J Gastroenterol Hepatol Endosc | Volume 4, Issue 4 | Case Report | Open Access
Tshijanu F1*, Biniari G1, Paraskevopoulou E1, Kabilafka L2 and Xiarchos A1
1Department of Surgery, Athens Medical Group, Clinic of Peristeri, Greece 2Department Anesthesiology, Athens Medical Group, Clinic of Peristeri, Greece
*Correspondance to: Fernand Tshijanu
Fulltext PDFBackground: The aim of surgical management of hemorrhoids is to decrease the volume of the swelled hemorrhoidal cushion and to fix the adjacent displaced tissues. However, there are numerous postoperative issues in the term of pain, bleeding etc. impeding to return to daily activities. The occurrence of such postoperative events constitutes a giant proctologic dilemma leading to ongoing debate regarding the best surgical approach for hemorrhoids. Objective: This prospective study aims to balance the postoperative outcome of two surgical approaches for hemorrhoidal disease, the bipolar Ligasure hemorrhoidectomy, and the classical Milligan-Morgan procedure. Patients: Consecutive patients from both genders and different ages, presenting with diverse grades of haemorrhoidal disease, and operated in our Department, from 2014 to 2018. We divided them in two groups accordingly to the procedure they were shifted to. We included only patients with primary haemorrhoidal disease and exclude all cases of recurrent hemorrhoids. For each, we collected age, gender, degree of hemorrhoids, postoperative events. The follow-up period was for 12 months. Results: A total of 4,540 patients were enrolled 2,759 males and 1,781 females, 2650 (58%) patients underwent Ligasure hemorrhoidectomy vs. 1890 (42%). In the Ligasure procedure group, the mean operative time was 10 minutes to 20 min vs. 15 min to 27 min. In both groups, the majority of patients were males. Regarding postoperative outcome, patients from LigaSure group noticed less postoperative pain (5%, 92% vs. 10%, 26%), as well as less recurrence rate (7%, 77% vs. 12%, 03%). There was no significant difference between the two procedural groups regarding other postoperative events, such as bleeding, fever, Urinary Retention (UR), Fecal Incontinence (IC), Anal Stenosis (AS). In both groups, pain was more noticed more in patients with 3rd degree haemorrhoids compared to 4th degree. In the ligature group, the recurrence rate was more inflated in 3rd degree haemorrhoids (14%, 14% vs. 7%, 04%) and in classical Milligan-Morgan group, the recurrence was noticed more in patients with 4th degree. Ethical considerations: We receive from each enrolled patients a written informed consent as well as an approval from the scientific board of our Clinic. Conclusion: According to our five year experience, Ligasure hemorrhoidectomy is a less painful procedure, with law recurrence rate, allowing a quickly return to daily activities. Therefore, it can be stated as an ideal surgical procedure rather than the classical Milligan-Morgan procedure.
Hemorrhoids; Classical Milligan-Morgan procedure; Ligasure hemorrhoidectomy
Tshijanu F, Biniari G, Paraskevopoulou E, Kabilafka L, Xiarchos A. Comparison of Bipolar LigaSure Hemorrhoidectomy with Classical Milligan-Morgan Procedure: A Five Year Randomized Prospective Study (2014-2018). J Gastroenterol Hepatol Endosc. 2019;4(4):1067..