Comparison of Hemorrhoidectomy Using Bipolar Diathermy Vs Harmonic Scalpel

Background: Milligan-Morgan hemorrhoidectomy is conventional procedure but recent advances in harmonic and bipolar scalpel use in hemorrhoidectomy opened new gateway towards dissection of hemorrhoids and their pedicle ligation. Comparison between two is less studied in terms of pain outcome as patient perceives and operative time. Aim: To compare outcome of hemorrhoidectomy using bipolar diathermy versus harmonic scalpel in a tertiary care hospital. Methods: This randomized control trial study was conducted in Surgical Unit-1, Services Hospital Lahore from 31st April 2014 to 31st October 2014. One hundred and thirty patients were included. They were divided in two groups; group one, hemorrhoidectomy was carried out using bipolar diathermy technique and group two by harmonic scalpel method. All the patients presenting to surgical OPD with Symptomatic Grade III and all Grade IV Hemorrhoids were evaluated by consultant. Patients enrolled in the study will be hospitalized on the operation day and enema were performed twice (6 hours and 1 hour) prior to the operation. Patients were placed in the lithotomy position. After dilatation of anal canal, situation of hemorrhoids was determined with an anoscope. Anal spongostan will be placed for both patient groups to control bleeding. Time consumed will be calculated in minutes from first incision to last suture. Patients were given standard and equal dosing of diclofenic sodium and followed at 24 hour post operatively and on day 7 for pain on visual analogue scale. Results: The mean age 38.32 +/- 12.84 years of group I and 36 +/- 12.36 of group 2. There were significant differences in operative time and post-operative pain score at 24 hours in both groups. Conclusion: Bipolar hemorrhpidectomy is significantly better than hemorrhoidectomy with harmonic scalpel.