A Comparative study of Post Operative Outcomes between Haemorrhoidectomy and Stapled Haemorrhoidopexy Done for Haemorrhoids

BACKGROUND: Haemorrhoids commonly affects adult population, due to proposed aetiology such as dietary factors, straining at stools, high resting anal posture, erect posture etc. Milligan Morgan’s open haemorrhoidectomy is the standard procedure done for haemorrhoids. Longo’s stapled haemorrhoidopexy is the recent surgical technique initially used in prolapsed piles, is now also used in second and third degree haemorrhoids. OBJECTIVES: 1. To compare the various post operative outcomes between haemorrhoidectomy and stapled haemorrhoidopexy done for haemorrhoids in detail. 2. To assess the benefits of this recent technique, stapled haemorrhoidopexy for haemorrhoids. METHODOLOGY: DESIGN: Prospective Study. SETTING: Coimbatore Medical College, Coimbatore. PARTICIPANTS: Patients with Second and Third Degree Haemorrhoids. SAMPLE SIZE: 50. The study is done to compare the post operative complications between 25 cases of open haemorrhoidectomy and 25 cases of stapled haemorrhoidopexy. Case selection was done at surgical out patient department with the following criteria, • Age between 20 and 50 years. • Both male and female patients. • Second and third degree haemorrhoids. EXCLUSION CRITERIA: • Age less than 20 years and above 50 years. • Associated ascites with portal hypertension. • Recurrent cases. • Associated fistula in ano. • Associated fissure in ano. • Rectal malignancy. • Symptomatic bladder outlet obstruction. • Previous perianal surgeries. • Thrombosed external haemmorhoids. • Bleeding disorders. • Sepsis. The patients were observed at immediate post operative period and upto the period of 3 months. RESULTS: The average hospital stay is about 1.5 day less in stapler method. Post-operative pain is mild in stapler method as compared to severe pain in open method. Urinary retention & reactionary bleeding is about 3 times lesser than open method. Pain and blood stained stools is less in stapler method during follow up. Return to normal work at 13 days is one week earlier than the open method. CONCLUSION: Post-operative pain & the length of the hospital stay is comparatively low and hence the return to work is earlier in stapler hemorrhoidopexy. According to the study, Stapled hemorrhoidopexy has better patient acceptability and earlier recovery, as compared with open hemorrhoidectomy