Harmonic scalpel assisted hemorrhoidectomy versus conventional Milligan Morgan hemorrhoidectomy in patients with Grade III and IV hemorrhoids: A prospective, randomized, controlled study

Abstract

Introduction: Harmonic scalpel Hemorrhoidectomy (HSH) is reported to have superior outcomes than Milligan-Morgan hemorrhoidectomy (MMH). However, there is considerable variability in time to return to daily activities, post-operative pain, operating time, and hospital stay. Aims and Objectives: To compare MMH and HSH in terms of various outcomes. Materials and Methods: This prospective randomized controlled study was performed over a period of 12-months (December 2019 to November 2020) in the Department of General Surgery of a tertiary care hospital and included 60 adult patients with grade III and IV hemorrhoids. The patients were randomly and equally divided into either of the two groups i.e., MMH (n=30) or HSH (n=30). Post-operatively patients were evaluated and follow-up to compare the outcomes, including operative time, intra-operative bleeding, post-operative pain, duration of hospitalization, time required to return to daily activities, and intra- and post-operative complications. Results: The time required to return to daily activity was significantly less in the HSH group (p-value=0.0004). The operative time, intra-operative bleeding, and duration of hospitalization were significantly less in the HSH group (all p-values<0.0001). The mean VAS score for post-operative static and post-defecation pain was significantly reduced in the HSH group at all the time intervals (all p-values<0.0001). Moreover, significantly higher proportion of patients in the MMH group had post-operative discharge (p-value=0.02). Conclusion: HSH is superior to MMH in terms of significantly reduced time to return to daily activities, operating time, intra-operative blood loss, post-operative static and post-defecation pain, hospitalization, and intra- and post-operative complications.