Publication:

Stapled haemmorhoidopexy versus open haemorrhoidectomy: our initial experience

Background Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non-surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely-used procedure. A recent novel technique called ‘Stapled haemorrhoidopexy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits.

Methods A total of 155 patients between the age group of 20 and 65 years, diagnosed to have grade III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (30 patients) and Group 2 undergoing Stapled haemorrhoidectomy (25 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post-surgery. The significant difference of the percentages between the two groups was tested using the Chi Square test. The significant difference in the mean values between the 2 groups was tested using the Student’s t- independent test. For all the tests, level of significance was taken as 0.05.

Results In present study, the mean operating time for stapled haemorrhoidopexy was 34.96±7.38 minutes with an average of 20-50 minutes, while with open haemorrhoidectomy, the mean operating time was 44.67±11.83 minutes (p<0.001). The mean VAS scores at 6, 12 and 24 hours with stapled haemorrhoidopexy were 1.79±0.76; 1.83±0.61 and 1.47±0.66, respectively, and with open haemorrhoidectomy, the mean VAS scores at 6, 12 and 24 hours were 2.88±0.88; 2.13±0.82 and 1.91±0.83, respectively. The mean hospital stay for patients with stapled haemorrhoidopexy was 1.96±0.55 days in comparison to the open group where the mean hospital stay was 3.51±0.72 days (P-value<0.001). The time for resumption to routine work was shorter in stapled group 8.61±2.76 as compared to 15.34± 2.12 which was statistically significant (P value <0.001). The mean amount of blood loss during stapled hemorrhoidectomy was statistically less than in open surgery.

Conclusions Stapled Haemorrhoidectomy is less painful with shorter duration of hospital stay and resumption of daily activity is faster than the open haemorrhoidectomy. However, long term follow-up is required to know the recurrence rate in stapled haemorrhoidectomy.