LigaSure hemorrhoidectomy versus the procedure for prolapse and hemorrhoids

Abstract

Background: LigaSure hemorrhoidectomy and the procedure for prolapse and hemorrhoids (PPH) are both relatively new treatments for managing symptomatic hemorrhoids. This review aimed to evaluate and compare their short-term outcomes. Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the China National Knowledge Infrastructure database for randomized controlled trials comparing the LigaSure procedure and PPH published in any language from 1998 to October 2013. Results: A total of 5 studies involving 397 participants were included in this review. Pooled analysis showed that the LigaSure procedure was associated with significantly lower recurrence rate [relative risk (RR) = 0.21, 95% confidence interval (CI): 0.06 to 0.72, P = .01] and significantly shorter operating time [mean difference (MD) = −6.39, 95% CI: −7.68 to −5.10, P < .001]. The analysis showed no significant difference in postoperative pain between the two techniques (MD = 0.55, 95% CI: −0.15 to 1.25, P = .12] or in time off work or away from normal activity [standard MD = 0.13, 95% CI: −1.80 to 2.06, P = .9]. The two techniques did not show significant differences in postoperative complications or other patient-related outcomes ( P > .05). Conclusions: Our review indicates that both LigaSure hemorrhoidectomy and PPH are safe alternatives for the management of hemorrhoids. Available evidence suggests that the LigaSure technique is associated with shorter operating time and lower hemorrhoid recurrence rate, but these conclusions should be further confirmed in large, multicenter randomized controlled trials with long-term follow-up.

Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials

“…They found as an overall judgment, there was no difference between LigaSure and PPH techniques, but the recurrence rate was less in the LigaSure group. All in all, a previous meta-analysis that investigated the efficacy and safety of different techniques like conventional, LigaSure, stapled, Milligan-Morgan, as well as a harmonic scalpel and bipolar diathermy; have the same conclusions and recommendations, and are consistent with our findings [ 3 , 19 - 23 ].…”

“…However, there is no difference between these techniques regarding the other outcomes like postoperative pain, bleeding, incontinence, and returned to normal activities. Also, Zhang and colleagues [ 23 ] conducted a systematic review and meta-analysis of trials that examine the difference between LigaSure hemorrhoidectomy and the procedure for prolapse and hemorrhoids (PPH) in postoperative pain, the rate of recurrence, returned to normal activities, and postoperative complications. They found as an overall judgment, there was no difference between LigaSure and PPH techniques, but the recurrence rate was less in the LigaSure group.…”

Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids

“…Based on the anal cushion descent theory, the procedure for PPH is designed to reposition and fix the descended cushions to their anatomical position, particularly in patients with Grade III and IV internal hemorrhoids. [19][20][21][22] Another minimally invasive technology, DG-HAL, has shown particular utility in treating Grade III and IV internal and mixed hemorrhoids. However, studies have indicated that PPH may result in long-term adverse effects, including high recurrence rates, rectal perforation, and pelvic abscesses.…”

“…Anatomically, variations in the vasculature and muscular support of the anorectal region can predispose individuals to developing hemorrhoids. [4] Furthermore, microbial flora imbalances can contribute to localized inflammation, thereby exacerbating the condition. [5,6] Dietary habits, particularly a low intake of fiber and high consumption of processed foods, can lead to constipation, which is a significant risk factor for hemorrhoidal development.…”

Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids

“…Once LigaSure has achieved coagulation of the vascular structure, the electric current is automatically interrupted. With this limited spread of electric energy, LigaSure enables effective, bloodless hemorrhoid excision with minimal tissue damage [10,11].…”