Randomized trial comparing LigaSure to closed Ferguson hemorrhoidectomy

Performing hemorrhoidectomy with LigaSure vessel sealing system is a relatively new technique. The aim of the study was to evaluate LigaSure hemorrhoidectomy by comparing its results to closed Ferguson technique.

Eighty patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure or Ferguson hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, morbidity, manometric assessment, need for analgesics, hospital stay, time to achieve complete wound healing, and patient satisfaction.

The LigaSure group achieved a significant reduction in operative time (P < 0.001), blood loss (P < 0.001), first postoperative day pain score (P < 0.006), seventh day pain score (P < 0.012), second week pain score (P < 0.001). Less patients in the LigaSure group required pethidine analgesia on the first postoperative day (P < 0.006). Hospital stay (P < 0.001), time to achieve complete wound healing (P = 0.001) were shorter in the LigaSure group, and third month satisfaction score was higher (P = 0.03). There was no difference in postoperative complications. Postoperative manometric resting (P = 0.0001) and squeeze (P = 0.001) pressures were significantly decreased in the Ferguson group.

LigaSure hemorrhoidectomy provides a valid alternative to closed hemorrhoidectomy. LigaSure patients gain short-term benefits in terms of reduced postoperative pain, wound healing, and better satisfaction. Based on our preliminary results, future studies addressing long-term functional results are needed to prove that LigaSure hemorrhoidectomy may be safer for the patients.