Outcome of Stapled Haemorrhoidectomy versus Open Milligan Morgan Haemorrhoidectomy at Allied Hospital

Abstract

Objective: To compare the postoperative outcome of stapled haemorrhoidectomy and conventional Milligan Morgan’s haemorrhoidectomy at Allied Hospital. Study Design: Simple comparative study. Place of Study: Surgical Unit 1, Allied Hospital Faisalabad. Duration of Study: January 2011 to September 2012. Sample size: 50 patients. Material & Methods: Fifty patients of 3rd and 4th degree hemorrhoids were selected for admission from the outpatient department. Patients with additional anal disease (e.g. fissure, abscess, fistula, ano-rectal cancer etc.) were excluded. Two groups of twenty five   each were made. Group A for stapled haemorrhoidectomy and Group B for Milligan-Morgan  haemorrhoidectomy (MMH). The operative time was measured in minutes. Postoperative pain was assessed through visual analogue scale (VAS). Bleeding was measured as mild, moderate and profuse. Other post-operative complications during hospital stay like urinary retention, anal stenosis etc. were noted. T-test, chi-square test and repeated measured analysis of variance were applied to compare the variables.  Results: A majority of patients(combined in both groups) had third degree haemorrhoids. The mean length of operative time was found statistically insignificant between stapled  and open groups (34 vs 36 minutes). In Group A 23 (92%) patients were discharged in 24 hrs while 2 (8%) patients were discharged after 24 hrs. In Group B 9 (36%) patients were discharged in 24 hrs and 16 (64%) patients were discharged after 24 hrs. In group A 19 (76%) patients were having mild bleeding, 5 (20%) moderate bleeding and 1 (4%) profuse bleeding. In Group B 7 (28%) patients were having mild, 16 (64%) moderate and 2 (8%) profuse bleeding. In Group A 15 (60%) patients were having mild pain, 7 (28%) moderate and 3 (12%) severe pain on visual analogue scale. In Group B 4 (16%) patients were having mild pain, 15 (60%) moderate and 6 (24%) severe pain. The proportion of postoperative anal stenosis, prolapsed recurrence, persistent pain, recurrent bleeding and urinary retention was higher in MMH than stapled haemorrhoidectomy group.  Conclusion: There was a significant difference between stapled haemorrhoidectomy and Milligan Morgan’s for bleeding, pain and hospital stay. However the mean length of operative time was insignificantly different.