Randomized controlled study between suture ligation and radio wave ablation and suture ligation of grade III symptomatic hemorrhoidal disease

Suture ligation is a simple method to curb the hemorrhoids. The present study was conducted to determine the usefulness of suture ligation in third-degree hemorrhoids and to compare it with author's procedure of suture ligation coupled with hemorrhoidal ablation through radiowave. One hundred and twenty-four consecutive patients with grade III hemorrhoids requiring surgery were randomized into two groups. Half of them were treated by suture ligation, while the remaining patients underwent a radiowave ablation of hemorrhoids using a Ellman radiowave generator followed by suture ligation. A blinded observer evaluated postoperative pain scores, amount of analgesics consumed, and complications encountered. He also assessed recurrence of hemorrhoids after 1 year. The postoperative pain score was significantly higher in the suture ligation group (3.4 +/- 0.2 vs. 2.2 +/- 0.1, p < 0.005). The mean total analgesic dose and duration of pain control using analgesics were greater and longer for suture ligation group than radiowave group (29 +/- 4 vs. 23 +/- 3 tablets, and 15 +/- 3 days vs. 12 +/- 4 days, respectively; p < 0.001). Complications were seen more frequently in radiowave group (22% vs.18%). At 1 year follow-up, the recurrence of hemorrhoids was more significant with the suture ligation group (five patients vs. one patient, p < 0.05). Suture ligation of hemorrhoids is a simple, cost-effective, and a convenient modality in treating third-degree hemorrhoids. The efficacy and postoperative comfort is further enhanced if the hemorrhoids are ablated with radiowave prior to ligating them.