Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles

Basdanis, G.; Papadopoulos, V. N.; Michalopoulos, Antonios; Apostolidis, Stylianos; Harlaftis, N.

doi:10.1007/s00464-004-9098-0

Cited by 67 publications

(113 citation statements)

References 15 publications

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“…There was no significant difference in the incidence of postoperative urinary retention between SH and CH (19 RCTs) [12,14,22,23,25,27,28,30,31,[34][35][36][37][38][39][40][41][42][43]. This remained nonsignificant when the study reporting an incidence of 31% after SH was removed (OR: 0.76; 95% CI: 0.53, 1.09; P = 0.14) [12].…”

Section: Complicationsmentioning

confidence: 81%

“…Pooled OR, where calculable, showed no significant differences between SH and CH for anal fissure [14,23,34,35,48], anal fistula [35,37,43], haemorrhoidal thrombosis [21,[23][24][25]28,30,34,37,39,41,43], pelvic ⁄ perianal sepsis [28,31,36,37], or rectovaginal fistula [36] in the postoperative period. In the longer term there were no reports of anal fistula [39], pelvic ⁄ perianal sepsis [21,36] Stapled haemorrhoidopexy [21,36] after either procedure.…”

Section: Complicationsmentioning

confidence: 99%

“…In the longer term there were no reports of anal fistula [39], pelvic ⁄ perianal sepsis [21,36] Stapled haemorrhoidopexy [21,36] after either procedure. A single incidence of haemorrhoidal thrombosis was reported after SH at 46 months [21,34].…”

Section: Complicationsmentioning

confidence: 99%

“…3) [12,22,[25][26][27][28]30,32,[35][36][37][38][39][40][41][42]. Significant heterogeneity was observed between studies (P = 0.003; I 2 = 57.8).…”

Section: Bleedingmentioning

confidence: 99%

See 3 more Smart Citations

Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review

et al. 2009

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Objective This systematic review aimed to evaluate the short-and long-term safety, efficacy and costs of stapled haemorrhoidopexy (SH) compared with conventional haemorrhoidectomy.Method We searched 26 electronic databases and websites for studies in any language up to July 2006. Inclusion criteria were predefined, and each stage of the review process was conducted in duplicate.Results Twenty-seven randomized controlled trials were included (n = 2279). All had some methodological flaws. Postoperatively, 19 trials (95%) reported less pain, 17 (89%) reported a shorter operating time, 14 (88%) a shorter hospital stay, and 14 (93%) a shorter convalescence time following SH. However, prolapse was significantly more common after SH (OR 3.38; 95% CI: 1.00, 11.47). In the longer term, prolapse was significantly more common after SH (OR 4.34; 95% CI: 1.67, 11.28) as was reintervention for prolapse (OR 6.78; 95% CI: 2.00, 23.00). There were no differences in the rate or type of complications. Conventional haemorrhoidectomy and SH had similar costs during the initial admission.Conclusion Compared with conventional haemorrhoidectomy, SH resulted in less postoperative pain, shorter operating time, a shorter hospital stay, and a shorter convalescence, but a higher rate of prolapse and reintervention for prolapse.

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Section: Complicationsmentioning

confidence: 81%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

“…3) [12,22,[25][26][27][28]30,32,[35][36][37][38][39][40][41][42]. Significant heterogeneity was observed between studies (P = 0.003; I 2 = 57.8).…”

Section: Bleedingmentioning

confidence: 99%

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Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review

et al. 2009

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“…Interestingly, these advantages are almost exclusively achieved by using it as a dissecting tool to take down the intestinal mesentery, even though the presence of collagen in many other tissues renders this technology potentially suitable for numerous other applications. Experience in other organs is currently limited to a few clinical and experimental studies that have investigated the possibility of sealing and transecting collagen-containing tissues, such as the cystic duct [12], ureter [4], lung parenchyma [11,14], liver [7,10], hemorrhoids [1,9], and appendix [20]. The present study differs fundamentally from these studies since the LigaSure was not applied for its dissecting properties but for its possible reconstructive capacities, the creation of intestinal anastomoses.…”

Section: Discussionmentioning

confidence: 99%

Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device

Smulders

Hingh

Stavast³

et al. 2007

Surg Endosc

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Introduction: Intestinal anastomotic healing requires apposition of the collagencontaining submucosal layers of the opposing intestinal walls, which is traditionallyachieved by staples or sutures. Recently, a feedbackcontrolled bipolar sealingsystem (LigaSure) has been successfully introduced to seal and transect vessels.Since this technology depends on fusion of collagen fibres which are abundantlypresent in the intestinal wall, the possibility to create intestinal anastomoses usingthis technology was investigated in the present study. Materials and methods: For this purpose a newgeneration radiofrequency(RF) generator and a prototype of the Ligasure Anastomotic Device (LAD) have beendeveloped. The generator incorporates a closed loop control system which monitorstissue fusion, compares it with a mathematical model of ideal fusion based on thedensity and compliance of intestinal tissue and adjusts energy output accordingly. Intotal 8 anastomoses were created in a porcine model (4 pigs, 2 anastomoses each)and healing was assessed by macroscopic and histological examination. Results: All seals were macroscopic intact both immediate after creation and atsacrifice at the 7th postoperative day. Between operations, pigs appeared healthy andhad normal intestinal passage. Histological examination of the anastomoses revealedundisturbed healing with granulation tissue, newly synthesised collagen in thesubmucosa and re-epithelialization at the borders of the seals. Conclusion: These results confirm the feasibility to create experimental intestinalanastomoses using LigaSure technology. This may be an important step towards thedevelopment of new laparoscopic equipment combining dissecting and reconstructiveproperties within one single instrument.

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Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs Conventional Hemorrhoidectomy

Tan

Cornish²,

Darzi³

et al. 2007

Arch Surg

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Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles

Abstract: Hemorrhoidectomy with a circular stapler device is easy to perform, but one more line of clips must be added to the device to avoid intraoperative bleeding from the cut line. Hemorrhoidectomy performed using Ligasure is more painful postoperatively but is a more radical operation.

Cited by 67 publications

References 15 publications

Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review

Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review

Exploring new technologies to facilitate laparoscopic surgery: creating intestinal anastomoses without sutures or staples, using a radio-frequency-energy-driven bipolar fusion device

Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs Conventional Hemorrhoidectomy

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