Open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomised study.
OBJECTIVE
Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology.


METHODS
We carried out a randomised prospective study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy (group A) versus 100 patients undergoing Ferguson haemorrhoidectomy (group B) for symptomatic haemorrhoids, in whom medical treatment or rubber band ligation had failed.


RESULTS
Characteristics of the population were: mean age 43.5 years, with predominance of males, 123 vs. 77; 88% ASA I-II.


METHODS
95% rectal bleeding; 87.5% third-fourth degree. The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients (90%). Length of surgery: 24 min (group A) and 30 min (group B) (p=n.s.). Resection of three haemorrhoidal cushions was done in 87.5% of cases. There were no re-operations or re-admissions after discharge. Symptomatic recurrence, stenosis and incontinence were not found during the follow-up of the first year. Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group, but the difference was statistically significant (p<0.05) only during bowel movements. There was complete healing in 40% of the patients in group A and 90% of those in group B (p<0.05) after 1 month. After 1 year, the results and complications were similar in both groups (p=n.s.).


CONCLUSIONS
Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy, whereas recurrence and complications are similar after 1 year.
Arroyo
A
A
Coloproctology Unit, Department of Surgery, University Hospital of Elche, C/Huertos y Molinos s/n. C.P., 03203 Elche (Alicante), Spain. arroyocir@hotmail.com
Pérez
F
F
Miranda
E
E
Serrano
P
P
Candela
F
F
Lacueva
J
J
Hernández
H
H
Calpena
R
R
D000328:Adult; D000553:Ambulatory Care; D003672:Defecation / Q000502:physiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D013030:Spain; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology