Comparison Between Harmonic
Scalpel and Open Hemorrhoidectomy
in Post-Operative Complications
BY
Zainab Kamil Kadhim
Supervised by
Dr. RAWAA A. SATTAR
F.A.C.S C.A.B.M. S
1 1- INTRODUCTION
2- PATIENTS
2 &METHODS
3- RESULTS
3 4- DISSCUSION
5- CONCLUSION
4
5
1- INTRODUCTION
Hemorrhoids, characterized by swollen veins around the anus or
rectum, are cushions of submucosal tissue containing venules,
arterioles, and smooth muscle fibers within the anal canal. They play
a role in the continence mechanism and aid in anal canal closure.
Surgical treatment, notably the open hemorrhoidectomy technique
first described by Milligan and Morganin 1937, has been the gold
standard for severe cases. However, advancements in technology
have led to the development of newer devices like the harmonic
scalpel
Harmonic scalpel which is a device that simultaneously cuts
and coagulates tissues by producing a vibration of 55.5 khz, when
compared with other devices, this ultrasonic cutting and coagulating
device has advantages such as causing minimal lateral tissue injury
less that caused by open excision haemorrhoidectomy.
less fumes, not making neuromuscular simulation, and more
localized impact.
The rationale for the use of harmonic scalpel in hemorrhoidectomy is
relatively low temperature that divides the tissues through the high
frequency ultrasonic energy that disrupts protein hydrogen bonds
and results in minimal injury and intraoperative bleeding.
2- PATIENTS & METHODS
Study design Comparative cross-sectional
Study setting and period At AL-Imamein AL-Kadimein
Medical City, Baghdad, Iraq from November 2023 till March 2024.
Data collection tool Data was collected by standard
questionnaire involves 40 patients who were operated for
symptomatic hemorrhoids at surgical wards and at outpatient clinic.
Patients were randomized into two groups: group A consist of 20
patients who had hemorrhoidectomy using harmonic scalpel and
group B with 20 patients who had open hemorrhoidectomy.
Data Collection tool :
Data of each patient were collected from the case sheet include
age, gender, occupation, hemorrhoid degree and risk factors like
smoking also type of anesthesia (local, regional, general,).
In addition to, complication after surgery which include pain
(mild, moderate, sever) according to Visual Analog Scale (VAS)
as well as, (bleeding, anal stenosis) and time return to normal daily
activities.
VAS
3- RESULTS
The net result was based on 40 patients
The study involves male19 participants and 21 female.
3- RESULTS
The Hemorrhoid degree in the patients.
3- RESULTS
The Occupation
3- RESULTS
4- DISSCUSION
The Aim of the current study was to prove the superiority of
hemorrhoidectomy performed by Harmonic Scalpel in reducing postoperative
pain compared to the classical open excision hemorrhoidectomy technique.
The harmonic scalpel is an ultrasonically activated instrument with sound
waves as its source of power, which vibrates at a rate of 55,000 times per
second. It is known for its ability to coagulate small and medium-sized vessels
thus potentially it may minimize postoperative swelling and edema to the
surrounding tissue.
And so that, it offers many benefits to patients, including shorter hospital
stay, less damage to tissues, quicker recovery and reduced scarring and the
surgical site may decrease the postoperative pain. (Msika S, 2001) (Sherman
JA, 2000)
4- DISSCUSION
We found that duration of surgery was significantly shorter in the
harmonic scalpel group. Postoperative hospitalization was also
significantly shorter in this group.
Pain degree during and after hospitalization was significantly lower
in the harmonic scalpel group as compared to the open
hemorrhoidectomy group and the return to normal daily activities
was faster in patients of the Harmonic scalpel group. Similar
results were found by (Armstrong DN, 2001)
Tan and Seow-Choen (Tan JJ, 2002) on the other hand, compared
diathermy and harmonic scalpel hemorrhoidectomy and found no
difference in pain degree between the two groups.
4- DISSCUSION
The bleeding in our study show that patients with Harmoinc
Scalpel had lower incidence of bleeding than hemorhoidectomy,
Similar findings have been reported by (FayyyazMU, 2017) enrolled
60 patients undergoing hemorrhoidectomy with either method.
In addition to an Iranian study conducted in Kerman enrolling 53
patients undergoing harmonic or electrocautery
hemorrhoidectomy, concluded that 24 h and 8-week postoperative
pain and bleeding is significantly lesser in harmonic scalpel group.
(Zeinalinejad, 2019)
The results of the studies are in parallel with our study indicating
that harmonic scalpel is associated with relatively reduced
postoperative pain and blood loss, hospitalization duration and
recurrence of hemorrhoids.
5- CONCLUSION
Harmonic Scalpel hemorrhoidectomy is not a painless procedure,
but the level of postoperative pain is significantly lower after this
procedure than after open hemorrhoidectomy.
The number of complications after Harmonic Scalpel
hemorrhoidectomy is lower, although statistically not significant.
So that long-term follow-up with larger-scale studies is required.
LIMITATION OF THE STUDY
Small sample size in our study in compare to the wide
diversity of hemorrhoidectomy surgical modalities is one
of the potential limitations, therefore we recommended
further studies with larger sample size and comparison
with different surgical modalities.
THAN
K
YOU
