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Surgical outcome and ethics in adopting new surgical technique in low resource settings: A case study in haemorrhoid surgery

Introduction: Our aim was to evaluate the surgical outcome and ethical considerations in adopting stapled hemorrhoidopexy (SH) in low-resource settings. Methods: This prospective comparative study of patients with Grade III hemorrhoids was conducted at our institute from December 2017 to July 2019. Short-term surgical outcome and the results of a short questionnaire associated with ethics were evaluated. Results: Sixty patients were operated on for third-degree hemorrhoids, thirty each in Group conventional hemorrhoidectomy (CH) and Group SH. The SH group had better postoperative pain control at 0, 1, and 4 weeks (P = 0.001), but this difference became insignificant at 12 weeks. Overall recurrence was more in SH group (11.37%) as compared to CH group (2.7%), and it was statistically significant (P = 0.01). The mean operative time was significantly less in the SH group (43 min vs. 50 min, P = 0.006). Similarly, the mean hospital stay was significantly less in the SH group as compared to the CH group (2.27 days vs. 3.83 days, P = 0.001). Survey of the operating surgeons revealed that all the three surgeons involved assessed the effectiveness and safety of SH through literature; the main motivation behind performing new technique in resource-poor settings was learning a new technique and teaching purpose. Conclusion: The main value of this research is to describe the adoption of surgical stapler into clinical practice in low-resource settings. Our analysis suggests that, in a rapidly developing area of surgical innovation, adoption of SH in resource-poor settings can give the same outcome as in expert hands.