Overview
Hemorrhoidal disease is a frequent benign anorectal ailment in surgical practice. Conventional excisional hemorrhoidectomy using the Milligan-Morgan technique remains effective but is significantly limited by severe postoperative pain and related complications. Sutureless hemorrhoidectomy utilizing energy-based vessel sealing devices (such as LigaSure or Harmonic Scalpel) aims to minimize tissue trauma, blood loss, and postoperative discomfort. This prospective comparative randomized clinical trial aims to evaluate and compare the perioperative and postoperative outcomes of sutureless hemorrhoidectomy versus conventional ligation hemorrhoidectomy in adult patients with advanced (grades III and IV) hemorrhoidal disease.
Description
Symptomatic advanced hemorrhoids (grades III-IV) frequently require excisional surgical intervention. Traditional ligation techniques involve pedicle transfixion that often exacerbates postoperative pain, anal spasms, and urinary retention. Energy-based vessel sealing systems provide reliable pedicle occlusion without conventional transfixion or suture ligation, potentially expediting operative time and recovery. In this prospective randomized study conducted at the Department of General Surgery, Sohag University Hospital, 50 eligible adult patients with symptomatic grade III-IV hemorrhoidal disease will be randomly allocated (1:1) into two equal groups: Group A (n=25): Sutureless hemorrhoidectomy using an energy-based vessel sealing device. Group B (n=25): Conventional ligation hemorrhoidectomy using the standard Milligan-Morgan technique. Postoperatively, patients receive standardized analgesia and care, with systematic follow-up at 1 week, 2 weeks, 1 month, 3 months, and 6 months to evaluate pain scores, bleeding, wound healing, complication rates, return to normal activity, and symptom recurrence.
Eligibility
Inclusion Criteria:
- Adult patients aged 18 years or older.
- Patients with symptomatic grade III or grade IV hemorrhoidal disease.
- Combined internal and external hemorrhoidal disease requiring excisional hemorrhoidectomy.
- Recurrent bleeding, prolapse, pain, mucous discharge, or hygiene difficulty despite conservative or office-based treatment.
Exclusion Criteria:
- Patients younger than 18 years.
- Grade I or grade II hemorrhoids suitable for conservative or office-based therapy.
- Acute thrombosed external hemorrhoids requiring emergency management.
- Associated anal fissure, fistula-in-ano, perianal abscess, or inflammatory bowel disease.
- Suspected or confirmed colorectal malignancy\[cite: 1\].
- History of previous anorectal surgery\[cite: 1\].
- Bleeding diathesis, uncontrolled anticoagulant therapy, or severe coagulopathy\[cite: 1\].
