Conventional Hemorrhoidectomy Versus Stapled Hemorrhoidopexy: Compare the Outcomes of both Techniques in Patients With Grade III and IV Hemorrhoids

Aim: To examine the outcomes of stapled hemorrhoidopexy and compare with conventional open hemorrhoidectomy in patients presented with grade III and IV hemorrhoids. Study design: Randomized controlled trial Place and duration: Department of surgery, Divisional Headquarter Teaching Hospital Mirpur AJK/CMH Rawalakot during from 31-05-2018 to 31-05-2019. Methods: Total 244 patients of both genders with ages 20 to 65 years presented with grade III and IV hemorrhoidal disease. All the patients were equally divided into two groups. Group I consist of 122 patients and received conventional hemorrhoidectomy, group II with same number of patients received stapled hemorrhoidopexy. Outcomes such as bleeding, postoperative pain by (VAS), hospital stay, return to normal activities and recurrence. Primary outcome was recurrence of hemorrhoids and examined at 6, 12 and 18 months postoperatively. Data was analyzed by SPSS 24.0.P-value <0.05 was taken as statistically significant. Results: There were 102 (83.61%) males and 20(16.39%) females in group I and in group II 105 (86.07%) were males and 17(13.93%) were females. No significant difference regarding age and body mass index was observed between both groups (p-value >0.05). Shorter hospital stay, less bleeding and less post-operative pain and shorter duration of surgery is associated with stapled hemorrhoidopexy with p-value <0.05. Recurrence rate was high in patients with stapled hemorrhoidopexy group as compared to conventional hemorrhoidectomy at final follow-up (p-value <0.001). Conclusion: Stapled hemorrhoidopexy is safe and effective with less complications as compared to conventional hemorrhoidectomy. However, high recurrence is associated with stapled hemorrhoidopexy.