LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

Abstract

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.

A comparison study between vessel sealing technique and conventional (Milligan Morgan) excisional hemorrhoidectomy

“…These findings are in consistent with the studies of Filingeri et al and Wang et al 12,13 Our findings reveals that there was no difference in the time required for the first bowel movement and in hospital stay between two groups which is in accordance with Gentile et al, study which concluded that there was no difference in hospital stay since patients were discharged 24±2 hours after the operation in both groups, and delayed discharges were registered in two cases of each group (III postoperative day) due to minor bleeding (2 conventional vs 1 vessel seal hemorrhoidectomy) and acute urinary retention (1 vessel seal hemorrhoidectomy) (P = 1 NS). 9 In our experience only one case of anal stenosis was detected and the incidence seems to be in line with the data of the literature (4-5%). This complication was treated by nifedipine topical ointment with a good final result, however as a useful trick to avoid the development of a circular scar, we preserved intact anoderm and mucosal bridges between the wounds.…”

“…Compared with conventional hemorrhoidectomy, vessel sealing technique reduces mean operative time and requirement of analgesia as similar to the earlier studies. [9][10][11] Other studies have also emphasized that lower intraoperative bleeding. 10,11 Comparing early complication rates, nine cases in conventional hemorrhoidectomy method (5 bleeding and 4 acute urinary retention) and five cases in the vessel sealing group (2 bleeding, 2 urinary retention and 1 perianal abscess) These patients were managed conservatively and there was no need for redo surgery.…”

Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids

“…Similarly, in our study with LigaSure, an easily applicable and trainable method, the operation time was significantly shorter than in the conventional method (15 versus 20 min). In a study by Khanna et al (7), the hospitalization period after operation (1.4 versus 3.2 days) was significantly shorter in the LigaSure group; however, in a study by Gentile et al (13), the hospitalization periods of 24±2 h were similar in the two groups. In our study, the median hospitalization period was one day in both groups.…”

“…Development of anal stenosis due to thermal damage from LigaSure usage has been described in many recent studies. Filingeri et al (17) reported anal stenosis in 4 of 203 LigaSure-treated patients, Wang (18) determined it in 1 of 42 cases, and Gentile et al (13) reported it in 1 of 25 patients. In our study, the results for anal stenosis were similar to the literature (2.7%) (9,11).…”

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

“…Radiofrequency scalpel technique resulted in significantly less immediate postoperative pain after hemoroidectomy with respect to conventional diathermy techniques [9]. Two other randomized trials confirmed this finding [10,11]. Radiofrequency scalpel was associated with less postoperative pain when compared with harmonic scalpel in one randomized controlled trial [12].…”