LigaSure Hemorrhoidectomy Research Articles

LigaSure hemorrhoidectomy versus excisional diathermy hemorrhoidectomy for all symptomatic hemorrhoids

Background: Hemorrhoidectomy by LigaSure electrosurgical unit seems to be very effective treatment and results in better surgical outcomes when compared with the conventional excisional hemorrhoidectomy. Objective: The aim of this study was to compare the feasibility and the surgical outcomes of LigaSure hemorrhoidectomy with that of conventional diathermy excisional hemorrhoidectomy. Materials and Methods: Patients characteristics were comparable in both groups. Ninety six patients with symptomatic mainly grade III and IV piles were randomized for either conventional excisional hemorrhoidectomy (48 patients) or to LigaSure hemorrhoidectomy (48 patients) for the period from April 2014 to July 2016. The surgical outcomes of both procedures including the operative time, intra-operative blood loss, postoperative pain, analgesic requirements, early and late postoperative complications, wound healing, recovery time and return to work, recurrence and patient satisfaction were recorded, compared and evaluated. Results: The mean operative time and amount of intra-operative blood loss were significantly lower in LigaSure hemorrhoidectomy group. Postoperative pain and need for parentral analgesia were comparable in the first 24 -48 hours postoperatively, but they were significantly lower in LigaSure group after the second postoperative day. Faster wound healing and early return to work were obviously noted among patient subjected to LigaSure hemorrhoidectomy. Early postoperative complications were lower in LigaSure group while late complications were comparable in both groups. Lastly, LigaSure group showed high satisfaction rate compared to conventional hexcisional hemorrhoidectomy group. Conclusion: LigaSure hemorrhoidectomy is superior and more advantageous in term of operative time, blood loss, post-operative complications, faster wound healing and return to work. It is simple, feasible and easy to learn.

Early and Late Surgical Outcomes after LigaSure and Conventional Diathermy Hemorrhoidectomy: A Comparative Randomized Study

Background: Hemorrhoidectomy is a known painful operation associated with a delayed convalescence. Aim: To report the early and late surgical outcomes after LigaSure and conventional diathermy hemorrhoidectomy. Patients and methods: Seventy-Seven patients with grade III and IV hemorrhoids were randomized into two groups; Group (I) treated with LigaSure hemorrhoidectomy and group (II) treated with conventional diathermy hemorrhoidectomy. The operative time, hospital stay, postoperative pain, analgesia, time of wound healing, return to work, postoperative complications and patients’ satisfactions were recorded in each group. Results: The patients treated with LigaSure hemorrhoidectomy had significantly less mean operative time (12.19 versus 35.3 min), postoperative pain score (5.12 versus 6.11), analgesia (11.97 versus 13.8 tablets) and time to return work (10.35 versus 14.94 days) than the patients who underwent conventional diathermy hemorrhoidectomy. Early postoperative complications were significantly less in the LigaSure group (P= 0.001), while late postoperative complications showed non- significant difference between both groups (P >0.05). Patients’ satisfactions were in favor of LigaSure group with significant statistical difference (P= 0.026). Conclusion: LigaSure is a superior alternative to conventional diathermy in doing hemorrhoidectomy due to less post- operative pain and analgesia, fast wound healing, early return to work and lower postoperative complications. Moreover, it is a simple and short time technique easy to learn.

Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids.

