A COMPARISON BETWEEN OPEN AND CLOSED HEMORRHOIDECTOMY
AbstractBackground: Haemorrhoidectomy is associated with complications including pain, bleeding andwound infection which can result prolonged hospital stay. Haemorrhoidectomy is considered to providea better outcome in terms of postoperative pain and wound healing. Aims were to comparepostoperative pain, bleeding, operating time and wound healing in patients undergoing open and closedhaemorrhoidectomy. Methods: This comparative study was conducted in the surgical department atFauji Foundation Hospital, Rawalpindi from December 13, 2006 to December 31, 2011. Consecutivepatients, both male and female, presenting with 3rd and 4th degree haemorrhoids in the surgical Outpatient Department were included in this study. Half of the patients were assigned to the openhaemorrhoidectomy group while the other half was put in the closed haemorrhoidectomy group. Eachpatient was evaluated by detailed history and examination. Both digital rectal examination (DRE) andproctoscopy were done to confirm the diagnosis. Results: A total of 260 patients were assessed, 130 ineach group. In the open group, 52 patients experienced mild pain and 78 moderate while in the closedgroup, 30 patients experienced mild pain, 87 moderate and 13 patients severe pain. All 130 patients inthe closed group showed complete wound healing after 2 weeks as compared to only 66 patients in theopen group with a p<0.001. Early and late postoperative bleeding was similar in both groups.Conclusions: The closed technique provides a better outcome in terms of less postoperative bleedingand complete wound healing, but it is associated with more pain.Keywords: Open haemorrhoidectomy, closed haemorrhoidectomy, postoperative, pain
Sardinha TC, Corman ML. Hemorrhoids. Surg Clin North Am
Orlay George. Hemorrhoids-a review. Aust family Physician
Bhatti AA, Ahmed R, Butt MA. Comparative study between
sclerotherapy and manual anal dilation in the management of
second-degree hemorrhoids. Pak Postgrad Med J 1993;4:267–76.
Waxner SD. The quest for painless surgical treatment of
Hemorrhoids continues. J Am Coll Surg 2001;193:174–8.
Milligan ET, Morgan CN, Jones LE Officer R. Surgical anatomy of
the anal canal and the operative treatment of hemorrhoids. Lancet
Gencosmanoglu R, Sad O, Koc D, Inceoglu R. Hemorrhoidectomy:
Open or closed technique? A prospective, randomized clinical trial.
Dis Colon Rectum 2002;45:70–5.
Ferguson JA, Heaton JR. Closed hemorrhoidectomy: Dis Colon
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus
conventional surgery for hemorrhoids. Cochrane Database Syst
Fazio VW. Early promise of stapling technique for
hemorrhoidectomy. Lancet 2000;355:768–9.
Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for
hemorrhoids versus Milligan-Morgan hemorrhoidectomy:
randomized controlled trial. Lancet 2000;355:782–5.
Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S.
Prospective randomized multicentre trial comparing stapled with
open hemorrhoidectomy. Br J Surg 2001;88:669–74.
You SY, Kim SH, Chung CS, Lee DK. Open Vs Closed
hemorrhoidectomy. Dis Colon Rectum 2005;48:108–13.
Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG.
Symptomatic hemorrhoids: current incidence and complications of
operative therapy Dis Colon Rectum 1992;35:277–81.
Bailey HR, Ferguson JA. Prevention of urinary retention by fluid
restriction following anorectal operations. Dis Colon Rectum
Gravié JF, Lehur PA, Huten N, Papillon M, Fantoli M, Descottes
B, et al. Stapled hemorrhoidopexy versus millegan-morgan
hemorrhoidectomy: a prospective, randomized, multicenter trial
with 2-year postoperative follow up. Ann Surg 2007;245:155–6.
Ripetti V, Caricato M, Arullani A. Rectal perforation, retropneumoperitoneum and pneumomediastinum after stapling
procedure for prolapsed hemorrhoids: report of a case and
subsequent considerations. Dis Colon Rectum 2002;45;268–70.
Maw A, Concepcion R, Eu KW, Seow-Choen F, Heah SM, Tang
CL, et al. Prospective randomized study of bacteremia in diathermy
and stapled hemorrhoidectomy. Br J Surg 2003;90;222–6.
Uba AF, Obekpa PO, Ardill W. Open versus closed
hemorrhoidectomy. Niger Postgrad Med J 2004;11:79–83.
Khubchandani IT. Randomized controlled trial of open and closed
hemorrhoidectomy. [letter] Br J Surg 1998;85:716–7.
Arbman G, Krook H, Haapaniemi S. Closed versus open
hemorrhoidectomy: is there a difference? Dis Colon Rectum
Carapeti EA, Kamm MA, McDonald PJ, Phillips RKS. Doubleblind randomized controlled trial of effect of metronidazole on pain
after day-case hemorrhoidectomy. Lancet 1998;351:169–72.
Ho YH, Seow-Choen F, Tsang C, Eu KW. Randomized trial
assessing anal sphincter injuries after stapled hemorrhoidectomy.
Br J Surg 2001;88:1449–55.
Basso L, Pescatori M. Outcome of delayed hemorrhage following
surgical hemorrhoidectomy. Dis Colon Rectum 1994;37:288.