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09 May 2017
Thoracic paravertebral block (TPB) can be administered for VATS (video-assisted thoracic surgery) method and often used for analgesic purposes and provides good results. Awake VATS (AVATS) has been

PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL OF LIGASURE VERSUS CONVENTIONAL HEMORRHOIDECTOMY FOR GRADE III AND IV HEMORRHOIDS

Performing hemorrhoidectomy with LigaSure™ vessel sealing system is a rapid and simple new technique.
The aim of this study was to evaluate LigaSure™ hemorrhoidectomy (LH) to open hemorrhoidectomy (OH) performed by the conventional diathermy. 
One hundred and sixteen patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure™ or open conventional diathermy hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, complications, need for analgesics and time to achieve complete wound healing. 
Multivisceral Resection for Colo-rectal cancers: An analysis of Prognostic factors and outcomes
The LigaSure™ group achieved a significant reduction in operative time, blood loss, first postoperative day pain score, seventh day pain score and overall pain score. Patients in the LigaSure™ group required less pethidine analgesia on the first postoperative day. Time to achieve complete wound healing were shorter in the LigaSure™ group. There was no difference in postoperative complications. 
LigaSure hemorrhoidectomy provides a valid alternative to conventional hemorrhoidectomy. Based on our results, further studies addressing long-term functional results are needed to prove that LigaSure™ hemorrhoidectomy is the ideal method of hemorrhoidectomy for the patients.
 
Wagih Mommtaz Ghnnam1
 
1) General Surgery Department, Mansoura Faculty of Medicine, Mansoura University, Egypt.

Disclosure: The author has declared no conflicts of interest.

Received: 14.07.16 Accepted: 04.08.16

Citation: 10.5455/ijsm.hemorrhoids-ligasure

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How to Cite this Article

Ghnnam, W. (2017). PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL OF LIGASURETM VERSUS CONVENTIONAL HEMORRHOIDECTOMY FOR GRADE III AND IV HEMORRHOIDS. International Journal of Surgery and Medicine, [online] 3(1). Available at: http://10.5455/ijsm.hemorrhoids-ligasure [Accessed 18 Mar. 2017].


References:

1. Agbo SP. Surgical Management of Hemorrhoids. Journal of Surgical Technique and Case Report. 2011; 3(2):68-75.

2. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001; 44:558-564.

3. Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg 2001; 234:21.

4. Ayman M. El Nakeeb, Amir A Fikry, Waleed H Omar et.al.Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases, World J Gastroenterol. 2008 November 14; 14(42): 6525–6530.

5. Wang JY, Lu CY, Tsai HL, Chen FM, Huang CJ, Huang YS, Huang TJ, Hsieh JS. Randomized controlled trial of Ligasure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg. 2006; 30:462–466.

6. Maurizio Gentile, Michele De Rosa, Gabriele Carbone, Vincenzo Pilone, Francesca Mosella, and Pietro Forestieri, “LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial,” ISRN Gastroenterology, vol. 2011, Article ID 467258, 6 pages, 2011. doi:10.5402/2011/467258

7. El Sebaei OI, El Sisi AA, Amar MS, El Sayed ME. Randomized comparative study of LigaSure versus conventional (Milligan-Morgan) hemorrhoidectomy. Menoufia Med J 2015; 28:27-33.

8. Wang JY, Tsai HL, Chen FM, Chu KS, Chan HM, Huang CJ, Hsieh JS. Prospective randomized controlled trial of Starion™ vs. Ligasure™ hemorrhoidectomy for prolapsed hemorrhoids. Dis Colon Rectum. 2007; 50:1146–1151

9. Khanna R, Khanna S, Bhadani S, Singh S, Khanna AK. Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson’s Hemorrhoidectomy. The Indian Journal of Surgery. 2010; 72(4):294-297.

10. Milito G., Cadeddu F., Muzi M. G., Nigro C., and Farinon A. M., “Haemorrhoidectomy with Ligasure vs. conventional excisional techniques: a meta-analysis of randomized controlled trials,” Colorectal Disease 2010, vol. 12, no. 2, pp. 85–93.

11. Milligan ETC, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal and the operative treatment of hemorrhoids. Lancet. 1937; 2:1119–1124.

12. Pattana-Arun J, Sooriprasoet N, Sahakijrungruang C, Tantiphlachiva K, Rojanasakul A. Closed vs. ligasure hemorrhoidectomy: a prospective, randomized clinical trial. J Med Assoc Thai 2006; 89:453. 3

13. Nienhuijs S1, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev. 2009 Jan 21;(1): CD006761

14. Chung Y, Wu HJ. Clinical experience of sutureless closed hemorrhoidectomy with ligasure. Dis Colon Rectum 2003; 46:87-92

15. Jayne D, Botterill I, Ambrose N,Brennan T, Guillou P, O‘Riordain D. Randomized clinical trial of ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg 2002; 89:428-432.

16. Palazzo F, Francis D, Clifton M. Randomized clinical trial of ligasure versus open hemorrhoidectomy. Br J Surg 2002; 89:154-157.

