Ligasure™ Hemorrhoidectomy versus Conventional Hemorrhoidectomy: Comparison in Outcome

Abstract

BACKGROUND: Hemorrhoids are a common problem faced in the surgical practice that cause a variety of symptoms ranging from bleeding per rectum to prolapsed, non-reducible and painful anal masses. Therefore, hemorrhoidectomy is one of most frequently performed surgical procedures worldwide. AIM: In this study, we will compare between the conventional surgical method and between LigaSure™ hemorrhoidectomy. PATIENTS AND METHODS: All 120 patients underwent hemorrhoidectomy by conventional and LigaSure™ method between September 2015 and September 2018 in Al-Kafeel hospital in Karbala city in Iraq. All cases underwent surgery by the three authors under regional anesthesia or general anesthesia by anesthetic team. A thorough history taking and physical examination were done and an informed consent has been taken from each patient before the surgery. Conventional hemorrhoidectomy was done for 50 patients randomly selected. The operation was done in the open method (Milligan Morgan’s). LigaSure™ hemorrhoidectomy was done for 70 patients randomly selected as well. Quantification of intra-operative bleeding was done by counting the number of gauzes. Patients were evaluated 5 days and a month and 3 months after the operation for complications and improvement of symptoms. The data were analyzed using Statistical Package for Social Sciences version 22.0. RESULTS: There were significant differences regarding the operation time, number of gauzes soaked with blood, hospital stay, pain score, post-operative bleeding, wound infection, residual mass, fecal incontinence and anal stenosis in favor of the LigaSure™ method. There was no significant difference regarding urine retention and post-operative discharge between the two methods. CONCLUSION: LigaSure™ hemorrhoidectomy can be a good alternative to conventional methods to reduce pain and make a more rapid recovery after hemorrhoidal surgery.

Comparative Study between Milligan Morgan Versus Ligasure Haemorrhoidectomy

“…16 This study found insignificant difference in urinary retention and the results matches with previously reported studies where similar insignificant difference was reported by Sakr et al, Alhamdany et al and Abdelaziz and Halim. 15,17,18 Frequency of anal stenosis between the groups in this study also did not differ significantly and the findings are similar to that of Haksal et al and Sakr et al 16,15 In the light of findings of this study, Ligasure Haemorrhoidectomy can be promoted for management patients with third and fourth degree haemorrhoids in future. A very key limitation to this trial was that the other outcome measures of surgery e.g.…”

“…The experiment and the control group did not possess any significant inherit difference as shown by chi-square and independent sample t tests. 17,15,18 We found male predominance in the study population with a male to female ratio of 1.58:1. Similar male predominance in such patients has been previously reported by some other authors as 1.53: 17,10 We noticed mean bleeding was significantly less in LS group than MM group.…”

“…17,15,18 We found male predominance in the study population with a male to female ratio of 1.58:1. Similar male predominance in such patients has been previously reported by some other authors as 1.53: 17,10 We noticed mean bleeding was significantly less in LS group than MM group. It was 5.0% vs. 25.0% between the two groups respectively.…”

“…A very higher frequency of 3 rd degree haemorrhoids was reported by Alhamdany et al as 93.46%. But quite less difference between 3 rd and 4 th degree haemorrhoids was reported by Abdelaziz and Halim as 51.3% and 48.7%, respectively 17,18. Mean operation time was significantly less in Ligature haemorrhoidectomy group as15.03±1.925 vs. 20.40±2.228; p-value=0.000 in comparison with the Milligan Morgan group.…”

“…1 by Haksal et al in Turkey and 1.60:1 by Alhamdany et al in Iraq 16,17. However, this predominance was reported very high as 3.44:1 by Abdelaziz and Halim in Egypt 18.…”