Comparative Study of Management of Hemorrhoids: Stapler vs Open Hemorrhoidectomy
Keyur Surati, Jatin Modi, Sourabh Damani, Kushal Prajapati, Aneri Shah
Citation Information :
Surati K, Modi J, Damani S, Prajapati K, Shah A. Comparative Study of Management of Hemorrhoids: Stapler vs Open Hemorrhoidectomy. World J Lap Surg 2022; 15 (1):8-10.
Aims and objective: To study postoperative pain, time taken for procedure, postoperative complications, return to normal activity, and recurrence between stapler and open hemorrhoidectomy.
Materials and methods: For this study, 40 patients of second- and third-degree hemorrhoids were operated for stapler or open method of hemorrhoidectomy. Follow-up of all patients was taken at first week, third week, and 1 year postoperatively.
Results: On the postoperative days one to four in stapler hemorrhoidectomy, there was decreased postoperative pain according to visual analog score, significantly reduced operating time and early gain of work (3 vs 20.5 days; p = 0.001). No difference in complications of both the method of surgeries was found. No recurrence was found in either of surgeries, while impaired wound healing was found more in open hemorrhoidectomy. After 1 year, there were no any complications such as recurrence, rectal stenosis, or perianal fistulas in stapler group.
Conclusions: Stapler hemorrhoidectomy was found to have decreased postoperative pain, earlier return to work, earlier recovery time, and zero recurrence in comparison with the open technique up to 1 year.
Clinical significance: Stapler hemorrhoidectomy can be a good option as compared to open hemorrhoidectomy in the form of less postoperative pain, hospital stay, and early return to work in second- and third-degree hemorrhoids without significant postoperative complications.
Brisinda G. How to treat hemorrhoids: prevention is best; hemorrhoidectomy needs skilled operators. BMJ 2000;321(7261):582–583. DOI: 10.1136/bmj.321.7261.582.
Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomised controlled trial. Lancet 2000;355(9206):779–781. DOI: 10.1016/s0140-6736(99)06122-x.
Sutherland LM, Burchard AK, Matsuda K, et al. A systematic review of stapled hemorrhoidectomy. Arch Surg 2002;137(12):1395–1406. DOI: 10.1001/archsurg.137.12.1395.
Milles E. Observations upon internal pils. Surg Gynecol Obstet 1919;29:497–506.
Khalil KH, O’Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed hemorrhoidectomy. J Br Surg 2000;87(10):1352–1355. DOI: 10.1046/j.1365-2168.2000.01624.x.
Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for hemorrhoids versus Milligan-Morgan hemorrhoidectomy: randomised controlled trial. Lancet 2000;355(9206):782–785. DOI: 10.1016/S0140-6736(99)08362-2.
Ho YH, Cheong WK, Tsang CE, et al. 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 2000;43(12):1666–1675. DOI: 10.1007/BF02236847.
Ganio E, Altomare DF, Milito G, et al. Long-term outcome of a multicentre randomized clinical trial of stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy. J Br Surg 2007;94(8):1033–1037. DOI: 10.1002/bjs.5677.
Fazio VW. Early promise of stapling technique for hemorrhoidectomy. Lancet 2000;355(9206):768–769. DOI: 10.1016/S0140-6736(00)00086-6.
Longo A. Pain after stapled hemorrhoidectomy. Lancet 2000;356(9248):2189–2190. DOI: 10.1016/s0140-6736(05)67258-3.