#STAPLED HEMORRHOIDOPEXY COMPLICATIONS MANUAL#

Unpaired t-test was used to compare quantitative variables between two groups.

Fisher exact test was used instead of chi-square when one expected cell less than 5.

Chi-square test was used to compare qualitative variables between groups.

Description of qualitative variables as number and percentage.

Description of quantitative variables as mean, SD and range.

Statistical methodologyĪnalysis of data was done by IBM computer using SPSS (statistical program for social science version 16) as follows Pain was assessed with visual analogue scale. Variables noted were postoperative pain, bleeding and urinary retention. In both groups patients were advised to receive laxatives for 2 weeks and daily sitz path after surgery. Surgery was done under either spinal or general anaethesia according to the preference of the anesthetist. Group B also, included 25 patients who were treated with LigaSure haemorrhoidectomy (LH) (Figure 4).

Participants were divided into two groups group A included 25 patients who underwent Stapled haemorrhoidectomy (SH) (Figures 1, 2 and 3). Patients aged between 20-60 years of both genders having no systemic illness were included and informed consent was obtained. Patients with 3 rd and 4 th degree haemorrhoids were chosen. This study was conducted in El Demerdash and Ain Sham Specialized Hospitals during the period from April 2011 till April 2013. This study was done to compare the results of two techniques of haemorrhoidectomy. Ligasure haemorrhoidectomy (LH) uses the LigaSure vessel sealing system, which consist of a bipolar electro-thermal hemostatic device that allows complete coagulation of vessels up to 7 mm in diameter with minimal surrounding thermal spread and limited tissue charring (9). Stapled hemorrhoidopexy (SH) reduces haemorrhoidal tissue prolapse by excising a ring of the prolapsed anal mucosa above the dentate line using specific stapling device (8). Surgical intervention is usually the treatment of choice for grade III to IV haemorrhoids, prolapsed grade II that have failed to respond to non-surgical treatments and circumferential grade II haemorhoids (7). Pain is not characteristic unless there had been thrombosis or strangulation of the haemorrhoids which possibly can lead to gangrene (6). Symptoms resulting from internal haemorrhoids are commonly bright red bleeding per rectum, mucosal prolapse, protrusion or pruritus ani (3).

#STAPLED HEMORRHOIDOPEXY COMPLICATIONS MANUAL#

The degree of resultant prolapse is used to grade internal haemorrhoids using Goligher’s classification system: grade I haemorrhoids non- prolapsing grade II haemorrhoids prolapse on straining but reduce spontaneously grade III haemorrhoids require manual reduction grade IV haemorrhoids are non-reducible (5). With weakening or fragmentation of the supportive connective tissue framework combined with the repeated passage of hard stools and straining producing a shearing force, these vascular cushions descend and prolapse (4). Internal Haemorrhoids result from chronic engorgement of the three submucosal venous plexi of the anal canal and originate above the dentate line (3). Haemorrhoids can occur at any age, but the peak incidence is found in the 5th decade of life (2). Haemorrhoidal disease is one of the commonest colorectal disorders (1). Stapled hemorrhoidopexy offers much less pain when compared to LigaSure haemorrhoidectomy and allow early return to work. The average pain scores on postoperative day 1, day 2 and day 3 were 2.5 and 2 for stapled hemorrhoidopexy while for LigaSure haemorrhoidectomy were 5.5 and 5. The average operating time was 45.5 minutes for stapled hemorrhoidopexy and 35.5 minutes for LigaSure haemorrhoidectomy. The majority of patients were males 12 patients had grade III haemorhoids and 38 patients had grade IV haemorhoids.

Postoperative pain was assessed using visual analogue scale. Operation time and postoperative progress was assessed.

This study included 50 patients who were divided into 25 patients underwent stapled hemorrhoidopexy and 25 patients underwent LigaSure Haemorrhoidectomy. This is a prospective study aimed to compare the results of stapled hemorrhoidopexy with LigaSure Haemorrhoidectomy.

Stapled hemorrhoidopexy complications