Abstract
Abstract Background: Hemorrhoidal disease is a very prevalent disorder that arises from engorgement of internal and/or external vascular plexuses surrounding the anal canal. Hem-orrhoidectomy is the standard treatment for grade III or grade IV internal hemorrhoids; in spite of this, pain after conventional hemorrhoidectomy is still a major challenge. Aim of Study: To compare the outcome of hemorrhoidec-tomy using Harmonic scalpel without ligation of the pedicle versus electrocautery with ligation of the pedicle as regarding cost, operative time, post-operative bleeding, pain, and healing process. Patients and Methods: This study was a prospective, clinical, randomized, trial that included 50 patients grade III internal hemorrhoids with external components or grade IV disease. The patients were divided into two groups: Group I that included 25 patients underwent electrocautery with ligation of the pedicle and Group II which included 25 patients under-went Harmonic scalpel hemorrhoidectomy without ligation of the pedicle. Results: There was statistically significant association between type of procedure and operative time (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant lower pain score at day 1, 3, 7, 15, and 30. There was statistically significant association between type of procedure and time to heal (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statistically significant shorter time to complete healing. On the contrary, there was statistically significant association between type of procedure and hospital stay (p=0.18). There was statistically significant association between type of procedure and late complications (p=0.001). Patients who underwent Harmonic scalpel hemorrhoidectomy had statisti-cally significant less incidence of late complications. Conclusion: It is concluded that there was significantly reduced post-operative pain after Harmonic Scalpel hemor-rhoidectomy compared with electrocautery controls. The diminished post-operative pain in the Harmonic Scalpel group likely results from the avoidance of lateral thermal injury.
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