Comparative efficiency of ultrasonic scalpel and monopolar coagulation in hemorrhoidectomy | Ukrainian Medical Journal

Ivanko О.V.,Skiba V.V.,Al-Lami Saad Hamud Hassan,Goman A.V.,Lysytsya V.V.

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Comparative efficiency of ultrasonic scalpel and monopolar coagulation in hemorrhoidectomy

Comparative efficiency of ultrasonic scalpel and monopolar coagulation in hemorrhoidectomy

December 9, 2020

824

Surgery

Ivanko О.V.

Skiba V.V.

Al-Lami Saad Hamud Hassan

Goman A.V.

Lysytsya V.V.

Keywords :

hemorrhoidectomy,

Milligan — Morgan hemorrhoidectomy,

ultrasonic scalpel

Specialities :

Surgery

Resume

Aim — to compare the results of hemorrhoidectomy performed with an ultrasonic scalpel and monopolar coagulation.

Methods. A retrospective analysis of data of 48 patients who underwent hemorrhoidectomy for internal hemorrhoids of 3 and 4 stage was performed. Removal of hemorrhoids and coagulation of the leg of the node was performed using an ultrasonic scalpel in the main group (n=24) and monopolar coagulation with stitching of the leg with PGA thread 3-0 in the control group (n=24).

Results. General patient performance, clinical characteristics, and length of hospital stay were the comparable in groups. Compared with the control group, the main group had a shorter operation time (p<0.005), less postoperative pain on a visual analog scale (p<0.05 on the 3rd postoperative day) and less postoperative bleeding (p=0.035). There were no significant differences in postoperative complications between two groups.

Conclusions. Hemorrhoidectomy with an ultrasound scalpel is an effective and safe procedure, which reduces the time of surgery, postoperative blood loss and postoperative pain. Long-term follow-up and more patients in the study are needed to assess late complications and quality of life after hemorrhoidectomy with an ultrasound scalpel.

References:

Ivanko O.V., Skiba V.V., Al-Lami Saad Hamoud Hassan et al. (2020) Comparative effectiveness of hardware-controlled coagulation and traditional method in surgical treatment of patients with stage 3 and 4 hemorrhoids. Ukr. Med. J., 5(139)(2): 24–26.
Ala S., Eshghi F., Enayatifard R. et al. (2013) Efficacy of cholestyramine ointment in reduction of postoperative pain and pain during defecation after open hemorrhoidectomy: results of a prospective, single-center, randomized, double-blind, placebo-controlled trial. World J. Surg., 37: 657–662.
Altomare D.F., Milito G., Andreoli R. et al. (2008) 2008 Ligasure Precise vs. Conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial. Dis. Colon. Rectum., 51: 514–519.
Ascanelli S., Gregorio C., Tonini G. et al. (2005) Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial. Chir. Ital., 57: 439–447.
Bulus H., Tas A., Coskun A. et al. (2014) Evaluation of two hemorrhoidectomy techniques: harmonic scalpel and Ferguson’s with electrocautery. Asian J. Surg., 37: 20–23.
Carapeti E.A., Kamm M.A., McDonald P.J. et al. (1998) Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet, 351: 169–172.
Chen J.S., You J.F. (2010) Current status of surgical treatment for hemorrhoids: systematic review and meta-analysis. Chang Gung. Med. J., 33: 488–500.
Engel A.F., Eijsbouts Q.A. (2000) Haemorrhoidectomy: painful choice. Lancet, 355: 2253–2254.
Ferguson J.A., Heaton J.R. (1959) Closed hemorrhoidectomy. Dis. Colon Rectum, 2: 176–179.
Galizia G., Lieto E., Castellano P. (2000) Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study. Eur. J. Surg., 166: 223–228.
Gentile M., De Rosa M., Carbone G. et al. (2011) LigaSure haemorrhoidectomy versus conventional diathermy for IV-degree haemorrhoids: is it the treatment of choice? A randomized, clinical trial. ISRN Gastroenterol., 2011: 467258.
Goligher J.C., Graham N.G., Clark C.G. et al. (1969) The value of stretching the anal sphincters in the relief of post-haemorrhoidectomy pain. Br. J. Surg., 56: 859–861.
Gravie J.F., Lehur P.A., Huten N. et al. (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann. Surg., 242: 29–35.
Hetzer F.H., Demartines N., Handschin A.E. et al. (2002) 2002 Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch. Surg., 137: 337–340.
Jayaraman S., Colquhoun P.H., Malthaner R.A. (2006) Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst. Rev., 4: CD005393.
Jayne D.G., Botterill I., Ambrose N.S. et al. (2002) Randomized clinical trial of Ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br. J. Surg., 89: 428–432.
Khan S., Pawlak S.E., Eggenberger J.C. et al. (2001) Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy. Dis. Colon Rectum, 44: 845–849.
London N.J., Bramley P.D., Windle R. (1987) Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial. Br. Med. J. (Clin. Res. Ed.), 295: 363–364.
Longo A. (1998) Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Bologna: Proceedings of the 6^th World Congress of Endoscopic Surgery, Rome, Italy. Monduzzi Publishing, 777–784 pp.
MacRae H.M., McLeod R.S. (1995) Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis. Colon Rectum, 38: 687–694.
Milligan E.T., Morgan C.N., Jones L.E. et al. (1937) Surgical anatomy of the anal canal, and the operative treatment of hæmorrhoids. Lancet, 230: 1119–1124.
Patti R., Almasio P.L., Muggeo V.M. et al. (2005) Improvement of wound healing after hemorrhoidectomy: a double-blind, randomized study of botulinum toxin injection. Dis. Colon. Rectum., 48: 2173–2179.
Ravo B., Amato A., Bianco V. et al. (2002) Complications after stapled hemorrhoidectomy: can they be prevented? Tech. Coloproctol., 6: 83–88.
Sayfan J., Becker A., Koltun L. (2001) Sutureless closed hemorrhoidectomy: a new technique. Ann. Surg., 234: 21–24.
Sgourakis G., Sotiropoulos G.C., Dedemadi G. et al. (2008) Stapled versus Ferguson hemorrhoidectomy: is there any evidence-based information? Int. J. Colorectal. Dis., 23: 825–832.