Harmonic Scalpel haemorroidectomy at rural tertiary care centre: a review of 52 cases

Saxena, Divish; Akhtar, Murtaza; Rode, A. M.; Tandon, Mrinal

doi:10.18203/2349-2902.isj20150500

Cited by 1 publication

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“…This male preponderance is also consistent with the studies available in literature. [5][6][7] While evaluating the clinical presentation and specifically looking at symptoms all patients (100%) in the present study had bleeding per rectum. This presentation is quite consistent with literature showing a range from 77.5% -100%.…”

Section: Discussionmentioning

confidence: 65%

Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial

et al. 2017

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INTRODUCTIONHaemorrhoids have been afflicting mankind since the dawn of history and is said to be the price paid by humans for their erect posture.1 It is one of the most frequently encountered ano-rectal disease in the clinical practice of a surgeon. Haemorrhoidectomy is one of the most commonly performed anorectal surgery in general surgical practice. Postoperative pain is protracted and post-operative complications are not negligible. For treating Grade III and Grade IV haemorrhoids, conventional Milligan-Morgan technique is one of the time-tested method but is associated with significant post-operative pain and complications like urinary retention, constipation, postoperative haemorrhage and in long term anal stenosis. Labelling surgical haemorrhoidectomy as a notoriously painful procedure, lots of research has been concentrated upon reducing the intra-operative bleeding and postoperative complications.The operative procedures vary from conventional cautery dissection to vessel-sealers, harmonic scalpel, laser ABSTRACT Background: Haemorrhoidal disease is one of the most frequently encountered anorectal condition in the clinical practice of a surgeon. Haemorrhoidectomy is the treatment of choice for grade III and IV haemorrhoids but is associated with significant postoperative pain and complications. Harmonic dissection causes less lateral tissue injury and thus less intra-operative bleeding and post-operative complications. The present study compares Harmonic Haemorrhoidectomy with conventional Haemorrhoidectomy. Methods: In a randomized controlled trial, patients with grade III and IV haemorrhoids satisfying inclusion and exclusion criteria were allocated to Harmonic scalpel haemorrhoidectomy or conventional Milligan Morgan open haemorrhoidectomy by block randomisation of 4. The outcome factors were intra operative blood loss, postoperative pain on VAS scale, urinary retention and anal stenosis after one month of follow up. Results: Total of 40 cases were enrolled. Of them, 22 were allocated to Harmonic haemorrhoidectomy, the rest 18 patients underwent conventional haemorrhoidectomy. The mean age of patients was 47.03 years with a Male to Female ratio of 1.35:1. Intraoperative blood loss measured by number of soaked gauze pieces and pain score measured on visual analogue scale at 12, 24 and 48hours was seen to be statistically significant (p<0.001) lesser in patients who underwent Harmonic scalpel haemorrhoidectomy. There was no statistically significant difference in operative time urinary retention or anal stenosis. Conclusions:Harmonic scalpel haemorrhoidectomy appears to be a better procedure for symptomatic grade III and grade IV haemorrhoids with ease of operating due to less bleeding, good postoperative recovery and patient acceptance.

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Section: Discussionmentioning

confidence: 65%