[The surgical treatment of hemorrhoids: diathermocoagulation and traditional technics. A prospective randomized study].

INTRODUCTION

The operations to treat hemorrhoids of III and IV degree are numerous but classifiable into two groups: "closed" techniques such as Ferguson, Parks and Khubchandani, and "open" techniques such as Arnous-Parnaud of the most famous Milligan-Morgan. Recently the Anglo-Saxon school was proposed a technical variant to Milligan-Morgan operation: it involves diathermy excision without peduncle ligature. This technique partly because of the coagulation of the pain receptor, partly because of the absence of "at risk" sutures in septic ground would involve a reduction in the postoperative pain. We have developed the following study to have a global valuation of these methodologies.

MATERIALS AND METHODS

From November 1993, 135 patients with haemorrhoids of III and IV degree have been recruited and grouped in 3 random groups: the patients of the I group have been subjected to closed hemorrhoidectomy (Ferguson and is variant according to Khubchandani), the patients of the II group have been subjected to the Milligan-Morgan operation and those the III group of the diathermy hemorrhoidectomy. All the patients have had the same kind of preoperative preparation and the same kind of analgesic during the post-operative course. Before the operation all the patients were given a questionnaire including a scale of the pain on which the administrations of analgesic were also noted.

RESULTS

A faster canalization and a minor postoperative pain were found in the patients of the II and III group and among them a minor use of analgesics in those subjected to diathermy-hemorrhoidectomy. No statistical difference occurred in postoperative haemorrhage into Milligan-Morgan and diathermy hemorrhoidectomy without peduncle ligature (2.2%).

CONCLUSIONS

All the methods we have considered have turned out to be effective for the clinical and anatomical recovery. However, in our experience, the open techniques involve in a significant reduction of the postoperative pain and those made with diathermy permit a minor use of analgesics in comparison with those made a conventional scissor excision. Finally the peduncle ligature doesn't influence postoperative haemorrhage.