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Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy.

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Harmonic Scalpel® hemorrhoidectomy (HSH) is an established surgical therapy for the treatment of symptomatic grade III and IV hemorrhoids. Hemorrhoid surgery is still being performed as an inpatient procedure with general or regional anesthesia in many centers today. There was a trend toward performing hemorrhoid surgery as an ambulatory procedure using local anesthesia supplemented with intravenous sedation. The aim of the current study was to evaluate the safety and efficacy of HSH performed with combination local anesthesia and intravenous sedation in an ambulatory surgical center.

Materials and methods

A retrospective review was performed on the clinical charts of all patients undergoing HSH in an ambulatory surgical center from 2001 to 2005. All hemorrhoidectomies were attempted under propofol/ketamine intravenous sedation and local anesthesia in the prone position. A simple, open technique without routine suture was used.

Results

During the study period, 180 patients (70 females) underwent HSM. Mean procedure and total operating room time were 12 and 28 min, respectively. One patient (0.6%) was converted to general endotracheal anesthesia. Ten patients (5.6%) required post anesthesia care unit (PACU) observation. All patients were discharged home after the procedure. Postoperative complications occurred in 19 patients (10.6%). There were no reoperations and the total readmission rate was 3.7%.

Conclusion

HSH performed with a combination of intravenous sedation and local anesthesia is safe and effective in the ambulatory surgery setting. The combined technique was associated with a rate of complications comparable to published series utilizing conventional hemorrhoidectomy techniques. Added benefits include shorter hospital stay and a potential for cost savings.

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Author information

Authors and Affiliations

  1. Section of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA, USA

    Liam A. Haveran, Paul R. Sturrock, Mark Y. Sun, Janet McDade, Craig A. Paterson & Timothy C. Counihan

  2. Department of Anesthesiology, University of Massachusetts Medical Center, Worcester, MA, USA

    Sudershan Singla

  3. Department of Surgery, University of Massachusetts Medical Center, 55 Lake Avenue-North, Room S3-717, Worcester, MA, 01655, USA

    Liam A. Haveran

Authors
  1. Liam A. Haveran
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  2. Paul R. Sturrock
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  3. Mark Y. Sun
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  4. Janet McDade
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  5. Sudershan Singla
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  6. Craig A. Paterson
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  7. Timothy C. Counihan
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Corresponding author

Correspondence to Liam A. Haveran.

Additional information

This study was approved by the Internal Review Board at the University of Massachusetts Medical Center and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Given the retrospective nature of this study, informed consent was not obtained (approved by the ethics committee).

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Haveran, L.A., Sturrock, P.R., Sun, M.Y. 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 22, 801–806 (2007). https://doi.org/10.1007/s00384-006-0242-2

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  • DOI: https://doi.org/10.1007/s00384-006-0242-2

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