Comparison of a Vessel Sealing System with a Conventional Technique in Hemorrhoidectomy

Abstract

Objective: Milligan-Morgan, Park and Ferguson hemorrhoidectomy procedures are the ones most frequently used for the surgical treatment of hemorrhoidal disease. Attempts to modify these conventional approaches are made by using different techniques or tools to decrease blood loss, and reduce operating time and postoperative analgesic requirement. In this prospective randomized trial, the conventional Ferguson hemorrhoidectomy method is compared with the LigaSure® hemorrhoidectomy according to various criteria. Material and Methods: Forty patients who had grade 3-4 hemorrhoidal disease were randomly divided into two equal groups: the Ferguson Hemorrhoidectomy (n=20) and the LigaSure® hemorrhoidectomy (n=20). Operating time, demographic data, intraoperative and postoperative complications, postoperative pain, return of bowel movements and postoperative hospital stay were evaluated. The visual analogue score was used for the evaluation of pain on the first postoperative day. The patients have been followed up for at least 19 months. Results: The pain score, blood loss and operating time were significantly reduced in the LigaSure® hemorrhoidectomy group. Conclusion: LigaSure® hemorrhoidectomy is safe and feasible for the surgeon, and more comfortable than classical surgery for the patient.

Keywords

• LigaSure®, Ferguson hemorrhoidectomy, closed hemorrhoidectomy, follow up, randomized prospective study

Comparison of a Vessel Sealing System with a Conventional Technique in Hemorrhoidectomy

Öz

Kaynakça

1. Chung Y, Wu H. Clinical experience of sutureless closed hemorrhoidectomy with LigaSure®.Dis Colon Rectum 2003;46:87-92.
2. Smith LE. Hemorrhoidectomy with Lasers and Other Contemporary Modalities. Surg Clin N Am 1992;72:665-79.
3. Ellesmore S, Windsor ACJ. In: Mann CV (ed.) Springer: Verlag London; 2002;1-4.
4. Zacharakis E, Pramateftakis MG, Kanellos D, Kanellos I, Betsis D. Long-term results after transanal stapled excision of rectal internal mucosal prolapse. Tech Coloproctol 2007;11:67-8.
5. Longo A. Treatment of Hemorrhoidal? Disease by Reduction of Mucosa and Haemorrhoidal Prolapse with a Circular Suturing Device:New Procedure.In: Sixth World Congress of Endoscopic Surgery; Jun 3-6; Rome, Italy. 1998;777-90.
6. Armstrong DN, Frankum C, Schertzer ME, Ambroze WL, Orangio GR. Harmonic Scalpel hemorrhoidectomy:fi ve hundred consecutive cases. Dis Colon Rectum 2002;45:354-9.
7. Ramcharan KS,Hunt TM. Anal stenosis after LigaSure hemorrhoidectomy. Dis Colon Rectum 2005;48:1670-1.
8. Franklin EJ, Seetharam S, Lowney J, Horgan PG. Randomized clinical trial of LigaSure vs.conventional diathermy in hemorrhoidectomy. Dis Colon Rectum 2003;46:1380-3.

9. Nivatvongs S .Hemorrhoids. Principles and Practice of Surgery of Colon, Rectum and Anus (Third edition). Gordon PH, Nivatvongs S (eds).Informa Healthcare USA, New York 2007;143-66.
10. Jayne DG, Botterill I, Ambrose NS, Brennan TG, Guillou PJ, O’Riordain DS. Randomized clinical trial of LigaSure versus conventional diathermy for-day case hemorrhoidectomy. Br J Surg 2002;89:428-32.
11. Tan EK, Cornish J, Darzi AW, Papagrigoriadis S, Tekkis PP. Metaanalysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy. Arch Surg 2007;142:1209-18.
12. Nienhuijs S, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids.Cochrane Database Syst Rev 2009;21:CD006761.
13. Tan JJY, Seow-Choen F. Prospective, randomized trial comparing diathermy and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum 2001;44:677-9.
14. Wang JY, Lu CY, Tsai HL, Chen FM, Huang CJ, Huang YS, et al. Randomized controlled trial of LigaSure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg 2006;30:462-6.