Table 8: Diathermy dissection versus Harmonic Scalpel™ dissection

Study

n diathermy/ Harmonic Scalpel

Study regimen

Analgesia given to all groups

Pain scores and type if specified

Postoperative supplemental analgesia

Functional outcomes

Other important outcomes

(Armstrong 2001)

LoE 1

25/25

Diathermy (electrocautery) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (closed haemorrhoidectomy in 38 patients, open in 12 patients)

Hydrocodone 10 mg orally every 4–6 h

VAS pain scores: HS superior on days 1, 2, 7, 14 and 28 (all p<0.01)

Narcotic analgesic requirement: HS superior on days 1, 2, 7, (all p<0.01) and 14 (p<0.05), NS on day 28

Not reported

Urinary retention in 1 patient in HS

(Chung 2002)

LoE 1

30/27

Diathermy (bipolar scissors) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (modified Milligan-Morgan haemorrhoidectomy in both groups)

Oral dologesic (2 tablets, 4 x daily as needed), IM pethidine (1 mg/kg every 4 h) for pain relief on demand

Pain scores perceived: HS superior (p=0.042), NS pain scores expected

NS number of pethidine injections

NS number of dologesic tablets consumed

Time to first bowel movement:

NS

Impaired wound healing at 4 weeks:

NS

Anal stenosis at 4 weeks:

NS

Flatus incontinence at 4 weeks:

NS

Blood loss:

NS

Urinary retention:

NS

Haemorrhage:

NS

Fever:

NS

Length of hospital stay:

NS

Time to return to normal activities:

NS

Satisfaction scores:

HS superior (p=0.002)

(Khan 2001)

LoE 2

16/14

Diathermy (electrocautery) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection, in patients undergoing conventional closed haemorrhoidectomy

Oxycodone 5 mg or parcetamol 325 mg

NS pain scores on POD 1 and 7 and at 6 weeks

NS number of narcotic tablets consumed

Incontinence on POD 7 and at 6 weeks:

NS

Constipation:

NS

Urinary retention:

NS

Postop bleeding:

NS

(Kwok 2005)

LoE 1

24/23

LigaSure™ diathermy dissection (DIA) versus Harmonic Scalpel™ dissection (HS) (an open haemorrhoidectomy technique was used in both groups)

Oral dologesic (1 tablet, 4 x daily as needed), IM pethidine (1 mg/kg every 4 h ) for pain relief

Pain score: DIA superior (p<0.001)

Number of dologesic tablets consumed: DIA superior (p=0.001)

NS number of patients requiring pethidine injection.

Time to first bowel movement:

NS

Anal stenosis, incontinence, poor wound healing:

NS

Blood loss:

DIA superior (p=0.008)

Urinary retention:

NS

Haemorrhage:

NS

Duration of hospital stay:

NS

Patient satisfaction scores:

NS

(Tan 2001)

LoE 1

25/25

Diathermy dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (an open haemorrhoidectomy technique without pedicle ligation was used in both groups)

Oral naproxen 550 mg twice per day; IM pethidine injections as necessary; 2% lidocaine jelly applied topically as required

NS pain scores on days 0–6

NS number of pethidine injections,

NS number of naproxen tablets consumed.

NS amount of lidocaine jelly used

Not reported

Bleeding rates:

NS

Hospital stay:

NS

Study	n diathermy/ Harmonic Scalpel	Study regimen	Analgesia given to all groups	Pain scores and type if specified	Postoperative supplemental analgesia	Functional outcomes	Other important outcomes
(Armstrong 2001) LoE 1	25/25	Diathermy (electrocautery) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (closed haemorrhoidectomy in 38 patients, open in 12 patients)	Hydrocodone 10 mg orally every 4–6 h	VAS pain scores: HS superior on days 1, 2, 7, 14 and 28 (all p<0.01)	Narcotic analgesic requirement: HS superior on days 1, 2, 7, (all p<0.01) and 14 (p<0.05), NS on day 28	Not reported	Urinary retention in 1 patient in HS
(Chung 2002) LoE 1	30/27	Diathermy (bipolar scissors) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (modified Milligan-Morgan haemorrhoidectomy in both groups)	Oral dologesic (2 tablets, 4 x daily as needed), IM pethidine (1 mg/kg every 4 h) for pain relief on demand	Pain scores perceived: HS superior (p=0.042), NS pain scores expected	NS number of pethidine injections NS number of dologesic tablets consumed	Time to first bowel movement: NS Impaired wound healing at 4 weeks: NS Anal stenosis at 4 weeks: NS Flatus incontinence at 4 weeks: NS	Blood loss: NS Urinary retention: NS Haemorrhage: NS Fever: NS Length of hospital stay: NS Time to return to normal activities: NS Satisfaction scores: HS superior (p=0.002)
(Khan 2001) LoE 2	16/14	Diathermy (electrocautery) dissection (DIA) versus Harmonic Scalpel™ (HS) dissection, in patients undergoing conventional closed haemorrhoidectomy	Oxycodone 5 mg or parcetamol 325 mg	NS pain scores on POD 1 and 7 and at 6 weeks	NS number of narcotic tablets consumed	Incontinence on POD 7 and at 6 weeks: NS Constipation: NS	Urinary retention: NS Postop bleeding: NS
(Kwok 2005) LoE 1	24/23	LigaSure™ diathermy dissection (DIA) versus Harmonic Scalpel™ dissection (HS) (an open haemorrhoidectomy technique was used in both groups)	Oral dologesic (1 tablet, 4 x daily as needed), IM pethidine (1 mg/kg every 4 h ) for pain relief	Pain score: DIA superior (p<0.001)	Number of dologesic tablets consumed: DIA superior (p=0.001) NS number of patients requiring pethidine injection.	Time to first bowel movement: NS Anal stenosis, incontinence, poor wound healing: NS	Blood loss: DIA superior (p=0.008) Urinary retention: NS Haemorrhage: NS Duration of hospital stay: NS Patient satisfaction scores: NS
(Tan 2001) LoE 1	25/25	Diathermy dissection (DIA) versus Harmonic Scalpel™ (HS) dissection (an open haemorrhoidectomy technique without pedicle ligation was used in both groups)	Oral naproxen 550 mg twice per day; IM pethidine injections as necessary; 2% lidocaine jelly applied topically as required	NS pain scores on days 0–6	NS number of pethidine injections, NS number of naproxen tablets consumed. NS amount of lidocaine jelly used	Not reported	Bleeding rates: NS Hospital stay: NS