Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial

Background: This study was designed to compare the surgical outcomes of haemorrhoidectomy performed by the Ligasure, Harmonic Scalpel with that performed by the conventional diathermy. Methods: A total of 180 patients were randomized to Ligasure, Harmonic Scalpel and diathermy haemorrhoidectomy, 60 patients for each group. The operative time, post-operative pain scores, parenteral analgesic requirements in the first 24 h, post-operative complications and wound healing rates were documented. Results: The median operative time was 8 min (range, 7-18) for the Ligasure and Harmonic Scalpel groups and 18 min (range, 15-21) for the diathermy group (P < 0.001). Throughout the first post-operative week, the daily median pain score was lower in the Ligasure and Harmonic Scalpel groups than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 h post-operatively was lower in the Ligasure and Harmonic Scalpel groups (P < 0.001). There was no statistically significant difference in the incidence of post-operative complications. At 6 weeks post-operation, more patients in the Ligasure and Harmonic Scalpel groups had complete healing of wounds (P = 0 < 0.001). Conclusion: Ligasure and Harmonic Scalpel provide a superior alternative to conventional diathermy in haemorrhoidectomy with no difference between them in reducing the operative time, post-operative pain, analgesic requirements during the first 24 h and time to complete healing of wounds.