Comparative study of management of grade III hemorrhoids by Harmonic Scalpel technique versus conventional surgical technique (Milligan Morgan method)

Authors

  • Amrithraj Thiyagarajan Department of Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pune-411018, Maharashtra, India
  • Shubhi Bhatnagar Department of Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pune-411018, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20173877

Keywords:

Harmonic Scalpel hemorrhoidectomy, Hemorrhoidectomy, Milligan Morgan hemorrhoidectomy

Abstract

Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.

Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.

Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.

Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.

Author Biographies

Amrithraj Thiyagarajan, Department of Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pune-411018, Maharashtra, India

General Surgery M.S.General Surgery Resident

Shubhi Bhatnagar, Department of Surgery, Dr. D. Y. Patil Medical College and Research Centre, Pune-411018, Maharashtra, India

General Surgery M.S.General Surgery Resident

References

MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. Dis Colon Rectum. 1995;38(7):687-94.

Sanchez C, Chinn BT. Hemorrhoids. Clin Colon Rectal Surg. 2011;24(1):5.

Kuehn HG, Gebbensleben O, Hilger Y, Rohde H. Relationship between anal symptoms and anal findings. Int J Med Sci. 2009;6(2):77.

Wexner SD, Baig K. The evaluation and physiologic assessment of hemorrhoidal disease: a review. Tech Coloproctol. 2001;5(3):165-8.

McCarus SD. Physiologic mechanism of the ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc. 1996;3(4):601-8.

Hulme-Moir M, Bartolo DC. Hemorrhoids. Gastroenterol Clin North Am. 2001;30(1):183-97.

Milito G, Cadeddu F. Tips and tricks: haemorrhoidectomy with Liga Sure. Tech Coloproctol. 2009;13(4):317-20.

Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic scalpel versus electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum. 2001:44(4):558-64.

Morri A, Prabhakar KB, Kurra SS. Ligasure (Precision) Haemorrhoidectomy at government general hospital. J Evidence based Med Healthcare. 2015;2(39):6383-6.

Tsunoda A, Sada H, Sugimoto T, Kano N, Kawana M, Sasaki T, et al. Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy. World J Gastrointest Surg. 2011;3(10):147-52.

Di Vita G, Patti R, Petrone R, Arcara M, Sieli G. Milligan-Morgan haemorrhoidectomy with ultrasonic scalpel. G Chir. 2003;24(11-12):422-7.

Ramadan E, Vishne T, Dreznik Z. Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method. Tech Coloproctol. 2002;6(2):89-92.

Lim DR, Cho DH, Lee JH, Moon JH. Comparison of a hemorrhoidectomy with ultrasonic scalpel versus a conventional hemorrhoidectomy. Ann Coloproctol. 2016;32(3):111-6.

Mushaya CD, Caleo PJ, Bartlett L, Buettner PG, Ho YH. Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol. 2014;18(11):1009-16.

Bulus H, Tas A, Coskun A, Kucukazman M. Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson's with electrocautery. Asian J Surg. 2014;37(1):20-3.

Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg. 2001;234(1):21-4.

Ivanov D, Babovic S, Selesi D, Ivanov M, Cvijanovic R. Harmonic Scalpel hemorrhoidectomy: a painless procedure? Med Pregl. 2007;60(9-10):421-6.

Downloads

Published

2017-08-24

Issue

Section

Original Research Articles