Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG343

Postoperative Recovery Profile of the Patients

Undergoing Conventional and Stapler
Hemorrhoidectomy
1
Suhail Riyaz; 2Dr. Wasim Qadir Kar; 3Ishfaq Ramzan; 4Dr. Pankaj Kaul; 5Suhail Anjum Rather
1
Post-Graduate Student, Department of Operation Theatre and Anesthesia Technology, University School of Allied Health
Sciences, Rayat Bahra University, Mohali, Punjab, India.
2
Consultant Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India.
3
Assistant Professor Department of Operation Theatre and Anesthesia Technology, University School of Allied Health Sciences,
Rayat Bahra University, Mohali, Punjab, India.
4
Dean, University School of Allied Health Sciences, Rayat Bahra University, Mohali, Punjab, India.
5
Anesthesia Technologist, Aamina Hospital and Nursing Home, Nowgam, Srinagar, India, and Post-Graduate Student,
Department of Operation Theatre and Anesthesia Technology, University School of Allied Health Sciences, Rayat Bahra
University, Mohali, Punjab, India.

Abstract:- I. INTRODUCTION

 Introduction: Regarding serious hemorrhoids (grade II-IV), the most

A unique technique for managing prolapsed used surgical procedures are stapled haemorrhoidopexy and
hemorrhoids surgically involves stapled conventional excisional surgery. Anal cushions that 'grow',
hemorrhoidectomy. Compared to open 'bleeding' 'thrombose', 'prolapse', and generate clinical
hemorrhoidectomy, it resulted in quicker convalescence symptoms are referred to as hemorrhoids (Zhang et al.
duration despite a significant increase in cost. The aim of 2020). Whereas internal hemorrhoids begin in the sub-
the study was to compare the effectiveness, short- and epithelial plexus located inside the anal canal above the
long-term outcomes, and post-operative complications of dentate line, external hemorrhoids are masses of packed
open vs staped. exterior perianal vascular plexus surrounded by perianal
skin. Four stages of prolapse can be used to categorize
 Methods: internal hemorrhoids, however, this may not accurately
60 patients in the age group 20 to 50 years, weight represent the seriousness of the symptoms a person
45-80 kgs, and ASA grade of I and II were elected for experiences (Coelho et al. 2020). The symptoms are linked
the surgery, diagnosed with hemmorid grad III and IV to a sense of fullness and inadequate evacuation, including
and were divided into two groups. Group I contains 30 unease, irritation, mucosal release, pain, bleeding, and
Patients operated under Open hemorrhoidectomy/ prolapse. The only symptoms of first-degree hemorrhoids
Milligan Morgan and Group- II 30 Patients operated (FDH) are bleeding and non-prolapse. Conservative
under Stapler hemorrhoidectomy. treatment of symptoms with a high-fiber diet and softened
stool is believed to be effective. Defecation-only bleeding
 Results: with prolapse indicates second-degree hemorrhoids (SDH).
Results were found to be better with the staple Band attachment and injection sclerosis treatment are
technique. There was significantly less pain in the post- extremely effective treatments for SDH4,5. Third and
operative period with faster recovery, There was no fourth-degree hemorrhoids are characterized by severe
postoperative infection in the SH patients, early illness with significant prolapse, bleeding, and other
resumption to walk, reduced postoperative complications problems needing major surgical intervention (Al-
of the patients operated by the SH technique as Thoubaity, 2020). The treatment of hemorrhoids in the third
compared to open technique. and fourth degree is frequently hemorrhoidectomy.
Hemorrhoids can expand and prolapse and are high in
 Conclusion: vascular supply. From minor bleeding and stinging to severe
Stapler haemorrhoidectomy requires less intra- discomfort, symptoms can vary. Sadly, due to the location, a
operative time, less hospital stay and less post-operative lot of people never come for therapy for humiliation-related
pain. Return to normal activity is also faster with stapler anxiety. First-line treatment is usually conservative, and a
surgery then open haemmorrhoidectomy. doctor with primary care can start this. Patient education is
crucial. An anorectal surgeon can treat hemorrhoids that are
severe or ongoing using a variety of techniques. Traditional
therapy, which includes changes in diet and lifestyle along
with the use of various medicinal products can be used to
manage painful hemorrhoids. Surgery is the suggested plan

