A comparative study of Longo’s procedure without stapler versus open hemorrhoidectomy in 2nd and 3rd degree hemorrhoids

Introduction: Hemorrhoids are one of the commonest anal disorders that affect mankind from the down of the history. Traditional open hemorrhoidectomy has an evil reputation due to post operative severe pain. So to reduce the severity of postoperative pain, transanal hemorrhoidectomy (Longo’s procedure) done by stapler device was evolved, which does not involve sensitive anal mucosa below the dentate line, but the disadvantage is its total operative cost. So it is not feasible in government hospital setup due to the high cost of stapler device. So, in this study, to minimize operative cost, we had operated patients of 2nd and 3rd degree hemorrhoids by Longo’s procedure which was done manually without stapler, using the principle of Longo’s procedure with stapler device of circumferential mucosectomy and manual hemorrhoidopexy and results were compared with open hemorrhoidectomy. Aim and objectives: Aim of the study was to evaluate outcome of patients undergone Longo’s hemorrhoidectomy without stapler over conventional hemorrhoidectomy in following aspects: restore anatomical integrity, technical easier, operative time, post operative pain and complications, hospital stay, return to work, cost effectiveness, better patient compliance and patient acceptance. Materials and methods: 40 patients with second and third degree hemorrhoids were selected for surgery. 20 patients were operated by conventional open method, while 20 patients were operated by Longo’s procedure. Detailed history and clinical examination was done. All patients were undergone medical and anesthetic evaluation as per protocol. Outcome of procedures were notified to reach objectives of study. Results: Manually done Longo’s procedure was done by using the principle of Longo’s procedure without stapler device was more time consuming, requires high technical skill, having more bleeding and reversible incontinence than open hemorrhoidectomy. While hospital stay, early return to work, better compliance and patient acceptance was better than open surgery. Longo’s procedure with stapler methods was much easier than without stapler except higher cost. Conclusion: We do not recommend Longo’s procedure without stapler over open hemorrhoidectomy because of higher rate of complications and very high technical skill requirement.