Haemorrhoidectomy Techniques for Grade III and IV Haemorrhoids (Guda Arsha): A Prospective Comparative Study of Open Versus Closed Methods

Abstract

Advanced haemorrhoids, classified as Grade III and IV in clinical practice and termed Guda Arsha in traditional Ayurveda, pose substantial challenges due to persistent symptoms like rectal bleeding, prolapse, perianal discomfort, and impaired daily functioning. This randomised controlled trial, executed at the Department of Shalya Tantra, Patanjali Ayurvedic College & Hospital, Haridwar, evaluated the comparative efficacy of open (Milligan–Morgan) and closed (Ferguson) haemorrhoidectomy techniques in 60 consenting patients aged 18–70 years with verified Grade III/IV Guda Arsha. Participants underwent random assignment to either procedure under spinal anaesthesia, with assessments encompassing operative duration, pain levels via Visual Analogue Scale at multiple intervals, wound epithelialisation timelines, complication incidences, hospital duration, and resumption of occupational duties. Adjunctive Ayurvedic interventions, including Triphala Kwatha immersion baths, Jatyadi Taila topical therapy, and Deepana-Pachana herbal formulations, were uniformly applied to promote Vrana Ropana and doshic equilibrium. However, the closed method yielded superior outcomes, with 78% achieving full wound closure by week three versus 26% in the open cohort, alongside reduced secondary bleeding (0% vs. 13.3%) and shorter convalescence (14.2 vs. 19.8 days to normalcy). Long-term symptom resolution and recurrence absence were uniform. In summary, while both modalities effectively resolve advanced Guda Arsha, the closed Ferguson variant excels in minimising discomfort and expediting rehabilitation, positioning it as the optimal selection for contemporary settings.