Login Register Cart 0
Generic placeholder image

Reviews on Recent Clinical Trials

Editor-in-Chief

ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
General Research Article

Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience

Author(s): Maurizio Rho*, Andrea Martina Guida, Marco Materazzo, Cristine Pathirannehalage Don, Carlo Gazia, Anton Mariani Ivanikhin, Valeria Tognoni and Dario Venditti

Volume 16, Issue 1, 2021

Published on: 06 October, 2020

Page: [101 - 108] Pages: 8

DOI: 10.2174/1574887115999201006201926

Price: $65

Abstract

Background: Hemorrhoidal disease represents one of the most common anorectal disorders in the general population. Energy devices, such as LigaSureTM scalpel, have reshaped the concept of hemorrhoid surgery and in turn, have improved patient outcomes and simplified the work of surgeon.

Objective: The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work.

Methods: In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed. Complications were classified in early, late, and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively.

Results: 90.2% of patients were treated in day surgery regimen and the mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st postoperative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3%-of patients experienced postoperative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing, and anal fissure were detected in 3.6%, 1.2%, and 1% of patients, respectively. The long term complications rate was 5.3%: anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively.

Conclusion: LH is a safe and fast procedure with a proven minimal complication rate.

Keywords: LigaSure™ hemorrhoidectomy, hemorrhoidectomy, hemorrhoids, hemorrhoidectomy complication, proctology, anal stenosis, anus diseases, internal hemorrhoids.

