Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation

Diseases of the Colon and Rectum
D N ArmstrongG R Orangio

Abstract

Management of posthemorrhoidectomy pain remains a very unsatisfactory clinical dilemma. Compared with electrocautery and laser, the Harmonic Scalpel causes minimal lateral thermal injury during tissue dissection. The aim of the study was to establish whether decreased lateral thermal injury translated into diminished posthemorrhoidectomy pain. A prospective randomized trial comparing Harmonic Scalpel hemorrhoidectomy and electrocautery was undertaken. Fifty consecutive patients were randomized into two groups: Harmonic Scalpels and electrocautery hemorrhoidectomy. The indications included Grade III internal hemorrhoids with external components or Grade IV disease. Patients with additional anorectal pathology (fissure or fistula) were excluded, as were patients with neurologic deficits, chronic pain syndrome, and those already taking narcotic analgesics. Pain was assessed using a visual analog scale preoperatively and on postoperative Days 1, 2, 7, 14, and 28. Twenty-four-hour narcotic usage (Hydrocodone, 10 mg) was recorded on postoperative Days 1, 2, 7, 14, and 28. A three-quadrant modified Ferguson hemorrhoidectomy was performed with each patient in the prone jackknife position. Pain in the Harmonic Scalpel hemorrhoidectomy g...Continue Reading

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