HARMONIC SCALPEL® VERSUS CONVENTIONAL DIATHERMY HAEMORRHOIDECTOMY; GAIN OR PAIN?

Document Type : Original Article

Authors

General Surgery Department, Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Egypt

Abstract

Aim: Postoperative pain is the most distressing drawbacks of surgical hemorrhoidectomy. We will compare 
harmonic scalpel hemorrhoidectomy with diathermy hemorrhoidectomy as regard postoperative pain, 
analgesic requirements duration of healing and other complications.
Methods: Seventy-two patients having symptomatic grade III & IV hemorrhoids were randomly classified 
into two groups; the first group (group I) (36 patients) were operated upon using harmonic scalpel® and the 
second group (group II) (36 patients) were operated upon using conventional monopolar diathermy. 
Operative time & postoperative pain severity and analgesic requirements were recorded 6, 12, 24, 48 hours, 7, 
14 and 28 days. Incidence of bleeding and wound infection was recorded in 1, 2, 3 & 4 weeks. The patients 
were followed up for 6 months where late complications as delayed wound healing, anal stenosis, 
incontinence and persistant pain, all were recorded in both groups. 
Results: Operative time was significantly shorter in harmonic scalpel group, also, there was no blood loss. 
Postoperatively, pain scoring was significantly lower in group I and subsequently daily analgesic 
requirements. Healing was faster in first group. Secondary infection and bleeding occurred in second group 
with no incidence in first group, also, temporary minor fecal incontinence occurred in second group only. 
Conclusion: Harmonic scalpel hemorrhoidectomy can be used safely for treatment of grade III & IV 
hemorrhoids and is better in most of aspects than conventional diathermy. Its cost is overcome by shorter 
operation, rapid healing and early return to work.

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