« Previous Next »
Graphical Abstract

[1]
Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-17.
[http://dx.doi.org/10.3748/wjg.v18.i17.2009] [PMID: 22563187]
[2]
Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27(2): 215-20.
[http://dx.doi.org/10.1007/s00384-011-1316-3] [PMID: 21932016]
[3]
Haas PA, Haas GP. The prevalence of hemorrhoids and chronic constipation. Gastroenterology 1990; 99(6): 1856-7.
[http://dx.doi.org/10.1016/0016-5085(90)90512-Y] [PMID: 2227308]
[4]
Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98(2): 380-6.
[http://dx.doi.org/10.1016/0016-5085(90)90828-O] [PMID: 2295392]
[5]
Guttadauro A, Maternini M, Chiarelli M, Lo Bianco G, Pecora N, Gabrielli F. Evolution in the surgical management of hemorrhoidal disease. Ann Ital Chir 2018; 89: 101-6.
[PMID: 29848814]
[6]
Riss S, Weiser FA, Riss T, Schwameis K, Mittlböck M, Stift A. Haemorrhoids and quality of life. Colorectal Dis 2011; 13(4): e48-52.
[http://dx.doi.org/10.1111/j.1463-1318.2010.02480.x] [PMID: 20977590]
[7]
Yeo D, Tan K-Y. Hemorrhoidectomy - making sense of the surgical options. World J Gastroenterol 2014; 20(45): 16976-83.
[http://dx.doi.org/10.3748/wjg.v20.i45.16976] [PMID: 25493010]
[8]
Filingeri V, Buonomo O, Sforza D. V F. Use of Flavonoids for the treatment of symptoms after hemorrhoidectomy with radiofrequency scalpel. Eur Rev Med Pharmacol Sci 2014; 18(5): 612-6.
[PMID: 24668700]
[9]
van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: Guideline for haemorrhoidal disease. Color Dis. 2020; 22(6): 650-62.
[10]
Milligan ETC, Naunton Morgan C, Jones LE, Officer R. Surgical anatomy of the anal canal, and the operative treatment of hæmorrhoids. Lancet 1937; 230: 1119-24.
[http://dx.doi.org/10.1016/S0140-6736(00)88465-2]
[11]
Jayaraman S, Colquhoun PHD, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 2006; (4): CD005393
[http://dx.doi.org/10.1002/14651858.CD005393.pub2] [PMID: 17054255]
[12]
Altomare DF, Milito G, Andreoli R, et al. Ligasure for Hemorrhoids Study Group. Ligasure Precise vs. conventional diathermy for Milligan-Morgan hemorrhoidectomy: A prospective, randomized, multicenter trial. Dis Colon Rectum 2008; 51(5): 514-9.
[http://dx.doi.org/10.1007/s10350-007-9171-6] [PMID: 18231834]
[13]
Kennedy JS, Stranahan PL, Taylor KD, Chandler JG. High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 1998; 12(6): 876-8.
[http://dx.doi.org/10.1007/s004649900733] [PMID: 9602010]
[14]
Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure vs conventional excisional techniques: Meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12(2): 85-93.
[http://dx.doi.org/10.1111/j.1463-1318.2009.01807.x] [PMID: 19220374]
[15]
Nienhuijs S, de Hingh I. Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic Hemorrhoids. Cochrane Database Syst Rev 2009; CD006761(1): CD006761.
[http://dx.doi.org/10.1002/14651858.CD006761.pub2] [PMID: 19160300]
[16]
Franklin EJ, Seetharam S, Lowney J, Horgan PG. Randomized, clinical trial of Ligasure vs conventional diathermy in hemorrhoidectomy. Dis Colon Rectum 2003; 46(10): 1380-3.
[http://dx.doi.org/10.1007/s10350-004-6754-3] [PMID: 14530679]
[17]
Simillis C, Thoukididou SN, Slesser AAP, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 2015; 102(13): 1603-18.
[http://dx.doi.org/10.1002/bjs.9913] [PMID: 26420725]
[18]
Mastakov MY, Buettner PG, Ho YH. Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure for haemorrhoids. Tech Coloproctol 2008; 12(3): 229-39.
[http://dx.doi.org/10.1007/s10151-008-0426-6] [PMID: 18679571]
[19]
Goligher JC. Surgery of the anus, rectum and colon. Br J Surg 1980; 67: 532-2.
[http://dx.doi.org/10.1002/bjs.1800670733]
[20]
Milito G, Lisi G, Aronadio E, et al. LigasureTM hemorrhoidectomy: how we do. Minerva Gastroenterol Dietol 2017; 63(1): 44-9.
[http://dx.doi.org/10.23736/S1121-421X.16.02343-6] [PMID: 27768009]
[21]
Salusso P, Testa V, Mochet S, et al. Management of hemorrhoidal disease in special conditions: A Word of Caution. Rev Recent Clin Trials 2021; 16(1): 22-31.
[http://dx.doi.org/10.2174/1574887115666200406121308] [PMID: 32250231]
[22]
Gentile M, De Rosa M, Carbone G, Pilone V, Mosella F, Forestieri P. LigaSure haemorrhoidectomy versus conventional diathermy for IV-Degree haemorrhoids: Is it the treatment of choice? A randomized, clinical trial. ISRN Gastroenterol 2011; 2011: 467258.
[http://dx.doi.org/10.5402/2011/467258] [PMID: 21991510]
[23]
Chierici A, Frontali A. Post Hemorrhoidectomy pain management: The latest news. Rev Recent Clin Trials 2021; 16(1): 32-8.
[http://dx.doi.org/10.2174/1574887115666200406122009] [PMID: 32250232]
[24]
Toyonaga T, Matsushima M, Sogawa N, et al. Postoperative urinary retention after surgery for benign anorectal disease: Potential risk factors and strategy for prevention. Int J Colorectal Dis 2006; 21(7): 676-82.
[http://dx.doi.org/10.1007/s00384-005-0077-2] [PMID: 16552523]
[25]
Vinson-Bonnet B, Higuero T, Faucheron JL, Senejoux A, Pigot F, Siproudhis L. Ambulatory haemorrhoidal surgery: Systematic literature review and qualitative analysis. Int J Colorectal Dis 2015; 30(4): 437-45.
[http://dx.doi.org/10.1007/s00384-014-2073-x] [PMID: 25427629]
[26]
Kim J, Lee DS, Jang SM, Shim MC, Jee DL. The effect of pudendal block on voiding after hemorrhoidectomy. Dis Colon Rectum 2005; 48(3): 518-23.
[http://dx.doi.org/10.1007/s10350-004-0798-2] [PMID: 15875295]
[27]
Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A systematic review and meta-analysis of published randomized, controlled trials. World J Surg 2016; 40(6): 1509-19.
