A Randomized Controlled Study on Open Versus Closed Haemorrhoidectomy in Patients with Grade III and Grade IV Haemorrhoids

Abstract

Background: Haemorrhoidectomy is a common surgical procedure aimed at treating symptomatic haemorrhoids (approximately 10% of cases require surgical intervention).

Objectives: To compare the surgical outcomes of open vs closed haemorrhoidectomy – including postoperative complications such as pain, infection, and wound healing rates; duration of surgery; and length of postoperative hospital stay.

Methods: This was a hospital based, prospective experimental study – randomized controlled study design conducted in the outpatient department and/or inpatient wards of the Department of General Surgery, Aarupadai Veedu Medical College and Hospital, a tertiary healthcare facility in Puducherry, India between June 2022 and June 2024.

Results: In this study, 64 patients were randomized into two groups: 32 underwent open haemorrhoidectomy (Group A) and 32 underwent closed haemorrhoidectomy (Group B). Both groups had similar demographic and clinical characteristics, with no significant differences in age, sex, or presenting symptoms. The mean age was 44.3 years in Group A and 45.8 years in Group B. Most patients were aged 30-50 years, and the majority were male. The duration of surgery was significantly shorter in Group A (38.4 minutes) compared to Group B (46.4 minutes). Postoperative hospital stay was also significantly shorter in Group A (3.3 days) compared to Group B (4.9 days). Pain levels (VAS scores) showed no significant difference on day 1, but Group A reported significantly lower pain from day 3 onwards. Bleeding and infection rates were significantly lower in Group A on day 1, day 3, and week 1. Fever rates were significantly lower in Group A on day 3 and week 1. Wound healing rates were significantly higher in Group A on day 3, week 1, week 2, and month 1. By month 3, the wound healing rates were similar in both groups.

Conclusion: Open haemorrhoidectomy resulted in shorter surgery and hospital stays, less postoperative pain, lower rates of bleeding, infection, and fever, and faster wound healing compared to closed haemorrhoidectomy.