Comparative study of management of grade III hemorrhoids by Harmonic Scalpel technique versus conventional surgical technique (Milligan Morgan method)

Abstract

Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.

Harmonica Scalpel Versus Milligan Morgan Technique With Electro Cautery for Haemorrhoidectomy.

“…In our study anal abscess and anal stenosis were recorded as a complication in MM but they weren't recorded in HS. Anal incontinence was not recorded in either group this was similar to Lim study in 2016 who also state that no anal incontinence was reported in his study (12).…”

Harmonic Scalpel® treatment of haemorrhoidectomy versus Milligan–Morgan's method

“…In this study patients satisfaction is excellent with harmonic scalpel group A than Milligan Morgan group B and this is consistent with comparative study done on 60 patients by A. Thiyagarajan compared Harmonic Scalpel haemorrhoidectomy versus Milligan Morgan haemorridectomy, he concluded that harmonic Scalpel had the lowest pain score and the highest satisfaction score (Thiyagarajan & Bhatnagar, 2017).…”