European Journal of Molecular & Clinical Medicine

Introduction: Anorectal disorders including fissure and haemorrhoids are among the most common afflictions of this region which negatively impact the ‘quality of life’ of the patient and incur a massive financial burden on both the patient. Most of the patients hesitate to seek medical care unless the symptoms become too bothersome. The present study was conducted in our proctology unit to compare the outcome of Manual anal dilatation and lateral internal sphincterotomy in the management of fissure in ano.

Background
Stapled hemorrhoidectomy has a number of advantages over excision hemorrhoidectomy, including less postoperative pain, a shorter stay in the hospital, and a faster recovery. Furthermore, stapled hemorrhoidectomy is linked to a reduced rate of hemorrhoidal recurrence during long-term follow-up.
Methods:
The study included 100 patients, 50 of whom received open and 50 of whom underwent stapled haemorrhoidectomy. Averages, standard deviation, unpaired student t test, Mann Whitney U test (for non-parametric skewed distribution), and Fischer exact test were used to assess significance levels. If the p-value ˂ 0.01 or 0.001, the difference is extremely significant. The difference is significant if the p-value ˂0.05.
Results
In terms of postoperative pain, operative time, and return to normal activities, the stapled method for haemorrhoids is preferable than the Milligan Morgan haemorrhoidectomy. It's simple and obvious to learn. Early functional and symptomatic results have been positive, and they appear to be comparable to or better than those obtained using conventional approaches. However, long-term assessment of these parameters is required.
Conclusion
I conclude that both treatments were effective for hemorrhoidectomy treatment, however Stapler hemorrhoidectomy had advantages in terms of shorter operative periods, less intra- and post-surgical bleeding, and a lower incidence of various post-operative sequelae. Patients with haemorrhoids frequently avoid surgery for fear of enduring excruciating pain after a haemorrhoidectomy.
 

Hemorrhoids (Piles) are arteriovenous vascular plexuses that surround the distal rectum and anal canal. Hemorrhoids are present in all individuals from birth and become symptomatic when enlarged, inflamed, thrombosed, or prolapsed. The development of symptomatic hemorrhoids is related to a combination of factors including venous engorgement and weakening of the supportive scaffold of connective tissue that supports this vascular bundle and the overlying mucosa. In the present prospective comparative study, 50 cases of 2nd and 3rd degree haemorrhoids were chosen with complaints of bleeding per rectum, mass per rectum, and pain during defecation. Patients were divided into 2 groups of 25 each. One group underwent open haemorrhoidectomy and other underwent closed haemorrhoidectomy. The most common presentation in haemorrhoids is bleeding per rectum in 86% of cases, while mass PR and pain in 70% and 20% of the cases respectively. In the present study 30% of the patients suffered from second degree haemorrhoids while 70% had third degree haemorrhoids.

Haemorrhoids are one of the most frequently encountered anorectal conditions in the clinical practice of a surgeon. Haemorrhoidectomy is the most effective approach for haemorrhoidal disease especially for grade III and grade IV disease and also in grade II disease which do not respond to conservative and non-invasive treatment. However, postoperative pain is a major concern, and the surgery itself is with complications including notably bleeding, wound sepsis, pain, and anal stenosis. The patients were explained about their disease and modalities of treatment as Open or closed haemorrhoidectomy with advantages and disadvantages of each. 25 patients were operated by open haemorrhoidectomy and another 25 patients by closed haemorrhoidectomy under spinal anaesthesia. Data was collected according to proforma which included detailed history, clinical examination and investigation. Data was tabulated, analyzed and results interpreted. The mean immediate post-operative pain score in open group was 2.88 ± 0.53 VAS and in closed group was 2.44 ± 1.9 VAS; these differences were significant with p value of 0.027. The mean duration hospital stay in open group was 4.64± 0.9 days and in closed group was 4.28 ± 0.9 days (p value= 0.18) the differences were not significant. People who underwent open procedure took 17.5 days and closed group patient took 16. 4 days to resume their normal activity, these differences were not significant (p Value = 0.42).