Randomized clinical trial of Ligasure™versus conventional diathermy for day-case haemorrhoidectomy

Abstract

Abstract Background Haemorrhoidectomy is frequently associated with postoperative pain and prolonged hospital stay. A new technique of haemorrhoidectomy using the Ligasure™ device suited to day-case surgery is described. This technique was compared with conventional open diathermy haemorrhoidectomy. Methods Forty patients with grade III or IV haemorrhoids were randomized to Ligasure™ (group 1) or conventional diathermy (group 2) haemorrhoidectomy. Operative details were recorded and patients recorded daily pain scores on a linear analogue scale. Follow-up was at 1, 3, 6 and 12 weeks to evaluate complications, return to normal activity, ongoing symptoms and patient satisfaction. Results Reduced intraoperative blood loss (median (range) 0 (0–5) ml versus 20 (12–22) ml; P < 0·001) and a shorter operating time (10 (8–11) versus 20 (18–25) min; P < 0·001) was observed in group 1 compared with group 2. More patients in group 1 were discharged on the day of operation (18 of 20 versus 11 of 20; P < 0·05) and there was a trend towards lower postoperative pain scores on day 1 (group 1 median 5 (95 per cent confidence interval (c.i.) 2·6 to 6·8) versus group 2 7 (95 per cent c.i. 4·2 to 7·7); P = 0·36). There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications. Conclusion Ligasure™ diathermy may be used safely in the treatment of patients with grade III or IV haemorrhoids. It reduces intraoperative blood loss and operating time, and facilitates same-day discharge.