Comparison of Early Outcome of Open and Closed Hemorrhoidectomy in the Surgical Management of 3rd and 4th Degree Hemorrhoids

Abstract

Background: Hemorrhoids is a benign disorder that is associated with considerable discomfort. Excisional hemorrhoidectomy is regarded as the gold standard surgical treatment for 3rd and 4th degree hemorrhoids. The aim of the current study was to compare the early outcome of open and closed   hemorrhoidectomy in the surgical management of 3rd and 4th degree hemorrhoids. Materials and Methods: This prospective comparative study conducted in the Department of colorectal surgery, Bangladesh Medical University (BMU), Dhaka, from January 2024 to December 2024. Total of 50 patients with 3rd and 4th degree hemorrhoids were included in the study who were divided in two groups each containing 25 patients. In Group-II, closed hemorrhoidectomy was done and, in Group-II, open hemorrhoidectomy was done. The main outcome variables were operation time, per-operative bleeding, post-operative pain, post- operative hemorrhage, wound infection or wound dehiscence, wound healing, return to daily work. A p value less than 0.05 was considered statistically significant. Result: The mean duration of operation was found 36.2±5.1 minutes in closed group and 33.6±5.3 minutes in open group respectively. VAS score at 1st week (1.12±1.05 vs 2.0±1.70) and at 2nd weeks (0.28±0.54 vs 0.84±1.06, p<0.05) were significantly also lower in closed group than open group. Post operating bleeding at 1st week was more in open group (32.0% vs 8.0%). The mean duration of wound healing was also significantly lower in closed group. (2.7±1.3 vs 4.4±1.2 days, p<0.05). The mean duration of return to work was lower in closed group (9.1±1.6 vs 11.8±4.0 days) which was statistically significant (p<0.05). Conclusion: The closed technique demonstrates superior outcomes in terms of reduced postoperative pain, effective haemorrhage control, facilitated early patient mobilization, and enhanced wound healing.