The aim of this study was to compare the clinical results of LigaSure-assisted hemorrhoidectomy and Milligan-Morgan hemorrhoidectomy as a conventional method in our clinic. Patients who underwent LigaSure-assisted hemorrhoidectomy or conventional hemorrhoidectomy for grade 3 and 4 hemorrhoids in our clinic between 2009 and 2014 were included in this study. The patient data were reviewed by screening records. Gender, age, preoperative hemoglobin and hematocrit levels, operation time, presence of thrombosis, number of packages, hospitalization time, early and late postoperative complications, prolonged pain presence, and follow-up period were recorded. In this period, surgical interventions were performed on 365 patients diagnosed with hemorrhoids. Among these, 159 underwent LigaSure-assisted operations, while 206 were operated on by conventional methods. One hundred forty-four (39.5%) cases were female, while 221 (60.5%) cases were male. The median age of the patients was 40 (19-82) years in the LigaSure group and 41 (16-78) years in the conventional method group. The operation time was 15 (4-60) min in the LigaSure group and 20 (6-40) min in the conventional method group. Postoperative analgesics were given to the 182 (88.3%) cases in the conventional group and 107 (67.3%) cases in the LigaSure group. The time required for returning to normal daily activity was 6 (1-15) days in the LigaSure group and 7 (1-30) days in the conventional method group. In this study, LigaSure was determined to be superior to a conventional method in terms of operation time, hospitalization period, postoperative analgesic requirements, time required for returning to normal daily activity, and postoperative bleeding.

Outcome of Hemorrhoidectomy with the Ligasure in Comparison with the Traditional open Method

OBJECTIVETo compare the operative time and outcomes of Ligasure hemorrhoidectomy with that of the traditional open hemorrhoidectomy.METHODOLOGYA total of 49 patients were included in this study. Out of which 24 were in the Ligasure group and 25 in the open group. The main objective or the primary variable was to assess the operative time for the excision of a single hemorrhoidal lesion, the need for morphine, for post operative pain relief and any other complications such as preoperative bleeding and the time to return to work. The data like age, sex, type of Haemorrhoidectomy, type of complicating etc. were recorded in already prepared proforma. The data was analysed through computer program SPSS10.RESULTSThe demographic data were comparable between the two groups. The time spent in excision of a solitary hemorrhoidal lesion was significantly shorter in the Ligasure group compared to the open group (8.25 min Vs 16.75 min ) and this difference was found to be statistically significant (p<0.001). Operative bleeding was also significantly lower than the open method of Haemorrhoidectony. Other parameters like post operative pain, opioid requirement, urinary retention and chronic complications like anal stenosis and gas incontinence were not significant. There was no difference in the period of convalescence and return to work between the two groups.CONCLUSIONHemorrhoidectomy with the Ligasure entails a shorter surgical time and could be associated with a lesser pain besides being safer.

PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL OF LIGASURETM VERSUS CONVENTIONAL HEMORRHOIDECTOMY FOR GRADE III AND IV HEMORRHOIDS

Background: Performing hemorrhoidectomy with LigaSure™ vessel sealing system is a rapid and simple new technique. The aim of this study was to evaluate LigaSure™ hemorrhoidectomy (LH) to open hemorrhoidectomy (OH) performed by the conventional diathermy. Patients and methods: One hundred and sixteen patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure™ or open conventional diathermy hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, complications, need for analgesics and time to achieve complete wound healing. Results: The LigaSure™ group achieved a significant reduction in operative time, blood loss, first postoperative day pain score, seventh day pain score and overall pain score. Patients in the LigaSure™ group required less pethidine analgesia on the first postoperative day. Time to achieve complete wound healing were shorter in the LigaSure™ group. There was no difference in postoperative complications. Conclusion: LigaSure™ hemorrhoidectomy provides a valid alternative to conventional hemorrhoidectomy. Based on our results, further studies addressing long-term functional results are needed to prove that LigaSure™ hemorrhoidectomy is the ideal method of hemorrhoidectomy for the patients.

Excision Hemorrhoidectomy: New Methods to Improve the Outcomes of an Old Technique

