Management of third degree hemorrhoids: comparison between open versus closed haemorrhoidectomy regarding hospital stay and postoperative complications

ABSTRACT

The objective of the study was to compare open versus closed haemorrhoidectomy regarding relief of the symptoms [bleeding, prolapse, mucus discharge, Pruritis ani, constipation, and diarrhea], hospital stay and postoperative complications [bleeding, pain, recurrence, wound sepsis, urinary retention, fecal incontinence and anal stenosis]. This study was carried out at the Surgical Department, Bahawal Victoria Hospital [BVH] Bahawalpur from March 2009 to November 2009. A total of 50 patients were studied. The patients were divided into two equal groups [25 each]. Group-A was subjected to open haemorrhoidectomy and in Group-B for closed haemorrhoidectomy was done. In both groups, sixty percent of the patient were between 20-50 years of age and 64% of the patients were male. Relief of symptoms after performing haemorrhoidectomy in both groups was equally good. Constipation and Diarrhea were completely relieved in both groups. Bleeding was relieved in 20[80%] of patients of Group-A and 19[76%] of Group-B; prolapse was relieved in 18[72%] of the patients in Group-A and 22[88%] of Group-B. Mucus discharge and Pruritis were also successfully treated in more than 20[more than 80%] patients of each group. Duration of hospital stay after haemorrhoidectomy was significantly shorter in Group-B. Regarding postoperative complications, bleeding, wound sepsis, fecal incontinence, anal stenosis and recurrence of the disease were almost same but postoperative pain in Group-A was slightly higher than Group-B. In our study we concluded that both methods are fairly efficient treatment of choice for hemorrhoids, without serious complications. None of the methods has any significant advantage in terms of post operative pain reduction over the other. The wound heals faster in closed technique and consequently hospital stay is shorter but the risk of wound dehiscence seems exaggerated along with the increased incidence of sepsis