A Prospective Study Comparing Stapler and Open Surgical Technique of Hemorrhoidectomy

Introduction Hemorrhoids are basically anal cushions which turn out to be pathological giving rise to bleeding, pain and protrusion outside the anal canal. The chief complaint of patients with hemorrhoids is bleeding from the rectum which is usually painless and associated with episodes of defecation. The study was done to assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence between the stapler and open hemorrhoidectomy for grade III and IV hemorrhoids. Material and methods The present prospective study was conducted among 60 patients in the General Surgery department at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar over the duration of two years presenting with grade III and IV degree hemorrhoids. Thirty patients each were divided into open hemorrhoidectomy and stapled hemorrhoidectomy groups. The study evaluated variables like operative time, stay at the hospital and postoperative complications and compared them between the two techniques. Follow-up of patients was done at regular intervals. Evaluation of postoperative pain was done using visual analogue scale (VAS) with ranges from 0 to 10. We evaluated the data using the chi-square test with a p-value <0.05 as significant. Results Of 60 patients, 47 (78.3%) were males and 13 (21.7%) were females with a male: female ratio being 3.6:1. The operating time and hospital stay were much less in the stapler hemorrhoidectomy group as compared to the open procedure group. Also, postoperative pain (visual analogue scale) was less in the stapler hemorrhoidectomy group with 36.7% of patients presenting with pain at one week, 23.3% at one month and 3.3% at three months in the open hemorrhoidectomy group whereas 13.3% presenting as pain in one week, 10% presenting at one month and none presenting at three months in the stapler hemorrhoidectomy group. There was recurrence seen in 10% of cases at three months in the open hemorrhoidectomy group as compared to the stapler hemorrhoidectomy group where no recurrence was found at three months follow-up. Conclusion Hemorrhoid offers a variety of surgical modalities of treatment. We have come to the conclusion that stapled hemorrhoidectomy has less complications and good patient compliance. It can be an effective option in the treatment of third and fourth-grade hemorrhoids. With proper training and expertise, stapler hemorrhoidectomy is a better and reliable technique for hemorrhoid surgery.