Context: Hemorrhoidal disease is the most common anorectal disorder that requires surgical intervention. Hemorrhoids require treatment when they result in symptoms such as bleeding or prolapse. Surgical intervention is indicated for significant prolapse, and a number of accepted and viable methods are available for treating prolapsing hemorrhoids that do not reduce spontaneously (Grade III and IV). Excision hemorrhoidectomy remains the gold standard treatment for Grade III and IV hemorrhoids despite great interest in alternative procedures such as stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation with mu- copexy. A large body of evidence demonstrates that excision hemorrhoidectomy is an eective, safe, and aordable procedure. Nevertheless, the main drawback of excision hemorrhoidectomy remains its notorious association with significant postoperative pain. Evidence Acquisition: A comprehensive literature search was conducted through MEDLINE and the Cochrane database of system- atic reviews. Only prospective case-controlled studies, review articles, and meta-analyses were considered. Results: Many strategies have been put forward in the literature to address the issue of pain after excision hemorrhoidectomy. These strategies can be broadly categorized into surgical techniques (e.g., LigaSure hemorrhoidectomy) and pharmacological adjuncts (e.g., intradermal methylene blue and chemical sphincterotomy with glyceryl trinitrate ointment). In recent years, meta-analyses and randomized controlled trials have been performed to evaluate their eects. Conclusions: This article evaluates the evidence behind these strategies and outlines the new methods available to improve the outcomes of an old technique.

Randomized Clinical Trial of LigaSure Haemorrhoidectomy versus Open Diathermy Haemorrhoidectomy

Introduction: Haemorrhoidectomy is the most effective and definitive treatment for grade III or IV haemorrhoids. The traditional surgical approaches include the open (Milligan–Morgan) and the closed (Ferguson and Parks) haemorrhoidectomy. Both procedures entail similar complications, in particular protracted postoperative pain that causes longer hospital stays. Recently, a variety of instruments have been used in an attempt to reduce postoperative pain and a quicker return to normal activities. A new option in performing Milligan -Morgan haemorrhoidectomy involves the LigaSure system, a bipolar electrothermal vessel sealing device.Objective: The randomized clinical trial was carried out to see the benefits of using LigaSure over monopolar diathermy in haemorrhoid surgery in terms of operating time, postoperative pain and complications.Materials and Methods: This randomized clinical trial was carried out in the Department of Surgery at Combined Military Hospital, Dhaka. The study was conducted for a period about two years. The sample size was one hundred cases of haemorrhoidectomy divided into 50 cases of two groups, which is LigaSure haemorrhoidectomy and open diathermy haemorrhoidectomy. Patients were included in the trial if they had symptomatic prolapsing internal haemorrhoids. All patients were randomized using sealed envelopes. Patients were blinded to the type of surgery performed. Patients kept a record of postoperative pain by means of a visual analogue scale. Symptom control and patient’s satisfaction were assessed at 12 weeks’ follow-up. LigaSure haemorrhoidectomy was performed by the mediumsized LigaSureTM forceps.Results: The operating time was less in LigaSure haemorrhoidectomy (mean 7.7 min with range of 4 to 16min) as compared with open diathermy haemorrhoidectomy (mean 18.2 with range 7-24 min) (p<0 .001). The median postoperative pain score was 4.3 (range 1-8.5) in the LigaSure group and 7.0 (range 3-9) in the open diathermy haemorrhoidectomy group. The difference was statistically significant (p<0.001). The median number of administrations of analgesia in postoperative period was less in the LigaSure group (10 with range 4-20) as compared with the open diathermy group (19.5 with range 6-24) (p<0.001). There were five cases of complications in LigaSure haemorrhoidectomy group, whereas eleven cases developed complications in open diathermy haemorrhoidectomy group. The complications were postoperative bleeding, urinary retention and anal fissure.Conclusion: Evidence to date confirms that LigaSure haemorridectomy is an effective technique. LigaSure appeared to be an effective tool for the dissection and haemostasis required for an excisional haemorrhoidectomy procedure.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

PTU-208 Short and long-term outcomes of transanal hemorrhoidal dearterialization – a systematic review of comparative evidence

