대한대장항문학회

<b>Purpose:</b> 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<br>performed<br>without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods.<br><br><b>Methods:</b> 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<br>using by<br>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).<br><br><b>Results:</b> 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<br>stapler<br>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,<br>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<br>analgesic<br>(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<br>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.<br><br><b>Conclusions:</b> 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<br>technique.<br>