Abstract
Background
Haemorrhoidectomy is the most effective and definitive treatment for grade 3 or 4 haemorrhoids despite being associated with considerable pain. The aim of this study was to search the literature, which compares outcomes of harmonic scalpel haemorrhoidectomy and traditional surgical procedures, and conduct a quantitative meta-analysis of the randomized trials.
Methods
Randomized controlled trials (RCTs) were identified from the major electronic databases using the keywords “harmonic scalpel haemorrhoidectomy” and “haemorrhoidectomy” and a quantitative meta-analysis conducted. The eight trials that met the inclusion criteria included 468 patients (233 in the harmonic scalpel group). Pain was the primary outcome measure, and other parameters assessed included duration of operation, length of hospital stay, time to return to work, and complications.
Results
Significantly, more patients returned to work in the first post-operative week, and pain scores were an average of one unit lower following harmonic scalpel haemorrhoidectomy. Generally, the incidence of complications in the harmonic scalpel group was less than half that found in conventional haemorrhoidectomy. There was no significant difference between the groups as regards operating time or length of hospital stay. Recurrence was not reported in any of the studies.
Conclusions
The meta-analysis showed that harmonic scalpel haemorrhoidectomy is a safe and effective modality associated with less post-operative pain and a more rapid return to work than traditional surgery for haemorrhoids. Statistical heterogeneity was high; thus, it may be too early to place complete confidence in these results. Further RCTs are required.
Similar content being viewed by others
References
Johannsson HO (2005) Haemorrhoids: aspects of symptoms and results after surgery. Uppsala University, Uppsala
MacRae HM, McLeod RS (1995) Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 38:687–694
Goligher JC, Graham NG, Clark CG, De Dombal FT, Giles G (1969) The value of stretching the anal sphincters in the relief of post-haemorrhoidectomy pain. Br J Surg 56:859–861
Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM (2010) Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 12:85–93
Schwartz R (1994) Total laparoscopic total hysterectomy with the harmonic scalpel. J Gynecol Surg 10:33–34
McCarus SD (1996) Physiologic mechanism of the ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc 3:601–608
Miller CE, Amaral JF (1994) Harmonic scalpel–pros and cons! Fertil Steril 62:1094–1095
Clarke M, Oxman AD (2002) Cochrane reviewers’ handbook 4.1.5. In: The Cochrane Library, Issue 2. Update Software, Oxford. Updated quarterly
Haveran LA, Sturrock PR, Sun MY et al (2007) Simple harmonic scalpel hemorrhoidectomy utilizing local anesthesia combined with intravenous sedation: a safe and rapid alternative to conventional hemorrhoidectomy. Int J Colorectal Dis 22:801–806
Armstrong DN, Frankum C, Schertzer ME, Ambroze WL, Orangio GR (2002) Harmonic scalpel hemorrhoidectomy: five hundred consecutive cases. Dis Colon Rectum 45:354–359
Fleshman J (2002) Advanced technology in the management of hemorrhoids: stapling, laser, harmonic scalpel, and ligasure. J Gastrointest Surg 6:299–301
Nicholson TJ, Armstrong D (2004) Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 47:711–716
Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384
Tan JJ, Seow-Choen F (2001) Prospective, randomized trial comparing diathermy and harmonic scalpel hemorrhoidectomy. Dis Colon Rectum 44:677–679
Khan S, Pawlak SE, Eggenberger JC et al (2001) Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the harmonic scalpel technique of excisional hemorrhoidectomy. Dis Colon Rectum 44:845–849
Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR (2001) Harmonic scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 44:558–564
Abo-hashem AA, Sarhan A, Aly AM (2010) Harmonic scalpel compared with bipolar electro-cautery hemorrhoidectomy: a randomized controlled trial. Int J Surg 8:243–247
Hintze J (2008) PASS 2008 NCSS, LLC. Kaysville, UT, www.ncss.com
Chung CC, Ha JP, Tai YP, Tsang WW, Li MK (2002) Double-blind, randomized trial comparing harmonic scalpel hemorrhoidectomy, bipolar scissors hemorrhoidectomy, and scissors excision: ligation technique. Dis Colon Rectum 45:789–794
Ivanov D, Babovic S, Selesi D, Ivanov M, Cvijanovic R (2007) Harmonic scalpel hemorrhoidectomy: a painless procedure? Med Pregl 60:421–426
Ramadan E, Vishne T, Dreznik Z (2002) Harmonic scalpel hemorrhoidectomy: preliminary results of a new alternative method. Tech Coloproctol 6:89–92
Ho YH, Buettner PG (2007) Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol 11:135–143
Ozer MT, Yigit T, Uzar AI et al (2008) A comparison of different hemorrhoidectomy procedures. Saudi Med J 29:1264–1269
Ho YH, Seow-Choen F, Tan M, Leong AF (1997) Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg 84:1729–1730
Pescatori M, Anastasio G, Bottini C, Mentasti A (1992) New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum 35:482–487
Giordano P, Gravante G, Sorge R, Ovens L, Nastro P (2009) Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 144:266–272
Mastakov MY, Buettner PG, Ho YH (2008) Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure for haemorrhoids. Tech Coloproctol 12:229–239
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mushaya, C.D., Caleo, P.J., Bartlett, L. et al. Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol 18, 1009–1016 (2014). https://doi.org/10.1007/s10151-014-1169-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-014-1169-1