Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure vs conventional hemorrhoidectomy.
OBJECTIVE
To evaluate the short-term outcomes of hemorrhoidectomy performed using the LigaSure vessel sealing device (Valleylab, Boulder, Colorado) or the conventional approach.


METHODS
MEDLINE, EMBASE, Ovid, and Cochrane databases for studies published between 2002 and 2006.


METHODS
Randomized controlled trials published between 2002 and 2006 comparing short-term outcomes for LigaSure vs conventional hemorrhoidectomy.


METHODS
Operative parameters, short-term complications, and postoperative recovery. Trials were assessed using a modified Jadad score. Random-effects meta-analytical techniques were used in the analysis.


RESULTS
Nine randomized controlled trials with matched selection criteria reporting on 525 patients, of whom 266 (50.7%) underwent LigaSure and 259 (49.3%) underwent conventional hemorrhoidectomy. Operative time (weighted mean difference [WMD], - 8.67 minutes; 95% confidence interval [CI], - 15.34 to - 2.00 minutes), blood loss (WMD, - 23.08 mL; 95% CI, - 27.24 to - 18.92 mL), and pain the day after the operation measured by the visual analog scale (WMD, - 2.31; 95% CI, - 3.37 to - 1.26) were significantly reduced following LigaSure hemorrhoidectomy. There was a decrease in time taken to return to work or normal activity (WMD, - 3.49 days; 95% CI, - 7.40 to 0.43), which was of marginal significance (P = .08). Incidence of postoperative hemorrhage was comparable as was incidence of anal stenosis and fecal and flatus incontinence between the 2 groups.


CONCLUSIONS
LigaSure hemorrhoidectomy results in a significant reduction in operative time and blood loss, but it may not confer any advantage over the conventional operation in terms of postoperative pain, length of hospital stay, or time taken to return to work or normal activity. The expediency of the device must be weighed against its additional cost. Long-term evaluation of outcomes and morbidity are still needed.
Tan
Emile K
EK
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, 10th Floor QEQM Wing, Praed Street, London W2 1NY, England.
Cornish
Julie
J
Darzi
Ara W
AW
Papagrigoriadis
Savas
S
Tekkis
Paris P
PP
D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome