Page 10 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Comparative Study of Management of Hemorrhoids: Stapler

vs Open Hemorrhoidectomy

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Keyur Surati , Jatin Modi , Sourabh Damani , Kushal Prajapati , Aneri Shah 5
AbstrAct
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.
Keywords: Open hemorrhoidectomy, Recurrence of hemorrhoids, Stapler hemorrhoidectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1492

IntroductIon 1–5 Department of General Surgery, AMCMET Medical College,
Pathological changes in cushion of vascular tissue in the anus Ahmedabad, Gujarat, India
leads to internal hemorrhoid development. Anal continence is Corresponding Author: Kushal Prajapati, Department of General
maintained by these cushions as they help internal sphincter in Surgery, AMCMET Medical College, Ahmedabad, Gujarat, India, Phone:
complete closure of the anal canal. Hemorrhoids are presented with +91 9723183879, e-mail: pkushal89.kp@gmail.com
bleeding, mucus discharge, itching, pain, and something coming How to cite this article: Surati K, Modi J, Damani S, et al.
out per rectum which might be symptomatic or asymptomatic. Comparative Study of Management of Hemorrhoids: Stapler vs Open
Hemorrhoid is present in 4–34% of population. Hemorrhoidectomy. World J Lap Surg 2022;15(1):8–10.
Theories behind the development of hemorrhoids are Source of support: Nil
rise in abdominal pressure, portal hypertension, straining
during defecation, connective tissue abnormalities, and tissue Conflict of interest: None
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metaplasia. There is different grading of hemorrhoids according
to their prolapse. First- and second-degree hemorrhoids are
treated by band ligation and sclerotherapy or by conservative MAterIAls And Methods
method. Surgical intervention is required for the third- and fourth- Patients for this clinical study were selected who have internal
degree hemorrhoids. Anal mucosa is sensitive, so in the patient of hemorrhoids with the following inclusion and exclusion criteria.
open hemorrhoidectomy, removal of the hemorrhoid with anal The study was comparing open hemorrhoidectomy and stapler
mucosa and perianal skin causes pain. Also, patients have to get hemorrhoidectomy for the management of grade-II bleeding
done cleaning and dressing of the wound and have to take care of hemorrhoids and grade-III hemorrhoids. Twenty cases of open
hygiene especially from fecal contamination. Infection may occur hemorrhoidectomy and 20 cases of stapler hemorrhoidectomy
which can prolong wound healing. Stapler hemorrhoidectomy were studied.
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also known as stapler rectal mucosectomy, has emerged as a
painless alternative. In this method, interruption of the blood Inclusion Criteria
supply of hemorrhoid reduces the size of the hemorrhoid and Patients coming to tertiary care center with grade-II bleeding
reduces the available rectal mucosa by which it decreases the hemorrhoids and grade-III hemorrhoids, who were willing for
rectal mucosal prolapse. 3 surgical management in hospital, were included in the study.
This study compares stapler and open hemorrhoidectomy
in terms of postoperative pain, hospital stay, and early return to Exclusion Criteria
work with or without complications for second- and third-grade Patients who were not fit for the surgery, patients not willing to
hemorrhoids. be a part of this study, patients having comorbid conditions and

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