Table 4: Closed versus open haemorrhoidectomy
Study | Comparison | n treatment/ control | Supplemental analgesia | Pain scores and type if specified | Use of supplemental analgesia | Other pain outcome | Functional outcomes | Other outcomes, including long-term effects |
LoE 1 | Open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy | 39/38 | All patients were treated with injections of opioids or ketorolac for pain, then oral medication with paracetamol + dextropropoxyphene. On day 1, bulk laxatives were administered 3 x per day, and patients had access to LA ointment | NS VAS scores on day 1, on first day at home, and on first day at work | NS postop analgesic consumption (opioids, ketorolac, and paracetamol + dextropropoxyphene) | NS % of patients with pain at 3 and 6 weeks, and > 1 year postop | % of patients with completely healed wounds: closed superior at 3 weeks (p<0.001, n=38/37), but NS at 6 weeks. % patients soiling: closed superior at 3 weeks (p=0.001, n=38/37), but NS at 6 weeks and >1 year. % of patients with evacuation problems at 3 and 6 weeks, and >1 year: NS | % patients with pruritus: closed superior at 6 weeks (p=0.001, n=33/32), NS at 3 weeks and >1 year Incidence of urinary retention: NS % of patients with postop bleeding: NS at 3 and 6 weeks, and >1 year % of patients with incontinence: NS at 3 and 6 weeks, and >1 year Length of hospital stay: NS Number of days off work: NS |
LoE 1 | Open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy | 100/100 | LA ointment and regular oral analgesia for the first week (metanizol 575 mg every 8 h alternating with oral ketorolac 10 mg every 8 h) | Pain scores during bowel movement: closed superior (p<0.05), NS during the first 3 days and at 1 week | Not reported | NS anal pain at 1 month | % of patients with completely healed wounds at 1 month: closed superior (p<0.05) | Urinary retention: NS Rate of incontinence: NS PONV: NS |
(Ho 1997b) LoE 1 | Open versus closed haemorrhoidectomy | 34/33 | Oral ketoprofen on demand (100 mg tablets) or IM pethidine (1 mg/kg) | NS pain scores during first 24 h, maximum postop pain score, pain score at first bowel movement | NS number of ketoprofen tablets required, NS pethidine requirements | Not reported | Time to first bowel movement: open superior (p<0.001) Time to completely healed wounds: open superior (p<0.05) | Number of patients with complications (bleeding and faecal impaction): NS Length of hospital stay: NS |
(Johannsson 2006) LoE 1 | Open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy | 115/110 | Rectal diclofenac 100 mg at end of surgery then 50 mg 3 times daily, paracetamol 1 g, 4 times daily for up to 2 weeks, plus metronidazole 400 mg 3 times daily | VAS pain scores: closed superior (p=0.041) on day 13, NS days 0–12 | Not reported | Not reported | Incontinence scores at 1 year: closed superior (p=0.035) Completely healed wounds at 1 month: NS | % patients reporting results of surgery as good or excellent at 1 year: closed superior (p=0.047) Total number of complications (including urinary retention, bleeding and infection): NS Length of hospital stay: NS Length of sick leave: NS |
LoE 1 | Open (Milligan Morgan) versus closed (Ferguson) haemorrhoidectomy | 29/26 | Spinal anaesthesia wih bupivacaine in all patients but 2, who had LA | NS VAS pain scores at 24 h. NS VAS in patients undergoing LIS | Not reported | LIS had no effect on the incidence of early postop pain | Faecal impaction: NS Incidence of non-healing wound: NS LIS had no effect on the incidence of anal stricture requiring dilation, or faecal incontinence | Severe bleeding: NS Urinary retention: NS |
(You 2005) LoE 1 | Open (Milligan-Morgan) versus closed (Ferguson) haemorrhoidectomy | 40/40 | Pethidine injections given immediately postop, oral oxycodone/paracetamol given on demand, plus oral metronidazole | VAS pain scores at recovery from anaesthesia: closed superior (p<0.05). Pain scores at first bowel movement: closed superior (p<0.01) | % of patients requiring additional oxycodone at recovery: closed superior (p<0.01). Total consumption of oxycodone tablets in first week: closed superior (p<0.01) | Not reported | % of patients with completely healed wounds: closed superior (p<0.001) at 3 weeks, NS at 2 weeks | Urinary retention: NS Early bleeding: NS Duration of hospital stay: NS |