A double-blind, randomized trial comparing Ligasure and Harmonic Scalpel hemorrhoidectomy.

PURPOSE: The major problem after hemorrhoidectomy is postoperative pain. New techniques have been evolved to circumvent this problem. The present study was conducted to compare the outcomes of Ligasure hemorrhoidectomy and Harmonic Scalpel hemorrhoidectomy.

METHODS: This study was a double-blind, randomized controlled trial. Patients with Grade 3 and 4 hemorrhoids admitted for hemorrhoidectomy were selected and randomized into two groups: 1) Ligasure hemorrhoidectomy or 2) Harmonic Scalpel hemorrhoidectomy. The primary outcomes measured were the analgesic requirement and the postoperative pain score (assessed by an independent assessor). Secondary outcome criteria included the operating time, blood loss, hospital stay, patient satisfaction score, and early and late complications.

RESULTS: Forty-nine patients were randomized into two groups (LigaSure 24, Harmonic Scalpel 25). Two patients were lost to follow-up, leaving 47 patients (LigaSure 24, Harmonic Scalpel 23) available for final analysis. The age and gender distribution were comparable. The postoperative pain score (median 2.6 vs. 4.8, P < 0.001) and postoperative oral analgesic (Dologesic) requirement (median 5 vs. 13, P = 0.001) were significantly less in the LigaSure group. The operating time (median 11 vs. 18 minutes, P < 0.001) was significantly less in the LigaSure group. The hospital stay, patient satisfaction score, percentage of patients requiring pethidine injection, percentage of patients with first bowel movement on or before the first postoperative day, and complication rates were similar between the two groups.

CONCLUSIONS: Ligasure hemorrhoidectomy reduces the postoperative pain and operating time compared to the Harmonic Scalpel hemorrhoidectomy. It is a safe, effective procedure for treating Grade 3 and 4 hemorrhoids.