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Yang J, Cui PJ, Han HZ, Tong DN. Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy. World J Gastroenterol 2013; 19:4799-4807. [PMID: 23922480 PMCID: PMC3732855 DOI: 10.3748/wjg.v19.i29.4799] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/08/2013] [Accepted: 07/01/2013] [Indexed: 02/07/2023] Open
Abstract
AIM: To compare outcome of stapled hemorrhoidopexy (SH) vs LigaSure hemorrhoidectomy (LH) by a meta-analysis of available randomized controlled trials (RCTs).
METHODS: Databases, including PubMed, EMBASE, the Cochrane Library, and the Science Citation Index updated to December 2012, were searched. The main outcomes measured were operating time, early postoperative pain, postoperative urinary retention and bleeding, wound problems, gas or fecal incontinence, anal stenosis, length of hospital stay, residual skin tags, prolapse, and recurrence. The meta-analysis was performed using the free software Review Manager. Differences observed between the two groups were expressed as the odds ratio (OR) with 95%CI. A fixed-effects model was used to pool data when statistical heterogeneity was not present. If statistical heterogeneity was present (P < 0.05), a random-effects model was used.
RESULTS: The initial search identified 10 publications. After screening, five RCTs published as full articles were included in this meta-analysis. Among the five studies, all described a comparison of the patient baseline characteristics and showed that there was no statistically significant difference between the two groups. Although most of the analyzed outcomes were similar between the two operative techniques, the operating time for SH was significantly longer than for LH (P < 0.00001; OR= -6.39, 95%CI: -7.68 - -5.10). The incidence of residual skin tags and prolapse was significantly lower in the LH group than in the SH group [2/111 (1.8%) vs 16/105 (15.2%); P = 0.0004; OR= 0.17, 95%CI: 0.06-0.45). The incidence of recurrence after the procedures was significantly lower in the LH group than in the SH group [2/173 (1.2%) vs 13/174 (7.5%); P = 0.003; OR= 0.21, 95%CI: 0.07-0.59].
CONCLUSION: Both SH and LH are probably equally valuable techniques in modern hemorrhoid surgery. However, LigaSure might have slightly favorable immediate postoperative results and technical advantages.
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Pescatori M. Hemorrhoids. PREVENTION AND TREATMENT OF COMPLICATIONS IN PROCTOLOGICAL SURGERY 2012:15-56. [DOI: 10.1007/978-88-470-2077-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Radiofrequency versus conventional diathermy Milligan-Morgan hemorrhoidectomy: a prospective, randomized study. Int J Colorectal Dis 2011; 26:1345-50. [PMID: 21519801 DOI: 10.1007/s00384-011-1216-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND In the past decade, several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain. Among these radiofrequency (RF), excisional surgery seems to be safe, fast, and accompanied by less postoperative pain. The aim of this study was to evaluate and compare RF (ligasure TM) to conventional diathermy Milligan-Morgan hemorrhoidectomy (MMH). PATIENTS AND METHODS Between January 2003 and July 2009, 210 symptomatic patients were randomized to undergo RF (118 patients) or diathermy MMH (92 patients). Mean follow-up was 39 ± 16 months. Clinical outcome was assessed by validated questionnaire on postoperative symptoms and satisfaction. Primary endpoints were pain and wound healing. Secondary endpoints were operative time, early and late complications (including recurrences), and patient satisfaction. Data was analyzed using chi-squared test and Fisher's exact test. RESULTS Despite postoperative pain was less after RF, this difference was significant only for severe pain (expressed as VAS score >7). Significant differences were observed in terms of wound healing. The two techniques were similar in terms of early and late complications. CONCLUSIONS RF hemorrhoidectomy is followed by reduced severe pain and better wound healing. However, in our experience, this is not followed by earlier return to daily activities.
