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KMID : 0356720020180030172
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Journal of the Korean Society of Coloproctology
2002 Volume.18 No. 3 p.172 ~ p.177
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Benefits of Stapled Hemorrhoidectomy Compared with Ultrasonic Dissector and Milligan’s Hemorrhoidectomy
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Seo Hyung-Min
Park Chul-Woon
Lee Kil-Yeon
Yoon Choong
Lee Kee-Hyung
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Abstract
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Purpose: Surgical hemorrhoidectomy has a reputation for being a painful procedure. Many surgical methods have been devised for reducing posthemorrhoidectomy pain. Nevertheless, the result are unsatisfactory. Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods.
Methods: A total of 150 consecutive patients with 3rd and 4th degree of prolapsed hemorrhoids underwent hemorrhoidectomy with stapler group (n=50) or hemorrhoidectomy with ultrasonic dissector group (n=50) or Milligan’s hemorrhoidectomy using by diathermy (n=50) (by same surgeon between January and September 2001). We evaluated the difference among three techniques in operative time, postoperative pain, and patient satisfaction (using visual analogue scale).
Results: Mean operative time for hemorrhoidectomy with ultrasonic dissector was 19 minute; for stapler group, it was 18 minute; for Milligan’s group, it was 23.6 minute (P＜0.05). There was significant difference in operative time between stapler and Milligan’s group. There were significant difference in pain measurement reported on immediate (5.8 for stapler, 7.2 for ultrasonic dissector, and 9.2 for Milligan’s group, P＜0.01), day 1 (4.3, 5.5, and 6.8, P＜0.01), day 2 (3.7, 4.7, and 6, P＜0.01), day 3 (3.0, 3.6, and 4.6, P＜0.01), day 4 (3.1, 3.5, and 4.6, P＜0.01), day 5 (2.5, 3.4, and 4.6, P＜0.01), day 6 (2.0, 3.2, and 4.3, P＜0.01), day 7 (1.8, 3, and 4.2, P＜0.01), and defecation (4.0, 7.0, and 8.9, P＜0.01). The mean
analgesic (piroxicam 20 ㎎) requirement was 0.3 times for stapler, 1.9 for Ultrasonic dissector, and 3.1 for Milligan’s group (P＜0.01). Mean hospital stay was 1.6 days for stapler, 1.7 for ultrasonic dissector, 2.8 for Milligan’s group (P＜0.01). Patient satisfaction on day 7 was 8.2 for stapler, 6.2 for ultrasonic dissector, and 5.2 for Milligan’s group (P＜0.01). There was no difference in catheterization for urinary retention. It is probably due to spinal anesthesia.
Conclusions: The study demonstrates significantly reduced postoperative pain and shorter hospital day after stapled hemorrhoidectomy compared among three groups. This resulted in an earlier return to working activities for stapled
technique.
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KEYWORD
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Stapled hemorrhoidectomy, Ultrasonic hemorrhoidectomy, Milligan’s hemorroidectomy
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