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG343

of treatment for individuals who have grade III and grade IV  Exclusion Criteria:
hemorrhoids and they do not show any positive result of any
other treatment (Anh et al. 2024). Surgery is not the only  BMI greater than 35 kg/m2.
option and it should be better to avoid this for hemorrhoids  ASA grade III or more.
of the first and second degree. However, the most often used  Age more than 50 years.
surgical procedure for treating third and fourth degree  weight more than 80 kgs.
hemorrhoids is the Milligan Morgan hemorrhoidectomy,  Active bleeding disorders or those on anticoagulants.
regarded as the precious method today. It continues to stand  Inflammatory bowel diseases.
over the years due to its lower rate of complications after the
 Pregnancy
surgery, affordability, and better long-term outcomes.
Fergusons' conventional hemorrhoidectomy has garnered  Pre-Anaesthesia Checkup:
significant attention in several areas of the world due to its
Pre-anaesthesia care included a thorough clinical
reduced post-operative pain, which is thought to be caused
history and assessment of the patient, as well as the ordering
by the mucosa's cut edges closing, quicker wound healing,
of standard tests such as blood sugar, hematocrit, liver
and excellent patient adherence (Nallajerla & Ganta, 2021).
function testing, renal function testing, coagulogram, ECG,
The treatment of stapled hemorrhoidectomy is a good
and chest X-rays. Before surgery, all the patients were
technique for treatment as it has a low chance of advised to not to take anything orally before the 8 hours of
complications and requires a few days stay in hospital yet it
surgery (NPO).
is an expensive procedure of treatment. The open
hemorrhoidectomy which is a traditional procedure to treat
III. METHDOLOGY
hemorrhoids is relatively more affordable than stapled,
however, it causes discomfort and pain after the surgery and On arrival into the operation theatre, all the patients
also creates other complications in the patient (Chhikara,
were cannulated and Ringer’s Lactate 10-15 ml /kg (500-
Bharti, & Sethi, 2020).
1000 ml) was started preoperatively. All the intravenous
fluids administered were stored at room temperature. All
 Objectives of the Study
the routine monitors (ECG, Pulse Oximeter, NIBP) were
applied and the baseline vitals were recorded. The
 To compare the time of ambulation in both groups. temperature in the Ot was adjusted in between 22-25°C.
 To evaluate the duration of hospital stay of all the Under all aseptic precautions guidelines the SA was given to
patients. patients in the sitting position by using Quincke’s needle
 To differentiate the incidence of surgical site infection in (25G) into the L3-L5 space. Injection Bupivacine Heavy
both groups. was injected in subarachnoid space after observing free tech
 To access in postoperative analgesic requirement in both flow of CSF through spinal needle. After the sensory and
the groups. motor blockade was achieved Patient was then giving
lithotomy position. Proctoscopy examination was done. A
II. MATERIALS AND METHODS transparent anal dilator was gently inserted.

The study entitled “A study on the comparison of In the open hemorrhoidectomy an artery forcep was
postoperative recovery profile of the patients undergoing placed over one haemorrhoidal pedicle and suture ligature
conventional and stapler hemorrhoidectomy” was carried was made at the apex of the haemorrhoidal pedicle. The
out at Florence Hospital between January 2024 to June hemorrhoid was cut and removed; the wound was left open
2024, located in Chanpora, Srinagar, J & K, Bharat, after to heal. The procedure was repeated for the remaining
receiving the approval from the hospital ethical committee. hemorrhoid pedicles, and hemostatic dressings were plugged
into the anal canal. This technique was formulated by Drs.
A total of 60 patients between the age group 20 to 50 Milligan and Morgan in the year 1937 and is currently
years, of weight 45-80 kgs, with ASA grade of I and II who recognized as the gold standard in the surgical management
were diagnosed with grade III and IV hemorrhoids, were of hemorrhoids because of its flexibility in the achievement
divided into two groups equally. Group- I 30 Patients of complete excision of hemorrhoids (Pata et al. 2021).
operated under Open hemorrhoidectomy/Milligan Morgan
and Group-II 30 Patients operated under Stapler In the stapler hemorrhoidectomy it involves making the
hemorrhoidectomy circular, hollow cylinder pass through the anus and then
surrounding the internal hemorrhoids by making a stitch at a
 Inclusion Criteria: higher level. A circular stapler was inserted through the
tube, secures and trims the free margin of the open wound at
 ASA category I and II. the upper and lower ends simultaneously. This technique
 Age group between 20-50 years. aims at repositioning the hemorrhoidal tissue has less post-
 weight 45-80 kgs surgical pain than in the open method and has a shorter
 BMI < 35 kg/m2. recovery time (Fišere et al. 2023). This technique of stapler
 Patients with ability to provide informed consent. haemorrhoidectomy is encouraged predominantly on the
 Hemorrhoid grade III and IV advanced forms of hemorrhoids or the higher grade