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Pescatori M. Emorroidi. PREVENZIONE E TRATTAMENTO DELLE COMPLICANZE IN CHIRURGIA PROCTOLOGICA 2011:15-55. [DOI: 10.1007/978-88-470-2062-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Sakr MF, Moussa MM. LigaSure hemorrhoidectomy versus stapled hemorrhoidopexy: a prospective, randomized clinical trial. Dis Colon Rectum 2010; 53:1161-7. [PMID: 20628280 DOI: 10.1007/dcr.0b013e3181e1a1e9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study was designed to compare the outcome of LigaSure hemorrhoidectomy and stapled hemorrhoidopexy for prolapsed hemorrhoids. METHODS Consecutive patients with grade III or IV hemorrhoids were randomly assigned to undergo either LigaSure hemorrhoidectomy or stapled hemorrhoidopexy. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, number of parenteral analgesic injections, duration of hospital stay, and time to return to work were all prospectively collected. Postoperative complications and recurrence of prolapse were also recorded. Patients were regularly followed for a total period of 12 months. RESULTS A total of 68 patients completed the study (34 per group). Patient demographic and clinical characteristics were similar in the 2 groups. No significant differences between LigaSure hemorrhoidectomy and stapled hemorrhoidopexy were observed in mean operating time, postoperative pain score, number of parenteral analgesic injections, duration of hospital stay, or time to return to work. The groups were also similar regarding postoperative complications, except that at 4 weeks postoperatively, residual prolapse was observed in 8 patients (23.5%) in the stapled hemorrhoidopexy group vs. 2 patients (5.9%) in the LigaSure group (P = .040). Rate of recurrence of prolapse at 1 year was higher with stapled hemorrhoidopexy (4 patients, 11.8%) than with the LigaSure procedure (1 patient, 2.9%), but the difference was not significant (P = .163). CONCLUSIONS LigaSure hemorrhoidectomy and stapled hemorrhoidopexy yield comparable good results, with a short operative time and minimal side effects in the treatment of grade III and IV hemorrhoids, but with a lower rate of residual prolapse for the LigaSure procedure. Both procedures offer low levels of postoperative pain and therefore are excellent therapeutic options for prolapsed grade III and IV hemorrhoids. A larger controlled study is needed to reach solid conclusions regarding risk of postoperative recurrence of hemorrhoidal prolapse.
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Affiliation(s)
- Mahmoud F Sakr
- Department of Surgery, Faculty of Medicine, University of Alexandria, Ramleh Station, Alexandria, Egypt.
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Haemorrhoidectomy by vessel sealing system under local anaesthesia in an outpatient setting: preliminary experience. Colorectal Dis 2010; 12:236-40. [PMID: 19508547 DOI: 10.1111/j.1463-1318.2009.01833.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM This prospective study was designed to assess the feasibility of local anaesthesia for LigaSure haemorrhoidectomy in an outpatient setting. METHOD From April 2006 to March 2007, 207 consecutive patients (median age 42, 126 males) with grade III (147) and grade IV (60) haemorrhoids, underwent Milligan-Morgan haemorrhoidectomy with LigaSure under local anaesthesia (lidocaine 1%, mean dose 27 +/- 1.7 ml) in an outpatient setting. Postoperative pain was assessed by a visual analogue scale (VAS). RESULTS Two, three and four files were removed in 120, 51 and 36 patients. Mean operative time was 12 +/- 5.2 min and mean blood loss was 3.4 +/- 3.9 ml. The mean postoperative pain scores were 6.2 +/- 2.1 for the maximal pain intensity and 6.1 +/- 2.5 for the pain on defecation. All patients left hospital after surgery within 2 h and 33 (15.9%) required analgesics. They returned to normal daily activity after 12.2 +/- 7.9 days including work (12.1 +/- 7.8 days). The wounds had healed by 32.2 +/- 9.1 days. At a follow-up of at least 6 months, only six cases of major bleeding had occurred and 24 patients had skin tags. The median satisfaction score was +2 (-2 to +3). CONCLUSION LigaSure haemorrhoidectomy under local anaesthesia in the outpatient setting is safe and effective.
