Belmonte-Montes C, Maydón-González HG, Velásquez-Ayuzo EO, Guerrero-Guerrero VH, Pérez-Aguirre J

Language: Spanish
References: 9
Page: 409-414
PDF size: 52.28 Kb.

ABSTRACT

Background: Surgical treatment is the definitive treatment for stages III and IV hemorrhoidal disease. Currently, there is no intervention that can efficiently eliminate postoperative pain and convalescence. It is necessary to study new technologies such as the Harmonic Scalpel that may lower tissue damage and to compare them to a widely used procedure such as Ferguson’s technique.
Methods: Our sample consisted of 29 randomized patients operated on with either the Harmonic Scalpel or modified Ferguson’s technique. All preparations, surgical team and postoperative care were standard for both groups. After surgery, patients were evaluated at 24 h, every week for 1 month and every month for up to 3 months. Student’s t-test for independent samples was used to compare pain and operative variables. Pearson’s χ2 test was used to compare age, gender, diagnosis, and convalescence time.
Results: Sugical time, operative bleeding and pain at 24 h and 2 weeks after surgery were significantly less in the Harmonic Scalpel group. Average convalescence time was 32 days for Harmonic Scalpel group and 46 days for the modified Ferguson’s group. One patient in the Harmonic Scalpel group required reintervention for hemostasis.
Conclusions: Use of the Harmonic Scalpel for hemorrhoidectomy may offer operative and clinical advantages over the modified Ferguson’s technique. These results encourage the realization of a larger scale clinical trial in order to obtain more conclusive evidence.

REFERENCES

1. Alonso-Coello, Castillejo MM. Office evaluation and treatment of hemorrhoids. J Family Pract 2003;52:366-374.

2. Correa RJ, Téllez RO. Hemorroides y fisura anal. En: Asociación Mexicana de Cirugía General, Consejo Mexicano de Cirugía General. Tratado de cirugía general. México: El Manual Moderno;2003. pp. 801-808.

3. Eblen ZA. Sensibilización nociceptiva al dolor. En: Bistre CS, ed. Estudio y tratamiento del dolor en la práctica diaria. México: Laboratorios Sanfer;2005. pp. 23-28.

4. Gencosmanoglu R, Sad O, Koc D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective randomized trial. Dis Colon Rectum 2002;45:70-75.

5. Belmonte MC, Decanini TC, Torres VF. Hemorroidectomía con técnica tradicional vs. láser CO2. Rev San Mil 1991;45:235-237.

6. Tan JJ, Seow-Choen F. Prospective, randomized trial comparing diathermy and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum 2001;44:677-679.

7. Armstrong DN, Ambroze WL, Schertzer ME, Orangio GR. Harmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation. Dis Colon Rectum 2001;44:558-564.

8. Bistre CS. Evaluación y cuantificación del dolor. En: Bistre CS, ed. Estudio y tratamiento del dolor en la práctica diaria. México: Laboratorios Sanfer; 2005. pp. 29-35.

9. Johnson & Johnson Gateway [homepage on the Internet]. New Jersey: The Company; c2000-2007 [updated 2004 Nov 22; cited 2007 Jul 30]. Harmonic Scalpel; [about 2 screens]. Available from http://www.jnjgateway.com/home.jhtml?loc=USENG&page=viewContent&contentId=09008b9880a2d37a&parentId=09008b9880a2ba17