Can stapler haemorrhoidectomy replace conventional open haemorrhoidectomy at present in Egypt

ABSTRACT

Postoperative pain associated with conventional open haemorrhoidectomy remains problematic. Stapler haemorrhoidectomy as a new technique with its advantages over conventional open haemorrhoidectomy in terms of operating time, postoperative pain and hospital stay, can replace it Patient and Fourty patients with symptomatic third-and-fourth-degree haemorrhoids were randomized to either stapled haemorrhoidectomy [n=20] or conventional open [Milligan-Morgan] haemorrhoidectomy [n-20], between November 2001 and November 2003. Operating time was recorded, each patient received standardized postoperative analgesic and laxative regimens, postoperative pain was measured every 4 hour during the first day after operation, after the first motion and daily until the end of the first week, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications and effectiveness of haemorrhoidal symptom control were recorded. Patients returned for the follow-up visits at 7 days, six weeks and 6 months, then at 1 year for pain, bleeding, fever, anal continence, haemorrhoidal recurrence, and level of satisfaction were compiled. The mean duration of the procedure was shorter in the stapled than open group, it ranged respectively as 15 minutes and 30 minutes [expect one case in stapled group needs addition 10 minutes to achieve perfect haemostasis], the pain intensity was less in the stapled group as the average mean visual pain score [2.1 Vs 5.5] in open group [in pain scale of 1-10], the frequency of mean postoperative analgesia intake per day was less in stapled group [0.8 Vs 3.7] in open group, the median hospital stay was shorter in stapled group than open group [1.1 day Vs 2.5 days]. Median time to return to normal activity was earlier in stapled than open group [5 days - 14 days]. The median time for wound healing occurred more earlier in stapled group than open group [7 days - 30.5 days]. Early and late postoperative complications and functional outcome were equal in both groups. With a correct selection of patients and adequate stapler technique, stapled haemorrhoidectomy may be considered as a good procedure, with satisfactory degree of pain and earlier return to normal activity, however its complications are disastrous and the device is very expensive for training and performance. Stapler haemorrhoidectomy can replace conventional open haemorrhoidectomy in certain patients, but it could not be popularized at present time