Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial

Background: Haemorrhoidal disease is one of the most frequently encountered anorectal condition in the clinical practice of a surgeon. Haemorrhoidectomy is the treatment of choice for grade III and IV haemorrhoids but is associated with significant postoperative pain and complications. Harmonic dissection causes less lateral tissue injury and thus less intra-operative bleeding and post-operative complications. The present study compares Harmonic Haemorrhoidectomy with conventional Haemorrhoidectomy.Methods: In a randomized controlled trial, patients with grade III and IV haemorrhoids satisfying inclusion and exclusion criteria were allocated to Harmonic scalpel haemorrhoidectomy or conventional Milligan Morgan open haemorrhoidectomy by block randomisation of 4. The outcome factors were intra operative blood loss, postoperative pain on VAS scale, urinary retention and anal stenosis after one month of follow up.Results: Total of 40 cases were enrolled. Of them, 22 were allocated to Harmonic haemorrhoidectomy, the rest 18 patients underwent conventional haemorrhoidectomy. The mean age of patients was 47.03 years with a Male to Female ratio of 1.35:1. Intraoperative blood loss measured by number of soaked gauze pieces and pain score measured on visual analogue scale at 12, 24 and 48hours was seen to be statistically significant (p<0.001) lesser in patients who underwent Harmonic scalpel haemorrhoidectomy. There was no statistically significant difference in operative time urinary retention or anal stenosis.Conclusions: Harmonic scalpel haemorrhoidectomy appears to be a better procedure for symptomatic grade III and grade IV haemorrhoids with ease of operating due to less bleeding, good postoperative recovery and patient acceptance.