Surgical treatment of hemorrhoids

Abstract

PURPOSE: The object of this study was to evaluate technique using the ultrasonically activated scalpel as an alternative to closed hemorrhoidectomy in an unbiased evaluation of this new technology. METHODS: Thirty patients with Grade 2 or 3 symptomatic hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by electrocautery or hemorrhoidectomy with the ultrasonically activated scalpel,i.e., the Harmonic Scalpel®. We evaluated the difference between techniques in operative time, postoperative pain, incontinence, and quality of life (using the Short Form-36 survey), as well as complications. RESULTS: Mean operative time for closed hemorrhoidectomy with electrocautery was 35.7 ± 3 minutes; for Harmonic Scalpel® patients, it was 31.7 ± 2 minutes (P<0.37). There was no statistical difference in operative time for two- or three-column hemorrhoidectomy. There was no significant difference in pain measurements reported on Day 1 (5.8 ± 0.4 for electrocautery and 5.6 ± 0.6 for Harmonic Scalpel®,P<0.82). On postoperative Dayaq 7, the difference in pain between groups approached significance, with pain reported as 3.7 ± 0.3 for electrocautery and 5.1 ± 0.7 for Harmonic Scalpel® (P<0.06). At six weeks, both groups were pain free. There was a significant decrease in pain between postoperative Days 1 and 7 in the electrocautery patients that was not seen in the Harmonic Scalpel® patients. Incontinence measured preoperatively, at postoperative Day 7, and at postoperative Week 6 was similar for both groups and reflected occasional incontinence of gas. When the various items of the Short Form-36 survey were compared, there was no significant difference between posttreatment and preoperative values. There was no difference in the number of complications between patient groups. CONCLUSION: Although the Harmonic Scalpel® is an effective tool in the treatment of hemorrhoidal disease, we found no specific advantage in postoperative pain, fecal incontinence, operative time, quality of life, or complications compared with traditional closed hemorrhoidectomy.