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Sakr MF. LigaSure versus Milligan-Morgan hemorrhoidectomy: a prospective randomized clinical trial. Tech Coloproctol 2010; 14:13-7. [PMID: 19997953 DOI: 10.1007/s10151-009-0549-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 06/22/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The present study was conducted to compare operative time, postoperative course and outcome of LigaSure hemorrhoidectomy (LH), and conventional open hemorrhoidectomy (OH) for prolapsed hemorrhoids. METHODS Eighty-four patients with grade III and IV hemorrhoids were randomized into two groups of 42 patients each; group 1 patients underwent LH whereas group 2 patients underwent OH. Data regarding patient demographics, operative details, postoperative pain score, amount of parenteral analgesics required, length of hospital stay, and time until return to work or normal physical activity were all prospectively collected. Postoperative complications and recurrence of prolapse were also recorded. All patients had regular follow-ups every 2 weeks for the first 8 weeks postoperatively, and at 2-month intervals thereafter, for a total period of 12 months. RESULTS Patient demographics, clinical characteristics, and length of hospital stay were similar in both groups (P > 0.05). The mean operative time, postoperative pain score (up to 48 h), amount of parenteral analgesics required, time off work, and time needed for complete wound healing were significantly less in patients who underwent LH (P < 0.001). Both groups had similar postoperative complications except for delayed wound healing that was observed at 4 weeks postoperatively, in seven patients (16.67%) in the LH group compared to 17 patients (40.48%) in the OH group (chi(2) = 5.83, P = 0.016). Although hemorrhoid recurrence, at 1 year, was also lower among the LH group compared to the OH group (2.38 vs. 9.14%, respectively), the difference was not statistically significant (P = 0.167). CONCLUSIONS LH is a better alternative than conventional OH in treating prolapsed hemorrhoids (grades III and IV) since it reduces operating time, postoperative pain, and time off work, and allows surgical wounds to heal faster, with minimal comparable side effects and a low recurrence rate.
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Affiliation(s)
- M F Sakr
- Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12:85-93. [PMID: 19220374 DOI: 10.1111/j.1463-1318.2009.01807.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the use of LigaSure devices with conventional excisional techniques, circular stapling and use of Harmonic Scalpel in patients with symptomatic haemorrhoids and to review literature on LigaSure technology (Valleylab Inc. USA). METHOD A literature review was performed using the National Library of Medicine's Pubmed Database using the keywords Ligasure, haemorrhoidectomy, vessel sealing technology. Randomized trials comparing LigaSure with other techniques of excisional haemorrhoidectomy with valid end points were reviewed in the present article and included in a quantitative meta-analysis. RESULTS There was no significant difference in the proportion of patients cured after Ligasure haemorrhoidectomy or other excisional techniques (P > 0.05). Patients treated with LigaSure had a significantly shorter operative time (P < 0.001), postoperative pain VAS Score (P < 0.001), wound healing time and time-off from work (P < 0.001), than the patients submitted to excisional techniques. Postoperative bleeding did not significantly differ between the two groups (P = 0.056); however, the surgeons observed a reduction of intra- and postoperative bleeding using LigaSure. In comparison to the circular stapler and Harmonic Scalpel the authors found similar postoperative outcomes and a slightly favourable trend for LigaSure regarding postoperative complications, ease of handling and length of the procedure. CONCLUSION Our meta-analysis shows that Ligasure haemorrhoidectomy is a fast procedure characterized by limited postoperative pain, short hospitalization, fast wound healing and convalescence.
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Affiliation(s)
- G Milito
- Department of Surgery, University Hospital Tor Vergata, Rome, Italy.
