LigaSure-assisted versus diathermy day case haemorroidectomy: a randomized controlled trial.

Aim: Milligan-Morgan haemorrhoidectomy is considered the best treatment for haemorrhoidal disease. The major drawback is severe post-operative pain. We postulate that using the LigaSure™ vessel sealing system to divide the haemorrhoidal pedicle may cause less postoperative pain. Methods: This was a double-blinded randomised controlled trial in a single institution. Consecutive patients undergoing elective day-case haemorrhoidectomy were recruited. Patients were randomised into the diathermy (D) group or the LigaSure™ (L) group. The haemorrhoidal pedicle was coagulated with monopolar diathermy in D group or the LigaSure vessel sealing system in L group. Patients were seen in post-operative weeks 1, 3, 6 and 12 for assessment. Primary outcome was post-operative pain by 10cm visual analog pain score. Secondary outcomes include operative time, complications and day discharge rate. Results: 68 patients were recruited in this study (n=33 in D group versus n=35 in L group) with comparable demographic data. There was no significant difference in VAS pain score (median postoperative one-week cumulative pain score: D group = 40.2 versus L group = 39, p=0.93). More complications were observed in D group (5 versus 2, p=0.25) but this was not statistically significant. Day discharge rate was similar in the two groups at about 88%. Conclusion: Ligasure-assisted haemorrhoidectomy is not superior to diathermy haemorrhoidectomy. Day case haemorrhoidectomy is feasible and safe with both techniques. [ABSTRACT FROM AUTHOR]