Comparing Open and Closed Hemorrhoidectomy: A Comparative Study

Abstract

Background: This prospective randomized clinical study aimed to evaluate and compare the outcomes of surgical hemorrhoidectomy using both open and closed techniques [1]. The study focused on assessing factors such as postoperative pain, wound healing, and overall morbidity to determine the effectiveness of these two approaches in the treatment of patients with third-degree or fourth-degree hemorrhoids, which are often considered for surgical intervention. Methods: In this study, all consecutive patients diagnosed with Grade III internal hemorrhoids or Grade IV hemorrhoids were included and randomly assigned to one of two groups. [2], [3] In the open group, the entire wound was intentionally left open, while in the closed group, the wound was completely closed using 2-0 chromic sutures. Postoperative pain levels were evaluated using a linear analog scale. Additionally, the consumption of analgesic medications on the day of surgery and during bowel movements in the first week following the procedure was carefully documented. Patients were then followed up at 1, 2, and 3 weeks after the surgical procedure to assess their progress and outcomes. Results: In this study, both groups consisted of 20 patients each, and no statistically significant differences were observed between the two surgical methods in terms of complications, pain levels, or length of postoperative hospital stay. However, it’s worth noting that there were four cases requiring reoperations due to bleeding, and all of these occurred after Milligan-Morgan operations. Conclusion: Both the open and closed surgical methods appear to be effective treatments for third and fourth-degree hemorrhoids, and neither method appears to have significant drawbacks [4]. In this study, it was found that the closed method did not provide a notable advantage in reducing postoperative pain. However, it did offer an advantage in terms of faster wound healing compared to the open method. These findings suggest that the choice between the two methods may depend on individual patient factors and surgeon preferences, as both techniques can be considered viable options for the treatment of third and fourth-degree hemorrhoids.