20494
document
Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy . BACKGROUND The new technique of circular stapler for the treatment of hemorrhoids has shown early promise in terms of minimal or no postoperative pain , early discharge from hospital , and quick return to work . This study was designed to compare stapled technique with the well-accepted conventional Milligan Morgan hemorrhoidectomy . METHODS After fulfilling the selection criteria , 84 patients were randomly allocated to the stapled ( n = 42 ) or open group ( n = 42 ) . All patients were operated on under spinal anesthesia . The 2 techniques were evaluated with respect to the operative time , pain scores , complications , day of discharge , return to work , and level of satisfaction . RESULTS The mean age of patients was 46.02 years ( SD , 12.33 ) in the stapled group and 48.64 years ( 14.57 ) in the open group . Grade III or IV hemorrhoids were more common in men ( ie , 80.9 % and 85.7 % in the stapled and open group , respectively ) . The mean operative time was shorter in the stapled group 24.28 minutes ( 4.25 ) versus 45.21 minutes ( 5.36 ) in the Milligan-Morgan group ( P < .001 ) . The blood loss , pain scores and requirement of analgesics was significantly less in the stapled group . Mean hospital stay was 1.24 days ( 0.62 ) and 2.76 days ( 1.01 ) ( P < .001 ) in the stapled and open group , respectively . The patients in the stapled group returned to work or routine activities earlier ( ie , within 8.12 days [ 2.48 ] ) as compared with 17.62 ( 5.59 ) in the open group . Only 88.1 % of patients were satisfied by the open method compared with 97.6 % after the stapled technique . The median follow-up period was 11 months with a maximum follow-up of 19 months ( range 2-19 months ) . CONCLUSIONS Stapled hemorrhoidectomy is a safe and effective day-care procedure for the treatment of grade III and grade IV hemorrhoids . It ensures lesser postoperative pain , early discharge , less time off work , complications similar to the open technique , and in the end a more satisfied patient with no perianal wound . However , more such randomized trials are essential to deny any long-term complication .
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Intervention_Surgical
stapled versus open hemorrhoidectomy .
20496
Intervention_Surgical
stapled technique with the well-accepted conventional Milligan Morgan hemorrhoidectomy .
20497
Intervention_Surgical
stapled
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Intervention_Surgical
open
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Intervention_Pharmacological
spinal anesthesia .
20500
Intervention_Surgical
Stapled hemorrhoidectomy
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Outcome_Other
operative time
20502
Outcome_Pain
pain scores
20503
Outcome_Adverse-effects
complications
20504
Outcome_Other
day of discharge
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Outcome_Other
return to work
20506
Outcome_Other
level of satisfaction
20507
Outcome_Physical
Grade III or IV hemorrhoids
20508
Outcome_Other
mean operative time
20509
Outcome_Physical
blood loss
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Outcome_Pain
pain scores
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Outcome_Other
requirement of analgesics
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Outcome_Other
Mean hospital stay
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Outcome_Other
returned to work or routine activities
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Outcome_Other
satisfied
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Outcome_Other
safe and effective
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Outcome_Pain
postoperative pain
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Outcome_Other
early discharge
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Outcome_Other
less time off work
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Outcome_Adverse-effects
complications
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Outcome_Other
satisfied patient
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Participant_Condition
hemorrhoidectomy
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Participant_Condition
hemorrhoids
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Participant_Sample-size
84
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Participant_Sample-size
42
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Participant_Sample-size
42
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Participant_Age
patients was 46.02 years
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Participant_Age
48.64 years ( 14.57
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Participant_Condition
hemorrhoids