Sheikh Atiq-ur Rehman, Adil Irshad, Muhammad Younus Khan, Usman Rizvi, Rashid Khan, Nawab Ali.
Comparison of the outcome of ultrasonic harmonic scalpel and electrocautry in open hemorrhoidectomy.
Pak J Surg Jan ;37(3):173-9.

Introduction: Hemorrhoidectomies are being performed with new devices, such as bipolar electrothermal devices, ultrasonic scalpels, and circular staplers. The operation performed with these devices have recently been reported to result in better pain relief and less bleeding post-operatively compared to previous conventional surgical methods. Objectives: To compare the outcome of ultrasonic harmonic scalpel and electrocautery in open hemorrhoidectomy. Study design: Randomized controlled trial Settings: Department of Surgery, Bahawal Victoria Hospital, Bahawalpur. Study duration:1st May 2019 to 30th November 2020. Materials and Methods: Total 100 patients with grade III haemorrhoids, of 25-65 years of age of both genders were selected. Patients with recurrent haemorrhoids, thrombosed haemorrhoids, chronic liver failure (CRF), chronic liver disease (CLD) and diabetes mellitus (DM) were excluded. Group-A included the cases in which ultrasonic harmonic scalpel hemorrhoidectomy was done while group-B included the cases in which electrocautery open hemorrhoidectomy was done. All the procedures were performed by the same surgeon (with at least 3 years post-fellowship experience). All the patients were assessed by me and outcome (as per operational definitions) was noted. Results: In our study, post-operative pain was seen in 01 (2.0%) patients aft er ultrasonic harmonic scalpel and in 17 (34.0%) after electrocautery in open hemorrhoidectomy (p-value = 0.0001). Post-operative bleeding was seen in 04 (8.0%) after ultrasonic harmonic scalpel and in 14 (28.0%) aft er electrocautery in open hemorrhoidectomy (p-value = 0.009). Recurrence was seen in 00 (0.0%) after ultrasonic harmonic scalpel and in 03 (6.0%) after electrocautery in open hemorrhoidectomy (p-value = 0.079). Conclusion: Post-operative pain, bleeding and recurrence is less after ultrasonic harmonic scalpel use as compared to electrocautery in open hemorrhoidectomy.

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