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Erschienen in: Diseases of the Colon & Rectum 2/2005

01.02.2005 | Original Contributions

A Double-Blind, Randomized Trial Comparing LigasureTM and Harmonic ScalpelTM Hemorrhoidectomy

verfasst von: S. Y. Kwok, F.R.A.C.S., F.R.C.S. (Edinb.), C. C. Chung, F.R.C.S. (Edinb.), K. K. Tsui, M.R.C.S. (Edinb.), M. K. W. Li, F.R.C.S. (Engl.), F.R.C.S. (Edinb.)

Erschienen in: Diseases of the Colon & Rectum | Ausgabe 2/2005

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PURPOSE

The major problem after hemorrhoidectomy is postoperative pain. New techniques have been evolved to circumvent this problem. The present study was conducted to compare the outcomes of LigasureTM hemorrhoidectomy and Harmonic ScalpelTM hemorrhoidectomy.

METHODS

This study was a double-blind, randomized controlled trial. Patients with Grade 3 and 4 hemorrhoids admitted for hemorrhoidectomy were selected and randomized into two groups: 1) LigasureTM hemorrhoidectomy or 2) Harmonic ScalpelTM hemorrhoidectomy. The primary outcomes measured were the analgesic requirement and the postoperative pain score (assessed by an independent assessor). Secondary outcome criteria included the operating time, blood loss, hospital stay, patient satisfaction score, and early and late complications.

RESULTS

Forty-nine patients were randomized into two groups (LigaSureT 24, Harmonic ScalpelT 25). Two patients were lost to follow-up, leaving 47 patients (LigaSureT 24, Harmonic ScalpelT 23) available for final analysis. The age and gender distribution were comparable. The postoperative pain score (median 2.6 vs. 4.8, P < 0.001) and postoperative oral analgesic (Dologesicreg) requirement (median 5 vs. 13, P = 0.001) were significantly less in the LigaSureT group. The operating time (median 11 vs. 18 minutes, P < 0.001) was significantly less in the LigaSureT group. The hospital stay, patient satisfaction score, percentage of patients requiring pethidine injection, percentage of patients with first bowel movement on or before the first postoperative day, and complication rates were similar between the two groups.

