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Randomized Controlled Trial
. 2024 Dec;95(Suppl 1):14-22.
doi: 10.1007/s00104-023-02010-9. Epub 2023 Dec 29.

Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial

Mohamed Ali Mohamed Nada  1 , Philobater Bahgat Adly Awad  1 , Andrew Morcos Azmy Kirollos  1 , Mostafa Mohamed Abdelaziz  1 , Karim Mohamed Saad Mohamed  1 , Kerolos Bahgat Adly Awad  1 , Basma Hussein Abdelaziz Hassan  2
Affiliations
Randomized Controlled Trial

Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial

Mohamed Ali Mohamed Nada et al. Chirurgie (Heidelb). 2024 Dec.

Abstract

Background: This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year.

Patients and methods: This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles.

Results: The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024).

Conclusion: Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.

Keywords: Bleeding; Colorectal surgery; Hemorrhoids; Prolapse; Surgical instruments.

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Conflict of interest statement

Declarations. Conflict of interest: M.A. Mohamed Nada, P.B. Adly Awad, A.M. Azmy Kirollos, M. Mohamed Abdelaziz, K.M. Saad Mohamed, K. B. Adly Awad and B.H. Abdelaziz Hassan declare that they have no competing interests. Ethical approval and consent to participate: To protect patient data and privacy, all methods were carried out in accordance with relevant guidelines and regulations and all experimental protocols were approved by the Ain Shams University ethics committee with informed consent obtained from all the patients. Trial no: PACTR202310528525409, Date of Approval: 31/10/2023.

Figures

Fig. 1
Fig. 1
Fourth-degree piles in a patient in lithotomy position
Fig. 2
Fig. 2
a The external device (transparent anoscope) of the PPH stapler is applied and fixed to the cutaneous margin with silk 0 sutures. b Double purse-string sutures inserted with submucosal bites of the lower rectum circumferentially using a 2/0 propylene suture
Fig. 3
Fig. 3
a The anvil (head) is inserted beyond the purse string. b The stapler is tied and kept closed for 60 s for hemostasis and then fired
Fig. 4
Fig. 4
a In women, the posterior vaginal wall is routinely checked before firing the stapler to ensure non-entrapment. b Hemostasis is achieved along the stapler line
Fig. 5
Fig. 5
a Fourth-degree piles in patient in lithotomy position. b The mosquito forceps grasping a hemorrhoidal complex
Fig. 6
Fig. 6
a The hemorrhoid is dissected from the surrounding tissue and underlying external sphincter by taking small bites between the device blades. b Proceeding more proximal underneath the hemorrhoid bundle, which is carefully separated from the internal anal sphincter
Fig. 7
Fig. 7
The same step as with the other hemorrhoids is carried out, leaving a skin bridge
Fig. 8
Fig. 8
Postoperative patient satisfaction
See this image and copyright information in PMC

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