Pain after conventional versus Ligasure haemorrhoidectomy. A meta-analysis.
BACKGROUND
Haemorrhoidectomy is a frequently performed surgical procedure and associated with postprocedural pain. The use of the Ligasure may result in a decreased incidence of pain as coagulation with high frequency current and active feedback control over the power output results in minimal thermal spread and limited tissue charring.


METHODS
A multi-database systematic search was conducted to identify trials randomizing conventional and Ligasure haemorrhoidectomy. Key journals were hand searched. There was no restriction on language. Two reviewers independently extracted data and assessed trial quality. Odd Ratios were generated for dichotomous variables. Weight Mean Differences were used for analysing continuous variables. Only random effects models were used. Heterogeneity was explored by sensitivity analysis.


RESULTS
Twelve studies with 1142 patients met the inclusion criteria. The pain score at the first day following surgery was significantly less in the Ligasure group (10 studies, 835 patients, WMD -2.07 CI -2.77 to -1.38). The benefit was diminished at day 14 (VAS pain score, 4 studies, 183 patients, WMD -0.12 CI -0.37 to 0.12). The conventional technique took significantly longer to complete (11 trials, 9.15 minutes, CI 3.21 to 15.09). Significantly less urinary retentions and less delayed wound healing were noted following Ligasure haemorrhoidectomy. There was no relevant difference in other postoperative complications, symptoms of recurrent bleeding or incontinence at final follow-up. Hospital stay was similar for both groups. Patients treated with the Ligasure-technique returned to work significantly earlier (4 studies, 451 patients, 4.88 days, CI 2.18 to 7.59). Sensitivity analysis in case of considerable heterogeneity distinguished closed from open conventional technique.


CONCLUSIONS
Since the usage of the Ligasure technique results in significantly less immediate postoperative pain after haemorrhoidectomy without any adverse effect on postoperative complications, convalescence and incontinence-rate, this technique is superior in terms of patient tolerance. Although there was a tendency for equal efficacy, more evaluation of the long-term risk of recurrent haemorrhoidal disease is required.
Nienhuijs
S W
SW
Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 25623 EJ Eindhoven, The Netherlands. s.nienhuijs@hccnet.nl
de Hingh
I H J T
IH
D004564:Electrocoagulation / Q000295:instrumentation*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome