232 A Comparative Study Between Stapled Hemorrhoidopexy and Harmonic Scalpel Hemorrhoidectomy in Management of Third and Fourth-Degree Piles: A Randomized Clinical Trial

Abstract

Abstract Aim This study compares the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of Grade III and Grade IV piles. Method The current study is a single-blind, prospective, randomized, controlled, single-center trial at Ain Shams University Hospitals. Results There were 70 patients in our study 35 patients in each group. Group(I) underwent stapled hemorrhoidopexy (SH) and Group (II) underwent harmonic scalpel hemorrhoidectomy (HSH). The mean time of the procedure in SH was 24.42 mins ± 2.367. While in HSH was 31.48 mins ± 2.21. Post-operative pain in SH showed to be less painful during the first two weeks. However, there is persistent mild pain in most of the patients of SH postoperative during and after two weeks. However, in HSH there was significant improvement in pain after two weeks. 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), While no patients were detected in group (II) (p=0.039). there were 3(15%) cases of incontinence to gases only scored by Wexner score 3/20 in group (II). Recurrence in one-year follow-up occurred in 7 (20%) patients in group (I). While in group II 1(2.9%) patient was reported with recurrence (p=0.024). Conclusions HSH was determined to be safer, easier, and associated with a lower incidence of recurrence in one-year follow-up as compared to the SH technique. In addition, better patient satisfaction is one of the most difficult accomplishments in the management of hemorrhoids.