Randomized clinical trial comparing LigaSure haemo

Authors: K Y Tan T Zin H L Sim P L Poon A Cheng K Mak

Publish Date: 2008/06/10

Volume: 12, Issue: 2, Pages: 93-

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Abstract

Despite the current interest in stapled haemorrhoidopexy conventional MilliganMorgan open haemorrhoidectomy remains a frequently performed operation in our country The lower cost of the procedure associated with a good longterm cosmetic effect in patients with large skin tags make open haemorrhoidectomy a viable option still An Italian study published very recently actually found the MilliganMorgan procedure to have better results than stapled haemorrhoidopexy 1 These results were echoed in a systematic review a few months previously 2The use of the LigaSure tissuesealing device provides an alternative to performing open haemorrhoidectomy for third and fourth degree piles Some Western studies have shown benefits of using LigaSure over diathermy in terms of operative time postoperative pain and wound healing 3 4 5The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy in our setting and population We sought to assess LigaSure in terms of ease of use postoperative pain and wound healing rate at our centreA prospective randomized clinical trial was conducted at our centre All patients with newly diagnosed symptomatic third and fourth degree haemorrhoids requiring haemorrhoidectomy were included in the recruitment for the trial For inclusion patients had to be between 21 to 80 years of age This trial was investigatorinitiated The distributor of the LigaSure tissuesealing system provided the electrodes for the trial so that the extra cost of treatment with LigaSure would not be passed on to the patientsAll patients were randomized to receive either LigaSure haemorrhoidectomy or conventional haemorrhoidectomy using sealed envelopes The randomization performed was nonconsecutive in nature The envelopes were sequentially numbered with allocations determined before the trial commenced Randomization was performed in the operating theatre just prior to surgery A standard medication package was issued to all patients postoperatively Patients were blinded to the type of surgery performed The National Healthcare Group of Singapore Domain Specific Review Board endorsed this trialA standardized general anaesthetic technique using propofol fentanyl and inhalation anaesthesia was used All patients were given a Fleet enema prior to surgery Patients underwent MilliganMorgan open haemorrhoidectomy using either LigaSure or diathermy according to the randomization In all patients 10 ml 025 bupivacaine was injected into the perianal skin prior to dissection The pile masses were retracted and dissected off the internal sphincter using either diathermy or the LigaSure vesselsealing device The pedicles were secured clear of the internal sphincter and the resected wound left open to granulate with adequate skin bridges The operative time was recorded by an operating theatre nurse Blood loss was recorded as the number of soaked gauzesAll patients were prescribed Fybogel one sachet daily for 2 weeks to aid in defecation after the operation All patients were prescribed Daflon two tablets twice daily for 2 weeks Paracetamol 1 g four times daily and diclofenac 50 mg twice daily orally were prescribed to all patients for postoperative analgesia The patients were discharged on the same postoperative day unless otherwise clinically indicated All patients were asked to clean the wound using a shower spray twice daily Patients were then followed up in the clinic 2 weeks after discharge and then further reviewed at 3 4 and 6 weeks after surgery

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