Table 9: LigaSure™ diathermy dissection versus conventional diathermy dissection

Study

n LigaSure/conventional

Study regimen

Analgesia given to all groups

Pain scores and type if specified

Postoperative supplemental analgesia

Functional outcomes

Other important outcomes

(Franklin 2003) LoE 1

17/17

LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (all patients underwent Modified Ferguson haemorrhoidectomy)

Not reported

VAS pain scores: LIG superior on days 1 (p<0.001) and 14 (p=0.002).

Pain on first defecation: LIG superior (p<0.001)

Not reported

Incontinence scores:

NS

Length of hospital stay:

NS

(Jayne 2002)

LoE 1

20/20

LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (modified open Milligan-Morgan haemorrhoidectomy in both groups)

In hospital: IM morphine 10 mg and co-codamol (2 tablets) for pain control. Discharge medication: diclofenac 50 mg 3 x daily, co-codamol (2 tablets)

NS pain scores on days 1–7

NS oral analgesic use

Time to first bowel motion:

NS

Intra-operative blood loss:

LIG superior (p<0.001)

Number of postoperative complications (including haemorrhage and urinary retention):

NS

Length of hospital stay:

LIG superior (p<0.05)

Time to return to normal activity:

NS

Patient satisfaction:

NS at 3 months

(Milito 2002) LoE 2

29/27

LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (modified open Milligan-Morgan haemorrhoidectomy in both groups)

Oral ketoprofen, 2 x 50 mg tablets on demand, max 3 x per day

NS pain scores

Number of analgesic administrations: LIG superior (p<0.001)

Time to complete wound healing:

LIG superior (p<0.0001).

Time to first bowel movement:

NS

Urinary retention:

NS

Constipation:

NS

Time to return to work/full activity:

LIG superior (p<0.01).

Length of hospital stay:

NS

(Palazzo 2002) LoE 1

18/16

LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (open haemorrhoidectomy in both groups)

Tramadol 50 mg as required, up to 100 mg every 4 h and 400 mg daily

NS pain scores

Total 7-day tramadol requirement: LIG superior (p=0.013)

No anal stenosis, loss of anal tone, or incontinence reported in either group at 6 weeks

Complications (reactive bleeding secondary bleeding, urinary retention):

3 (LIG) versus 0 (CON)

Overall satisfaction:

NS

(Wang 2006)

LoE 1

42/42

LigaSure™ diathermy with submucosal dissection (LIG) versus conventional (CON) diathermy dissection (all patients underwent closed Ferguson haemorrhoidectomy)

Oral paracetamol 500 mg, 1 tablet four times per day, and additional parenteral analgesics administered if needed

VAS pain scores at 24 h:

LIG superior (p<0.0001)

Parenteral analgesic requirement: LIG superior (p<0.0001)

Complete wound healing at 6 weeks:

NS

Anal stenosis at 6 weeks:

NS

Flatus incontinence at 6 weeks:

NS

Intraop blood loss: LIG superior (p<0.0001)

Incidence of urinary retention, haemorrhage, and constipation:

NS

Time to return to work/normal activities:

LIG superior (p<0.0001)

Length of hospital stay:

LIG superior (p<0.0001)

Study	n LigaSure/conventional	Study regimen	Analgesia given to all groups	Pain scores and type if specified	Postoperative supplemental analgesia	Functional outcomes	Other important outcomes
(Franklin 2003) LoE 1	17/17	LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (all patients underwent Modified Ferguson haemorrhoidectomy)	Not reported	VAS pain scores: LIG superior on days 1 (p<0.001) and 14 (p=0.002). Pain on first defecation: LIG superior (p<0.001)	Not reported	Incontinence scores: NS	Length of hospital stay: NS
(Jayne 2002) LoE 1	20/20	LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (modified open Milligan-Morgan haemorrhoidectomy in both groups)	In hospital: IM morphine 10 mg and co-codamol (2 tablets) for pain control. Discharge medication: diclofenac 50 mg 3 x daily, co-codamol (2 tablets)	NS pain scores on days 1–7	NS oral analgesic use	Time to first bowel motion: NS	Intra-operative blood loss: LIG superior (p<0.001) Number of postoperative complications (including haemorrhage and urinary retention): NS Length of hospital stay: LIG superior (p<0.05) Time to return to normal activity: NS Patient satisfaction: NS at 3 months
(Milito 2002) LoE 2	29/27	LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (modified open Milligan-Morgan haemorrhoidectomy in both groups)	Oral ketoprofen, 2 x 50 mg tablets on demand, max 3 x per day	NS pain scores	Number of analgesic administrations: LIG superior (p<0.001)	Time to complete wound healing: LIG superior (p<0.0001). Time to first bowel movement: NS	Urinary retention: NS Constipation: NS Time to return to work/full activity: LIG superior (p<0.01). Length of hospital stay: NS
(Palazzo 2002) LoE 1	18/16	LigaSure™ diathermy dissection (LIG) versus conventional diathermy dissection (CON) (open haemorrhoidectomy in both groups)	Tramadol 50 mg as required, up to 100 mg every 4 h and 400 mg daily	NS pain scores	Total 7-day tramadol requirement: LIG superior (p=0.013)	No anal stenosis, loss of anal tone, or incontinence reported in either group at 6 weeks	Complications (reactive bleeding secondary bleeding, urinary retention): 3 (LIG) versus 0 (CON) Overall satisfaction: NS
(Wang 2006) LoE 1	42/42	LigaSure™ diathermy with submucosal dissection (LIG) versus conventional (CON) diathermy dissection (all patients underwent closed Ferguson haemorrhoidectomy)	Oral paracetamol 500 mg, 1 tablet four times per day, and additional parenteral analgesics administered if needed	VAS pain scores at 24 h: LIG superior (p<0.0001)	Parenteral analgesic requirement: LIG superior (p<0.0001)	Complete wound healing at 6 weeks: NS Anal stenosis at 6 weeks: NS Flatus incontinence at 6 weeks: NS	Intraop blood loss: LIG superior (p<0.0001) Incidence of urinary retention, haemorrhage, and constipation: NS Time to return to work/normal activities: LIG superior (p<0.0001) Length of hospital stay: LIG superior (p<0.0001)