A COMPARATIVE EXAMINATION OF BAND LIGATION, CRYOTHERAPY, STAPLER, AND OPEN HAEMORRHOIDECTOMY IN INTERNAL HEMORRHOIDS
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Abstract
Background: Haemorrhoids are normal, vascular tissue within the submucosa located in the anal canal. They are typically located in the left lateral, right anterior, and right posterior quadrants of the canal. “Despite a long medical history of identification and treatment, haemorrhoids still pose a challenge to the medical fraternity in terms of finding satisfactory cure of the disease.” There are various modalities of treatment of haemorrhoids available at present. This study is intended to find out the overall best solution for the patient.
Objective: To study and compare cryosurgery, band ligation, Stapler and open haemorrhoidectomy in internal haemorrhoids in terms of:Cost effectiveness, Complication, Hospital stay, Patient comfort, Pain, Cosmesis.
Methods: The study group comprises of patients with complains of bleeding per rectum and on examination diagnosed to be having internal haemorrhoids, admitted in department of General surgery at SS Institute of Medical Sciences & Research Centre, Davangere from August 2022 to June 2024. Patients who are coming to Out Patient Department with complaints of bleeding per rectum or mass per rectum are subjected for detailed history taking which includes symptoms and duration of disease. According to severity and type of symptoms, patients are subjected for open haemorrhoidectomy, banding, stapler and cryosurgery based on simple random sampling. Cost effectiveness, Hospital stay, patient comfort, pain and cosmesis are considered. Complications like infection, excessive bleeding and stenosis are noted.
Results: Bleeding per rectum was the most common presenting complaint present in 66.25% of subjects followed by mass per rectum present in 47.5% of subjects.The duration of the stay in hospital was least for Cryo probe followed by band ligation. Patients with open haemorrhoidectomy stayed for longer duration.Complications were seen maximum in the open group with pain being the most common complication across other groups except in the cryo group where bleeding and discharge were more common than the pain. Stapler haemorrhoidopexy had least post op complications among the four
Conclusions: Open Hemorrhoidectomy had post operative complications till post-op day 7 but were easily managed by analgesics and sitz bath and was most cost-effective with zero recurrence.Rubber band ligation and Cryotherapy had less postoperative complications by the end of day 7 and were cost-effective however recurrence is a complication seen higher than all other 2 groups.Stapler haemorrhoidopexy was costliest of all the four groups without significant improvement in post operative complications and recurrence as compared to other 3 groups.
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Panindra Pilli
III Year Postgraduate, Department Of General Surgery S S Institute of Medical Sciences, Davangere, Katnataka India
Dinesh L Jadhav
Professor, Department Of General Surgery S S Institute of Medical Sciences, Davangere, Katnataka India
Sagar Kannavar
Associate Professor, Department Of General Surgery S S Institute of Medical Sciences, Davangere, Katnataka India
Avinash Hanchinal
Senior Resident, Department Of General Surgery, Shri BM Patil Medical College, BLDE University Vijayapur, Katnataka India