Randomized comparison of stapled haemorrhoidopexy and open haemorrhoidectomy

Background: Surgical management of haemorrhoids is reserved for stage III and IV haemorrhoids. Both Milligan-Morgan technique (CH-Conventional Haemorrhoidectomy) and stapled haemorrhoidopexy technique are used as surgical therapy. Our prospective, comparative study of conventional haemorrhoidectomy versus stapled haemorrhoidectomy was designed in present institution.Methods: This prospective randomised comparative study was carried out in present Surgery Dept from July 2016 to December 2017 with total 60 sample size. All data were analysed according to applicable statistical methods. The results were compared to previous studies so as to arrive at a conclusion.Results: The mean duration of surgery with stapled method was 30.76±3.13 minutes and with conventional method was 49.36±4.08 minutes which was significantly high in conventional method. VAS scores for pain at 12 hours, 24 hours, 72 hours and 7 days for stapled group were 2.63±0.76, 1.66±0.88, 0.90±0.71 and 0.50±0.43 while that for the conventional group were 5.63±0.72, 4.56±1.22, 3.26±1.25 and 2.00±0.69. At all points of time the VAS was significantly lower in stapled group. The mean duration of hospital stay of the patients with stapled method was 3.10±0.75 days and with conventional method was 6.06±0.94 days, which was significantly high in conventional method. The mean time to return to normal activities of the patients with stapled method was 8.16±1.93 days and with conventional method was 12.60±1.67 days, which also significantly high in conventional method.Conclusions: Present study inferred that stapled haemorrhoidopexy is faster, minimally invasive for treatment of haemorrhoids as compared to Conventional haemorrhoidectomy. It is associated less pain and provides a more satisfactory alternative to Conventional surgery because of reduced hospitalisation and earlier return of patient to daily activities, with no significant differences in short term follow up.

Complications of Stapled Haemorrhoidectomy for Primary Haemorrhoid – Our Experience in ShSMCH

Objective: The aim of the study was to cheek the rate of significant complications amongst the patients undergoing Stapled haemorrhoidectomy. This study reflects our experience with Stapled haemorrhoidectomy in our Population.Methods: Two hundred and ninety patients with primary hemorrhoid of different degree underwent staple Hemorrhoidectomy in ShSMCH since January 2011 to December 2016. All patients were evaluated by history, clinical examination and proctosigmoidoscopy. They were followed up post operatively at 1, 3, 6, 12, 15, 18 Month.Result : Regarding presenting symptoms (pain less) per rectal bleeding was the main symptom (89%). Bulk of the pt were 3rd degree(50.16%). Regarding post operative complication – Urgency of defecation was most frequent (19%). Others were Urinary retention (4.5%), anal pain (4.01%), reactionary hemorrhage (4.01%). Regarding late post operative complication most frequent was mild pain (3.34%); others were – flatus incontinence, stenosis, recurrent haemorrhoid, fissure.Conclusion : Stapled haemorrhaidectomy is widely used, quick, safe and effective method of treating all degree of primary hemorrhoid with some complications. Therefore surgeon should be well aware of the type and post operative complicationsJ Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 78-82

Haemorrhoid disease

Haemorrhoids may affect over 70% of the Western population. Symptoms include prolapse, bleeding, and discomfort. Classification of haemorrhoids is important before deciding on therapy or conservative management. Treatment may include submucosal sclerotherapy, elastic band ligation, haemorrhoidal artery ligation, stapled haemorrhoidectomy, and conventional open or closed haemorrhoidectomy.

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.

Long-term Functional Outcome after Stapled and Excisional Haemorrhoidectomy

Background: Stapled haemorrhoidectomy (SH) described by Longo has been a recently added option for hemorrhoid surgery. Interest in SH has been principally driven by the fact that conventional excision haemorrhoidectomy (EH) has been an extremely painful procedure as it involves excision of haemorrhoidal tissue along the extremely sensitive anoderm. SH on the other hand has been shown to be associated with decreased postoperative pain, as it does not involve the sensate anal mucosa below the dentate line. To date there have been many randomized controlled studies comparing circular stapled haemorrhoidectomy with traditional excision techniques. Despite proven early postoperative advantages for SH the long-term benefits and effect on patients quality of life (QOL) compared to EH still remains to be debated. Methods: To evaluate long-term patient outcomes via a validated health related QOL survey. Results: QOL measures were satisfactory in both groups across all subscales of physical health summary measures and mental health summary measures. This coincided with Wexner continence scores, which were also satisfactory with median of 0 in both groups. Conclusion: QOL, continence scores and long term symptom follow-up is similar in patients that undergo SH or EH.

Stapled Hemorrhoidectomy: hope or hype!

This study was carried out to assess the feasibility of Stapled haemorrhoidectomy. This included 45 patients of which twenty nine were males and sixteen females. Age ranged from 23 to 84 years. The severity of the disease ranged from 3rd to 4th degree haemorrhoids. Place of study was Sir Ganga Ram, Masood and Wishaw Hospital Scotland. Period of study was two years from October 2002 to October 2004.