CONCLUSIONS

LigasureTM hemorrhoidectomy reduces the postoperative pain and operating time compared to the Harmonic ScalpelTM hemorrhoidectomy. It is a safe, effective procedure for treating Grade 3 and 4 hemorrhoids
Literatur
1.
Zurück zum Zitat McRae, HM, McLeod, RS 1995Comparison of hemorrhoidal treatment modalities: a meta-analysisDis Colon Rectum3868794PubMed McRae, HM, McLeod, RS 1995Comparison of hemorrhoidal treatment modalities: a meta-analysisDis Colon Rectum3868794PubMed
2.
Zurück zum Zitat Golighten, J, Graham, NG, Cleark, CG, Dohmal, IT, Giles, G 1969The value of stretching the anal sphincter in the relief of post-haemorrhoidectomy painBr J Surg5685961 Golighten, J, Graham, NG, Cleark, CG, Dohmal, IT, Giles, G 1969The value of stretching the anal sphincter in the relief of post-haemorrhoidectomy painBr J Surg5685961
3.
Zurück zum Zitat Walker, GL, Nigro, ND 1959Postoperative anorectal hemorrhageSurg Clin North Am39165560 Walker, GL, Nigro, ND 1959Postoperative anorectal hemorrhageSurg Clin North Am39165560
4.
Zurück zum Zitat Milsom, JW, Mazier, WP 1986Classification and management of post-surgical anal stenosisSurg Gynecol Obstet16315 Milsom, JW, Mazier, WP 1986Classification and management of post-surgical anal stenosisSurg Gynecol Obstet16315
5.
Zurück zum Zitat Milligan, ET, Morgan, CN, Jones, LE, Officer, R 1937Surgical anatomy of the anal canal and the operative treatment of haemorrhoidsLancet211924 Milligan, ET, Morgan, CN, Jones, LE, Officer, R 1937Surgical anatomy of the anal canal and the operative treatment of haemorrhoidsLancet211924
6.
Zurück zum Zitat Ferguson, JA, Heaton, JR 1959Closed hemorrhoidectomyDis Colon Rectum21769PubMed Ferguson, JA, Heaton, JR 1959Closed hemorrhoidectomyDis Colon Rectum21769PubMed
7.
Zurück zum Zitat Seow-Choen, F, Ho, YH, Ang, HG, Goh, HS 1992Prospective randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoidsDis Colon Rectum3511659 Seow-Choen, F, Ho, YH, Ang, HG, Goh, HS 1992Prospective randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoidsDis Colon Rectum3511659
8.
Zurück zum Zitat Ibrahim, S, Tsang, C, Lee, YL, Eu, KW, Seow-Choen, F 1998Prospective randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomyDis Colon Rectum41141820 Ibrahim, S, Tsang, C, Lee, YL, Eu, KW, Seow-Choen, F 1998Prospective randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomyDis Colon Rectum41141820
9.
Zurück zum Zitat Chung, CC, Ha, JP, Tai, YP, Tsang, WW, Li, MK 2002Double-blind, randomized trial comparing Harmonic ScalpelTM hemorrhoidectomy, bipolar scissors hemorrhoidectomy and scissors excision/ligation techniqueDis Colon Rectum4578994 Chung, CC, Ha, JP, Tai, YP, Tsang, WW, Li, MK 2002Double-blind, randomized trial comparing Harmonic ScalpelTM hemorrhoidectomy, bipolar scissors hemorrhoidectomy and scissors excision/ligation techniqueDis Colon Rectum4578994
10.
Zurück zum Zitat Franklin, EJ, Seetharam, S, Lowney, J, Horgan, PG 2003Randomized, clinical trial of LigasureTM vs conventional diathermy in hemorrhoidectomyDis Colon Rectum4613803PubMed Franklin, EJ, Seetharam, S, Lowney, J, Horgan, PG 2003Randomized, clinical trial of LigasureTM vs conventional diathermy in hemorrhoidectomyDis Colon Rectum4613803PubMed
11.
Zurück zum Zitat Palazzo, FF, Francis, DL, Clifton, MA 2002Randomized clinical trial of LigasureTM versus open hemorrhoidectomyBr J Surg891547 Palazzo, FF, Francis, DL, Clifton, MA 2002Randomized clinical trial of LigasureTM versus open hemorrhoidectomyBr J Surg891547
12.
Zurück zum Zitat Jayne, DG, Botterill, I, Ambrose, NS, Brennan, TG, Guillou, PJ, O’Riordain, DS 2002Randomized clinical trial of LigasureTM versus conventional diathermy for day-case hemorrhoidectomyBr J Surg8942832 Jayne, DG, Botterill, I, Ambrose, NS, Brennan, TG, Guillou, PJ, O’Riordain, DS 2002Randomized clinical trial of LigasureTM versus conventional diathermy for day-case hemorrhoidectomyBr J Surg8942832
13.
