2000) Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg 87:1352–1355CrossRefGoogle Scholar
  11. 11.
    Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102(13):1603–1618. doi: 10.1002/bjs.9913 CrossRefGoogle Scholar
  12. 12.
    Nisar PJ, Acheson AG, Neal KR, Scholefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Colon Rectum 47(11):1837–1845CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Sumit Shukla
    • 1
  • Ankur Maheshwari
    • 1
  • Brijesh Tiwari
    • 1
    Email author
  1. 1.M.S. General SurgeryM.G.M. Medical College & M.Y.H. Hospital IndoreIndoreIndia

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