title: Conventional haemorrhoidectomy, stapled haemorrhoidectomy, Doppler guided haemorrhoidectomy artery ligation; post operative pain and anorectal manometric assessment.
abstract: OBJECTIVE
  The aim of the present article was to compare stapled haemorrhoidectomy, and haemorrhoidal artery ligation with open haemorrhoidectomy with respect to the postoperative pain, symptom control, and manometric alterations.
  
  
  METHODS
  Forty five patients with third or fourth-degree haemorrhoids were randomly classified into three groups; first group managed by stapled haemorrhoidectomy, second group managed by conventional haemorrhoidectomy and third group managed by Doppler guided haemorrhoidal artery ligation. (15 patients each) Preoperative and 12 weeks postoperative anorectal manometry were done for all patients.
  
  
  RESULTS
  There was a significant difference of the operative time between stapled group and Milligan-Morgan group (p < 0.001) while no significant difference between stapled group and Doppler group. The pain scores were significantly higher in open group (p < 0.001) during the first 24 hours at the time of first motion and one week after operation. Postoperative control of prolapsed symptoms was significantly better with open diathermy haemorrhoidectomy than with stapled. The control of other symptoms was similar with regard to bleeding, pain, pruritus, and incontinence scores. Anorectal manometry showed a decrease in the maximum resting pressure and maximum squeeze pressure in all groups, but this decrease was only significant in the stapled haemorrhoidectomy group.
  
  
  CONCLUSIONS
  Stapled and Doppler 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.
authors.affiliation: Colorectal Surgical Unit, Mansoura University Hospitals, Egypt. wkhafagy@mans.edu.eg
authors.forename: Wael
authors.initials: W
authors.lastname: Khafagy
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Elyamany
authors.initials: E
authors.lastname: Fouda
authors.forename: Walid
authors.initials: W
authors.lastname: Omar
authors.forename: Nabil Gad
authors.initials: NG
authors.lastname: Elhak
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elshobaky
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008365:Manometry; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D017792:Surgical Stapling; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional