Geleneksel diyatermi ile kıyaslandığında harmonik bistürinin hemoroidektomide faydası var mıdır?

Öz

Amaç: Semptomatik hemoroidal hastalık, en yaygın cerrahi hastalıklar arasındadır ve tedavide cerrahi müdahale gerekebilir. Cerrahi tedavide etkili yaklaşımlar harmonik bistüri ile hemoroidektomi ve konvansiyonel diyatermi ile eksizyondur. Çalışmanın amacı, harmonik bistüri ve konvansiyonel diyatermi eksizyon teknikleriyle yapılan hemoroidektomi sonuçlarını karşılaştırmaktı.

Yöntemler: Semptomatik Evre III-IV hemoroid nedeniyle ardışık operasyon yapılan 113 hasta (26 kadın, % 23; 87 erkek, % 77) dosyaları retrospektif olarak incelendi ve operasyon ve hastanede kalış süresi, erken ve gecikmiş kanama, idrar yapmada zorluk, postoperatif apse ve anal stenoz araştırıldı. Dışlama kriterleri; ek cerrahi uygulanması, rekürren vakalar ve inflamatuvar bağırsak hastalığı idi. 

Bulgular: Altmış hastada (%53) konvansiyonel diyatermi ile hemoroidektomi ve 53 hastada (%47) harmonik bistüri ile hemoroidektomi uygulandı. Operasyon ve yatış süreleri arasında harmonik bistüri grubu lehine anlamlı farklılık tespit edildi (her ikisi için p<0,05). Diğer parametrelerde anlamlı bir farklılık yoktu (hepsi için p>0,05).

Sonuç: Harmonik bistüri ile hemoroidektomi, ameliyat süresinin kısa olması ve hastaneden daha erken taburcu olmasına karşın ek bir komplikasyona rastlanmadığı için konvansiyonel diyatermi hemoroidektomisine göre avantajlıdır.

Anahtar Kelimeler

• Harmonik,Hemoroidektomi,Bistüri,Cerrahi,Teknik

Is there any benefit of harmonic scalpel for hemorrhoidectomy versus conventional diathermy?

Abstract

Aim: Symptomatic hemorrhoidal disease is among the most common surgical diseases and it may necessitate surgical intervention. The most common and effective approaches used for surgical treatment are harmonic scalpel hemorrhoidectomy and conventional diathermy excision. The aim of the study was to compare the outcomes of hemorrhoidectomy using harmonic scalpel and the conventional diathermy excision techniques. 

Methods: The files of 113 consecutively operated patients (26 females 23%, 87 males 77%), who were operated on for symptomatic Grade III–IV hemorrhoids, were retrospectively reviewed for length of operation and hospitalization, early and delayed bleeding, urinary retention, postoperative abscess and anal stenosis. Exclusion criteria were additional operations, recurrent cases and inflammatory bowel disease. 

Results: Conventional diathermy hemorrhoidectomy in 60 (53%) and harmonic scalpel hemorrhoidectomy were used in 53 patients (47%). There were significant differences between the operation and hospitalization times in favor of harmonic scalpel group (p<0.05 for both). The other parameters did not show any significant differences (p>0.05 for all). 

Conclusion: Harmonic scalpel hemorrhoidectomy is advantageous and superior to conventional diathermy hemorrhoidectomy in regard to shorter operation time and earlier discharge from the hospital with no additonal complications.

Keywords

• harmonic,hemorrhoidectomy,scalpel,surgery,technique

Kaynakça

1. 1. Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27:215-20.
2. 2. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98:380-6.
3. 3. Morgado PJ, Suárez JA, Gómez LG, Morgado PJ. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum. 1988;31:474-80.
4. 4. Brown SR. Haemorrhoids: an update on management. Ther Adv Chronic Dis. 2017;8:141-7.
5. 5. Lee KC, Chen HH, Chung KC, Hu WH, Chang CL, Lin SE, et al. Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults. Int J Surg. 2013;11:914-8.
6. 6. Lim DR, Cho DH, Lee JH, Moon JH. Comparison of a hemorrhoidectomy with ultrasonic scalpel versus a conventional hemorrhoidectomy. Ann Coloproctol. 2016;32:111-6.
7. 7. Carlander J, Johansson K, Lindström S, Velin AK, Jiang CH, Nor-dborg C. Comparison of experimental nerve injury caused by ultrasonically activated scalpel and electrosurgery. Br J Surg. 2005;92:772-7.
8. 8. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015;21:9245-52.

9. 9. Johannsson HO, Pahlman L, Graf W. Randomized clinical trial of the effects on anal function of Milligan-Morgan versus Ferguson haemorrhoidectomy. Br J Surg. 2006;93:1208-14.
10. 10. Arbman G, Krook H, Haapaniemi S. Closed vs. open hemorrhoidectomy--is there any difference? Dis Colon Rectum. 2000;43:31-4.
11. 11. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118:934-44.
12. 12. Joshi GP, Neugebauer EA, Bonnet F, Camu F, Fischer HB, Rawal N. Evidence-based management of pain after haemorrhoidectomy surgery. Br J Surg. 2010;97:1155-68.
13. 13. Chung CC, Ha JP, Tai YP, Tsang WW, Li MK. Doubleblind, randomized trial comparing harmonic scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum. 2002;45:789-94.
14. 14. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum. 2001;44:558-64.
15. 15. Jensen C, Jørgensen H. Late, life-threatening bleeding after hemorrhoidectomy. Ugeskr Laeger. 2001;163:41-2.
16. 16. Kunitake H, Poylin V. Complications following anorectal surgery. Clin Colon Rectal Surg. 2016;29:14-21.
17. 17. Haveran LA, Sturrock PR, Sun MY, McDade J, Singla S, Paterson CA, et al. Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy. Int J Colorectal Dis. 2007;22:801-6.
18. 18. Ho YH, Seow-Choen F, Tan M, Leong AF. Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg. 1997;84:1729-30.
19. 19. Neto JA, Quilici FA, Cordeiro F, Reis JA. Open versus semi-open hemorrhoidectomy: a random trial. Int Surg. 1992;77:84-90.
20. 20. Abo-hashem AA, Sarhan A, Aly AM. Harmonic scalpel compared with bipolar electro-cautery hemorrhoidectomy: a randomized controlled trial. Int J Surg. 2010;8:243-7.
21. 21. Tan JJ, Seow-Choen F. Prospective randomized trial comparing diathermy and harmonic scalpel hemorrhoidectomy. Dis Colon Rectum. 2001;44:677-9.
22. 22. Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Wu JS, et al. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the harmonic scalpel technique of excisional hemorrhoidectomy. Dis Colon Rectum. 2001;44:845-9.
23. 23. Ramadan E, Vishne T, Dreznik Z. Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method. Tech Coloproctol. 2002;6:89-92.
24. 24. Ozer MT, Yigit T, Uzar AI, Mentes O, Harlak A, Kilic S, et al. A comparison of different hemorrhoidectomy procedures. Saudi Med J. 2008;29:1264-9.
25. 25. Vinson-Bonnet B, Coltat JC, Fingerhut A, Bonnet F. Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery. Dis Colon Rectum. 2002;45:104-8.
26. 26. Bansal H, Jenaw RK, Mandia R, Yadav R. How to do Open Hemorrhoidectomy Under Local Anesthesia and its Comparison with Spinal Anesthesia. Indian J Surg. 2012;74:330-3.