17. Peters C, Botterill I, Ambrose N, Hick D, Casey J, Jayne D. Ligasure vs. conventional diathermy haemorrhoidectomy: long-term follow-up of a randomized clinical trial. Colorectal Dis 2005; 7:350-353.

18. Gravante G, Venditti D. Postoperative anal stenosis with ligasure hemorrhoidectomy. World J Surg 2007; 31:245-245

19. Basdanis G, Papadopoulos V, Michalopoulos A, Apostolidis S, Harlaftis N. Randomized clinical trial of stapled hemorrhoidectomy vs. open with ligasure for prolapsed piles. Surg Endosc 2005; 19:235-239.

20. Tan K, Zin T, Sim H, Poon P, Cheng A, Mak K. Randomized clinical trial comparing LigaSure haemorrhoidectomy with open diathermy haemorrhoidectomy. Tech Coloproctol 2008; 12 :93-97.

21. Lawes D, Palazzo F, Francis D, Clifton M. One year follow up of a randomized trial comparing ligasure with open haemorrhoidectomy. Colorectal Dis 2004; 233-235.

22. Galandiuk S. Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs. Conventional Hemorrhoidectomy—Invited Critique. Arch Surg. 2007; 142(12):1218.

23. Tan EK, Cornish J, Darzi AW, Papagrigoriadis S, Tekkis PP. Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs. Conventional Hemorrhoidectomy. Arch Surg. 2007; 142(12):1209-1218.


Cited by:

1. Al-Dhahiry JKS (2018) Maxium Sutureless Closed Haemorrhoidectomy for Symptomatic Haemorrhoids Grades III and IV: An Observational Cross-sectional Study. Int J Surg Res Pract 5:062. doi.org/10.23937/2378-3397/1410062


2. Wael Barakaat Ahmed Mohamed, Omar Abdelraheem and Mohammed A. Omar. 2017. Does the use of Ligasure improve the outcome of Hemorrhoidectomy?; International Journal of Current Research; 9, (10), 59834-59837.

 

Agbo SP. Surgical Management of Hemorrhoids. Journal of Surgical Technique and Case Report. 2011; 3(2):68-75. 2. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001; 44:558-564. 3. Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg 2001; 234:21. 4. Ayman M. El Nakeeb, Amir A Fikry, Waleed H Omar et .al.Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases, World J Gastroenterol. 2008 November 14; 14(42): 6525–6530. 5. Wang JY, Lu CY, Tsai HL, Chen FM, Huang CJ, Huang YS, Huang TJ, Hsieh JS. Randomized controlled trial of Ligasure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg. 2006; 30:462–466. 6. Maurizio Gentile, Michele De Rosa, Gabriele Carbone, Vincenzo Pilone, Francesca Mosella, and Pietro Forestieri, “LigaSure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choice? A Randomized, Clinical Trial,” ISRN Gastroenterology, vol. 2011, Article ID 467258, 6 pages, 2011. doi:10.5402/2011/467258 7. El Sebaei OI, El Sisi AA, Amar MS, El Sayed ME. Randomized comparative study of LigaSure versus conventional (Milligan-Morgan) hemorrhoidectomy. Menoufia Med J 2015; 28:27-33. 8. Wang JY, Tsai HL, Chen FM, Chu KS, Chan HM, Huang CJ, Hsieh JS. Prospective randomized controlled trial of Starion™ vs. Ligasure™ hemorrhoidectomy for prolapsed hemorrhoids. Dis Colon Rectum. 2007; 50:1146–1151 9. Khanna R, Khanna S, Bhadani S, Singh S, Khanna AK. Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson’s Hemorrhoidectomy. The Indian Journal of Surgery. 2010; 72(4):294-297. 10. Milito G., Cadeddu F., Muzi M. G., Nigro C., and Farinon A. M., “Haemorrhoidectomy with Ligasure vs. conventional excisional techniques: a meta-analysis of randomized controlled trials,” Colorectal Disease 2010, vol. 12, no. 2, pp. 85–93. 11. Milligan ETC, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal and the operative treatment of hemorrhoids. Lancet. 1937; 2:1119–1124. 12. Pattana-Arun J, Sooriprasoet N, Sahakijrungruang C, Tantiphlachiva K, Rojanasakul A. Closed vs. ligasure hemorrhoidectomy: a prospective, randomized clinical trial. J Med Assoc Thai 2006; 89:453. 3 13. Nienhuijs S1, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev. 2009 Jan 21;(1): CD006761 14. Chung Y, Wu HJ. Clinical experience of sutureless closed hemorrhoidectomy with ligasure. Dis Colon Rectum 2003; 46:87-92 15. Jayne D, Botterill I, Ambrose N,Brennan T, Guillou P, O‘Riordain D. Randomized clinical trial of ligasure versus conventional diathermy for day-case haemorrhoidectomy. Br J Surg 2002; 89:428-432. 16. Palazzo F, Francis D, Clifton M. Randomized clinical trial of ligasure versus open hemorrhoidectomy. Br J Surg 2002; 89:154-157.
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