Introduction Aim of this study is to assess comparative evidence on short and long term outcomes of transanal hemorrhoidal dearterialization (THD) vs. stapled hemorrhoidopexy (SH), conventional hemorrhoidectomy (CH) and ligasure hemorrhoidectomy (LH). Method Litterature review of published prospective controlled trials of THD. Potentially relevant studies were identified by the title and the abstract, searched and selected in the MEDLINE, EMBASE, and Cochrane Library databases using the keywords transanal dearterialization, prospective, haemorrhoids, THD, hemorrhoidectomy, artery ligation without language restrictions. Full articles were obtained and assessed in detail. Primary outcome measure was recurrence rate. Secondary outcome measures were postoperative pain and morbidity. Results Thirteen studies (THD vs. SH = 5; THD vs. CH = 6; THD vs. LH = 1; THD vs. SH vs. CH = 1) including 947 patients were analysed. There were 452 THD patients, 267 stapled hemorrhoidopexy (SH), 228 conventional hemorrhoidectomy (CH) 68 ligasure hemorrhoidectomy. Six patients had grade I haemorrhoids, 79 patients grade II, 554 patients grade III, 166 patients grade IV and 142 were unspecified. Minimum follow up length ranged from 1 week to 36 months. Mean operative time (minutes) was 33 for THD procedure, 27 for SH and 19 for CH. Postoperative pain was assessed in 12 studies (THD vs. SH = 6; THD vs. CH = 6). All studies demonstrated a trend in favour of THD reaching statistical significance in 7 of the studies. Early complications occurred in 83/427 THD (19.4%), 60/267 SH (22.5%), 54/135 CH (40%) patients. Postoperative bleeding occurred in 10/303 THD (3.3%), 10/165 SH (6.1%), 7/90 CH (7.7%), 12/68 LH (17.6%) patients (P Conclusion Comparative evidence on THD is still scarce. However, THD procedure has shown significantly less postoperative bleeding and pain compared to both SH and CH. Late complications are also less frequent following THD. Long-term symptomatic relief seems to be better after SH and CH. Disclosure of interest None Declared.

Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials.

To compare outcomes of Ligasure hemorrhoidectomy (LH) versus Ferguson hemorrhoidectomy (FH) by a meta-analysis of available randomized controlled trials. Original studies in any language were searched from MEDLINE database, PubMed, Web of science and the Cochrane Library database, and Wangfang database. Randomizes control trials that compared LH with FH were identified. Data were extracted independently for each study and a meta-analysis was performed using fixed-effects and random-effects models. Five trials including 318 patients met the inclusion criteria. The urinary retention rate and early postoperative pain scores were higher in patients undergoing FH. Patients treated with Ligasure had a significantly shorter operative time and hospital stay than the patients submitted to Ferguson techniques. The blood loss during operation was less in Ligasure group than Ferguson group. No statistically significant differences were noted in postoperative bleeding, difficult defacating, anal fissure, anal stenosis, and incontinence. Our meta-analysis shows that LH is superior to FH in the short-term outcomes. Future studies addressing long-term outcomes are needed to prove these results.

Randomized comparative study of Ligasure versus conventional (Milligan-Morgan) hemorrhoidectomy

Objectives The objective of this study was to evaluate the two approaches for hemorrhoid surgery - Ligasure hemorrhoidectomy and conventional (Milligan-Morgan) hemorrhoidectomy - in terms of operative time and blood loss, as well as postoperative pain, bleeding, analgesic requirement, urinary retention, discharge, stenosis, fecal incontinence, wound healing, and patient satisfaction. Background To compare the surgical outcome of hemorrhoidectomy performed using Ligasure bipolar diathermy with conventional hemorrhoidectomy. Patients and methods Twenty patients with grade III or IV hemorrhoids were randomized equally to conventional hemorrhoidectomy (group 1) and Ligasure (group 2) hemorrhoidectomy. Operative details were recorded, and patients recorded daily pain scores on a linear analogue scale. Follow-up was weekly for 2 months and then monthly for 6 months to evaluate complications, return to normal activity, ongoing symptoms, and patient satisfaction. Results The mean reduced intraoperative blood loss (±SD) was 1.2 ± 1.6 ml (ranging from 0 to 5 ml) in the Ligasure group (group 2) versus 22.2 ± 6.58 ml (ranging from 15 to 35 ml) in the conventional group (group 1) (P = 0.0001). The mean operative time in minutes in the Ligasure group was 6.6 ± 4.3 (ranging from 5 to 10 min) versus 21.7 ± 4.3 in the conventional group (ranging from 15 to 26 min) (P Conclusion Ligasure is an effective instrument for hemorrhoidectomy, which results in lower volume of blood loss, less postoperative pain, quicker wound healing, and earlier return to work.