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Ligasure versus diathermy hemorrhoidectomy under spinal anesthesia or pudendal block with ropivacaine: a randomized prospective clinical study with 1-year follow-up. Int J Colorectal Dis 2009; 24:1011-8. [PMID: 19396451 DOI: 10.1007/s00384-009-0715-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2009] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluate the safety and efficacy of a spinal anesthesia with lidocaine versus a local anesthesia of pudendal block with ropivacaine combined with intravenous sedation in the hemorrhoidectomy procedure and also we compared the short- and long-term efficacy of conventional diathermy versus Ligasure diathermy hemorrhoidectomy. METHODS Seventy-four patients of grade III or IV hemorrhoids were randomized to conventional diathermy hemorrhoidectomy under spinal (n = 19) or local anesthesia (n = 18) and Ligasure diathermy hemorrhoidectomy under spinal (n = 17) or local anesthesia (n = 20). Time of follow-up was 12 months. RESULTS Patients operated under local anesthesia had less pain (p < 0.01), less analgesic requirements (p < 0.001), shorter hospital stay (p < 0.01), and less postoperative complications (p < 0.05). A shorter operating time (p < 0.001) and less complications at 4 months postoperatively (p < 0.05) was observed in the Ligasure group, but differences at 12 months were not found. CONCLUSIONS Hemorrhoidectomy under local anesthesia with pudendal block with ropivacaine and sedation reduced postoperative pain, analgesic requirements, and postoperative complications, and can be performed as day-case procedure. Ligasure diathermy hemorrhoidectomy reduced operating time and was equally effective than conventional diathermy in long-term symptom control.
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Tan KY, Zin T, Sim HL, Poon PL, Cheng A, Mak K. Randomized clinical trial comparing LigaSure haemorrhoidectomy with open diathermy haemorrhoidectomy. Tech Coloproctol 2008; 12:93-7. [PMID: 18545884 PMCID: PMC2780654 DOI: 10.1007/s10151-008-0405-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 03/28/2008] [Indexed: 12/12/2022]
Abstract
Background Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results. The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results. The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy Methods A prospective clinical trial was conducted. Patients with newly diagnosed haemorrhoids requiring haemorrhoidectomy were randomized to either LigaSure haemorrhoidectomy or diathermy haemorrhoidectomy. Surgical technique and postoperative care was standardized. Outcome measures were operative time and bleeding, postoperative pain (measured on a visual analogue scale) and rate of wound healing Results We randomized 44 patients, 22 to LigaSure and 22 to diathermy; 43 patients were evaluated. They were aged between 19 and 71 years. There were no differences in patient demographics or type of haemorrhoid being operated on. LigaSure haemorrhoidectomy had a significantly lower mean operative time and intraoperative bleeding. At 3 weeks after surgery, haemorrhoidectomy performed with LigaSure had an odds ratio for complete epithelialization of 3.1 over diathermy (95% CI 1.2–8.2). There was no difference in postoperative pain Conclusion LigaSure haemorrhoidectomy is superior to diathermy for open haemorrhoidectomy
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Affiliation(s)
- K-Y Tan
- Department of Surgery Colorectal Service, Alexandra Hospital, 378 Alexandra Road, Singapore 159964, Singapore.
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Bessa SS. Ligasure vs. conventional diathermy in excisional hemorrhoidectomy: a prospective, randomized study. Dis Colon Rectum 2008; 51:940-4. [PMID: 18273670 DOI: 10.1007/s10350-008-9214-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/26/2007] [Accepted: 10/17/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to compare the surgical outcomes of hemorrhoidectomy performed by the Ligasure with that performed by the conventional diathermy. METHODS A total of 110 patients were randomized to Ligasure (55 patients) or diathermy (55 patients) hemorrhoidectomy. The operative time, postoperative pain scores, parenteral analgesic requirements in the first 24 hours, postoperative complications, and wound healing rates at six weeks postoperatively were documented. RESULTS The median operative time was 8 (range, 7-10) minutes for the Ligasure group and 18 (range, 15-21) minutes for the diathermy group (P < 0.001). Throughout the first postoperative week, the daily median pain score was lower in the Ligasure group than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 hours postoperatively was lower in the Ligasure group (P < 0.001). There was no statistically significant difference in the incidence of postoperative complications. At six weeks postoperatively, more patients in the Ligasure group had complete healing of wounds (P = 0). CONCLUSION Ligasure provides a superior alternative to conventional diathermy in hemorrhoidectomy by reducing the operative time, postoperative pain, parenteral analgesic requirements during the first 24 hours postoperatively, and the time to complete healing of wounds.
