Page 13 - WJOLS - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Hemorrhoidectomy with Harmonic Scalpel vs Conventional

Hemorrhoidectomy

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Hana Alhomoud , Mohamed Mohsen , Salah Termos
AbstrAct
Background: Hemorrhoidal disease is one of the most frequently encountered anorectal conditions in the clinical practice. A variety of instruments
including circular staplers, harmonic scalpel, laser, and bipolar electrothermal devices are currently used when performing hemorrhoidectomy
grades III and IV.
Objective: This study compares outcomes between hemorrhoidectomy performed with harmonic scalpel and conventional methods.
Materials and methods: A prospective randomized study of consecutive 50 patients who underwent hemorrhoidectomy between January 2017
and October 2017. Patients were randomly enrolled in two different groups. Group I consisted of 25 patients who underwent hemorrhoidectomy
using an ultrasonic scalpel device (harmonic) and group II with 25 patients who had conventional hemorrhoidectomy.
Results: The patients’ demographics data and clinical characteristics were similar in both groups. The harmonic group had a shorter operation
time, less postoperative pain, less postoperative bleeding, and shorter hospital stay.
Conclusion: Harmonic scalpel hemorrhoidectomy appears to be a better procedure for symptomatic grades III and IV hemorrhoids with ease
of operating due to less bleeding, less postoperative pain, and patient acceptance. Long-term follow-up with larger scale studies is required.
Keywords: Harmonic scalpel, Hemorrhoids, Milligan–Morgan procedure.
World Journal of Laparoscopic Surgery (2018): 10.5005/jp-journals-10033-1352

IntroductIon 1,2 Department of Surgery, Al-Sabah Hospital, Alyarmouk, Kuwait
Hemorrhoidectomy is the standard treatment for patients 3 Department of Surgery, Amiri Hospital, Kuwait city, Kuwait
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with grade III or IV hemorrhoids. Milligan and Morgan open Corresponding Author: Hana Alhomoud, Department of Surgery,
hemorrhoidectomy or Ferguson closed hemorrhoidectomy is Al-Sabah Hospital, Alyarmouk, Kuwait, Phone: +965 99227676, e-mail:
still the gold standard for surgical treatment of symptomatic hana_alhomoud@hotmail.com
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hemorrhoids. However, both are associated with significant How to cite this article: Alhomoud H, Mohsen M, et al. Hem-

postoperative pain and complicaions such as urinary retention, orrhoidectomy with Harmonic Scalpel vs Conventional Hemorrhoid-
constipation, postoperative bleeding, anal incontinence, and anal ectomy. World J Lap Surg 2018;11(3):121–123.
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stenosis. Source of support: Nil

As a result, various types of surgical equipment have been Conflict of interest: None

introduced to overcome the postoperative pain and bleeding.
The operative procedures vary from conventional
cautery dissection to vessel-sealers, harmonic scalpels, laser
hemorrhoidectomy, and stapling devices. Patients were randomized into two groups: group I consist of 25
A harmonic scalpel is a device that simultaneously cuts and patients who had hemorrhoidectomy using harmonic scalpel and
coagulates tissues by producing a vibration of 55.5 kHz. When group II with 25 patients who had conventional hemorrhoidectomy.
compared with conventional electrosurgical devices, this ultrasonic All patients underwent preoperative lab tests, chest X-rays,
cutting and coagulating device has advantages such as causing electrocadiography, and urinanalysis and were admitted to the
minimal lateral tissue injury 1–3 mm wide, less fumes, more localized hospital the day before surgery. All patients were fully informed
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impact, better hemostasis, less stimulation to neuromuscular about the procedure and possible complications, and a written
tissues, and local control of the surgical site compared to a consent was given. All patients had a glycerin enema the night
hemorrhoidectomy performed with surgical scissors or monopolar before surgery and prophylactic antibiotics were injected before
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electric cautery. surgery.
The aim of this study was to analyze and compare between The outcome factors including intraoperative bleeding,
conventional hemorrhoidectomy and hemorrhoidectomy postoperative pain (on VAS scale), postoperative bleeding, urinary
performed with harmonic scalpel. retention, and anal stenosis were compared between the two
groups.
MAterIAls And Methods All data were collected and analyzed using SPSS 2 version.
A prospective randomized study involving 50 patients who were Chi-square test and student t test were performed for com-

operated for symptomatic grade III and IV hemorrhoids, in Sabah parison of groups. A p value <0.05 was considered as statistically
Hospital, Kuwait, between January 2017 and October 2017. significant.

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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