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

Autor: Nada MAM; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Awad PBA; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Kirollos AMA; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Abdelaziz MM; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Mohamed KMS; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Awad KBA; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt., Hassan BHA; General Surgery Department, Faculty of Medicine, Ain Shams University, 2022, Cairo, Egypt. basmabasam0100667@med.asu.edu.eg.
Jazyk: angličtina
Zdroj: Chirurgie (Heidelberg, Germany) [Chirurgie (Heidelb)] 2024 Dec; Vol. 95 (Suppl 1), pp. 14-22. Date of Electronic Publication: 2023 Dec 29.
DOI: 10.1007/s00104-023-02010-9
Abstrakt: 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.
Competing Interests: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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