Comparative study between pile plication technique and open hemorrhoidectomy in the management of noncomplicated second-degree and third-degree hemorrhoids

Background
Hemorrhoids are a common clinical condition affecting half of the population. It is estimated that 58% of people aged over 40 years have the disease in the USA. Milligan–Morgan hemorrhoidectomy is considered the gold standard for the surgical treatment of hemorrhoids. However, these procedures are associated with significant postoperative complications, including pain, sepsis, anal stenosis, bleeding, and incontinence. The pile plication technique is based on the fact that the hemorrhoidal vessels have a constant anatomical location. They penetrate the hemorrhoid at its base. Sutures applied at the base of the hemorrhoid cushion can diminish the blood flow to the hemorrhoidal plexus and control the prolapse as well.
Patients and methods
This randomized prospective study was conducted at Ain Shams University hospitals from January 2020 to December 2021 and included 110 patients who presented with third-degree noncomplicated piles and second-degree noncomplicated piles after the failure of medical treatment. They were randomly allocated into two groups (group A: open hemorrhoidectomy and group B: plication group), and each group included 55 patients. In the plication group, the pile masses were plicated continuously just below the anorectal till the dentate line occluded the superior hemorrhoidal vessel. Postoperative follow-up visits were scheduled on the first and second week postoperatively, and then after 1, 3, and 6 months from the initial procedure. Careful postoperative assessment was carried out, including resolved clinical symptoms, bowel habits, complications, or recurrences, which were recorded and carefully assessed.
Results
Patients’ age ranged from 35 to 54 years. Overall, 82% of patients presented with third-degree noncomplicated piles, and the remainder presented with second-degree noncomplicated piles. There was no statistically significant difference regarding patients’ mean age, sex, and piles degree between both groups. The mean operative time for the open group was 41.85 min and for the plication group 29.4 min, with a clear statistical significance. There was a statistically significant difference regarding the mean hospital stay, postoperative visual analog scale score, and mean time to return to work, in favor of the plication group. There was no statistically significant difference regarding the early and late postoperative complications, except for urine retention, which was much higher among the open group.
Conclusion
Pile plication technique is a minimally invasive procedure, which is effective in controlling hemorrhoidal symptoms, thus improving the quality of life by preserving the rectal arterial flow and considerably avoiding postoperative complications in comparison with open hemorrhoidectomy.