A Comparative Study of Conventional Hemorrhoidectomy vs. Anoderm-Preserving Partial Hemorrhoidectomy after BANANA-Clip Ligation for Grade III-IV Hemorrhoids: Retrospective Study

Abstract

Dong Wan Kang*, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim and Gyong Suk Kang

Background: Chronic non-healing wounds, delayed bleeding, and recurrence are concerns for both patients and physicians following hemorrhoid surgery. Debate continues over which surgical method effectively reduces these side effects in grade III-IV hemorrhoids.

Objective: This study aimed is to evaluate the incidence of chronic non-healing wounds and other complications following anoderm-preserving Partial Hemorrhoidectomy (PH) after BANANA-Clip (BC) ligation, compared to conventional hemorrhoidectomy in patients with grade III-IV internal hemorrhoids.

Design: This was an observational study conducted at a single institution to compare complications between partial hemorrhoidectomy after BANANA-Clip and conventional hemorrhoidectomy in patients with grade III-IV internal hemorrhoids.

Setting: Partial hemorrhoidectomy after BANANA-Clip involves ligation of the proximal hemorrhoidal pile with BANANA-Clip followed by dissection up to the distal half of the anoderm from the external sphincter border, while preserving the proximal half of the anoderm.

Patients: Study participants consisted of patients who received surgical intervention for grade III-IV hemorrhoids at the Department of Colorectal Surgery, Wellness Hospital, from 1 January 2019 to 30 November 2020.

Main outcome measures: The primary outcome was the incidence of chronic nonhealing wounds.

Results: The incidences of chronic non-healing wounds were 8.1% for conventional hemorrhoidectomy and 3.3% for partial hemorrhoidectomy after BANANA-Clip (p=0.002). The adjusted odds ratio for chronic non-healing wounds comparing partial hemorrhoidectomy after BANANA-Clip to conventional hemorrhoidectomy was 0.467 (95% CI (Confidence Interval): 0.240-0.907, p=0.02), after adjusting for other variables.

Limitations: This study had a retrospective design, and data on pain scores were no included.

Conclusion: Patients who underwent partial hemorrhoidectomy after BANANA-Clip demonstrated a significantly lower incidence of chronic non-healing wounds compared to those who underwent conventional hemorrhoidectomy.