Haemorrhoidectomy by vessel sealing system under local anaesthesia in an outpatient setting: preliminary experience

Objective:To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy.Methods:This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A (Haemorrhoidectomy by Ligasure) and group B (Milligan Morgan Haemorrhoiectomy). Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day.Results:Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 – 60 years. Third degree Heamorrhoids were present in 37 (67.3%) of patients while remaining 18 (32.7%) had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6± 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34±25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method.Conclusion:The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups.

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“…So generally less amount of thermal injury at the surgical site leads to decrease postoperative pain. 16 …”

Section: Discussionmentioning

confidence: 99%

Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan’s hemorrhoidectomy

Bakhtiar¹,

Moosa²,

Jaleel³

et al. 2016

Pak J Med Sci

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“…Several results from this study suggested that after this treatment, pain rapidly reduces to a level where the patient can return to work on day 3, although it is intense immediately after treatment. First, the maximal pain score was 7.4, which is >6.2 that has been reported for common hemorrhoidectomy [6]. This increased pain may be because the ALTA injection itself caused pain, although it may have reduced pain from resection wounds.…”

Section: Discussionmentioning

confidence: 73%

Initial experience with sclerotherapy with complementary minimum hemorrhoidectomy

Yano¹

2019

J Transl Sci

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Aim:The major problem after hemorrhoidectomy is postoperative pain. This study was designed to investigate the hypothesis that the pain will be reduced as the resection wound is smaller. Aluminum potassium sulphate and tannic acid (ALTA) injection sclerotherapy was performed on the internal hemorrhoid component and the external hemorrhoid component was resected.Methods: 59 patients with Grade 3 or 4 hemorrhoids who underwent ALTA sclerotherapy with complementary resection were included for the analysis. The patients were asked to record their pain for 3 days after surgery. Outcome measures included maximal pain score (0-10), time off work, and patient satisfaction score (-3 to +3). This is a prospective, observational and single arm study. Results:The median maximal pain score was 7.4 [interquartile range (IQR), 5.4-9.0], the median time off work was 3 days (IQR, 2-4 days), and the median patient satisfaction score was +3 (IQR, 2.5-3.0). Conclusion:Minimizing the extent of resection by performing thorough sclerotherapy may reduce pain a few days after surgery and expedite the return to work.

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“…Although, general or epidural anesthesia is the most commonly performed anesthetic techniques, local anesthesia (LA) is considered as a safe alternative with a significant reduction in complications (13)(14)(15). Ambulatory anorectal surgery is becoming a routine procedure for several proctologic diseases including fistula, abscess, condyloma, pilonidal disease, and hemorrhoids.…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of Tailored Hemorrhoidectomy in Outpatients Setting

et al. 2021

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Introduction: Single or double prolapsed pile instead of full muco-hemorrhoidal prolapse is a common finding in patients with symptomatic III or IV degree hemorrhoids. For this selected group of patients, relief of symptoms could be achieved by managing the single/double prolapsed piles instead of performing traditional hemorrhoidectomy. The aim of this single-center study was to evaluate the safety and medium- and long-term effectiveness of an outpatient tailored Milligan-Morgan hemorrhoidectomy (MMH) performed under local anesthesia (LA).Material and methods: Clinical records of 202 patients submitted to outpatient tailored MMH, under LA and without anal dilation, treated between 2013 and 2020, were retrospectively reviewed using a prospectively maintained database and completed by a telephone interview or outpatient consultation. Postoperative pain score, the need for painkillers, postoperative complications and symptoms recurrence, return to working activities, and patient grading assessment scale were recorded.Results: Thirty-five (17%) out of 202 patients recruited were lost to the follow-up. One hundred and fifty-two and 15 patients underwent a single and double pile hemorrhoidectomy, respectively. With regard to postoperative outcomes, visual analogue scale (VAS) decreased from a median value of 4 [interquartile range (IQR) 2–6] on the day of surgery to 1 (IQR 0–4) on the 10th postoperative day (p < 0.001). Sixty-one patients (37%) needed oral painkillers during the 1st week after surgery. There was no mortality or major postoperative complication. Bleeding requiring hospital readmission was reported in seven (4%) patients, and one patient underwent emergency surgery with no need for blood transfusion. No postoperative urinary retention, anal incontinence, or stricture occurred in the series. During the median follow-up of 39 (IQR 12–60) months, 26 patients (16%) reported symptoms of recurrence but only six underwent traditional MMH. Recovery to normal activity occurred within a median period of 6 days (IQR 3–10) and the Clinical Patient Grading Assessment Scale (CPGAS) at 1 year after surgery was reported to be a “good deal better.”Conclusions: Tailored MMH performed under LA in an ambulatory setting can be considered a safe and effective technique with high compliance and satisfaction of patients.

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Haemorrhoidectomy by vessel sealing system under local anaesthesia in an outpatient setting: preliminary experience

Abstract: LigaSure haemorrhoidectomy under local anaesthesia in the outpatient setting is safe and effective.

Cited by 10 publications

References 27 publications

Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan’s hemorrhoidectomy

Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan’s hemorrhoidectomy

Initial experience with sclerotherapy with complementary minimum hemorrhoidectomy

Safety and Effectiveness of Tailored Hemorrhoidectomy in Outpatients Setting

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