Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastrointest Surg. Oct 27, 2011; 3(10): 147-152
Published online Oct 27, 2011. doi: 10.4240/wjgs.v3.i10.147
Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy
Akira Tsunoda, Haruki Sada, Takuya Sugimoto, Nobuyasu Kano, Mariko Kawana, Tadanori Sasaki, Hideki Hashimoto
Akira Tsunoda, Haruki Sada, Takuya Sugimoto, Nobuyasu Kano, Department of Surgery, Kameda Medical Center, Chiba 296-8602, Japan
Mariko Kawana, Tadanori Sasaki, Department of Pharmacy Services, Kameda Medical Center, Chiba 296-8602, Japan
Hideki Hashimoto, Department of Health economics and Epidemiology Research, School of Public Health, University of Tokyo, Tokyo 108-8639, Japan
Author contributions: Tsunoda A, Sada H, Sugimoto T, Kano N and Sasaki T concept and designed this study; Tsunoda A, Sada H and Sugimoto T contribute to the surgical treatment; Sada H, Kawana M and Sugimoto T collected the data; Hashimoto H contributed to the statistical analyses; Tsunoda A, Kano N and Sasaki T analyzed and interpreted the data; Tsunoda A drafted the manuscript; Sada H, Sugimoto T, Kano N, Kawana M and Sasaki T revised the manuscript critically for important intellectual contact; Tsunoda A, Sada H, Sugimoto T, Kano N, Kawana M and Sasaki T made the final approval of the version to be published.
Correspondence to: Akira Tsunoda, Chief, Department of Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba 296-8602, Japan. a.tsunoda@kameda.jp
Telephone: +81-4-70922211 Fax: +81-4-70991198
Received: March 28, 2011
Revised: October 17, 2011
Accepted: October 22, 2011
Published online: October 27, 2011
Abstract

AIM: To compare hemorrhoidectomy with a bipolar electrothermal device or hemorrhoidectomy using an ultrasonically activated scalpel.

METHODS: Sixty patients with grade III or IV hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by bipolar diathermy (group 1) or hemorrhoidectomy with the ultrasonic scalpel (group 2). Operative data were recorded, and patients were followed at 1, 3, and 6 wk to evaluate complications. Independent assessors were assigned to obtain postoperative pain scores, oral analgesic requirement and satisfaction scores.

RESULTS: Reduced intraoperative blood loss median 0.9 mL (95% CI: 0.8-3.7) vs 4.6 mL (95% CI: 3.8-7.0), P = 0.001 and a short operating time median 16 (95% CI: 14.6-18.2) min vs 31 (95% CI: 28.1-35.3) min, P < 0.0001 was observed in group 1 compared with group 2. There was a trend towards lower postoperative pain scores on day 1 group 1 median 2 (95% CI: 1.8-3.5) vs group 2 median 3 (95% CI: 2.6-4.2), P = 0.135. Reduced oral analgesic requirement during postoperative 24 h after operation median 1 (95% CI: 0.4-0.9) tablet vs 1 (95% CI: 0.9-1.3) tablet, P = 0.006 was observed in group 1 compared with group 2. There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications.

CONCLUSION: Bipolar diathermy hemorrhoidectomy is quick and bloodless and, although as painful as closed hemorrhoidectomy with the ultrasonic scalpel, is associated with a reduced analgesic requirement immediately after operation.

Keywords: Hemorrhoidectomy, Ligasure™, Harmonic Scalpel™, Randomized controlled trial, Pain