A study of post operative outcomes of open versus closed hemorrhoidectomy

INTRODUCTION: Milligan-Morgan excision haemorrhoidectomy remains a very popular treatment modality for third and fourth degree hemorrhoids due to its cost effectiveness and better long-term results. Ferguson haemorrhoidectomy is believed to result in less postoperative pain because of a closed wound. The aim of this study was to compare the effectiveness of Milligan-Morgan excision haemorrhoidectomy with Ferguson haemorrhoidectomy. Aims and Objectives: To compare the outcomes following hemorrhoidectomy by the Milligan-Morgan’s open and Ferguson’s closed technique. The variables that are being compared are: a) Post-operative pain, b) Complications, c) Length of hospital stay, d) Wound healing. METHODS: A prospective clinical trial was conducted. Patients with newly diagnosed hemorrhoids requiring haemorrhoidectomy were randomized to either Milligan-Morgan excision haemorrhoidectomy or Ferguson haemorrhoidectomy. Surgical technique and prospective care was standardized. Outcome measures were operative time and bleeding, postoperative pain (measured on visual analogue scale) and rate of wound healing. RESULTS: About sixty patients undergoing hemorrhoidectomy in our hospital, who have fulfilled the criteria have been selected and included in our study. Patients are randomized in to two groups. Group a will have 30 patients undergoing open hemorrhoidectomy. And group B will have 30 patients undergoing closed hemorrhoidectomy. The mean age of group a sample was 39.1 yrs. The mean age of group b was 37.77 yrs. In group a mean operation time in minutes was 40.5. In group b the mean operation time in minutes was 49.33. The operating time for open hemorrhoidectomy was significantly less than closed hemorrhoidectomy. In our study the mean pain score at 6 hours was 6.6 for Group A and 5.56 for Group B. The pain score at 6 Hours was significantly low in closed hemorrhoidectomy with p value of 0.0003 .the mean score at 24 hrs for Group A was 5.133 and 4.6 for Group B which was also statistically significant with p value of 0.015. But the Mean pain score at 48 hrs, 3 days and 7 days did not show any significant difference between the two Groups. Hence the early post operative pain was significantly low in closed hemorrhoidectomy group in Comparison to open approach. The post defecation pain score following hemorrhoidectomy is significantly low for closed hemorrhoidectomy In comparison to open approach. The mean analgesic requirement for Group A is 2.2 and Group B is 1.7 with p value of 0.004. Thus the Analgesic requirement is also low for the closed hemorrhoidectomy group. The post operative complication were noted in both the groups following open and closed approach without Any significant difference. CONCLUSION: There are reports of better post-operative outcome following closed hemorrhoidectomy in terms of pain and Wound healing. Both open and closed approach are less expensive and safe, easy to perform with Satisfactory results. In short we think that patients with Grade III and IV hemorrhoids who are operated with fergusons closed Hemorrhoidectomy have better results.