Comparative Analysis of Triple Hemostatic Open Hemorrhoidectomy Versus Traditional Open Hemorrhoidectomy

Background: Traditional open hemorrhoidectomy is the most commonly performed operation for the third or fourth degree hemorrhoids in the developing world, despite considerable postoperative pain and bleeding complications. This modification is an attempt to reduce these complications and compare the outcome of both methods. Methods: A prospective, comparative study was conducted in phase I, at Fatima hospital at Baqai Medical University, from March 2009 to August 2011. It was followed by a descriptive case-series in phase II, conducted at different hospitals from September 2011 to August 2017. The inclusion criteria were patients of both genders and all age groups, with third or fourth degree hemorrhoids requiring surgery. The exclusion criteria were patients in between blocks (operated by other surgeons), patients with complicated hemorrhoids, closed hemorrhoidectomy cases, cases operated by residents, and cases lost to follow-up. In phase I, a total of 182 patients were enrolled and randomly allocated to group A or B undergoing triple hemostatic hemorrhoidectomy and traditional open hemorrhoidectomy, respectively; 231 patients were included in phase II (group C) undergoing modified hemorrhoidectomy. The analyzed variables were operative blood loss, operative time, postoperative pain, hospital stay, time to pain-free defecation, and per-operative or postoperative complications. Results: There was significantly more operative blood loss in group B patients. Pain perception was significantly high in group B patients at eight and 24 hours, as well as eighth, 15th, and 30th days. Group B patients also had longer duration of operation and more prolonged pain-free defecation. Both, intra-operative and post-operative complications were higher among the group B. The outcome of phase II (group C) was similar to those of group A. Conclusions: In a limited resource setting, triple hemostatic open hemorrhoidectomy offers potential advantages of less operative blood loss, shorter duration of operation, shortened hospital stay, shorter time to pain free defecation, and less postoperative pain and other complications.