Publication:

Comparison of efficacy of open hemorrhoidectomy versus stapled haemorrhodopexy in grade 3 and above internal haemorrhoid patients

Background Haemorrhoidal disease is a common anorectal condition, with Grade III and IV haemorrhoids often requiring surgical intervention. Open haemorrhoidectomy (Milligan-Morgan technique) has long been the standard procedure but is associated with significant postoperative pain and prolonged recovery. Stapled haemorrhoidopexy has emerged as a minimally invasive alternative with the potential for improved postoperative outcomes. This study aimed to compare the efficacy and postoperative outcomes of open haemorrhoidectomy and stapled haemorrhoidopexy in patients with advanced haemorrhoids.

Methods This prospective observational study was conducted at a tertiary care center over a period of one year (July 2023 to July 2024). A total of 84 patients with Grade III and IV internal haemorrhoids were included and equally divided into two groups: open haemorrhoidectomy (n=42) and stapled haemorrhoidopexy (n=42). Outcomes assessed included postoperative pain using the Visual Analogue Scale (VAS) at 12, 24, and 48 hours, postoperative bleeding, duration of hospital stay, and time to return to work. Statistical analysis was performed using appropriate tests, with p <0.05 considered significant.

Results Stapled haemorrhoidopexy demonstrated significantly lower postoperative pain scores at all time intervals compared to open haemorrhoidectomy (p<0.001). The stapled group experienced minimal postoperative bleeding (mean 0.36 days vs 3.14 days), shorter hospital stays (mean 0.74 vs 2.55 days), and earlier return to work (mean 3.33 vs 7.43 days). In contrast, open haemorrhoidectomy was associated with higher pain intensity, prolonged bleeding, and delayed recovery.

Conclusions Stapled haemorrhoidopexy is superior to open haemorrhoidectomy in terms of reduced postoperative pain, minimal bleeding, shorter hospital stay, and faster return to normal activities. It can be considered a preferred surgical option for the management of Grade III and IV haemorrhoids, provided adequate surgical expertise is available.