Zurück zum Zitat Rowsell, M, Bello, M, Hemingway, DM 2000Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomized controlled trialLancet35577981CrossRefPubMed Rowsell, M, Bello, M, Hemingway, DM 2000Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomized controlled trialLancet35577981CrossRefPubMed
14.
Zurück zum Zitat Mehigan, BJ, Monson, JR, Hartley, JE 2000Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trialLancet35577981CrossRefPubMed Mehigan, BJ, Monson, JR, Hartley, JE 2000Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trialLancet35577981CrossRefPubMed
15.
Zurück zum Zitat Ho, YH, Cheong, WK, Tsang, C, et al. 2000Stapled haemorrhoidcetomy: cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry and endoanal ultrasound assessment at up to three months.Dis Colon Rectum43166675PubMed Ho, YH, Cheong, WK, Tsang, C,  et al. 2000Stapled haemorrhoidcetomy: cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry and endoanal ultrasound assessment at up to three months.Dis Colon Rectum43166675PubMed
16.
Zurück zum Zitat Molloy, RG, Kingsmore, D 2000Life-threatening pelvic sepsis after stapled haemorrhoidectomyLancet355810CrossRefPubMed Molloy, RG, Kingsmore, D 2000Life-threatening pelvic sepsis after stapled haemorrhoidectomyLancet355810CrossRefPubMed
17.
Zurück zum Zitat Yau, KK, Chung, CC, Chan, ES, Li, MK 2002Initial experience with stapled hemorrhoidectomy: a local reportAnn Coll Surg Hong Kong6811CrossRef Yau, KK, Chung, CC, Chan, ES, Li, MK 2002Initial experience with stapled hemorrhoidectomy: a local reportAnn Coll Surg Hong Kong6811CrossRef
18.
Zurück zum Zitat Ho, YH, Seow-Choen, F, Tsang, C, Eu, KW 2001Randomized trial assessing anal sphincter injuries after stapled hemorrhoidectomyBr J Surg88144955 Ho, YH, Seow-Choen, F, Tsang, C, Eu, KW 2001Randomized trial assessing anal sphincter injuries after stapled hemorrhoidectomyBr J Surg88144955
19.
Zurück zum Zitat Cheetham, MJ 2000Persistent pain and faecal urgency after stapled hemorrhoidectomyLancet3567303CrossRefPubMed Cheetham, MJ 2000Persistent pain and faecal urgency after stapled hemorrhoidectomyLancet3567303CrossRefPubMed
20.
Zurück zum Zitat Tan, JJ, Seow-Choen, F 2001Prospective, randomized trial comparing diathermy and Harmonic ScalpelTM hemorrhoidectomyDis Colon Rectum446779 Tan, JJ, Seow-Choen, F 2001Prospective, randomized trial comparing diathermy and Harmonic ScalpelTM hemorrhoidectomyDis Colon Rectum446779
21.
Zurück zum Zitat Khan, S, Pawlak, SE, Eggenberger, JC, et al. 2001Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic ScalpelTM hemorrhoidectomyDis Colon Rectum448459 Khan, S, Pawlak, SE, Eggenberger, JC,  et al. 2001Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic ScalpelTM hemorrhoidectomyDis Colon Rectum448459
22.
Zurück zum Zitat Chester, JF, Stanford, BJ, Gazet, JC 1990Analgesic benefit of locally injected bupivacaine after hemorrhoidectomyDis Colon Rectum334879PubMed Chester, JF, Stanford, BJ, Gazet, JC 1990Analgesic benefit of locally injected bupivacaine after hemorrhoidectomyDis Colon Rectum334879PubMed
23.
Zurück zum Zitat Lacerda-Filho, A, Cunha-Melo, JR 1997Outpatient haemorrhoidectomy under local anaesthesiaEur J Surg163(12)93540 Lacerda-Filho, A, Cunha-Melo, JR 1997Outpatient haemorrhoidectomy under local anaesthesiaEur J Surg163(12)93540
24.
Zurück zum Zitat Ho, KS, Eu, KW, Heah, SM, Seow-Choen, F, Chan, YW 2000Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia vs general anaesthesiaBr J Surg874103 Ho, KS, Eu, KW, Heah, SM, Seow-Choen, F, Chan, YW 2000Randomized clinical trial of haemorrhoidectomy under a mixture of local anaesthesia vs general anaesthesiaBr J Surg874103
Metadaten
Titel
A Double-Blind, Randomized Trial Comparing LigasureTM and Harmonic ScalpelTM Hemorrhoidectomy
verfasst von
S. Y. Kwok, F.R.A.C.S., F.R.C.S. (Edinb.)
C. C. Chung, F.R.C.S. (Edinb.)
K. K. Tsui, M.R.C.S. (Edinb.)
M. K. W. Li, F.R.C.S. (Engl.), F.R.C.S. (Edinb.)
Publikationsdatum
01.02.2005
Erschienen in
Diseases of the Colon & Rectum / Ausgabe 2/2005
Print ISSN: 0012-3706
Elektronische ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-004-0845-z

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