Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial

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Haemorrhoidectomy is a known painful procedure and this reputation, in combination with the high prevalence of haemorrhoidal disease, has generated much interest in outpatient treatments of haemorrhoids.1 Rubber‐band ligation, injection sclerotherapy, infrared photocoagulation and cryotherapy have been used with some success, but the results are inferior to surgery.1 Surgical treatment, reserved for patients with prolapsing haemorrhoids, consists of excision and ligation of the ‘pile’ with or without closure of the defect. Milligan–Morgan haemorrhoidectomy, as described in 1937,5 remains the most popular technique. Considerable research over the last two decades has concentrated on reducing pain following these surgical procedures. The research was mainly directed towards three areas: analgesic delivery during the post‐operative period, modification of the surgical technique and the use of a variety of surgical instruments in the hope of decreasing post‐operative pain.1 Modifications include open, semi‐open,1 closed incisions,1 routine performance of lateral internal sphincterotomy6 and the use of stapling devices as advocated by Longo and colleagues.7
Among these modifications are the use of diathermy pedicle coagulation,9 the Harmonic Scalpel (Ethicon, Cincinnati, OH, USA)9 and the Ligasure System (Valleylab, Boulder, CO, USA).10 Several studies have suggested that both the Harmonic Scalpel and the Ligasure System were associated with less post‐operative pain compared with the conventional diathermy.10
Motivated by these reports, this study was designed to compare the surgical outcomes of haemorrhoidectomy performed by Ligasure, Harmonic Scalpel with that performed by conventional diathermy.
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