Publication:

Stapler hemorrhoidectomy versus open hemorrhoidectomy

Background Hemorrhoidal disease is a painful concern to the sufferer and the treating surgeon. Several methods are available for treatment of hemorrhoids. Milligan Morgan hemorrhoidectomy is the most widely practiced Gold standard surgical technique for the management of 3rd and 4th degree hemorrhoids. Staplers are novel methods known for its simplicity, ease and standardization to an anastomosis.

Methods A prospective randomized control study was done including 60 consecutive patients.  The patients were divided into two groups viz. Stapler hemorrhoidectomy group (SH) and Open (Milligan Morgan) hemorrhoidectomy group (OH). Randomization of the patient and assigning them to either of the group was done by the sealed envelope technique on the morning of the surgery. Pain score data sheet was filled out by the patients postoperatively. Data was analysed using SPSS. Significant difference was estimated using Chi Square test and Student’s ‘t’ independent test.  Level of significance was taken as 0.05.

Results Sixty patients in two equal groups were studied.  Mean age of the two groups was similar.  The male: female ratio was 6.5:1 for the stapled group and 9:1 for the open group.  The mean operating time for open group was significantly higher than the stapled group (P = 0.0001).  The SH group returned to normal activity significantly early. There was no significant difference in pain score on day one.  Pain score was significantly lower for the SH group on days 2 and 3. There was no significant difference in complication between the two groups.

Conclusions Operative time, duration of hospital stay and return to normal activity were satisfactory with stapler hemorrhoidectomy than the open method. Hence those who can afford the cost of surgery will definitely benefit, though it cannot be prescribed to all patients due to economic constraints. We still suggest long-term follow-up of all stapler hemorrhoidectomy patients.