[Ferguson hemorrhoidectomy, modified by using the Ligasure radiofrequency coagulator]

The aim of the study was the evaluation of results of modified Ferguson hemorrhoidectomy, with use of the Ligasure radiofrequency coagulator, compared to the Milligan-Morgan and Longo techniques. From January 1988 to December 2005, 3011 patients underwent Ferguson hemorrhoidectomy (1849 F, 1162 M; age range: 18 to 84 years). One thousand three hundred patients had previously been treated by medical therapy with poor results and in 225 patients (7.5%) the indication was recurrence after previous surgical treatment. All patients underwent a closed Ferguson hemorrhoidectomy (combined with anoplasty in 28 cases of post-hemorrhoidal stenosis). Eighty percent of patients were operated on with loco-regional assisted anaesthesia, and the remainder with narcosis (cases of recurrence). During the last two years we performed hemorrhoidal excision in 116 patients (4%) with the Ligasure radiofrequency coagulator, followed by continuous suturing with Vicryl 4/0. There was no intraoperative mortality. Mean operation time was 25 minutes. Postoperative complications were hemorrhage in 6 patients (0.2%) and acute urinary retention in 9 patients (0.3%). No important complications were observed in any of the patients treated with Ligasure. The hospital stay was 24 hours for 2852 patients, and 36-86 hours in the other 5%. Seventy-two percent of patients (2160) had moderate postoperative pain, while 14% (420) had severe postoperative pain necessitating repeated administration of analgesics. The 115 patients undergoing Ferguson haemorrhoidectomy plus Ligasure were discharged within 24 hours of surgery. No cases of major domiciliary haemorrhage were observed. There were 13 cases of suture dehiscence (none in the Ferguson plus Ligasure group). Five patients presented suture infection, not requiring surgical drainage, but only medical treatment with local antibiotics. These results, obtained with the modified Ferguson technique, as compared to the classical and even the most innovative hemorrhoidectomy, appear to confirm the feasibility and accuracy of this operation in almost all patients, with both a considerable reduction in costs and enhanced patient comfort and compliance.