Table 7: Diathermy dissection versus conventional scissors dissection
Study | n diathermy/ scissors | Study regimen | Analgesia given to all groups | Pain scores and type if specified | Postoperative supplemental analgesia | Functional outcomes | Other outcomes, including long-term effects |
LoE 1 | 10/10 | Diathermy dissection (DIA) versus conventional scissors dissection (CON) (all patients underwent Milligan-Morgan haemorrhoidectomy) | All patients given either papaveretum or coproxamol tablets, as required | NS pain scores daily from days 0–10 NS average pain score over duration of hospital stay | Total quantity of analgesia administered during whole postop period: NS | Time to first bowel action: NS Incidence of complications at 4 weeks (wound healing, anal stenosis, stool/flatus incontinence): NS | Length of hospital stay: NS |
LoE 1 | 30/27 | Diathermy dissection (DIA) versus conventional scissors dissection (CON) (all patients underwent Milligan-Morgan haemorrhoidectomy) | Oral dologesic (2 tablets, 4 x daily as needed), IM pethidine (1 mg/kg every 4 h) for pain relief | NS pain scores perceived and expected | Number of pethidine injections required: NS Number of dologesic tablets consumed: NS | Time to first bowel movement: NS Impaired wound healing at 4 weeks: NS Anal stenosis at 4 weeks: NS | Blood loss: DIA superior (p=0.028) Incidence of early complications (urinary retention, haemorrhage, fever): NS Length of hospital stay: NS Time to return to normal activities: NS Satisfaction scores: NS |
LoE 2 | 44/47 | Diathermy dissection (DIA) versus conventional scissors dissection (CON) (closed haemorrhoidectomy in both groups) | Naproxen 550 mg twice per day, IM pethidine 50 or 75 mg as needed, 2% topical lidocaine jelly | NS pain scores on POD 0–6 | Number of pethidine injections required: CON superior (p<0.009). Number of naproxen tablets taken: DIA superior (p<0.001). NS use of lidocaine jelly | Time to first bowel movement: NS Incontinence: NS Anal stricture at 6 months: NS (n=0/group) | Length of hospital stay: NS Incidence of bleeding: NS Incidence of urinary retention: NS |
LoE 1 | 23/22 | Ligasure diathermy dissection (DIA) versus conventional scissors dissection (CON) (conventional closed (Fansler’s) haemorrhoidectomy in both groups) | Oral paracetamol every 4 h, IM pethidine 1 mg/kg as requested | NS verbal numeric pain scores at 6 and 24 h, and on POD 14 and 28 | Total dose of pethidine required: NS | Complete wound healing at 4 weeks: NS | Urinary retention: NS Incidence of postoperative bleeding or haemorrhage: NS Wound dehiscence at 2 weeks: NS |
LoE 1 | 33/16 | Diathermy excision without ligation (DIA) was compared with conventional scissors dissection with ligation (CON) during closed haemorrhoidectomy | IM pethidine 50–75 mg, oral naproxen 500 mg b.i.d., topical lidocaine jelly | NS pain scores on POD 1–7 | Number of naproxen tablets required: DIA superior (p<0.02). IM pethidine requirements: NS Number of topical analgesic applications: NS | Anal strictures: NS Rate of wound healing: NS Incontinence: NS | Length of hospital stay: NS |