Abstract

Post-operative pain is most common problem in haemorrhoid surgery. There are various methods available for treatment of haemorrhoids but none of the methods are good for post-operative pain control. Newer method to control the post-operative pain is stapler surgery.

Method and Material- A hospital-based comparative study was carried out in 60 patients, were divided in two groups, 30 patients in each group, which were presented in department of General Surgery, Mata Chanan Devi hospital, New Delhi, during the time period of June 2014-dec2015. It is a 210 bedded, tertiary care hospital in west Delhi, where the patients travel from all northern India. 

Result- In the present study attempt has been made to compare the Open Haemorrhoidectomy (group A) with the new modality of Stapler Haemorrhoidopexy (group B)for the treatment of distressing and widely prevalent disease of Hemorrhoids. An attempt has been made to assess the role of Stapler in the treatment of Grade III and IV Hemorrhoids, thereby, trying to highlight the advantages and disadvantages of this new method. In our study the two groups of patients were matched with respect to age. Mean age in group A was 41.93±13.76 years and in group B was 48.37±13.25 years. There was no statistical difference in the mean age group between the two groups. The haemorrhoidal disease was more common in males as compared to females .Third degree haemorrhoids were the commonest haemorrhoids requiring surgical treatment as reported in various studies.  In the present study 39 of 60 patients (65%) had grade III haemorrhoids. The most common complaint of the patients were bleeding (76.67%).More than 50% of patients had constipation as an associated condition at some point of time and (65.22%) had a fissure. There was a significant difference in the operative time in the two techniques In group A mean operative time was 26.77+5.25 min as against 47.33+5.87 min in group B with a p-value of < 0.001(significant).The Post-operative bleeding was significantly less in the stapled group 3(10.00%) as compared to the open group 11(36.67%) (Tabel-7). The calculation of the hospital stay was made from the day of surgery. The duration of stay in the hospital was significantly less in group A (mean 1.13+0.43 days) as compared to group B (mean 1.8+ 0.71 days ) with p value of  <0.005.The VAS pain scores to access Post-operative pain were lesser in group A than group B with statistical significance(6.33± 0.76 versus 6.87± 0.73,P value<0.01 ) in the first day, (4.00± 0.64 versus 4.80± 0.92, P value <0.0004) third day, (2.23± 0.63 versus 2.97±0.89, P VALUE<0.001) seventh day, (0.67±0.66 versus 1.57±0.57, P VALUE<0.001) 14^th day and(0.37± 0.56 versus 1.2± 0.85, P value<0.0001) at third month (Tabel 9). The requirement of analgesics during the hospital stay as  well as after discharge was less in group A. The pain scores compared between the two groups in various studies conclusively proved that the post-operative pain is much less after stapled haemorrhoidectomy than after open haemorrhoidectomy. The calculation of cost of stapler haemorrhoidectomy was significantly higher (P vale<0.0005) as compared to open haemorrhoidectomy but most of the authors noticed cost savings are difficult to measure when not combined with the possible socioeconomic advantages of faster rehabilitation; however, the crude cost analysis in this randomized, controlled trial has demonstrated an advantage of stapled anopexyvs. open haemorrhoidectomy. The savings may be even greater.

Conclusion- Stapled procedure for hemorrhoids is superior to Milligan- Morgan haemorrhoidectomy (open haemorrhoidectomy)   in terms of postoperative pain, operative time and return to normal activity. It is straightforward and easy to learn. Early functional and symptomatic outcomes have been   satisfactory and appear similar or better to those achieved using conventional technique.  However, long term follow-up with respect to these factors is required.