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

(Andrews 1993)

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

(Chung 2002)

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

(Ibrahim 1998)

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

(Pattana-arun 2006)

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

(Seow-Choen 1992)

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

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
(Andrews 1993) 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
(Chung 2002) 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
(Ibrahim 1998) 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
(Pattana-arun 2006) 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
(Seow-Choen 1992) 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