Harmonic scalpel versus bipolar diathermy in Milligan-Morgan haemorrhoidectomy: a randomized controlled study

Background: Post-operative pain and bleeding are two major dilemmas associated with haemorrhoidectomy. Recent advances in energy sources have provided an alternative in reducing both the issues. This study was conducted with an aim to compare use of ultrasonic scalpel (Harmonic Scalpel) and bipolar diathermy in reducing post-operative pain and bleeding in Milligan-Morgan haemorrhoidectomy (MMH).Methods: Sixty patients with grade III and IV haemorrhoids underwent MMH, after being randomized into two groups, one half of them using Harmonic Scalpel and other group, using Bipolar diathermy scissors over a period of one year at Department of General Surgery at Sir Sayajirao Gaekwad (SSG) Hospital, Baroda. Operative data were recorded, and the patients were followed-up accordingly. Independent assessors were assigned to obtain blood loss, post-operative pain scores, analgesic requirements and other secondary outcomes.Results: Intra-operative bleeding, post-operative pain scores and duration of hospital stay were significantly lower with Harmonic scalpel as compared to bipolar diathermy scissors. However, there was no significant difference in both the groups with respect to first bowel movement and early or late complications.Conclusions: Harmonic scalpel can be used as an alternative to bipolar diathermy, in view of its good haemostatic capability, reduced post-operative pain and analgesic requirements.