Ligasure Versus Stapled Hemorrhoidectomy in the Treatment of Hemorrhoids

The aim of this meta-analysis was to compare the outcomes of Ligasure hemorrhoidectomy and stapled hemorrhoidectomy for prolapsed hemorrhoids. Original studies in any language were searched from MEDLINE database, PubMed, Web of science and the Cochrane Library database, and Wangfang database. Randomized control trials that compared Ligasure hemorrhoidectomy with stapled hemorrhoidectomy were identified. Data were extracted independently for each study, and a meta-analysis was performed using fixed and random-effects models. Five trials including 397 patients met the inclusion criteria. Patients treated with Ligasure had a significantly shorter operative time compared with patients who underwent stapler techniques. The recurrence rate was higher in patients who underwent stapled hemorrhoidectomy. No statistically significant differences were observed in postoperative bleeding, urinary retention, difficult defecating, anal fissure, anal stenosis, incontinence, postoperative pain, return to normal activities, and hospital stay. Our meta-analysis shows that Ligasure is an effective instrument for hemorrhoidectomy, which results in shorter operation time and lower recurrence rate.

LigaSure Hemorrhoidectomy for Symptomatic Hemorrhoids: First Pediatric Experience.

Hemorrhoids are uncommon in children. Third and fourth degree symptomatic hemorrhoids may be surgically excised. We describe the first experience of using LigaSure (Covidien, Mansfield, Massachusetts, United States) to perform hemorrhoidectomies in children. LigaSure hemorrhoidectomy has been well described in adults and is found to be superior in patient tolerance as compared with conventional hemorrhoidectomy.

Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults

This purpose of the meta-analysis was to compare treatment outcomes for adult patients with symptomatic hemorrhoids treated by stapled hemorrhoidopexy or LigaSure hemorrhoidectomy.A search of public medical databases was made to identify randomized controlled trials (RCTs) comparing stapled hemorrhoidopexy (SH) with LigaSure hemorrhoidectomy (LH) for the treatment of adult patients with symptomatic grade 3 and grade 4 hemorrhoids. Postoperative pain as measured using a visual analog scale was the primary outcome, and rate of recurrent prolapse and postoperative bleeding were secondary outcome measures. Four RCTs were identified that met the inclusion criteria. Data for the pooled outcomes were analyzed using odds ratio (OR) analysis. None of the studies in the analysis indicated a significant difference between SH and LH for the outcomes VAS pain score, recurrence rate, or postoperative bleeding. Pooled analysis revealed a significant OR in favor of the SH method for recurrent prolapse (OR = 5.529, P = 0.016) for up to 2 years after surgery. No significant differences between the two methods were identified for VAS pain scores (OR = −1.060, P = 0.149) or postoperative bleeding OR = 1.188, P = 0.871). Pooled analysis of RCT results comparing SH to LH for symptomatic hemorrhoids revealed a significantly greater incidence of recurrent prolapse for SH. The two techniques were associated with similar levels of postoperative pain and postoperative bleeding.

Modified LigaSure hemorrhoidectomy for the treatment of hemorrhoidal crisis

This study aimed at reporting a modified LigaSure technique for the treatment of acute hemorrhoidal crisis. Consecutive patients with an acute hemorrhoidal crisis received a modified LigaSure hemorrhoidectomy. After removing the hemorrhoidal tissues above the welding line, scissors were used to undermine the anoderm to excise residual thrombosed hemorrhoidal tissue. The wound was approximated with a continuous 4-0 vicryl suture. Forty patients (mean age, 47.5 years; range 22.0-76.0 years) were included. The mean duration of the crisis, length of the operation, and follow-up were 2.0 days (range 1.0-5.0 days), 35.6 min (range 15.0-60.0 min), and 13.2 months (range 6-24 months), respectively. At the final follow-up, all patients were continent and there were no cases with anal stenosis, recurrent bleeding, prolapse, or thrombus. The mean pain score before surgery was 8.3, and was 4.4 and 3.2 on postoperative days 1 and 7, respectively. Complications within 30 days of surgery included two cases of urine retention, two cases bleeding, one wound infection and one case of fecal impaction, which all resolved with conservative treatment. The only late complication was one case of residual skin tags. The modified LigaSure hemorrhoidectomy offers rapid pain relief, early recovery, and low morbidity for patients with an acute hemorrhoidal crisis.

