Comparison Outcome of Vessel-Sealing Devices Hemorrhoidectomy Versus Conventional Ferguson Hemorrhoidectomy in Samut Prakan Hospital
Keywords:Vessel-Sealing Devices hemorrhoidectomy, Conventional Ferguson hemorrhoidectomy
Background: Hemorrhoidal disease is one of the most common anorectal diseases and surgical hemorrhoidectomy, it remains one of the most common operations in general surgery for patients with internal hemorrhoid grade 3 and 4. Milligan-Morgan and Ferguson described the conventional hemorrhoidectomy since about 70 years ago. In the last decade, many studies show that Vessel-Sealing Devices hemorrhoidectomy seems to be very effective treatment and results in better surgical outcomes when compared with the conventional hemorrhoidectomy. Objective: This study aims to compare the outcome of haemorrhoidectomy done by Vessel-Sealing Devices technique with conventional Ferguson technique. Methods: This retrospective study was done at Samut Prakan Hospital over a period from 1 July 2016 to 31 December 2018 on the basis of: It included 90 adult patients with 3rd and 4th degree hemorrhoids divided into 2 groups: Group one (53 patients) underwent Conventional Ferguson hemorrhoidectomy. Group two (37 patients) underwent Vessel-Sealing Devices hemorrhoidectomy. The outcomes of two groups were compared using the Chi-square test and Fisher’s exact test. A p-value less than 0.05 was considered statistically significant. Results: The results of the operations by using between Vessel-Sealing Devices hemorrhoidectomy and Conventional Ferguson hemorrhoidectomy, there were statistically significant difference in terms of operative time (8.0 ± 5.0 minutes and 20.6 ± 12.5 minutes; p<0.001), intraoperative blood los s(2.7 ± 1.3 milliliters and 11.6 ± 4.0 milliliters; p<0.001) , pain score at post operative 1st day (3.6 ± 1.2 and 6.3 ± 1.3; p<0.001) and 2nd day (2.0 ± 1.1 and 4.1 ± 1.1; p<0.001), length of hospital stay (1.2 ± 0.6 days and 2.3 ± 2.2 days; p = 0.003), dose of NSAIDs used (3.0 ± 0.8 dose and 5.0 ± 2.1 dose; p <0.001), and wound healing time (3.3 ± 0.6 weeks and 5.6 ± 1.0 weeks 0; p<0.001). But post operative complication and hospital cost were not statistically significant different between two groups. Conclusion: Vessel-Sealing Devices hemorrhoidectomy is better than Conventional Ferguson hemorrhoidectomy in terms of less operative time, less post-operative pain, less intraoperative blood loss, length of hospital stay, less post-operative analgesics and earlier wound healing.
Varut L. Definition of hemorrhoids. World J Gastroenterol 2015; 31: 9245–52.
Elesmore S, Windsore AC. Surgical history of haemorrhoids. In: Charles MV, editor. Surgical Treatment of Haemorrhoids. London: Springer 2002; 1:1-4.
MacRae HM, Vu NV, Graham B, Werd – Sims M, Collver JA, Robbs RS. Comparison of hemorrhoidal treatment modalities: a meta-analysis. Diseases of the Colon and Rectum 1995; 38: 687–94.
Milligan ETC, Naunton CN, Morgan, Jones L, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. The Lancet 1937; 230:1119–24.
Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Diseases of the Colon and Rectum 1959; 2:176–79.
Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, et al. Stapled hemorrhoidectomy—cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis of the Colon Rectum 2000; 43:1666–75.
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database of Syst Rev 2006; 4:CD005393.
Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg 2001; 234: 21–4.
Kennedy JS, Stranahan PL,Taylor KD, Chandler JG. High-burst-strength, feedback-controlled bipolar vessel sealing. Sur Endosc 1998; 12: 876–8.
Nighat B, Moosa FA, Jaleel F,Qureshi NA, Jawaid M. Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan’s hemorrhoidectomy, Pak J Med Sci 2016; 32:657-61.
Thorbeck CV, Montes MF. Haemorrhoidectomy: randomized controlled clinical trial of LigaSure compared with Milligan-Morgan operation. Eur J Surg 2002; 9: 482-4.
Nienhuijs S, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev 2009; 1: 21.
Muzi MG, Milito G, Nigro C, Cadeddu F, Andreoli F, Amabile D, et al. randomized clinical trial of LigaSure™ and conventional diathermy haemorrhoidectomy. Br J Surg 2007; 94: 937 – 42.
Altomare DF, Milito G, Andreoli R, Arcana F, Tricomi N, Salafia C,et al. Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial. Dis Colon Rectum 2008; 51: 514-9.
Tan EK, Cornish J, Darzi AW. Meta-analysis of short-term outcomes of randomized controlled trials of ligasure vs conventional hemorrhoidectomy. Arch Surg 2007;142:1209–10.
Chen JS, You JF. Current status of surgical treatment for hemorrhoids – systematic review and meta-analysis. Chang Gung Med J 2010;33:488–500.
Chung CC, Ha JP, Tai YP, Tsang WW, Li MK. Double-blind, randomized trial comparing Harmonic Scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum 2002; 45:789–94.
Milito G, Cadeddu F, Muzi MG. Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12:85–93.
Bessa SS. Ligasure VS. conventional diathermy in excisional hemorrhoidectomy: a prospective, randomized study. Dis Colon Rectum 2008; 51:940-4.
Gentile M, De Rosa M, Carbone G, Pilone V, Mosella F, Forestieri P. LigaSure haemorrhoidectomy versus conventional diathermy for IV-degree haemorrhoids: Is it the treatment of choice? A Randomized, clinical trial. ISRN Gastroenterol 2011:467258.
How to Cite
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์