Comparative Study of Minimal Invasive Procedure for Hemorrhoids Vs Conventional Hemorrhoidectomy in Management of Hemorrhoids

Abstract

Introduction: Till recently Milligan – Morgan hemorrhoidectomy i.e. conventional or open hemorrhoidectomy is the most popular surgical treatment for hemorrhoids. With the advent of minimal invasive surgery, the scenario has changed. More recently, stapler hemorrhoidectomy is becoming popular as a day care procedure with minimal post-operative pain and early return to work. The present study is designed to compare make a comparative assessment of the Stapled hemorrhoidectomy against Conventional hemorrhoidectomy in the surgical treatment of hemorrhoids. Material & Methods: A hospital based Non-randomised comparative study was conducted in Dept. of Surgery of at a tertiary care hospital. A total of 50 eligible cases scheduled for haemorrhoidectomy in our hospital were included in the study. These 50 patients were then divided into two groups i.e. 25 for stapled procedure and other 25 patients for conventional procedure Data was analyzed using statistical software SPSS ver. 21. Results: Mean operative time was significantly less in stapler group (39.12 vs 45.75 mins; p<0.01) while mean hospital stay was significantly longer in conventional surgery group (7.02 vs 3.01 days; p<0.01). Post-op complains of pain, immediately after surgery (6 hrs.) and at day 1 and day 3 was significantly less in stapler group (p<0.01). Post-op complications after conventional surgery include bleeding (28%), urinary retention (12%), wound infection, anal incontinence (8% each) and anal stenosis (4%). Complications of stapler surgery include bleeding (16%) and urinary retention (4%). Mean time for return to work was significantly less in stapler group as compared to conventional surgery group (4.91 vs 13.8 days; p<0.01). xi Conclusion: Stapler hemorrhoidectomy requires less operative time, reduces hospital stay and decreases post-operative pain. Return to normal activity is also significantly faster with stapler surgery. Stapler hemorrhoidectomy is thus recommended for all patients undergoing surgery of hemorrhoids. However, there is a need to conduct larger prospective double-blind trials with longer period of follow-up to study rate of recurrence along with trials for cost effectiveness.