[http://dx.doi.org/10.1007/s00268-016-3419-z] [PMID: 26813541]
[28]
Kunitake H, Poylin V. Complications following anorectal surgery. Clin Colon Rectal Surg 2016; 29(1): 14-21.
[http://dx.doi.org/10.1055/s-0035-1568145] [PMID: 26929747]
[29]
Chen HH, Wang JY, Changchien CR, et al. Risk factors associated with posthemorrhoidectomy secondary hemorrhage: A single-institution prospective study of 4,880 consecutive closed hemorrhoidectomies. Dis Colon Rectum 2002; 45(8): 1096-9.
[http://dx.doi.org/10.1007/s10350-004-6366-y] [PMID: 12195196]
[30]
Shanmugan S, Champagne BJ, Senagore A. Hemorrhoids and Rectoceles.Yeo CJ, editor Shackelford’s Surg Aliment Tract, VIII Ed VIII. 2018; pp. 1848-63.
[31]
Muzi MG, Milito G, Nigro C, et al. Randomized clinical trial of LigaSure and conventional diathermy haemorrhoidectomy. Br J Surg 2007; 94(8): 937-42.
[http://dx.doi.org/10.1002/bjs.5904] [PMID: 17636512]
[32]
Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: A meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 2015; 25(2): 106-10.
[http://dx.doi.org/10.1097/SLE.0000000000000136] [PMID: 25738704]
[33]
Brisinda G. How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators. BMJ 2000; 321(7261): 582-3.
[http://dx.doi.org/10.1136/bmj.321.7261.582] [PMID: 10977817]
[34]
Milsom JW, Mazier WP. Classification and management of postsurgical anal stenosis. Surg Gynecol Obstet 1986; 163(1): 60-4.
[PMID: 3726727]
[35]
Wang JY, Lu CY, Tsai HL, et al. Randomized controlled trial of LigaSure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg 2006; 30(3): 462-6.
[http://dx.doi.org/10.1007/s00268-005-0297-1] [PMID: 16479346]
[36]
Gravante G, Venditti D. Postoperative anal stenoses with ligasure hemorrhoidectomy. World J Surg 2007; 31(1): 245.
[http://dx.doi.org/10.1007/s00268-006-0310-3] [PMID: 16957820]
[37]
Arslani N, Patrlj L, Rajković Z, Papeš D, Altarac S. A randomized clinical trial comparing Ligasure versus stapled hemorrhoidectomy. Surg Laparosc Endosc Percutan Tech 2012; 22(1): 58-61.
[http://dx.doi.org/10.1097/SLE.0b013e318247d966] [PMID: 22318061]
[38]
Kraemer M, Parulava T, Roblick M, Duschka L, Müller-Lobeck H. Prospective, randomized study: proximate PPH stapler vs. LigaSure for hemorrhoidal surgery. Dis Colon Rectum 2005; 48(8): 1517-22.
[http://dx.doi.org/10.1007/s10350-005-0067-z] [PMID: 15937619]
[39]
Kadhim TJ. Postoperative complication of haemorrhoidectomy done by ligasure. ~ 1151 ~ Pharma. Innov J 2018; 7: 1151-3.
[40]
Chen CW, Lai CW, Chang YJ, Chen CM, Hsiao KH. Results of 666 consecutive patients treated with LigaSure hemorrhoidectomy for symptomatic prolapsed hemorrhoids with a minimum follow-up of 2 years. Surgery 2013; 153(2): 211-8.
[http://dx.doi.org/10.1016/j.surg.2012.06.035] [PMID: 22910492]
[41]
Nelson R. Anal fissure (chronic). 2014; 2014: 0407.
[42]
Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P. Endoscopic pilonidal sinus treatment: Long-term results of a prospective series. JSLS 2017; 21(3): e2017.00043.
[http://dx.doi.org/10.4293/JSLS.2017.00043] [PMID: 28904522]
[43]
Naldini G. Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 2011; 13(3): 323-7.
[http://dx.doi.org/10.1111/j.1463-1318.2009.02160.x] [PMID: 20002689]
[44]
Candela G, Varriale S, Di Libero L, et al. The gold standard in the treatment of haemorrhoidal disease. Milligan-Morgan haemorrhoidectomy vs Longo mucoprolapsectomy: Comparing techniques. Minerva Chir 2007; 62(3): 151-9.
[PMID: 17519839]
[45]
Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery 1971; 70(3): 480-4.
[PMID: 5568533]
[46]
Al-Tamimi AS. Classical milligan morgan hemorrhoidectomy versus its modification: Higher risk of fistula and mucosal ectropion. Int J Med Res Heal Sci 2018; 7: 144-51.
[http://dx.doi.org/10.26452/ijrps.v9iSPL1.1287]
[47]
Milone M, Maietta P, Leongito M, Pesce G, Salvatore G, Milone F. Ferguson hemorrhoidectomy: Is still the gold standard treatment? Updates Surg 2012; 64(3): 191-4.
[http://dx.doi.org/10.1007/s13304-012-0155-2] [PMID: 22488271]
[48]
Lee KC, Chen HH, Chung KC, et al. Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults. Int J Surg 2013; 11(9): 914-8.
[http://dx.doi.org/10.1016/j.ijsu.2013.07.006] [PMID: 23876770]
[49]
Madiba TE, Esterhuizen TM, Thomson SR. Procedure for prolapsed haemorrhoids versus excisional haemorrhoidectomy--a systematic review and meta-analysis. S Afr Med J 2009; 99(1): 43-53.
[PMID: 19374087]
[50]
Ielpo B, Venditti D, Balassone V, Favetta U, Buonomo O, Petrella G. Proctalgia as a late complication of stapled hemorrhoidectomy. Report of our case series. Int J Surg 2010; 8(8): 648-52.
[http://dx.doi.org/10.1016/j.ijsu.2010.07.303] [PMID: 20797456]
[51]
Thomson WHF. The nature of haemorrhoids. Br J Surg 1975; 62(7): 542-52.
[http://dx.doi.org/10.1002/bjs.1800620710] [PMID: 1174785]
[52]
Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 2008; 12(1): 7-19.
[http://dx.doi.org/10.1007/s10151-008-0391-0] [PMID: 18512007]
[53]
Faucheron JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 2012; 99(6): 746-53.
[http://dx.doi.org/10.1002/bjs.7833] [PMID: 22418745]
[54]
Greensmith S, Ip B, Vujovic Z. Rectal perforation secondary to transanal haemorrhoidal dearterialisation. Ann R Coll Surg Engl 2017; 99(5): e154-5.
[http://dx.doi.org/10.1308/rcsann.2017.0059] [PMID: 28462643]

Rights & Permissions Print Cite
Article Metrics
602
© 2024 Bentham Science Publishers | Privacy Policy