title: Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy.
abstract: BACKGROUND
  Harmonic Scalpel(R) hemorrhoidectomy (HSH) is an established surgical therapy for the treatment of symptomatic grade III and IV hemorrhoids. Hemorrhoid surgery is still being performed as an inpatient procedure with general or regional anesthesia in many centers today. There was a trend toward performing hemorrhoid surgery as an ambulatory procedure using local anesthesia supplemented with intravenous sedation. The aim of the current study was to evaluate the safety and efficacy of HSH performed with combination local anesthesia and intravenous sedation in an ambulatory surgical center.
  
  
  METHODS
  A retrospective review was performed on the clinical charts of all patients undergoing HSH in an ambulatory surgical center from 2001 to 2005. All hemorrhoidectomies were attempted under propofol/ketamine intravenous sedation and local anesthesia in the prone position. A simple, open technique without routine suture was used.
  
  
  RESULTS
  During the study period, 180 patients (70 females) underwent HSM. Mean procedure and total operating room time were 12 and 28 min, respectively. One patient (0.6%) was converted to general endotracheal anesthesia. Ten patients (5.6%) required post anesthesia care unit (PACU) observation. All patients were discharged home after the procedure. Postoperative complications occurred in 19 patients (10.6%). There were no reoperations and the total readmission rate was 3.7%.
  
  
  CONCLUSIONS
  HSH performed with a combination of intravenous sedation and local anesthesia is safe and effective in the ambulatory surgery setting. The combined technique was associated with a rate of complications comparable to published series utilizing conventional hemorrhoidectomy techniques. Added benefits include shorter hospital stay and a potential for cost savings.
authors.affiliation: Section of Colon and Rectal Surgery, University of Massachusetts Medical Center, Worcester, MA 01655, USA. haveranl@ummhc.org
authors.forename: Liam A
authors.initials: LA
authors.lastname: Haveran
authors.forename: Paul R
authors.initials: PR
authors.lastname: Sturrock
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Sun
authors.forename: Janet
authors.initials: J
authors.lastname: McDade
authors.forename: Sudershan
authors.initials: S
authors.lastname: Singla
authors.forename: Craig A
authors.initials: CA
authors.lastname: Paterson
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Counihan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives