Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method

Abstract

Surgical treatment is considered to be the best therapeutic modality for severe hemorrhoidal disease. Different surgical methods of hemorrhoidectomy aim to decrease pain, bleeding, stenosis and discharge. The aim of this study was to evaluate the efficacy of harmonic scalpel hemorrhoidectomy. During a period of seven months, 54 consecutive patients with third- and fourth-degree hemorrhoids were prospectively randomized for harmonic scalpel hemorrhoidectomy (HS) or Milligan-Morgan procedure (MM). These patients were examined at one, two, and six weeks after the operation. All patients had a lower gastrointestinal investigation prior to operation to exclude other colorectal pathologies. All patients had the same kind of preoperative preparation and analgesia during the postoperative course. Pain was assessed using a visual analog scale from 0 to 10. Patient satisfaction was defined as decrease or absence of symptoms and return to normal daily activities. HS groups included 29 patients, while the MM group had 25 patients. There as no difference between the groups in terms of age, gender, hemorrhoidal degree and indication for operation. The types of intra-operative anesthesia administered to the two groups were similar. Duration of surgery was significantly higher in the MM group ( p<0.0001). Postoperative hospitalization was longer in the MM group ( p<0.0001), and the pain degree was higher in MM group ( p<0.0001). No significant difference was noted in the overall amount of analgesics used in the two groups at week 1, although it was significantly higher in the MM group 2 and 3 weeks after the operation. Early complication occurred more frequently in the MM group but overall the difference was not statistically significant. In conclusion, harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage. It is associated with significant less postoperative pain and a fast return to normal activity.

A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy

“…First and second degree hemorrhoids can be treated conservatively with dietary modifications, injection sclerotherapy, rubber band ligation etc. For third and fourth degree hemorrhoidal disease surgery is the treatment of choice is surgery 6 …”

Hemorrhoidectomy in Patients with Grade III or IV Disease: Harmonic Scalpel Compared With Conventional Closed Technique

“…Harmonic scalpel achieved favorable postoperative pain scores compared with open or closed hemorrhoidectomy with scissors and/or monopolar or bipolar electrocautery in a number of prospective randomized studies [14][15][16][17][18][19]. The difference in pain was attributed to avoidance of lateral thermal energy in harmonic scalpel as opposed to electrocautery.…”

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

“…Because the instrument operates at temperature less than 100°, it is associated with minimal tissue damage, the lateral thermal spread being only 0.5 to 1.0 mm as compared to conventional electrocautery which uses heat energy causing more tissue charring. [2][3][4][5] The use of harmonic scalpel therefore causes less time for tissues to heal and thereby early return to daily activities. [2][3][4] In our study, 52 patients underwent Harmonic Scalpel Hemorrhoidectomy.…”

“…[2][3][4][5] The use of harmonic scalpel therefore causes less time for tissues to heal and thereby early return to daily activities. [2][3][4] In our study, 52 patients underwent Harmonic Scalpel Hemorrhoidectomy. The operative time for 23 patients (44.23%) having single haemorrhoid was less than 10 minutes, whereas in 29 patients (55.76%) as multiple haemorrhoids were present operating time was more than 10 minutes.…”