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Randomized controlled trial of open and closed haemorrhoidectomy
1Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Background:
This study was a prospective randomized comparison of healing following open and closed haemorrhoidectomy.
Methods:
Sixty-seven consecutive patients (mean(s.e.m.) age 45(1.7) years; 35 men, 32 women) with three prolapsed piles were randomized to open haemorrhoidectomy (n = 34) or closed haemorrhoidectomy (n = 33).
Results:
Mean(s.e.m.) follow-up was 8.7(0.2) months. There were no differences in the linear analogue pain scores, analgesic requirements and length of hospitalization after open haemorrhoidectomy and closed haemorrhoidectomy. Complete wound healing took significantly longer after closed haemorrhoidectomy (mean(s.e.m.) 6.9(0.7) weeks) compared with open haemorrhoidectomy (4.9(0.4)weeks) (P < 0.05). This was related to wound dehiscence in eight patients. Complication rates, however, were similar except for prolonged serous discharge from unhealed wounds. The anal manometry findings after both procedures were equivalent.
Conclusion:
Open haemorrhoidectomy leads to faster and more reliable wound healing, although this did not result in less pain or fewer complications.