Approach to Hemorrhoids

Hemorrhoids are a very common anorectal disorder defined as the symptomatic enlargement and abnormally downward displacement of anal cushions. The current pathophysiologies of hemorrhoids include the degenerative change of supportive tissue within the anal cushions, vascular hyperplasia, and hyperperfusion of hemorrhoidal plexus. Low-grade hemorrhoids are easily and effectively treated with dietary and lifestyle modification, medical intervention, and some office-based procedures. An operation is usually indicated in symptomatic high-grade and/or complicated hemorrhoids. Whilst hemorrhoidectomy has been the mainstay of surgical treatment, more recently other approaches have been employed including Ligasure hemorrhoidectomy, stapled hemorrhoidopexy, and doppler-guided hemorrhoidal artery ligation. Post-procedural pain and disease recurrence remain the most challenging problems in the treatment of hemorrhoids. This article deals with modern approaches to hemorrhoids based on the latest evidence and reviews of the literature. The management of hemorrhoids in complicated situations is also discussed.

Meta-analysis of stapled hemorrhoidopexyvsLigaSure hemorrhoidectomy

To compare outcome of stapled hemorrhoidopexy (SH) vs LigaSure hemorrhoidectomy (LH) by a meta-analysis of available randomized controlled trials (RCTs). Databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index updated to December 2012, were searched. The main outcomes measured were operating time, early postoperative pain, postoperative urinary retention and bleeding, wound problems, gas or fecal incontinence, anal stenosis, length of hospital stay, residual skin tags, prolapse, and recurrence. The meta-analysis was performed using the free software Review Manager. Differences observed between the two groups were expressed as the odds ratio (OR) with 95%CI. A fixed-effects model was used to pool data when statistical heterogeneity was not present. If statistical heterogeneity was present (P < 0.05), a random-effects model was used. The initial search identified 10 publications. After screening, five RCTs published as full articles were included in this meta-analysis. Among the five studies, all described a comparison of the patient baseline characteristics and showed that there was no statistically significant difference between the two groups. Although most of the analyzed outcomes were similar between the two operative techniques, the operating time for SH was significantly longer than for LH (P < 0.00001; OR= -6.39, 95%CI: -7.68 - -5.10). The incidence of residual skin tags and prolapse was significantly lower in the LH group than in the SH group [2/111 (1.8%) vs 16/105 (15.2%); P = 0.0004; OR= 0.17, 95%CI: 0.06-0.45). The incidence of recurrence after the procedures was significantly lower in the LH group than in the SH group [2/173 (1.2%) vs 13/174 (7.5%); P = 0.003; OR= 0.21, 95%CI: 0.07-0.59]. Both SH and LH are probably equally valuable techniques in modern hemorrhoid surgery. However, LigaSure might have slightly favorable immediate postoperative results and technical advantages.

Results of 666 consecutive patients treated with LigaSure hemorrhoidectomy for symptomatic prolapsed hemorrhoids with a minimum follow-up of 2 years

