LigaSure or Diathermy Excision of III-IV Degree Pile
Condition: Pile
MeSH terms: Hyperthermia
Study type: Interventional

Summary: 
      Abstract:

      Introduction:

      Pile excision is frequently associated with post-operative pain and prolong hospital stay. A
      modern technique performed with LigaSure appears to be mainly effective in large pile tissue
      removal is required. The study compares LigaSure pile excision with diathermy for the
      treatment of III-IV degree pile.

      Patients and Methods:

      208 patients with pile III or IV degree randomized into 2 groups. Group one LigaSure and
      group two diathermy. The study evaluates the mean post-operative time, post-operative pain,
      discharge date, time return to usual works early and late complication. All patient
      followed-up for range (12-24) months.

      Results:

      108patient treated by diathermy, 100 by LigaSure. The mean operative time significantly
      shorter in LigaSure, post-operative pain disappears earlier in LigaSure than diathermy. The
      time return to work less in LigaSure, while no difference in hospital stay and post-operative
      complications.

      Conclusions:

      LigaSure is effective procedure when large degree III or VI pile excised. The procedure
      enhances to use LigaSure as treatments of choice for class III-IV pile, even it is more
      expensive than diathermy operation.
    

Detailed description: 
      Surgery remains the mainstay in patients with symptomatic pile grades III and IV. The usual
      operation by Milligan-Morgan and Ferguson is still most used and effective for symptomatic
      grades IV and some of grade III. The two procedures get mimicked, like blood loss and
      postoperative pain, which cause prolonged hospital stay. Rapid wound healing permits the
      early return to usual works and day activity . Many articles seek the best treatments of
      piles published in recent years and modern device the procedures trials to overcome the
      haemorrhoidectomy complication.: like stapling, laser, doppler-guided vessels ligation with
      different principles aimed at excisional surgery. The LigaSure system vessels sealed were
      introduced newly in [6] as a tool for treatments of piles. It is a bipolar electro-thermal
      device; it offers both radiofrequency and pressure. Blood vessels seal up to 7mm in diameter
      and create energy according to the tissue impendence and confined 2 mm thermal injury over
      operation site. The limited thermal injury spread decreases the anal spasm and permits
      bloodless surgery to decrease postoperative pain and promote rapid healing. So the operation
      is recommended as an ideal procedure because of the significant less tissue trauma . The
      objective of some randomized trials to estimate the advantage of the LigaSure approach over
      the conventional diathermy approaches. in spite of the favourite toward the LigaSure, the
      conclusion gets some uncertainly regarding the cost of using disposable device although an
      overall favourable trend exists toward LigaSure, conclusions are not univocal and definitive;
      this creates some uncertainty, also considering the increasing cost for the use of the
      disposable device so essential to compare our study with another centres to emphasis the true
      advantage present. The debate is the "gold standard" for III degrees. There are large
      agreements that Milligan-Morgan and Ferguson are the most effective in IV degree pile . Ortiz
      mentions that stapled procedure is ineffective for curing itching in an IV degree pile . So
      the diathermy pile excision continues as an effective therapy for the symptomatic,
      irreducible and prolapsed pile. The designed study to estimate the LigaSure procedures as
      effective as conventional diathermy in all grades IV and III with less pain, less blood loss
      and when we need large tissue excision needed.
    

Intervention name(s): Compare between two procedure for II-IV degree pile excision
Intervention type(s): Device
Intervention description(s): LigaSure or diathermy excision of III-IV degree pile?
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: ligaSure; pile; diathermy; hamemorrdectomy; grade II-IV pile