Does the use of bipolar scissors hemorrhoidectomy reduce bleeding in comparison to harmonic scapel™ hemorrhoidectomy? – An Update

Objective: To test whether selection bias has affected the reported effect estimate for bipolar scissors hemorrhoidectomy, in comparison to harmonic scapel™ hemorrhoidectomy (Risk Difference, 0.03; 95%CI: -0.06 to 0.12; p = 0.45), to reduce bleeding. Method: Trial adjusted, simulated comparator trial (SCT) based I2 test for single randomised controlled trials, using revised I2 threshold limits. Result: A baseline covariate imbalance, either due to chance or due to selection bias was established, being equivalent to selection bias level = B% 0-30 (Bias category = 1). This level suggests that 0-39% of (0 – 23 of the total 59) subjects were non-randomly allocated in favour of one treatment group above the other. Conclusion: The effect estimate reported by the tested trial does not suggest any significant differences between bipolar scissors hemorrhoidectomy in comparison to harmonic scapel™ hemorrhoidectomy in reducing bleeding. The selection bias level, estimated by use of the trial adjusted, SCT based I2 test for single RCTs (B% = 0-30), appears to be low enough in order not to have affected the reported effect estimate. In line with new findings, this report updates previous report to the same RCT: EBSM Volume 2, Issue 1, 2026 Pages 5-8, DOI: 10.5281/zenodo.17760763.