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Affiliation(s)
- Samer S Bessa
- Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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Muzi MG, Milito G, Nigro C, Cadeddu F, Andreoli F, Amabile D, Farinon AM. Randomized clinical trial of LigaSure and conventional diathermy haemorrhoidectomy. Br J Surg 2007; 94:937-42. [PMID: 17636512 DOI: 10.1002/bjs.5904] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this randomized prospective trial was to compare LigaSure and conventional diathermy haemorrhoidectomy. METHODS Two hundred and eighty-four patients with grade III or IV haemorrhoids were randomized to LigaSure or diathermy (Milligan-Morgan) haemorrhoidectomy as a day-case procedure. Operating time, postoperative pain score, hospital stay, postoperative complications, wound healing time and time to return to normal activities were assessed. Thirty-four patients were lost to follow-up. RESULTS The mean operating time for LigaSure haemorrhoidectomy was significantly shorter than that for diathermy (P = 0.011). Patients treated with LigaSure had significantly less postoperative pain (measured on a visual analogue scale; P = 0.010), a shorter wound healing time (defined as time to absence of swelling; P = 0.012) and less time off work (P = 0.010) than patients who had diathermy. Neither postoperative complications nor mean hospital stay (day-case surgery) were significantly different. CONCLUSION LigaSure haemorrhoidectomy demonstrates simplicity, reproducibility, a low complication rate, fast wound healing, a quick return to work and reduced postoperative pain.
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Affiliation(s)
- M G Muzi
- Department of Surgery, Tor Vergata University Hospital, Rome, Italy.
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Wang JY, Tsai HL, Chen FM, Chu KS, Chan HM, Huang CJ, Hsieh JS. Prospective, randomized, controlled trial of Starion vs Ligasure hemorrhoidectomy for prolapsed hemorrhoids. Dis Colon Rectum 2007; 50:1146-51. [PMID: 17587087 DOI: 10.1007/s10350-007-0260-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study was designed to evaluate the efficacy and outcome of the Starion and Ligasure vessel sealing systems for sutureless hemorrhoidectomy. METHODS Sixty-four patients with Grades III and IV hemorrhoids were randomized into two groups: 1) Starion hemorrhoidectomy (32 patients), and 2) Ligasure hemorrhoidectomy (32 patients). The patient demographics, operative details, numbers of parenteral analgesic injections, postoperative pain scores (assessed by an independent assessor), operating time, intraoperative blood loss, hospital stay, early and delayed complications, and time off from work or normal activity were recorded. The patients were regularly followed-up at 1, 2, 4, 6, 8, and 12 weeks after surgery. RESULTS The mean blood loss, mean operating time, duration of hospital stay, and time off from work or normal activity were not significantly different between the two methods (all P > 0.05), except for a lower pain score (P = 0.032) and reduced numbers of parenteral analgesic injections (P < 0.001) in Starion hemorrhoidectomy. In addition, there were no differences in the early and delayed postoperative complications between the two methods (all P > 0.05). Unfortunately, two patients with symptomatic anal stenosis requiring treatment were encountered by Ligasure hemorrhoidectomy, but none by Starion hemorrhoidectomy. CONCLUSIONS Starion hemorrhoidectomy with submucosal dissection is a safe and effective procedure, comparable to Ligasure hemorrhoidectomy. Patients derive a short-term benefit of less pain and reduced parenteral analgesic use by Starion hemorrhoidectomy. The superiority of no cases complicated with symptomatic anal stenosis requiring treatment by Starion hemorrhoidectomy seems to offer a better therapeutic alternative for prolapsed hemorrhoids.
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Affiliation(s)
- Jaw-Yuan Wang
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan
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Gravante G, Venditti D. Postoperative anal stenoses with Ligasure hemorrhoidectomy. World J Surg 2007; 31:245; author reply 246. [PMID: 16957820 DOI: 10.1007/s00268-006-0310-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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