A comparative study of modern techniques of stapled versus enseal haemorrhoidectomy: a prospective randomized trial on 240 cases

Abstract

Background: Increasing incidence of haemorrhoids in population consuming diet rich in calories, low in fibre, spicy food, tropical climate and other known factors has led to development of new techniques for haemorrhoid treatment. The aim of study is to compare pros and cons of haemorrhoidectomy with stapler v/s enseal. Methods: A prospective randomized trial was conducted on a total of 240 patients having 3rd and 4th degree haemorrhoids, divided into two groups of 120 each during 2012-2014 at NIMS Medical College and Hospital, Jaipur, India. Pre-operative complaints (bleeding P/R, rectal/perianal pain, mass coming out of anus), operative and postoperative outcomes, operative time, post-operative pain, bleeding, urinary retention, faecal/flatus incontinence, thrombosis of external haemorrhoids/perianal hematoma, anal/rectal stenosis, wound problems and recurrence were assessed. Results: Average operating time was 1.5 times in Stapler Haemorrhoidectomy(SH) v/s Enseal Haemorrhoidectomy (EH), average hospital stay, recovery time and total analgesics required during 5 POD was almost 0.5 in SH v/s EH. Post-operative complications like bleeding, urinary retention, faecal/flatus incontinence, anal discomfort, rectal/anal stenosis and wound infection were found significantly less in SH v/s EH. Residual skin tags prolapse and recurrence was almost three times in SH v/s EH. Kochar MP et al. Int Surg J. 2016 May;3(2) Both techniques are equally good, require less operating time, control post-operative bleeding, pain and prolapsed part of haemorrhoids and allow for early resuming of work. Conclusions METHODSA prospective randomized trial was conducted on a total of 240 patients having symptomatic 3 rd and 4 th degree haemorrhoids divided into two groups of 120 each. Group 'A' Stapler haemorrhoidopexy (SH) and Group 'B' Enseal haemorrhoidectomy (EH). All patients followed a fixed protocol. The operation was performed under either general anesthesia (78 patients i.e. 32.5%) or spinal/saddle block anesthesia (162 patients i.e. 67.5%) depending on anesthetist's advice or patient preference. A proctoclysis enema was given to all patients' 3-4hrs prior to surgery. All patients were operated in lithotomy position.In SH group PPH03 was used on 76 patients while HEM 3348 circular stapler was used on the remaining 44 patients. HEM 3348 having detachable anvil which provide good working space for applying purse string suture and having no side holes in casing of device as in PPH03, so traction on purse string is not possible that results into less pulling inside prolapsed haemorrhoids and rectal mucosa into device housing that ultimately gets excised. 30 seconds time was given before and after shoot of stapler that acts as temponade and haemostasis as well. Operating time was recorded from the time of anal dilator insertion to the application of endoanal dressing. An interrupted purse string suture was applied 2-3cm above the dentate line with prolene 2/0 on 38mm round body needle, before tightening it was checked by placing ...

ENSEAL® Hemorrhoidectomy, a Novel Technique, Versus Conventional Open Method for the Management of Grade III and IV Hemorrhoids

“…These results are comparable to our study, proving ENSEAL® hemorrhoidectomy to be as efficient as harmonic scalpel haemorrhoidectomy. Kochar and Singh presented comparable results to our study, stating that the ENSEAL® hemorrhoidectomy (EH) group experienced less pain as ENSEAL® damages the nerve endings and EH has the additional benefit of ease of operating and reduced duration of operation [14].…”