Our aim is to report the outcomes of hemorrhoidectomy performed via LigaSure™ with a minimum follow-up of 2 years. A total of 666 patients underwent hemorrhoidectomy for symptomatic prolapsed hemorrhoids (grade III and IV) via LigaSure between June 2006 and June 2008. Patient demographic and operative data were collected and analyzed. The mean patient age was 45.4 ± 11.1 years (x ± SD; range, 22-77), and approximately 72% had grade III hemorrhoids. All procedures were performed without complications. The operative time was 18.7 ± 4.1 minutes (range, 9-43), and hospital stay was 1.5 ± 0.6 days (range, 1-4). There was no immediate postoperative bleeding or other procedure-related complications. Twelve (1.8%) patients required urinary catheterization for a maximum of 1 day, and 21 (3.2%) patients had delayed postoperative bleeding. Most cases of bleeding resolved spontaneously; 3 patients (0.4%) required reoperation. A total of 645 patients (96.6%) responded to a follow-up telephone interview at a mean of 36 months (range, 24-49) after hemorrhoidectomy. After 1 year postoperatively, 2 patients received additional excisions for residual skin tags, 1 was treated for an anal stricture, 1 was treated for an anal fistula, and 3 were treated for anal fissures. Minor incontinence (flatus) was present in 11 (1.7%) patients, and 13 (2.0%) experienced mild bleeding caused by residual hemorrhoids; 1 patient underwent rubber-band ligation, and the others were successfully treated medically. No recurrent prolapse or persistent anal pain occurred during the follow-up period. The overall recurrence rate at 2-years follow-up was 3.1%. The long-term recurrence rate after hemorrhoidectomy with LigaSure is low and comparable with conventional hemorrhoidectomy.

Ferguson hemorrhoidectomy: is still the gold standard treatment?

Hemorrhoidectomy remains the most definitive procedure to treat symptomatic grades III and IV hemorrhoids. However, over the years, several modifications have been made to the original operation to improve the outcomes. A total of 693 consecutive patients with grade III and IV hemorrhoids underwent Ferguson hemorrhoidectomy. Our results serve as a standard for comparison conventional hemorrhoidectomy (Ferguson's technique) with recent methods such as stapled hemorrhoidopexy and LigaSure hemorrhoidectomy. We have obtained a very low rate of post-operative pain after Ferguson hemorrhoidectomy (VAS pain score was 2.47 ± 1.1 after a day, 1.34 ± 0.7 after 7 days and 0.51 ± 0.1 after 2 weeks) as to for stapler and LigaSure procedure in the literature. Moreover, long-term results demonstrate high levels of patient satisfaction (the satisfaction was good in 624 patients after 2 weeks and in 658 patients after 1 year) with a low recurrence rates (7 patients had recurrence after 1 year and 21 patients after 2 years). We believe that Ferguson-closed hemorrhoidectomy could still be, at the moment, the gold standard to which other techniques are compared.

A Randomized Clinical Trial Comparing Ligasure Versus Stapled Hemorrhoidectomy

Stapled hemorrhoidectomy (SH) and Ligasure hemorrhoidectomy (LH) are standard for hemorrhoidal disease treatment, but the surgical principle is different. This randomized clinical trial compared the 2 methods. We included 98 patients with grade 3 hemorrhoidal disease: 46 patients treated by SH and 52 patients by LH. Incidence of complications, recurrence, postoperative pain, wound healing time, and time off everyday activity were observed. The follow-up period was 24 months. We found that LH has a significantly shorter wound healing time. The recurrence rate and the overall postoperative complication rate was higher after SH but not significantly (recurrence LH vs. SH: 1.9% vs. 11.1%; complications LH vs. SH: 13.5% vs. 23.9%). Postoperative pain level, analgesic consumption, and time off everyday activity were practically the same in both groups. Both procedures can be used to treat grade 3 hemorrhoidal disease with the same efficacy, but analysis of recurrence after SH is necessary.

LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial

Introduction. Milligan-Morgan haemorrhoidectomy performed with LigaSure system (LS) seems to be mainly effective where a large tissue demolition is required. This randomized study is designed to compare LigaSure haemorrohidectomy with conventional diathermy (CD) for treatment of IV-degree haemorrhoids. Methods. 52 patients with IV-degree haemorrhoids were randomized to two groups (conventional diathermy versus LigaSure haemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge, early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12–24). All data were statistically evaluated. Results. 27 patients were treated by conventional diathermy, 25 by LigaSure. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate. Conclusions. LigaSure is an effective instrument when a large tissue demolition is required. This study supports its use as treatment of choice for IV degree haemorrhoids, even if the procedure is more expansive than conventional operation.