Ligasure versus diathermy hemorrhoidectomy under spinal anesthesia or pudendal block with ropivacaine: a randomized prospective clinical study with 1-year follow-up.
OBJECTIVE
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.
Castellví
J
J
Department of Surgery, Hospital de Viladecans, E-08840 Viladecans, Barcelona, Spain. 27044jcv@comb.es
Sueiras
A
A
Espinosa
J
J
Vallet
J
J
Gil
V
V
Pi
F
F
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000700:Analgesics; D000775:Anesthesia, Spinal / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D003972:Diathermy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain; D011183:Postoperative Complications; D000077212:Ropivacaine; D016896:Treatment Outcome; D055815:Young Adult
D000577:Amides; D000700:Analgesics; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008012:Lidocaine