title: A comparison of different hemorrhoidectomy procedures.
abstract: OBJECTIVE
  To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel (HS) and classical methods.
  
  
  METHODS
  Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS (n=22), closed HS (n=22), Miligan Morgan (n=22), and Ferguson (n=21) hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time.
  
  
  RESULTS
  Bleeding volume was significantly lower in Groups I-II (p<0.001). Operation time was significantly shorter in Group I (p<0.001). Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III (p<0.001) compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III (p<0.004). Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV (p<0.001). Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III (p<0.007) and similar in closed hemorrhoidectomy group.
  
  
  CONCLUSIONS
  The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain.
authors.affiliation: Department of General Surgery, Gulhane Military Medical Academy, Ankara, Turkey. mtahirozer@gmail.com
authors.forename: Mustafa T
authors.initials: MT
authors.lastname: Ozer
authors.forename: Taner
authors.initials: T
authors.lastname: Yigit
authors.forename: Ali I
authors.initials: AI
authors.lastname: Uzar
authors.forename: Oner
authors.initials: O
authors.lastname: Mentes
authors.forename: Ali
authors.initials: A
authors.lastname: Harlak
authors.forename: Selim
authors.initials: S
authors.lastname: Kilic
authors.forename: Ahmet
authors.initials: A
authors.lastname: Cosar
authors.forename: Ismail
authors.initials: I
authors.lastname: Arslan
authors.forename: Turgut
authors.initials: T
authors.lastname: Tufan
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged