Excisional haemorrhoidectomy remains the gold standard for the management of symptomatic grade III and grade IV haemorrhoids. No standardised technique for the procedure has gained widespread acceptance due to post-operative pain. In this prospective randomised study, we aimed to compare the results of Harmonic scalpel haemorrhoidectomy with conventional open Milligan Morgan haemorrhoidectomy in the surgical treatment of symptomatic grade III and grade IV haemorrhoidal disease.
Methods: 72 patients with symptomatic grade III and grade IV haemorrhoids were admitted and randomised into two groups: 1. Harmonic Scalpel haemorrhoidectomy (HSH) or 2. Open Milligan-Morgan haemorrhoidectomy (MMH). The outcomes were measured on the basis of operative duration, blood lost during surgery, post-operative Visual Analog Scores (VAS) of the patient, length of hospital stay and complications, both early and late.
Results: Baseline patient demographics (mean age, gender-based distribution, haemorrhoidal grade and symptoms) were similar in both the groups. But the mean operative time in HSH group and MMH group was 13.12±2.67 min and 24.12±2.18 min respectively and blood lost was 14.67±2.04 mL and 38.48±5.13 mL respectively. The average VAS of the patients of the HSH group was 4.47±0.78, 3.67±0.55, 1.13±0.035 and for the MMH group was 7.3±0.77, 5.9±0.84, 1.57±0.77 on day 1, day 2, and day 14 respectively. 17 patients who developed complications were managed conservatively.
Conclusion: Harmonic scalpel haemorrhoidectomy is a safe, and fast alternative for the surgical management of grade III and grade IV haemorrhoids. It effectively minimises post-operative bleeding and pain and has a lesser complication rate when compared to open Milligan Morgan haemorrhoidectomy.