Outcome of manual hemorrhoidopexy in the management of hemorrhoids

Abstract

Background: Manual hemorrhoidopexy is a new technique of treating second degree hemorrhoids. In contrast to the conventional resectional techniques (Milligan-Morgan), manual hemorrhoidopexy is a novel technique as described by T Carlo. It does not involve excision but plication with fixation of the prolapsing hemorrhoid.

Objective: To study the outcome of manual hemorrhoidopexy and to compare manual hemorrhoidopexy with the traditional hemorrhoidectomy.

Methods: This is a prospective study conducted over 16 months (January 2012 to April 2013) in the College of Medical Sciences Teaching Hospital (COMS-TH), Bharatpur, Chitwan, Department of Surgery. The patients who presented with third degree internal-hemorrhoids on a random basis, and underwent either conventional hemorrhoidectomy (Group A) or Manual hemorrhoidopexy (Group B) by senior consultant surgeons were included. The patients who had external hemorrhoids in addition to internal were excluded. Preoperative, intraoperative, and postoperative characteristics were evaluated.

Results: Twenty five patients with median age group 42.5 years underwent conventional (Milligan-Morgan) hemorrhoidectomy (Group A) and 25 patients with mean age of 40.1 years underwent manual hemorrhoidopexy (Group B). Male patients were predominant in both groups. The patients in group A had more postoperative pain as compared to group B (as assessed by the visual analogue scale and requirement of post-operative analgesic) and this was statistically significant (p<0.001). There was no significant difference among the other post-operative urinary retention. Twelve percent (n=3) patients in group A had post-operative bleeding and only 4% (n=1) in group B which was statistically significant (p<0.001). Mean duration of hospital stay in group A was 2.5 days as compared to 1.5 day in group B. Median follow up in both the study group was 3 (2-4) months.

Conclusion: Manual hemorrhoidopexy has comparable outcomes in term of postoperative analgesic requirement, and post operative complications.

Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 15-19

DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9682