Stapler Haemorrhoidopexy As Compared To Conventional Haemorrhoidectomy: A Short-Term Prospective Randomised Controlled Study

摘要

Background: There is growing evidence supporting a lesser degree of complications with stapler haemorrhoidopexy. We did a study to compare the postoperative evolution of patients after stapler haemorrhoidopexy and conventional haemorrhoidectomy. Methods: Fifty patients with symptomatic haemorrhoids of late second, third and fourth grade, were randomly assigned to either stapler haemorrhoidopexy or conventional haemorrhoidectomy (25 each). Median follow-up was 6 months. Results: In patients who underwent stapler haemorrhoidopexy, the duration of surgery was less (p=0.005), postoperative pain was less (p=0.0001), postoperative bleeding was also less (p=0.005), the patients were ambulated in 12-24 hours (p=0.05) and hospital stay was 1-2 days (p=0.0001). Fifty-two per cent of the patients returned to their routine work postoperatively in 2 days (p=0.002), 32% within 3 days (p=0.005) and only 16% within 4 days (p=0.05).Conclusion: Stapler haemorrhoidopexy is effective in terms of decreased per- and postoperative blood loss, minimal pain, less requirement of analgesics and less pain at first bowel movement, faster wound healing with faster postoperative recovery and short postoperative hospital stay with early return to normal routine activity. However, long-term follow-up is necessary to determine whether these initial results are lasting. Introduction The word hemorrhoids is derived from Greek words (Haem-blood, Rhow-flowing) meaning dilated veins occurring in relation to the anus.Haemorrhoids are one of the most common afflictions of human beings from time immemorial [1] . It is said that 40 percent of the population have symptoms due to haemorrhoids at some time of their lives, a price possibly man has had to pay following the evolution of his erect posture. Terrel expresses it in the following way: Man is a victim of a capricious creator. There is no doubt that man was intended to walk on all limbs, and having perhaps frustrated his creator's plan by walking on two, he has created several problems; haemorrhoids is one of them. The assumption of an erect posture was a prodigious accomplishment and man pays for his arrogance by the pain and humility that go with hemorrhoids. Morgagni [2] (1749) attributed haemorrhoids to the upright posture of man as the causative factor.Vascular cushions within the anal canal of normal individuals do not differ anatomically from those in symptomatic patients. It is therefore probably illogical to talk about the incidence of vascular cushions since they are ubiquitous. Both sexes, all races and all ages have anal cushions. If the cushions are omnipresent then it is only the existence of symptoms that merits classification as a disease. Hundred percent of the population have haemorrhoids but only fifty percent are symptomatic.The typical morphological situation of the haemorrhoidal and mucous prolapse is caused by weakening and breakage of the supporting muscular and connective fibers. Prolapse implies the distal dislocation of the internal haemorrhoidal cushions that push the external haemorrhoidal sac in an outward and lateral direction, thus causing the sacs to protrude. The upper haemorrhoidal vessels extend, while the middle and lower haemorrhoidal vessels are subject to the formation of “kinks.”Hemorrhoid sufferers are often afraid to seek treatment because they are afraid of the pain associated with haemorrhoidectomy. The interim results indicate that a procedure for prolapse and hemorrhoids (PPH) is good news for chronic hemorrhoid sufferers because they now have an effective, less painful option.We are pleased that these interim results are being presented today so that surgeons and physicians can be aware of this procedure and can talk to their patients about PPH.A new entry into the arena of excisional hemorrhoidectomy is the circular stapler haemorrhoidopexy. The technique uses a circular transanally placed purse-string suture, 4cm from the dentate line and within the enlarged interna