A Prospective Randomized Trial of Open and Closed Hemorrhoidectomies

ABSTRACT

BACKGROUND: Open and closed hemorrhoidectomies are the most common surgical treatment methods for hemorrhoids. However, the advantages and the disadvantages of each procedure have not yet delineated. PURPOSE: To compare open and close hemorrhoidectomies. METHODS: A prospective randomized trial of open and closed hemorrhoidectomies was performed between January 1997 and July 1997. All patients who underwent consecutive, surgery by a single surgeon (JSJ) for grade III or IV homorrhoids were classified into two groups Open (GI) and closed (GII) hemorrhoidectomies. For the comparison of each procedure, the duration of the hospital stay, the patients' complaints, the pain score (Grade 1-10), and the complications after surgery were assessed.. Followup data were also obtained by telephone interviews. For the physiologic comparison, the preoperative and the postoperative anorectal manometry results were evaluated. RESULTS: Fortyone (41) patients were underwent hemorrhoidectomies GI (n=18) and GII (n=23). There were no differences between the two groups in terms of duration of symptoms, degree of hemorrhoid, age, and gender. There were no differences respect to parameters related with postoperative complaints during the hospital stay, such as pain on defecation, skin edema, and anal itching. However, bleeding on defecation (83% in GI vs. 43.5% in GII, p<0.05), and anal soiling (61% in GI vs. 13% in GII, p<0.05) were significantly higher in GI patients. The pain score on postoperative day 1 was significantly higher in GI (6.6 vs. 4.9, p<0.05). Other parameters of complications (stricture, 5.7% in GI. vs. 4.3% in GII; defecation difficulty; 5.7% in GI vs. 4.3% in GII; and fecal incontinence; 0% in GI vs. 4.3% in GII) showed no significant differance during the mean followup period of 4.7 months. Neither the mean hospital stay (7 days in GI, 6.2 days in GII) nor the period of complete wound healing (32.7 vs 28.3 days in GI, GII, respectively) was different between the two groups. The preoperative and the postoperative anorectal manometric findings were not different in the two groups. CONCLUSIONS: The closed hemorrhoidectomy was superior to the open procedures in terms of some parameters such as the pain score on postoperative day 1, bleeding on defecation, and postoperative soiling during the hospital stay. However, the intermediate postoperative outcomes were not different for the two procedures.