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Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials

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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.

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Authors and Affiliations

  1. Institute of Surgery, The Townsville Hospital/School of Medicine, James Cook University, Townsville, QLD, 4811, Australia

    C. D. Mushaya & P. J. Caleo

  2. Faecal Incontinence Research Group, School of Public Health, Tropical Medicine and Rehabilitation Science within the North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, 4811, Australia

    L. Bartlett

  3. School of Medicine and the Australian Institute of Tropical Medicine, within the North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, 4811, Australia

    Y. H. Ho

  4. Tropical Health Solutions Pty Ltd, Townsville, QLD, 4811, Australia

    P. G. Buettner

Authors
  1. C. D. Mushaya
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  2. P. J. Caleo
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  3. L. Bartlett
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  4. P. G. Buettner
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  5. Y. H. Ho
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Correspondence to L. Bartlett.

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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

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  • DOI: https://doi.org/10.1007/s10151-014-1169-1

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