A Cochrane review [Abstract] 1 included 12 studies with a total of 1 142 subjects comparing conventional and Ligasure assisted hemorrhoidectomy. Ligasure is a bipolar electrothermal sealing device that uses a very high frequency current providing hemostasis by denaturating collagen and elastin from the vessel wall and surrounding connective tissue. It is postulated that sealing of hemorroidal tissue in between the Ligasure-forceps is achieved with minimal collateral thermal spread and limited tissue charring through use of active feedback control over the power output and could result in diminished post procedural pain as compared to conventional surgical techniques. The pain score at the first day following surgery was significantly less in the Ligasure group (WMD -2.07, 95% CI -2.77 to -1.38; 10 studies, n=835). Most outcomes concerning analgesics used and pain scores up to 7 days favoured the Ligasure-technique. The benefit was diminished at day 14. There was no relevant difference in postoperative complications, symptoms of recurrent bleeding or incontinence at final follow-up. Hospital stay was similar for both groups. Patients treated with the Ligasure-technique returned to work significantly earlier (4.88 days, 95% CI 2.18 to 7.59; 4 studies, n=451). The authors state that more evaluation of the long-term risk of recurrent hemorrhoidal disease is required.
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment).
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