Our initial experience of three versus two rows circular stapler devices for stapled hemorrhoidopexy: a single institution review of 224 cases

Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.

A comparative study of closed versus open haemorrhoidectomy

Background: Haemorrhoids, commonly called piles, are small, round, fleshy bumps that contain enlarged blood vessels, and are found around your anus or in your anal canal. They are associated with an increased pressure in your blood vessels in and around your anus causing them to become inflamed and swollen. It is thought that irritable bowel syndrome (IBS) may contribute to haemorrhoids developing around the anus as it can cause constipation and diarrhoea that lead to unusual straining during bowel movements.Methods: In the present study 60 cases of 2nd and 3rd degree haemorrhoids were chosen with complaints of bleeding per rectum, pain during defecation, mass per rectum, discharge and irritation. A detailed history of each patient was taken, and the data entered in the proforma.Results: Present study given 86% of cases good healing after six weeks of treatment. Open haemorrhoidectomy showed healing in 43% of cases and closed haemorrhoidectomy showed healing in 73 % cases after 3 weeks of treatment in present study.Conclusions: The results of the study concluded that post-operative pain was less in closed haemorrhoidectomy with early wound healing.

Haemorrhoid disease

Haemorrhoids may affect over 70% of the Western population. Symptoms include prolapse, bleeding, and discomfort. Classification of haemorrhoids is important before deciding on therapy or conservative management. Treatment may include submucosal sclerotherapy, elastic band ligation, haemorrhoidal artery ligation, stapled haemorrhoidectomy, and conventional open or closed haemorrhoidectomy.

HAEMORRHOIDECTOMY;

Haemorrhoids are one of the most common anorectal disorders. Internalhaemorrhoids are symptomatic anal cushions and characteristically lie in the 3, 7 and 11 o’clockposition whereas external haemorrhoids relate to venous channels of the inferior haemorrhoidalplexus. Objectives: To compare the outcome of haemorrhoidectomy using harmonic scalpelversus conventional closed haemorrhoidectomy. Study Design: Randomized control trial.Setting: Department of Surgical unit II, Jinnah Hospital, Lahore. Period: Six months from 25thDecember 2014 to 24th June 2015. Methodology: A total of 140 patients were included inthis study. Patients were divided in two groups A & B. In Group A, (70 patients) conventionalhaemorrhoidectomy was performed by the Ferguson Technique (closed technique) whereasin Group B, (70 patients) suture less closed haemorrhoidectomy was performed by using theharmonic scalpel. Results: The mean age of the patients in group A was 43.3±8.2 years andin group B was 42.3±7.3 years. The mean time for surgery in group A was 23.8±4.2 minutesand in group B was 8.5±3.6 minutes. The mean pain score in group A was 5.3±1.8 VAS andin group B was 3.9±1.9 VAS. In group A, less than 1 day postoperative hospital stay was in 62(88.6%) patients and in group B, it was in 66 (94.3%) patients. Conclusions: It is concludedfrom this study that haemorrhoidectomy by harmonic scalpel results in decrease in operationtime and less postoperative pain although there is not much significant difference in less than 1day hospital stay as compared to the conventional closed haemorrhidectomy technique.