A comparative study of open and closed hemorrhoidectomy

Abstract

Background: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree haemorrhoids. This prospective randomized clinical study compared the outcome of surgical haemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity.Methods: All consecutive patients with Grade III internal haemorrhoids or Grade IV haemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 2-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of analgesics on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure.Results: There were 30 patients in each group. No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 78 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 26 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent.Conclusions: Both methods are fairly efficient treatment for third and fourth degree hemorrhoids, without serious drawbacks. The closed method has no advantage in postoperative pain reduction but is more advantageous with respect to faster wound healing.

A comparative study of open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy with and without internal sphincterotomy

“…6 In present study, patients operated by close technique were discharged earlier when compared to patients operated by open technique. This is in correlation with study conducted by Borse H et al, Mohapatra R et al, Jasim HI et al [4][5][6] In present study, per-operative haemorrhage was less in close group than in open group. This is in correlation with the findings of Borse H et al 4 In this study no patient developed incontinence and anal stenoses.…”

“…4 In another study conducted by Mohapatra R et al, reveal number of patients presented with haemorrhoids were in the age group of 31-50 years, which is nearly compatible with this study. 5 In present study, 56.4% were males and 43.6% were females. Higher percentage of patients were males though haemorrhoids are common in females, giving an indication the ailment remains under diagnosed in females.…”

“…This observation is in correlation with study conducted by Borse H et al, in contrast Mohapatra R et al, did not find close method has advantage in post-operative pain reduction. 4,5 Pain is less post operatively in open group with internal sphincterotomy compared to open group without internal sphincterotomy. Haemorrhoidectomy with internal sphincterotomy reduces pain because of relaxation of internal sphincter.…”

Efficiency of Closed Hemorrhoidectomy in the Treatment of Third-Degree Hemorrhoids

“…In the absence of prior intervention, hemorrhoidal venous cushions are physically present and considered as normal anorectal structures [1][2] . Hemorrhoidal venous cushions mostly encountered anal pathology due to its extremely sensitive position, abundant vascular supply, and propensity to prolapse and engorge.…”