Harmonic Scalpel (R) vs. electrocautery hemorrhoidectomy: A prospective evaluation

INTRODUCTION: Management of posthemorrhoidectomy pain remains a very unsati sfactory clinical dilemma. Compared with electrocautery and laser, the Harm onic Scalpel(R) causes minimal lateral thermal injury during tissue dissect ion. PURPOSE: The aim of the study was to establish whether decreased later al thermal injury translated into diminished posthemorrhoidectomy pain. MET HODS: A prospective randomized trial comparing Harmonic Scalpel(R) hemorrho idectomy and electrocautery was undertaken. Fifty consecutive patients were randomized into two groups: Harmonic Scalpel(R) and electrocautery hemorrh oidectomy. The indications included Grade III internal hemorrhoids with ext ernal components or Grade IV disease. Patients with additional anorectal pa thology (fissure or fistula) were excluded, as were patients with neurologi c deficits, chronic pain syndrome, and those already taking narcotic analge sics. Pain was assessed using a visual analog scale preoperatively and on p ostoperative Days 1, 2, 7, 14, and 28. Twentyfour-hour narcotic usage (Hydr ocodone, 10 mg) was recorded on postoperative Days 1, 2, 7, 14, and 28. A t hree-quadrant modified Ferguson hemorrhoidectomy was performed with each pa tient in the prone jackknife position. RESULTS: Pain in the Harmonic Scalpe l(R) hemorrhoidectomy group was significantly less than in electrocautery p atients on each postoperative day studied. Analgesic requirements were also significantly less in the Harmonic Scalpel(R) group on Days 1, 2, 7, and 1 4. There was no correlation between postoperative pain and grade of hemorrh oid, status of the surgical incision (open vs. closed), or any other study variable. Fifty-five percent of Harmonic Scalpel(R) patients returned to wo rk within one week of surgery, compared with 23 percent of electrocautery p atients. CONCLUSION: The study demonstrates significantly reduced postopera tive pain after Harmonic Scalpel(R) hem orrhoidectomy compared with electro cautery controls. The diminished postoperative pain in the Harmonic Scalpel (R) group likely results from the avoidance of lateral thermal injury.