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG343

hemorrhoids where excision of the tissue is favoured as  In post operative period, pain at surgical site was
compared to mobilization. checked as soon the patients reaches in post operative
area. After then the pain assessment was done at 6th ,6th
 Parameters were Recorded: and 12th hour intervals as per the duties of nursing staff.
Visual analog scale 10cm was used for scoring of pain.
 Demographic (age, weight of the patients, gender of the At vas score more than 5 parenteral analgesic was given
patients, and total duration of surgery). to the patients.
 In open hemorrhoidectomy (pain, surgical site infection  The surgical site infection (SSI) was checked at the time
(SSI), total time taken for the ambulation and total of dressing of surgical site every time.
hospital stay duration) were recorded.  The time of Ambulation were noted when the patients
 In staple hemorrhoidectomy (pain, surgical site infection walks to washroom to pass urine.
(SSI), total time taken for the ambulation and total
hospital stay duration) were recorded. The duration of hospital stay was calculated from the
time of admission of the patient in hospital till the time
discharge.

IV. RESULTS AND ANALYSIS

Table 1 Shows the Demographic Variables

Variable Group I Group II P value
Age (years) 34.43 ± 7.8 32.56 ± 6.4 0.3143
Weight (kg) 59.66 ± 10.71 64.63 ± 8.9 0.0554
Gender (M/F) 16/14 18/12 0.532

The data is mean ± SD for all the demographic features of both the groups.

P > 0.05 – insignificant (NS)

The demographic variables, age, weight, gender, were comparable in both the groups.

Table 2: Shows the Comparison of the Total Surgery Duration among the Groups
Surgical Duration Group I Group II P value
(minutes) 61.33 ± 4.21 47.16 ± 4.33 < 0.0001

The data is mean ± SD for comparison of surgical Table 2 shows that, the duration of surgery in Group I
duration in both the groups. was 61.33 ± 4.21 minutes and 47.16 ± 4.33 minutes in
Group II and when compared statistically using student’s t-
P <0.05 – significant (NS) test, the difference in the duration of surgery in both the
groups was significant (P < 0.05) (Table 2)

Table 3 Comparison of outcome Variables among Both the Two Groups.

Parameter Group I Group II p-value
VAS SCORE (12 Hour) 4.46 ± 0.86 2.43 ± 0.868 < 0.0001
Incidence of SSI (%) 10 (33.33%) 0 < 0.0001
Ambulation (Hours) 12.6 ±1.438 8.43 ± 0.86 < 0.0001
Hospital Stay (Days) 4.3 ±0.851 2.5 ±0.454 < 0.0001

Table 3 shows that mean vas score in group I after 12 The time taken for the ambulation in group I was 12.6
hour after surgery was 4.46 ± 0.86 and 2.43 ± 0.868 in group ±1.438 hours and 8.43 ± 0.86 hours in group II and when
II and when compared statistically using student’s t-test, the compared statistically using student’s t-test, the difference in
difference in the vas score of the patients in both the groups the ambulation of the patients in both the groups was
was significant (P < 0.05) (Table 3) significant (P < 0.05)

