title: Surgical treatment for IV-degree hemorrhoids: LigaSure™ hemorroidectomy vs. conventional diathermy. A prospective, randomized trial.
abstract: OBJECTIVE
  Milligan-Morgan operation is still considered the treatment of choice for IV-degree haemorrhoids: it is frequently associated with significant postoperative pain and prolonged hospital stay. Many instruments were conceived to reduce these complications, such as the LigaSure™ (LS) system, a combination of radiofrequency and pressure that seems mainly effective where a large tissue demolition is required. This randomized study is
  
  
  METHODS
  Fifty-two patients with IV-degree hemorrhoids were randomly assigned to two different surgical treatments (conventional diathermy vs. LigaSure™ hemorrhoidectomy). They were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain, day of discharge early and late complications. The time of recovery of work was also assessed. All patients had a minimum follow-up of twelve months (range 12-24). All data were statistically evaluated.
  
  
  RESULTS
  Twenty-seven patients were treated by conventional diathermy, 25 by LigaSure™. The mean operative time was significantly shorter in LS, such as postoperative pain, mainly lower on the third and fourth postoperative day: moreover pain disappeared earlier in LS than CD. The time off-work was shorter in LS, while there was no difference in hospital stay and overall complications rate .
  
  
  CONCLUSIONS
  This randomized prospective controlled trial confirms, according to other large trials in literature , the benefits of the LigaSure™ hemorrhoidectomy over conventional diathermy when a large tissue demolition is required, supporting the use of this device as treatment of choice in IV degree hemorrhoids, even if the procedure is more expensive than conventional operation.
authors.affiliation: Department of General, Oncological and Videoassisted Surgery, Federico II University of Naples, Naples, Italy. magentil@unina.it
authors.forename: M
authors.initials: M
authors.lastname: Gentile
authors.forename: M
authors.initials: M
authors.lastname: De Rosa
authors.forename: V
authors.initials: V
authors.lastname: Pilone
authors.forename: F
authors.initials: F
authors.lastname: Mosella
authors.forename: P
authors.initials: P
authors.lastname: Forestieri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D003972:Diathermy; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000145:classification / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult