Submucosal Hemorrhoidectomy versus Hemorrhoidectomy Utilizing an Energy Device in the Treatment of Grade III and IV Hemorrhoidal Disease

Background: Harmonic scalpel hemorrhoidectomy is associated with lesser pain postoperatively and shorter hospital stays than conventional hemorroidectomy. Objective: To compare the outcome of harmonic scalpel hemorrhoidectomy (HSH) and submucosal ligation hemorrhoidectomy (SLH) in management of Grade III and Grade IV hemorrhoids. Design: A prospective comparative study. Setting: A tertiary hospital was selected. Patients and Methods: This is a prospective randomized study that includes 120 patients with Grade III or Grade IV internal hemorrhoids who were operated in the surgical department of Menoufia University Hospital between February 2016 until December 2018. Main Outcome Measures: Demographic data, perioperative parameters, postoperative complications, and recurrence of hemorrhoids were recorded. All patients were regularly followed up after 1 month, 3 moths, 6 months, and 12 months postoperative for a year. Sample Size: One hundred and twenty patients with Grade III or Grade IV hemorrhoids were divided randomly to SLH (n = 61) and HSH (n = 59) groups. Results: Operative time was 35±12 min in Group A while 18±6 min in Group B with no significant difference between both groups regarding mean hospital stay and time to return to daily activity. Severe pain occurred in 3 cases in Group A while 9 cases in Group B with significantly higher incidence of severe pain in HSH group. The cost was highly significant in HSH group. Anal stenosis occur in 2 (3.2%) cases in Group A and 7 (11.9%) cases in Group B with significantly higher incidence of anal stenosis in HSH group. Conclusion: Both SLH and HSH were safe and effective surgical techniques for management of Grade III and Grade IV hemorrhoids. The SLH technique was associated with less incidence of severe postoperative pain, lower cost, and fewer rate of stenosis. Limitations: Prospective study design, short follow-up period, and learning curve. Conflict of Interest: None.