Page 11 - World Journal of Laparoscopic Surgery

Stapler vs Open Hemorrhoidectomy
associated gastrointestinal diseases, patients with gangrenous The mean length of the hospital stay after stapler
thrombosed piles, and patients with internal + external hemorrhoids hemorrhoidectomy was 1.5 days, whereas it was 2.4 days in the
were excluded. open hemorrhoidectomy. Return to work by patients was an
In our study, we used 33-mm-diameter two-row staple line average of 3 days (range: 2–8 days) in the stapler hemorrhoidectomy
stapler. and 20.5 days (range: 6–46 days) in the open hemorrhoidectomy
(p = 0.001).
result Postoperative complications observed included bleeding in
Nineteen patients of second-degree hemorrhoids and 21 of one patient of stapler hemorrhoidectomy which was minor from
the stapler line while urinary retention in one patient in the open
third-degree hemorrhoids were selected (according to the Milles group (Table 2). Bleeding complications occurred intraoperatively
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classification). Age, sex, and degree of hemorrhoid in all the and managed by suturing with Vicryl (4’0) interrupted suture
patients were comparable. The findings of the patients in each technique. Retention in open hemorrhoidectomy required K-90
groups are as follows (Table 1). catheterization.
The mean operating time was 34 minutes with minimum of Patients were followed up at 3 and 12 weeks, and impaired
20 and maximum of 50 minutes in the stapler group and mean wound healing was found in 3 of the 40 patients, all in the open
of 40 minutes with minimum of 20 minutes and maximum of group, while none were found in stapler hemorrhoidectomy group.
60 minutes in the open group which was comparable to the Khalil None of the patients had complaint of incontinence.
study. 5 There were no recurrence, rectal stenosis, or perianal fistula in
Mean pain scores were 2.4 by using the visual analog scale 1-year follow-up in any of the group.
(Fig. 1) on the first postoperative day and 0.3 on the fourth
postoperative day in the stapler hemorrhoidectomy, while in the
open hemorrhoidectomy, the values were 5.9 and 2.6, respectively. dIscussIon
The average amount of pain in the stapler group was significantly There are promising results of comparison of stapler
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lower than in the open group (p = 0.001). In Mehigan study, mean hemorrhoidectomy with open hemorrhoidectomy. Stapler
pain scores were 2.7 and 0.5 on day 1 and day 4 in the stapler hemorrhoidectomy group had significantly reduced postoperative
group, while in the open group, the respective values were 6.3 pain compared to open hemorrhoidectomy group. In the stapler
and 4.8 which is comparable to our study. More pain in the open Group IV, patients had no pain on the first operative day. Results
hemorrhoidectomy is due to formation of raw area as compared of this study are similar with five randomized trials 4–8 on stapler
to stapler hemorrhoidectomy which was performed without versus open hemorrhoidectomy. In our open hemorrhoidectomy
formation of raw area. group, after postoperative day 4, pain was less as compared to
above studies because we used to apply mixture of metronidazole
with povidone-iodine ointment and lignocaine jelly. More and
Table 1: Comparison of study groups longer duration of pain in open hemorrhoidectomy was because
Characteristics Stapler group Open group of larger raw area, and we have to operate in the sensitive part of
Total no. of patients 20 20 anal canal (Fig. 2).
Stapler hemorrhoidectomy had significantly less operative
Degree of hemorrhoids: duration compared to open technique (mean 34 vs 40 minutes).
Second-degree 10 9 Other than one intraoperative minor bleeding episode,
Third-degree 10 11 no local or systemic complications were seen in the stapler
Mean age (range) 48.4 (28–73) 45.8 (30–71) Table 2: Postoperative complications
Male/female ratio 16:4 15:5
Complications Bleeding Urinary retention
Stapler group 1 —
Open group — 1

Figs 2A and B: Postoperative images of stapler (left) and open (right)
Fig. 1: Postoperative pain evaluated by the visual analog scale hemorrhoidectomy

World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 9