This study compares three different ways surgeons close the wound after removing hemorrhoids (piles): leaving it completely open, stitching it completely closed, or stitching only half of it closed (semi-closed). The goal is to see which method leads to faster healing, less pain, fewer complications, and better long-term results. Patients undergoing hemorrhoidectomy will be randomly assigned to one of the three groups. All patients will receive standard post-operative care. Researchers will measure healing time, pain levels, need for pain medication, hospital stay, complications, and check if hemorrhoids come back within one year.
Patients aged 18 to 75 years.
Clinical diagnosis of mixed hemorrhoids requiring surgical intervention.
Scheduled to undergo hemorrhoidectomy with ligation of internal hemorrhoids and excision of external hemorrhoids.
Willing and able to provide written informed consent.
History of mental illness or cognitive impairment that may affect the ability to provide informed consent or comply with the study protocol.
Diagnosis of diabetes mellitus.
Planned concomitant procedures (e.g., radiofrequency ablation, sclerotherapy) in addition to hemorrhoidectomy.
Inability or unwillingness to comply with scheduled follow-up visits.
Parallel
Open Hemorrhoidectomy
Procedure/SurgeryPatients in this group undergo a hemorrhoidectomy procedure where, after external stripping and internal ligation, the surgical wound is left entirely open without sutures to heal by secondary intention. All patients receive standard postoperative care including potassium permanganate rinses and povidone-iodine disinfection.
Closed Hemorrhoidectomy (Ferguson Technique)
Procedure/SurgeryPatients in this group undergo a hemorrhoidectomy procedure where, after achieving hemostasis, the entire surgical wound is closed primarily using interrupted non-absorbable sutures. All patients receive standard postoperative care including potassium permanganate rinses and povidone-iodine disinfection.
Semi-Closed Hemorrhoidectomy
Procedure/SurgeryPatients in this group undergo a hemorrhoidectomy procedure where, after achieving hemostasis, the distal half of the incision (away from the anal canal) is closed with interrupted sutures, while the proximal half remains open. All patients receive standard postoperative care including potassium permanganate rinses and povidone-iodine disinfection.
Wound healing time
The time required for complete wound healing, defined as 100% re-epithelialization of the surgical site with no exudate or scab, assessed by a blinded evaluator.
Postoperative pain intensity (NRS score)
Pain intensity was evaluated on a 0 to 10 Numerical Rating Scale (NRS), with higher scores indicating more severe pain (0 = no pain; 10 = worst possible pain).
Perianal edema severity
Severity of swelling around the surgical site evaluated by trained research nurses using a standardized 0-6 point scale.
Length of hospital stay
Duration of hospitalization measured in hours from the end of surgery to discharge, using standardized discharge criteria.
Complication incidence
Occurrence of postoperative complications (e.g., infection, bleeding, urinary retention) classified and graded using the Clavien-Dindo system.
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