Volume : 7, Issue : 7, July - 2018

A study of harmonic scalpel assisted haemorrhoidectomy at tertiary care centre

Dr Avishkar Kacheshwar Barase, Dr Kirankumar Jadhav, Dr Sudhir B Dube

Abstract :

<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:200%;mso-layout-grid-align:none;text-autospace:none"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Background:</span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Conventional haemorrhoidectomy is still considered as gold standard therapy for grade III &amp;IV haemorrhoids. The conventional haemorrhoidectomy can be made easier with the help of harmonic scalpel with associated less post-operative complications.This study evaluated in a randomized prospective manner the differences in; duration of hospital stay, postoperative complications, symptomatic recurrence and cost effectiveness between conventional and harmonic scalpel assisted haemorrhoidectomy.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:200%;mso-layout-grid-align:none;text-autospace:none"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Methods: </span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">The prospective study was carried out in 60 patients of symptomatic grade III &amp; IV haemorrhoids, presented during August 2015 to August 2017. Each group of 30 patients treated with harmonic scalpel assisted haemorrhoidectomy and conventional haemorrhoidectomy; followed up for 6 months for complications.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:200%;mso-layout-grid-align:none;text-autospace:none"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Results: </span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black">In present study, the severity of pain was significantly more following conventional haemorrhoidectomy than harmonic scalpel assisted haemorrhoidectomy. Urinary retention was more common with conventional haemorrhoidectomy. Anal incontinence had similar incidence in both the groups of haemorrhoidectomy. Two patients had anal stenosis after conventional haemorrhoidectomy as compared to none in the harmonic scalpel group. No recurrence noted in both the groups. Cost effectiveness of the procedure is measured in form of hospital stay and return to daily activity and harmonic scalpel group have advantage over the conventional haemorrhoidectomy group in terms of less hospital stay and early return to daily activity.</span><span lang="EN-IN" style="font-size:12.0pt;&#10;line-height:200%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;"><o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;text-align:&#10;justify;line-height:200%;mso-layout-grid-align:none;text-autospace:none"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN"><span style="mso-spacerun:yes">&nbsp;</span>Conclusion</span></b><span lang="EN-IN">: Harmonic scalpel<span style="mso-spacerun:yes">&nbsp; </span>assisted haemorrhoidectomy appears to be a better procedure compared with conventional haemorrhoidectomy in terms of less post-operative complications and decreased hospital stay in symptomatic patients with grade III &amp; IV haemorrhoids.</span></p>