Open vs. closed hemorrhoidectomy.
OBJECTIVE
This prospective, randomized, clinical trial compared the outcome of surgical hemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity.


METHODS
All consecutive patients with Grade III internal hemorrhoids with prominent external components or Grade IV hemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 5-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of oxycodone hydrochloride on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure.


RESULTS
There were 40 patients in each group. Pain score at recovery from the anesthesia was significantly lower in the closed group (P < 0.05). Altogether, 15 percent of patients in the closed group required additional oxycodone hydrochloride for pain compared to 45 percent in the open group (P < 0.01). The pain score at the first bowel movement was significantly lower in the closed group (P < 0.01). Wound healing was significantly faster in the closed group: 75 percent of patients in the closed group had healed at 3 weeks after the procedure compared to 18 percent in the open group (P < 0.001).


CONCLUSIONS
The closed technique is more advantageous with respect to less pain during the early postoperative period and faster wound healing.
You
Seong Y
SY
Department of Colon and Rectal Surgery, Hang Clinic Gangnam, Seoul, Korea. seongyou@hotmail.com
Kim
Seung H
SH
Chung
Choon S
CS
Lee
Dong K
DK
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D003672:Defecation; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing