Comparative Analysis for the Treatment of Hemorrhoids Using Harmonic Scalpel versus Conventional Hemorrhoidectomy: A Single-Center Experience

Blood Loss ◽

Patient Group ◽

Harmonic Scalpel ◽

Conventional Hemorrhoidectomy ◽

Background: Hemorrhoidectomy is one of the most effective treatments for Grade III/IV hemorrhoids. This study was aimed to compare the outcomes and postoperative complications arising from the harmonic scalpel hemorrhoidectomy with conventional hemorrhoidectomy. Methods: In this retrospective study, 1120 patients were operated on for symptomatic Grade III/IV hemorrhoids during April 2004-April 2020. In the conventional hemorrhoidectomy patient group, the operation was performed by Ferguson closed method using monopolar electrocautery, while the other patient group was operated using a harmonic scalpel. Patient demographic data and common patient complaints were recorded. Operation duration and blood loss during the procedure were noted. Regular follow up of the patients was done for 4 weeks, and postoperative pain relief was recorded using the Visual Analog Scale. Finally, patient satisfaction and complete wound healing were analyzed along with postoperative complications like incontinence, secondary hemorrhage, recurrence, and anal stenosis. Results: The patient demographic characteristics and preoperative complaints were similar for both groups. Harmonic scalpel procedure resulted in shorter operation time and less blood loss. Postoperative pain relief was substantially better in the patient group who underwent harmonic scalpel hemorrhoidectomy. Harmonic hemorrhoidectomy procedure also resulted in higher patient satisfaction and wound healing. Minimal postoperative complications were observed for both groups. Conclusion: Harmonic scalpel hemorrhoidectomy is a safe and effective procedure that achieves simultaneous tissue and vessel sealing. It reduces the duration of the operation, blood loss, postoperative pain, and complications compared to a conventional hemorrhoidectomy procedure.

Harmonic scalpel compared with conventional open (Milligan-Morgan) method in surgical management of symptomatic haemorrhoids

10.18203/2349-2902.isj20172402 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2010

Author(s):

Ravi Kumar G. V. ◽

Madhu B. S. ◽

Vishal Tanga ◽

Naveen Kumar Reddy M. ◽

Praveen M. Pawar

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Hospital Stay ◽

Harmonic Scalpel ◽

Early Postoperative Complications ◽

Surgical Methods ◽

Significant Difference ◽

Normal Work ◽

Background: There have been many attempts to find less painful surgical methods for treating haemorrhoids. Harmonic scalpel is a device that simultaneously cuts and coagulates soft tissues through ultrasonic vibrations. The aim of this study was to compare the results of Harmonic scalpel hemorrhoidectomy with conventional Milligan Morgan hemorrhoidectomy for the treatment of grade III and IV hemorrhoids.Methods: Patients with grade III or IV hemorrhoids, operated between January 2016 and December 2016, using the harmonic scalpel (n=30) or the conventional open technique (n=30) were studied. Both the groups were compared with respect to Operative time, Blood loss during surgery, early postoperative complications, postoperative pain measured on a visual analog scale (VAS), hospital stay, and return to normal work.Results: Harmonic scalpel and conventional open haemorrhoidectomy patients differ significantly in terms of VAS score of postoperative pain, blood loss during surgery, early post-operative complications, return to normal work. However, there is no significant difference in terms of duration of surgery and hospital stay in both the groups.Conclusions: Harmonic scalpel haemorrhoidectomy has been found advantageous method when assessing the amount of bleeding intraoperatively, post-operative pain, early postoperative complications, and Return to normal work. Hence Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternate method for treating symptomatic haemorrhoids.

Harmonic Scalpel versus Conventional Haemostasis in Neck Dissection: A Prospective Randomized Study

International Journal of Surgical Oncology ◽

10.1155/2013/369345 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Emanuele Ferri ◽

Enrico Armato ◽

Giacomo Spinato ◽

Marcello Lunghi ◽

Giancarlo Tirelli ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Hospital Stay ◽

Neck Dissection ◽

Operative Time ◽

Harmonic Scalpel ◽

Intraoperative Blood Loss ◽

Bipolar Diathermy ◽

Classic Technique

Purpose.The aim of this prospective randomized trial was to compare operative factors, postoperative outcomes, and surgical complications of neck dissection (ND) when using the harmonic scalpel (HS) versus conventional haemostasis (CH) (classic technique of tying and knots, resorbable ligature, and bipolar diathermy).Materials and methods.Sixty-one patients who underwent ND with primary head and neck cancer (HNSCC) resection were enrolled in this study and were randomized into two homogeneous groups: CH (conventional haemostasis with classic technique of tying and knots, resorbable ligature, and bipolar diathermy) and HS (haemostasis with harmonic scalpel). Outcomes of the study included operative time, intraoperative blood loss, drainage volume, postoperative pain, hospital stay, and incidence of intraoperative and postoperative complications.Results.The use of the HS reduced significantly the operating time, the intraoperative blood loss, the postoperative pain, and the volume of drainage. No significant difference was observed in mean hospital stay and perioperative, and postoperative complications.Conclusion.The HS is a reliable and safe tool for reducing intraoperative blood loss, operative time, volume of drainage and postoperative pain in patients undergoing ND for HNSCC. Multicenter randomized studies need to be done to confirm the advantages of this technique and to evaluate the cost-benefit ratio.

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

10.18203/2349-2902.isj20171610 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1627

Author(s):

Atul Philipose ◽

Murtaza Akhtar ◽

Divish Saxena ◽

Siddharth Keswani

Keyword(s):

Randomized Controlled Trial ◽

Postoperative Pain ◽

Blood Loss ◽

Urinary Retention ◽

Harmonic Scalpel ◽

Controlled Trial ◽

Anal Stenosis ◽

Randomized Controlled ◽

Conventional Haemorrhoidectomy ◽

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.

Efficacy of Ruiyun procedure for hemorrhoids combined simplified Milligan–Morgan hemorrhoidectomy with dentate line-sparing in treating grade III/IV hemorrhoids: a retrospective study

BMC Surgery ◽

10.1186/s12893-021-01251-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qiuxiang Yu ◽

Congcong Zhi ◽

Lansi Jia ◽

Hui Li

Keyword(s):

Wound Healing ◽

Recurrence Rate ◽

Dentate Line ◽

Healing Time ◽

Post Operation ◽

Time Required ◽

Wound Healing Time ◽

Normal Work ◽

Abstract Background Hemorrhoids are common. Hemorrhoidectomy should typically be offered to patients whose symptoms result from external hemorrhoids or combined internal and external hemorrhoids with prolapse (grades III/IV). However, none of the currently used surgical methods could be considered an ideal surgical option that is effective, safe, and painless. We hypothesized that a combination of Ruiyun procedure for hemorrhoids (RPH) and simplified Milligan–Morgan hemorrhoidectomy (sMMH) will increase the safety and effectiveness of surgical treatment hemorrhoids. This study aimed to evaluate the efficacy of Ruiyun procedure for hemorrhoids combined simplified Milligan–Morgan hemorrhoidectomy with dentate line-sparing (RPH + sMMH) to treat grade III/IV hemorrhoid. Methods Total 452 patients with hemorrhoids of grade III/IV were retrospectively reviewed in China-Japan Friendship Hospital, 244 cases were assigned to RPH + sMMH group, and 208 cases in MMH group. The primary efficacy outcome was rate of curative at 3 month after operation, and the recurrence rate within 12 months post operation. Secondary efficacy outcomes included wound healing time, time required to resume normal work, constipation symptom, quality of life, and pain post operation was also evaluated. The safety outcome included postoperative complications. Results There were no differences between the two groups in demographic characteristics. There was no statistically significant difference between the two groups in the curative rate. The recurrence rate after 12 months post operation in the RPH + sMMH (3.0%) was significantly lower than the sMMH group (7.8%) (P = 0.032). The wound healing time was significantly shorter in RPH + sMMH group than that in MMH group (P < 0.001). The time required to resume normal work in the RPH + sMMH group was significantly shorter than MMH group (P < 0.001). Compared with the MMH group, the RPH + sMMH therapy preserve better life quality and lower constipation symptom (all P < 0.05). Patients who underwent RPH + sMMH had significantly less postoperative pain than MMH therapy. The total rate of patients with postoperative complications in the RPH + sMMH group (8.6%) was significant lower than the MMH group (16.3%) (P = 0.012). Conclusion RPH + sMMH may more effective in treating patients with III/IV hemorrhoids, which indicated lower recurrence rate, lower postoperative complications and pain, shorter recovery and return to normal life.

Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v25i1.1434 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Mukesh Kumar Prasad ◽

Payal Jain ◽

Rohit Kumar Varshney ◽

Aditi Khare ◽

Gurdeep Singh Jheetay

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Blood Loss ◽

General Anesthesia ◽

Local Anesthesia ◽

Skin Graft ◽

Tumescent Local Anesthesia ◽

Graft Harvest ◽

Contracture Release ◽

Split Skin

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique. Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale). Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group. Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia. Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39. DOI: 10.35975/apic.v25i1.1434 Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

Ultrasound-guided anterior and posterior quadratus lumborum block for analgesia after laparoscopic hysterectomy

Pain Management ◽

10.2217/pmt-2020-0008 ◽

2021 ◽

Vol 11 (1) ◽

pp. 5-8

Author(s):

Neha Singh ◽

Parnandi Bhaskar Rao ◽

Anirudh Elayat

Keyword(s):

Patient Satisfaction ◽

Postoperative Pain ◽

Pain Relief ◽

Laparoscopic Hysterectomy ◽

Multimodal Analgesia ◽

Total Laparoscopic Hysterectomy ◽

Opioid Consumption ◽

Ultrasound Guided ◽

Analog Scale ◽

Quadratus Lumborum

Aim: Laparoscopic procedures are now preferred over open surgeries, and total laparoscopic hysterectomy is becoming increasingly popular. Quadratus lumborum (QL) block is an evolving technique for abdominal surgeries that blocks T5–L1 nerve branches. Methods: We used a combination of anterior and posterior QL block given bilaterally in two patients and evaluated perioperative opioid consumption, postoperative pain score and patient satisfaction. Results: There was reduced perioperative opioid consumption along with postoperative visual analog scale for pain over the first 24 h. Both patients appreciated the level and standard of pain relief. Conclusion: QL block is promising as a part of multimodal analgesia for laparoscopic abdominal surgeries. Further studies are needed to determine the best possible combination of different approaches to QL block.

A Prospective Study Comparing Diathermy and Scalpel Incisions in Tension-Free Inguinal Hernioplasty

The American Surgeon ◽

10.1177/000313480507100410 ◽

2005 ◽

Vol 71 (4) ◽

pp. 326-329 ◽

Cited By ~ 11

Author(s):

Emmanuel Chrysos ◽

Elias Athanasakis ◽

Sokratis Antonakakis ◽

Evaghelos Xynos ◽

Odysseas Zoras

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Blood Loss ◽

Wound Infection ◽

Skin Incision ◽

Prosthetic Material ◽

Complication Rates ◽

Inguinal Hernioplasty ◽

Tension Free ◽

Tissue Dissection

Although still controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rates or postoperative pain are reported with the use of electrocautery. However, these studies include operations without the use of prosthetic materials during abdominal wall closure. The purpose of this study was to investigate the hypothesis that a) application of extreme heat may result in significant postoperative pain and poor wound healing because of excessive tissue damage and scarring respectively, and b) skin incision with the use of diathermy entails increased risk of wound infection in the presence of an underlying prosthetic material. One hundred twenty-five consecutive patients submitted to inguinal hernioplasty using the tension-free technique and fulfilling the inclusion criteria for the study were allocated alternately to either scalpel (n = 60), or diathermy (n = 57) groups. Eight patients had bilateral hernias. Five of them were allocated to the scalpel group and three to the diathermy group. According to the study protocol, they received both approaches for skin and underlying tissues incision, thus resulting in a total of 68 scalpel and 65 diathermy individual hernioplasties. Parameters measured included blood loss during the skin incision and underlying tissue dissection, postoperative pain and requirements for analgesics, the presence of wound dehiscence in the absence of infection, and postoperative wound infection on the day of discharge, on the day staples were removed, and 1 month after surgery. The two groups of patients were similar in relation to patient demographics, type of hernias, and operation details. Blood loss was minimal, and the amount of blood lost did not differ between the two groups. Diathermy group patients required less parenteral analgesics on the first postoperative day. A higher proportion of patients in the scalpel group continued to need oral analgesics on the second postoperative day compared to patients in the diathermy group. There was no difference between the two groups in terms of wound strength. Infectious complications were totally absent. The use of diathermy for skin incision during inguinal hernioplasty is as safe as the use of scalpel in terms of wound healing and reduces the analgesics requirements in the postoperative period.

Evaluation of Surgical Treatment of Oroantral Fistulae in Smokers Versus Non-Smokers

Medicina ◽

10.3390/medicina56060310 ◽

2020 ◽

Vol 56 (6) ◽

pp. 310 ◽

Cited By ~ 1

Author(s):

Adi Sella ◽

Yehonatan Ben-Zvi ◽

Leon Gillman ◽

Gal Avishai ◽

Gavriel Chaushu ◽

...

Keyword(s):

Wound Healing ◽

Surgical Treatment ◽

Postoperative Pain ◽

Soft Tissue ◽

Maxillofacial Surgery ◽

Bony Defect ◽

Surgical Closure ◽

Significant Difference ◽

Severe Postoperative Pain

Background and Objectives: Smoking has been found to interfere with wound healing processes. Therefore, the purpose of this study was to compare surgical treatment of oroantral fistulae (OAFs) in smokers and non-smokers. Materials and Methods: Medical records of all consecutive patients who underwent surgical closure of OAFs between 2003 and 2016 at the oral and maxillofacial surgery department, Rabin Medical Center, Israel were reviewed. Patients’ demographic data, preoperative signs and symptoms, surgical method of repair, and postoperative complications were recorded. Results: The cohort consisted of 38 smokers and 59 non-smokers. Age and gender distributions were similar in both groups. The main etiology in both groups was tooth extraction, followed by pre-prosthetic surgery in smokers and odontogenic infection in non-smokers (p = 0.02). Preoperative conditions were not significantly different between smokers and non-smokers in terms of size of soft tissue fistula and bony defect, chronic sinusitis and foreign bodies inside the sinus. OAFs were repaired by local soft tissue flaps without consideration of smoking status. Smokers experienced more moderate-severe postoperative pain (p = 0.05) and requested more weak opioids (p = 0.06). Postoperative complications included infection, delayed wound healing, residual OAF, pain, sensory disturbances and sino nasal symptoms. These were mostly minor and tended to be more frequent in smokers (p = 0.35). Successful closure of OAFs was obtained in all patients except one smoker who required revision surgery. Conclusions: Smokers may be more susceptible to OAFs secondary to preprosthetic surgery. In this cohort, there was no statistically significant difference in outcome between smokers and non-smokers in terms of failure. However, smokers tended to have more severe postoperative pain and discomfort and to experience more postoperative complications. Further studies with larger sample sizes should be conducted to validate these results.

A comparative study of open and closed hemorrhoidectomy

10.18203/2349-2902.isj20182249 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2332

Author(s):

Raghunath Mohapatra ◽

Dasarathi Murmu ◽

Alok Mohanty

Keyword(s):

Wound Healing ◽

Postoperative Pain ◽

Analog Scale ◽

Delayed Wound Healing ◽

Fourth Degree ◽

Efficient Treatment ◽

Randomized Clinical Study ◽

Closed Hemorrhoidectomy ◽

Background: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree haemorrhoids. This prospective randomized clinical study compared the outcome of surgical haemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity.Methods: All consecutive patients with Grade III internal haemorrhoids or Grade IV haemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 2-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of analgesics on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure.Results: There were 30 patients in each group. No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 78 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 26 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent.Conclusions: Both methods are fairly efficient treatment for third and fourth degree hemorrhoids, without serious drawbacks. The closed method has no advantage in postoperative pain reduction but is more advantageous with respect to faster wound healing.

Comparative study of management of grade III hemorrhoids by Harmonic Scalpel technique versus conventional surgical technique (Milligan Morgan method)

10.18203/2349-2902.isj20173877 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3007

Author(s):

Amrithraj Thiyagarajan ◽

Shubhi Bhatnagar

Keyword(s):

Fecal Incontinence ◽

Blood Loss ◽

Harmonic Scalpel ◽

Postoperative Outcome ◽

Late Complications ◽

Analgesic Requirement ◽

Significant Difference ◽

Hospital Stays ◽

Background: The study aimed to compare the management of Grade III hemorrhoids by conventional Milligan Morgan versus Harmonic scalpel hemorrhoidectomy with respect to the intraoperative time, intra operative blood loss, length of hospital stays, postoperative outcome based on immediate and late complications and activity resumption, recurrence and cost.Methods: In this prospective study, a total of 60 patients, 30 patients undergoing Harmonic Scalpel hemorrhoidectomy and 30 patients undergoing Milligan Morgan hemorrhoidectomy, were studied. Operated patients were monitored for bleeding, pain, retention of urine, fecal incontinence ambulatory time and recurrence.Results: Symptoms such as pain during defecation, bleeding PR were significantly reduced at follow up in patients undergoing Harmonic scalpel hemorrhoidectomy over Milligan Morgan technique. Fecal incontinence was present in 8 cases following Milligan Morgan method over 3 months follow up. Recurrence was highest in (26.08%) in Milligan Morgan group while lowest in (4.34%) in Harmonic Scalpel group. No of days absent from work is more Milligan Morgan group and significantly less in Harmonic Scalpel group.Conclusions: This study showed significant difference in operative time, blood loss during surgery and pain score on postoperative days 15, 1 month, 3 months and 6 months and postoperative analgesic requirement for Harmonic scalpel assisted hemorrhoidectomy as compared to conventional Milligan Morgan, which were statistically significant. Harmonic scalpel hemorrhoidectomy is a newer, safer, more effective, faster and bloodless operative technique with minimal tissue damage and further larger sample studies and required to establish its complete efficacy and benefit over other modalities of hemorrhoidectomy.