Randomized clinical trial comparing LigaSure haemorrhoidectomy with open diathermy haemorrhoidectomy

BACKGROUND MILLIGAN-MORGAN EXCISION HAEM-ORRHOIDECTOMY REMAINS A VERY POPULAR TREATMENT MODALITY FOR THIRD AND FOURTH DEGREE HAEMORRHOIDS DUE TO ITS COST EFFECTIVENESS AND GOOD LONG-TERM RESULTS. THE LIGASURE TISSUE-SEALING DEVICE IS AN ALTERNATIVE TECHNIQUE USED IN HAEMORRHOIDECTOMY THAT HAS BEEN SHOWN TO PRODUCE FAVOURABLE RESULTS. THE AIM OF THIS STUDY WAS TO ASSESS THE EFFECTIVENESS OF THE LIGASURE TISSUE SEALING DEVICE IN COMPARISON WITH CONVENTIONAL DIATHERMY HAEMORRHOIDECTOMY: METHODS A PROSPECTIVE CLINICAL TRIAL WAS CONDUCTED. PATIENTS WITH NEWLY DIAGNOSED HAEMORRHOIDS REQUIRING HAEMORRHOIDECTOMY WERE RANDOMIZED TO EITHER LIGASURE HAEMORRHOIDECTOMY OR DIATHERMY HAEMORRHOIDECTOMY. SURGICAL TECHNIQUE AND POSTOPERATIVE CARE WAS STANDARDIZED. OUTCOME MEASURES WERE OPERATIVE TIME AND BLEEDING, POSTOPERATIVE PAIN (MEASURED ON A VISUAL ANALOGUE SCALE) AND RATE OF WOUND HEALING: RESULTS WE RANDOMIZED 44 PATIENTS, 22 TO LIGASURE AND 22 TO DIATHERMY; 43 PATIENTS WERE EVALUATED. THEY WERE AGED BETWEEN 19 AND 71 YEARS. THERE WERE NO DIFFERENCES IN PATIENT DEMOGRAPHICS OR TYPE OF HAEMORRHOID BEING OPERATED ON. LIGASURE HAEMORRHOIDECTOMY HAD A SIGNIFICANTLY LOWER MEAN OPERATIVE TIME AND INTRAOPERATIVE BLEEDING. AT 3 WEEKS AFTER SURGERY, HAEMORRHOIDECTOMY PERFORMED WITH LIGASURE HAD AN ODDS RATIO FOR COMPLETE EPITHELIALIZATION OF 3.1 OVER DIATHERMY (95% CI 1.2–8.2). THERE WAS NO DIFFERENCE IN POSTOPERATIVE PAIN: CONCLUSION LIGASURE HAEMORRHOIDECTOMY IS SUPERIOR TO DIATHERMY FOR OPEN HAEMORRHOIDECTOMY: