title: Randomized, clinical trial of Ligasure vs conventional diathermy in hemorrhoidectomy.
abstract: OBJECTIVE
  Hemorrhoidectomy is frequently associated with significant postoperative pain, and new techniques to reduce this pain are constantly under evaluation. The present study was conducted to determine the usefulness of the Ligasure system and compare it with conventional diathermy for hemorrhoidectomy.
  
  
  METHODS
  Thirty-four consecutive patients with Grade 3 or 4 hemorrhoids requiring surgery were recruited and randomized into two groups by preoperative assignment of sealed envelopes. Patients with coexisting perianal disease, previous perianal surgery, or thrombosed hemorrhoids were excluded. All patients were anesthetized and operated on by a single team. In one group, monopolar diathermy in the coagulation mode was used to dissect hemorrhoidal tissue from the internal sphincter. In the second group, tissue was coagulated by Ligasure and then divided with scissors. Operating time was documented by theater staff. Postoperatively, pain scores and Cleveland Clinic incontinence scores were documented.
  
  
  RESULTS
  Seventeen patients were randomized into each group. There were no significant differences in age, gender, or clinical symptoms between the groups. The mean operating time in the Ligasure group was 6 (range, 4-10) minutes compared with 11 (range, 7-20) minutes in the other group, and this was statistically significant (P < 0.001). Patients in the Ligasure group reported significantly less pain with first defecation and at postoperative Days 1 and 14 (P < 0.001). The mean hospital stay in both groups was one (range, 1-5) day, and there was no difference in the incontinence scores.
  
  
  CONCLUSIONS
  Ligasure diathermy provides a superior alternative to conventional diathermy in hemorrhoidectomy by reducing operating time and postoperative pain.
authors.affiliation: Barnes Hospital, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Franklin
authors.forename: Seema
authors.initials: S
authors.lastname: Seetharam
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lowney
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
mesh_terms: D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain; D011183:Postoperative Complications; D011446:Prospective Studies