Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study

PYY Lau, WCS Meng, AWC Yip
Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong

OBJECTIVE. To compare stapled haemorrhoidectomy with open diathermy haemorrhoidectomy in Chinese patients with respect to the postoperative pain, symptom control, and manometric alterations.

DESIGN. Prospective randomised controlled trial.

SETTING. A regional general surgical unit, Hong Kong.

PATIENTS. Twenty-four patients with second- or third-degree haemorrhoids or who have had failed medical treatment.

INTERVENTION. Open diathermy haemorrhoidectomy or stapled haemorrhoidectomy.

MAIN OUTCOME MEASURES. Structured questionnaire for symptoms, anorectal manometry, transrectal ultrasound, and postoperative pain.

RESULTS. Stapled haemorrhoidectomy compared with open diathermy haemorrhoidectomy resulted in similar postoperative pain and drug requirements. Postoperative control of prolapse symptoms was significantly better with open diathermy haemorrhoidectomy than with stapled. The control of other symptoms was similar with regard to bleeding, pain, pruritis, and incontinence scores. Anorectal manometry showed a decrease in the maximum resting pressure and maximum squeeze pressure in both groups, but the decrease was only significant in the stapled haemorrhoidectomy group.

CONCLUSIONS. Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy for the treatment of haemorrhoids, but with the exception of skin tag prolapse. There is a need for long-term follow-up for the changes in manometric parameters after haemorrhoidectomy.

Hong Kong Med J 2004;10:373-7

Key words: Hemorrhoids; Pain, postoperative; Surgical stapling; Manometry