Randomized clinical trial of circumferential stapled anoplasty versus conventional hemorrhoidectomy: a prospective study of 42 patients

ABSTRACT

The present study was designed to compare stapled hemorrhoidectomy with Milligan -Morgan hemorrhoidectomy with regard to operating time, postoperative pain, hospital stay, early post operative complications, costs, time to return to normal working activities, and finally the late follow up results. Forty-two patients with symptomatic third-and fourth degree hemorrhoids were enrolled by my study at Ain-Shams University hospital between January 1999 and December 2000. All were subjected to thorough clinical examination, proctoscopy, sigmoidoscopy to exclude associated ano-rectal disorders and routine laboratory investigations. Patients were divided into 2 groups. Group A had Stapled hemorrhoidectomy and Group B had conventional Milligan Morgan open hemorrhoidectomy. Visual analogue pain score [VAS] was used to asses postoperative pain, at the time of first motion and daily until the end of the first week, operating time, hospital stay, any post operative complications were recorded a symptom severity score was used to follow up patients by the end of 6 months after treatment. In my study there was a non-significant difference in the mean age of patients between the 2 groups as well as in the clinical presentation and gender [P> 0.05] mean operating time was less for group A patient [P< 0.05]. Comparing the total pain scores [visual analogue score added to the composite pain score] for the 2 groups showed that the total pain score was statistically significant less for the stapled group [A] versus the open hemorrhoidectomy group B patients P = 0.003. Postoperative hospital stay was significantly less for group A patient range [0-3] days versus group [B] patients [range 0-12 days]. Group [A] patients resumed their normal working activity after a median of 5 [range 1-16] days compared to patients of group [B] after 13 days [range 3-25] days which is statistically different significantly [P = 0.04]- comparing the results of the two groups by the end of six-months depending on the symptom severity score, there was no statistically significant difference between the 2 groups with no records of staple line stenosis or anal strictures. Stapled hemorrhoidectomy is safe, effective, causes minimal pain, shorter hospital stay and earlier return to normal working activities in comparison to the open hemorrhoidectomy. This technique also costs the patients more money because of the cost of the device