title: Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy.
abstract: OBJECTIVE
  To compare hemorrhoidectomy with a bipolar electrothermal device or hemorrhoidectomy using an ultrasonically activated scalpel.
  
  
  METHODS
  Sixty patients with grade III or IV hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by bipolar diathermy (group 1) or hemorrhoidectomy with the ultrasonic scalpel (group 2). Operative data were recorded, and patients were followed at 1, 3, and 6 wk to evaluate complications. Independent assessors were assigned to obtain postoperative pain scores, oral analgesic requirement and satisfaction scores.
  
  
  RESULTS
  Reduced intraoperative blood loss median 0.9 mL (95% CI: 0.8-3.7) vs 4.6 mL (95% CI: 3.8-7.0), P = 0.001 and a short operating time median 16 (95% CI: 14.6-18.2) min vs 31 (95% CI: 28.1-35.3) min, P < 0.0001 was observed in group 1 compared with group 2. There was a trend towards lower postoperative pain scores on day 1 group 1 median 2 (95% CI: 1.8-3.5) vs group 2 median 3 (95% CI: 2.6-4.2), P = 0.135. Reduced oral analgesic requirement during postoperative 24 h after operation median 1 (95% CI: 0.4-0.9) tablet vs 1 (95% CI: 0.9-1.3) tablet, P = 0.006 was observed in group 1 compared with group 2. There was no difference between the two groups in the degree of patient satisfaction or number of postoperative complications.
  
  
  CONCLUSIONS
  Bipolar diathermy hemorrhoidectomy is quick and bloodless and, although as painful as closed hemorrhoidectomy with the ultrasonic scalpel, is associated with a reduced analgesic requirement immediately after operation.
authors: Akira Tsunoda, Haruki Sada, Takuya Sugimoto, Nobuyasu Kano, Department of Surgery, Kameda Medical Center, Chiba 296-8602, Japan.
authors: Akira
authors: A
authors: Tsunoda
authors: Haruki
authors: H
authors: Sada
authors: Takuya
authors: T
authors: Sugimoto
authors: Nobuyasu
authors: N
authors: Kano
authors: Mariko
authors: M
authors: Kawana
authors: Tadanori
authors: T
authors: Sasaki
authors: Hideki
authors: H
authors: Hashimoto