Harmonic Scalpel® compared with bipolar electro-cautery hemorrhoidectomy: A randomized controlled trial

Introduction: Surgical excision using Harmonic Scalpel (R) is a modern technique used for ablation of symptomatic third degree and all fourth-degree hemorrhoids. Compared with electrocautery, Harmonic Scalpel (R) causes minimal lateral thermal injury during tissue dissection. The resulting mucosal defect is then either left open or sutured (closed) depending on surgeon preference. The aim of this work was to evaluate the value of using Harmonic Scalpel (R) in reducing incidence of postoperative complications following Hemorrhoidectomy. Patients & Methods: This is a single-blind randomized controlled trial done at Zagazig University hospital during the period from July 2007 to December 2008. Patients underwent surgical excision of complex grade III or grade IV hemorrhoids. They were divided into two groups: (A) Harmonic Scalpel (R) Hemorrhoidectomy group and (B) Bipolar Electro-cautery Hemorrhoidectomy group. Pain levels scoring and postoperative complications were analyzed. Results: Postoperative pain in Group (A) was significantly less with less analgesic requirement. There was no significant difference between both groups regarding other postoperative complications. Conclusion: This study demonstrates significantly reduced postoperative pain after Harmonic Scalpel (R) Hemorrhoidectomy compared with bipolar electro-cautery Hemorrhoidectomy. Most likely, this result came from the avoidance of excessive lateral thermal injury caused by bipolar electrocautery. (C) 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.