Hemorrhoidectomy in Patients with Grade III or IV Disease: Harmonic Scalpel Compared With Conventional Closed Technique.
Keywords:hemorrhoidectomy, harmonic scalpel
Background: Harmonic scalpel (Ultracision) is a device that simultaneously cuts and coagulates soft tissues through ultrasonic vibration. In this study we aimed to determine the operative and postoperative characteristics of hemorrhoidectomy using the harmonic scalpel compared with the conventional closed technique.
Methods and Findings: Patients with grade III or IV hemorrhoids, operated between 2010 and 2013, using the harmonic scalpel (n=21) or the conventional closed technique (n=42) were included in the study. Exclusion criteria were thrombosed or strangulated hemorrhoids, concomitant perianal disease, history of recurrent perianal surgery and known tendency for bleeding. Patient characteristics, duration of operation, complications, postoperative pain measured on a visual analog scale (VAS), hospital stay, and return to regular activity were compared between the two groups retrospectively.
Patient characteristics (female:male ratio, mean age, hemorrhoid grade, and symptom duration) were similar between the two groups. Harmonic scalpel and conventional hemorrhoidectomy patients did not differ significantly in terms of VAS score of pain, complications, hospital stay or return to regular activity. However, duration of operation was significantly shorter with harmonic scalpel (24.2 vs. 36.2 min, p<0.05).
Conclusion: There is no clear evidence to support the routine use of harmonic scalpel system in hemorrhoid surgery.
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012;18:2009-17.
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990;98:380-6.
Feil W. Principles of ultrasonic energy for cutting and coagulation. In: Degueldre M, LÃ¶hlein D, Dallemagne B, Kauko M, Walther B, editors. Ultrasonic energy for cutting, coagulating and dissecting. New York, NY: Thieme; 2005. p. 14-25.
Sanchez, Caroline, and Bertram T. Chinn. "Hemorrhoids." Clinics in colon and rectal surgery 24.1 (2011):5.
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 1994; 81: 946-954
Cintron J, Abacarian H. Benign anorectal: hemorrhoids. In: Wolff BG, Fleshman JW, eds. The ASCRS of Colon and Rectal Surgery. New York, NY: Springer-Verlag; 2007: 156â€“177
Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ 2008; 336: 380-383
Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J Am Coll Surg 2007; 204: 102-117
Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J
Gastroenterol 1992; 87: 1600-1606
Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane
Database Syst Rev 2005: CD005034
Nienhuijs S, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev 2009: CD006761
Burch J, Epstein D, Sari AB, Weatherly H, Jayne D, Fox D, Woolacott N. Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review. Colorectal Dis 2009; 11: 233-243; discussion 243
McCarus SD. Mechanism of ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc 1996;3:601â€“8.
Bulus H, Tas A, Coskun A, Kucukazman M. Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson's with electrocautery. Asian J Surg 2013.
Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001;44:558-64
Chung CC, Ha JP, Tai YP, Tsang WW, Li MK. Double-blind, randomized trial comparing Harmonic Scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum 2002;45:789-94
Abo-hashem AA, Sarhan A, Aly AM. Harmonic Scalpel compared with bipolar electro-cautery hemorrhoidectomy: a randomized controlled trial. Int J Surg 2010;8:243-7.
Ozer MT, Yigit T, Uzar AI, Mentes O, Harlak A, Kilic S, et al. A comparison of different hemorrhoidectomy procedures. Saudi Med J 2008;29:1264-9.
Ramadan E, Vishne T, Dreznik Z. Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method. Tech Coloproctol 2002;6:89-92.
Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Wu JS, et al. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy. Dis Colon Rectum 2001;44:845-9.
Tan JJ, Seow-Choen F. Prospective, randomized trial comparing diathermy and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum 2001;44:677-9.
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;3:147-52.
Haveran LA, Sturrock PR, Sun MY, McDade J, Singla S, Paterson CA, et al. Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy. Int J Colorectal Dis 2007;22:801-6.
Kwok SY, Chung CC, Tsui KK, Li MK. A double-blind, randomized trial comparing Ligasure and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum 2005;48:344-8
Chung CC, Cheung HY, Chan ES, Kwok SY, Li MK. Stapled hemorrhoidopexy vs. Harmonic Scalpel hemorrhoidectomy: a randomized trial. Dis Colon Rectum 2005;48:1213-9
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under aÂ Creative Commons Attribution LicenseÂ that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeÂ The Effect of Open AccessÂ and Benefits of Publishing Open Access).