title: LigasureTM hemorrhoidectomy: how we do.
abstract: BACKGROUND
  Hemorrhoidectomy is considered the gold standard and the most effective and definitive treatment for grades 3 or 4 hemorrhoids, and Milligan-Morgan's and Ferguson's procedures are the most widely used techniques throughout the world. The aim of the study was to present our surgical technique using LigasureTM vessel sealing, focus on technical aspects and surgical tricks showing our results with a huge number of patients and a long-term follow-up.
  
  
  METHODS
  Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, Italy, 1000 patients were selected to underwent LigasureTM hemorrhoidectomy for III and IV degree hemorrhoids. Age range 19-80 years, ASA I-II-III. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. Patients were followed-up at one week, one month, six, and twelve months after the operation and after 60 months they responded to the follow-up telephone interview and replied to the questionnaire.
  
  
  RESULTS
  One-thousand patients were undergone LigasureTM hemorrhoidectomy. The mean follow-up was 7 years and 110 (11%) patients was lost from the follow-up after the first postoperative month. Among early postoperative complications, 21 patients (2.1%) has urinary retention treated with a urinary catheter and removed before the discharge. 3 (0.3%) patients had a minor bleeding that required a package of hemostatic absorbable sponge, as late complications, in 35 patients (4%) anal fissure due to hard stool, an incomplete healing was observed in 11 patients (1.1%) after the first month. Three transphincteric anal fistulas (0.3%) were collected and four perianal abscess (0.4%) were observed during the first month of the follow-up and they required a delayed surgical treatment. At the end of the seven years of follow-up 70 recurrences (7.8%) and 35 anal stenosis (4%) were detected.
  
  
  CONCLUSIONS
  If technical guidelines are respected rigorously and the device is applied correctly, feared late complications, such as impaired fecal continence, anal stricture and postoperative pain can be minimized.
authors: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors: Giovanni
authors: G
authors: Milito
authors: Department of Surgery, University Hospital of Verona, Borgo Roma, Verona, Italy - giolimas06@yahoo.it.
authors: Giorgio
authors: G
authors: Lisi
authors: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors: Elena
authors: E
authors: Aronadio
authors: Department of Surgery, University Hospital of Modena e Reggio Emilia, Modena, Italy.
authors: Michela
authors: M
authors: Campanelli
authors: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors: Dario
authors: D
authors: Venditti
authors: Department of Surgery, University Hospital of Messina, Messina, Italy.
authors: Simona
authors: S
authors: Grande
authors: Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
authors: Michele
authors: M
authors: Grande
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000295:instrumentation*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D055815:Young Adult