Short note Randomized trial of open versus closed day-case haemorrhoidectomy E. A. Carapeti, M. A. Kamm, P. J. McDonald, S. J. D. Chadwick and R. K. S. Phillips St Mark's Hospital, Northwick Park, Watford Road, Harrow HA1 3UJ, UK Correspondence to: Mr R. K. S. Phillips Paper accepted 22 January 1999 British Journal of Surgery 1999, 86, 612±613 Introduction Full three-quadrant haemorrhoidectomy can be performed as a day-case procedure with high patient satisfaction, a low readmission rate and few complications 1 . Haemorrhoid- ectomy is most commonly performed open using either scissors dissection or diathermy) or closed. Proponents of thelatterhavesuggestedthatprimaryclosureofthewounds results in less pain after operation 2 ; however, this claim has not been substantiated in surveys 3 . Similarly, prospective studies have shown no differences between the open and closedtechniques 4 .Thein¯uenceofoperativetechniqueon postoperative pain has not been addressed in the setting of day-case haemorrhoidectomy. Patients and methods Consecutive patients were recruited. As with open haemorrhoidectomy, the closed technique was carried out using diathermy dissection 5 and the wounds were sutured with plain catgut. Patients received local anaesthetic in®ltration and a diclofenac suppository. They were discharged home with non-opiate analgesia, metron- idazole, lactulose and topical glyceryl trinitrate 1 . Postoperative pain was assessed using a linear analogue scale. Patient satisfaction was determined using a ques- tionnaire, scoring between ±3 extreme dissatisfaction with day surgery) and +3 complete satisfaction). Analysis of variance was used to compare mean pain scores between groups and between days. The Mann± Whitney U test was used for categorical data. It was calculated that a sample size of 18 was necessary to show a signi®cant difference at the 5 per cent level with 80 per cent power. Results Seventeen patients underwent open and 18 closed haemorrhoidectomy Table 1). The ®rst postoperative bowel motion was within 24 h of surgery for 22 patients, with no difference between the groups P  0á69). There was no signi®cant difference in mean pain scores between the groups P  0á33). Twelve patients having open haemorrhoidectomy and 11 in the closed group used additional analgesia P  0á72). Therewerenoreadmissionsandnomajorcomplications. Ten patients with closed haemorrhoidectomy had wound dehiscence. This did not delay healing at 6 weeks, which wascompleteinall18patients,comparedwith16of17after open haemorrhoidectomy P  0á49, Fisher's exact test). Overall 30 patients expressed a preference for day surgery, while the remaining ®ve were indifferent. The satisfaction score was similar at week 1 P  0á75) and week 6 P  0á26). Postoperative return to normal activity was also similar for the open median 15 range 6± 25) days) and closed 18 7±25) days) groups P  0á33). Discussion This prospective randomized trial has shown no differ- ences in postoperative pain, wound healing, return to normal activities or patient satisfaction between closed Table 1 Patient characteristics and extent of surgery in the two groups No. of piles excised Operative technique No. of patients Age years)* Sex ratio M : F) Anxiety score Depression score ³3 2 1 Open 17 44 27±68) 7:10 7á54) 4á52á5) 14 3 0 Closed 18 46 36±75) 10:8 84) 53á5) 13 4 1 Values are *mean range) or  means.d.) 612 British Journal of Surgery 1999, 86, 612±613 www.bjs.co.uk Ó 1999 Blackwell Science Ltd Downloaded from https://academic.oup.com/bjs/article/86/5/612/6269554 by guest on 12 June 2022