Comparison of Postoperative complications between Conventional Ferguson’s Hemorrhoidectomy and LigaSureTM Hemorrhoidectomy

Background For symptomatic grade III and IV haemorrhoids, some form of hemorrhoidectomy remains the accepted modality of treatment. The traditional methods like the Milligan-Morgan method and the Ferguson‘s method have been in practice for more than half a century. Recently we acquired the LigaSureTM device. It is an electro-surgical device, which is an improved version of bipolar diathermy, now widely used for hemorrhoidectomy. This study will give a comprehensive overview on differences between conventional Ferguson‘s haemorrhoidectomy and LigaSureTM haemorrhoidectomy focusing on post-operative complications mainly postoperative pain, bleeding and peri-anal fistulae occurrence Objective To compere between closed hemorrhoidectomy, Ferguson‘s method, and LigaSureTM hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Patients and Methods It is a prospective study conducted over 40 patients with grade III and IV hemorrhoids, randomly divided into two groups to compare between closed hemorrhoidectomy, Ferguson‘s method, and LigaSure™ hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Results An overall favorable trend exists toward LigaSureTM hemorrhoidectomy in all parameters of the current study, in another word, the postoperative complications mainly pain, bleeding and peri-anal fistula occurrence was much lesser in the LigaSureTM group. Conclusion LigaSureTM hemorrhoidectomy is a sutureless, hemorrhoidectomy technique dependent on a modified electro- surgical unit to achieve vessel and tissue sealing. It is safe and effective, has less blood loss, postoperative pain, bleeding and perianal fistula occurrence compared to conventional Ferguson‘s hemorrhoidectomy.

OPEN VERSUS CLOSED HEMORRHOIDECTOMY – A COMPARATIVE STUDY

Background and Objectives: - Hemorrhoids are specialized, highly vascularized cushions within the normal anal canal. Hemorrhoidectomy is considered as an effective treatment for III degree and IV degree hemorrhoids. The conventional Milligan-Morgan open hemorrhoidectomy remains the more commonly performed operation. Ferguson's closed hemorrhoidectomy has gained considerable attention because of the less pain, faster wound healing and better patient compliance. Nonetheless, randomized controlled trials have reported conicting results regarding post-operative outcomes between two methods. Methods: - 60 patients were included in this study, who underwent hemorrhoidectomy, by split them into two equal groups. Group A underwent open hemorrhoidectomy and group B underwent closed hemorrhoidectomy. Patient in each group were studied in terms of post-operative pain, wound healing, bleeding, length of hospital stays and the results were analysed and tested with statistical methods. Results: - In study of 60 cases, peak incidence was found at 46 years of age and more common in males (5.67:1). Difference in pain between the 2 groups was found statistically signicant (P value <0.05). 29 (96/67%) patients had completely healed wound from group B (closed) at 3rd week compared to 5 (16.67%) from group B. 7 (23.3%) patients in closed group had complications, in contrast to 25 (83.3%) in open group. Conclusion: - We got in this study that patients who underwent Ferguson's closed hemorrhoidectomy had less post-operative pain, bleeding, complications, early healing of wound and early back to routine work compared to Milligan-Morgan's open hemorrhoidectomy group

SURGICAL TREATMENT OF PATIENTS WITH CHRONIC HEMORRHOIDS

Symmary. About 300 surgical treatments for hemorrhoids are known now. The most common method in the world remains the Milligan-Morgan operation and its numerous modifications. These surgical interventions are essential in the choice of surgical treatment for chronic hemorrhoids. However, both open and closed hemorrhoidectomy have their disadvantages. Purpose. To study the effectiveness of various surgical treatments for patients with chronic hemorrhoids using a laser coagulator. Materials and methods. We conducted a clinical examination and treatment of 140 patients with chronic grade III-IV hemorrhoids by Goligher. All patients were presentably divided into three groups. The first group included 60 patients who had classic open hemorrhoidectomy - the Milligan-Morgan operation. The second group included 40 patients in whom had surgical treatment with a laser coagulator - laser open hemorrhoidectomy. The third group consisted of 40 patients who underwent laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia. Results and discussion. Analyzing the indicators of pain in different groups of patients at different postoperative period, we found that on the first postoperative day the classic Milligan-Morgan surgery, the was most uncomfortable procedure (the first group of patients). Among the patients in the second and third groups there were no people who rated pain above 7 points. In the first group, the median period of first defecation was in 5.0 days. As for in patients of the second group, the first defecation was observed in terms of the 3-5 days with a median of 4.0 days. A similar indicator was observed in patients of the third group. Patients in the second and third groups did not indicate severe pain during the first act of defecation. The anal hematoma was found only in patients of the first group (p<0.01). Anal infiltration occurred in 12.5±5.23 % in the third group (p<0.01). Infections of wounds were not found in any group. Conclusion. Laser open hemorrhoidectomy is an effective method of surgical treatment of patients with chronic hemorrhoids. However, like the classic open hemorrhoidectomy Milligan-Morgan, it allows to eliminate only pathological substrate (cavernous bodies). To prevent recurrence of the disease, it should be supplemented with laser transcutaneous submucosal mucopexia. Analysis of cases of early postoperative complications showed that the classic Milligan-Morgan hemorrhoidectomy, compared with intraoperative laser coagulation, had a significantly higher frequency (p<0.001).

A comparative study of open and closed hemorrhoidectomy

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.

THE BENEFITS OF COMBINED MINIMALLY INVASIVE TREATMENT IN REHABILITATION OF PATIENTS WITH CHRONIC HEMORRHOIDS

Currently, the post-surgical rehabilitation of patients with hemorrhoidal disease is a serious medical and social problem. The authors proposed a comprehensive method of the management of hemorrhoids, combining seam artery ligation under Doppler ultrasound control with subdermal-submucous laser destruction of internal and external hemorrhoids. There was executed the comparative study of the safety and efficiency of both this method and the closed hemorrhoidectomy, with the use of linear stapler, in patients with chronic hemorrhoids at the stage II and III. The combined method of HAL + laser was shown to be potent of both improving the quality of life for patients during the rehabilitation period and significantly diminishing its duration. This method eliminates the risk of wound complications, reduces the risk of urinary retention by 7 times, and significantly relief from the pronounced pain in the postoperative period.