33.33% of patients possessing surgical site infection in The comparison of hospital stay in group I was 4.3
group I and none of the patients in group II possessing ±0.851days and 2.5 ±0.454 days in group II and when
surgical site infection and when compared statistically using compared statistically using student’s t-test, the difference in
student’s t-test, the difference in the percentage of surgical the hospital stays of the patients in both the groups was
site infection of the patients in both the groups was significant (P < 0.05)
significant (P < 0.05)

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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG343

V. DISCUSSION the difference in the percentage of surgical site infection of

the patients in both the groups was significant (P < 0.05).
In this study we evaluated that study on the comparison
of postoperative recovery profile of the patients undergoing  Ambulation
conventional and stapler hemorrhoidectomy. Various Time taken for the ambulation in group I was 12.6
parameters were assessed including demographic ±1.438 hours and 8.43 ± 0.86 hours in group II and when
characteristics, total time of surgery, hospital stay, surgical compared statistically, the difference in the ambulation of
site infection, ambulation time and pain management to the patients in both the groups was significant (P < 0.05)
determine the comparative recovery profile in the both the (Table 3,)
surgeries.
 Hospital Stay
60 surgical patients between the age group 20 to 50 Hospital stay in group I was 4.3 ±0.851 days and 2.5 ±
years, having weight 45-80 kgs, with grade of I and II ASA, 0.454 days in II group, when compared statistically using
were diagnosed with III and IV grade hemorrhoids, and student’s t-test, was significant (P < 0.05) (Table 3,)
were divided into two groups equally.
Severa studies may be compared to this. An early
Group-1 operated under Open hemorrhoidectomy and return to regular daily exercise was determined by Mehigan
B. J. et al.
Group II Patients operated under Stapler hemorrhoidectomy.
Mostafa M. Salama et al. Found that in SH group
The initial evaluation of demographic and baseline patients begun their dail activites faster than OH group.
characteristics such as age, weight, gender, ASA grade,
showed no significant differences between the two groups. The results of systematic reviews by Tjandea J. J. et
al. and meta-analyses by Nisar P. J. et al. clearly show that
 Duration of Surgery patients who were operated under stapled
The analysis revealed that the duration of the surgeries hemorrhoidectomy returned to their regular daily activities
were similar across both the groups. In our study the earlier than the patients operated under OH.
duration of surgery in Group I was 61.33 ± 4.21 minutes and
47.16 ± 4.33 minutes in group II and when compared In our study it shows that the average length of hospital
statistically using student’s t-test, the difference in both the stay was lower in the open group, as compared to staple
groups was statistically significant (table 2) group which is very important in developing countries
where daily wages are mostly involved.
Shukla S et al. also found similar results in with the
duration of surgery for patients’ operated under open VI. CONCLUSION
hemorrhoidectomy as 44 ± 5 minutes while patients
operated under stapler hemorrhoidectomy as 39.75 ± 5.73 Stapled hemorrhoidectomy is a less painful and more
minutes (p< .001). Gravie et al. also found that Stapled successful surgical procedure than conventional
hemorrhoidectomy is faster than the Milligan-Morgan hemorrhoidectomy. The benefits of stapler hemorroidopexy
technique (21 minutes versus 31 minutes) have been noted in the current study with less operating time,
decreased between and after surgery bleeding, and decreased
 Vas Score pain following the procedure, which may result in recovery
The mean vas score recorded in our study at the end of and fast discharge with the patient's thought of satisfaction,
12 hours in group I was 4.46 ± 0.86 hours and 2.43 ± 0.868 no matter of other complications. Experts might easily and
in group II and when compared t, the difference in the vas securely modify this method and present patients with this
score in both the groups was statistically Significant and p choice.
value was 0.0001 (P < 0.05) (table 3).
ACKNOWLEDGEMENT
Thejeswi et al. found that the average vas scores on
post-operative day 1, 2 and day 3 in the SH group was as The authors were thankful to the patients those who
3.8, 2.4 and 1.6 as against 5.4, 4.3 and 3.9 in the OH group, cooperated in the study.
respectively (p<0.01)
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Volume 9, Issue 8, August – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24AUG343

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