Conventional Hemorrhoidectomy versus Ligasure Hemorrhoidectomy: A Comparative Study

摘要

Background: Hemorrhoidal disease is one of the most common anorectal diseases and surgical hemorrhoidectomy remains one of the most common operations in general surgery. Milligan-Morgan Described the conventional hemorrhoidectomy since about 70 years ago, then surgical hemorrhoidectomy had changed little over years until the introduction of LigaSure hemorrhoidectomy. Aim of the Work: Is to compare between conventional (Milligan-Morgan) hemorrhoidectomy and LigaSure hemorrhoidectomy in treating patients with 3rd and 4th degree internal piles. Patients and Methods: This randomized control clinical trial was done at Mounira General Hospital over a period from April 2017 to March 2018 on the basis of: It included 40 adult patients with 3rd and 4th degree hemorrhoids divided randomly into 2 equal groups: Group A (n: 20 patients) underwent LigaSure hemorrhoidectomy. Group B (n: 20 patients) underwent Conventional hemorrhoidectomy. Results: There was a highly significant difference between the two study groups as regard the operative time, in the LigaSure hemorrhoidectomy group the mean operative time was 11.15 ± 2.68 minutes, while in the conventional technique group the mean time was 28.75 ± 4.20 minutes. As regards the post-operative pain, in the 1st day, there was a highly significant difference between the two study groups; in the LigaSure hemorrhoidectomy group the mean post-operative pain was 3.80 ± 1.54; while in the conventional technique it was 5.95 ± 0.99. Regarding the post-operative pain, in the 1st week, the LigaSure hemorrhoidectomy group mean was 2.60 ± 1.27; while in the conventional method was 4.80±0.89. As regard the intra-operative estimated blood loss, a significant difference between the two study groups was present. In ligaSure hemorrhoidectomy group 40% had almost no bleeding, 20% had minimal blood loss, 20% had mild loss and 20% had moderate blood loss in comparison with conventional method group patients; 0% with no blood loss, 15% with minimal loss, 55% with mild loss and 30% with moderate blood loss. As regards duration of wound healing, in the LigaSure group, the mean time was 2.65 ± 0.74 weeks while in the in the conventional technique group, it was 4.60 ± 0.82 weeks which was statistically highly significant. With LigaSure hemorrhoidectomy only 6 patients out of 20 needed anal packing, in contrast with conventional method group that needed an anal pack for the whole 20 patients. Conclusion: We conclude that LigaSure hemorrhoidectomy is better than conventional (Milligan-Morgan) hemorrhoidectomy in terms of less operative time, less intra- operative blood loss, less post-operative pain, less post-operative analgesics and earlier wound healing and return to daily work hence higher patient satisfaction. Recommendations: Further studies on a larger scale of patients are needed to confirm the results obtained by this work.