الفهرس 
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Abstract
The purpose of this study is to compare between LigaSure™ hemorrhoidectomy and conventional open hemorroidectomy using diathermy in grade III and IV haemorrhoids, regarding the time needed for surgery, risk of bleeding, post-operative pain and analgesia requirement, early and late post-operative complications, duration of hospital accomodation, and time to return to regular activities.
The current study was conducted in Alexandria Faculty of Medicine; Department of Gastro-Intestinal Surgery; Department of Surgery after agreement of the Ethics Committee had been obtained during a period of six months started on February 2021 till October 2021.
Patients included in this study are those who suffer from grade three symptomatic internal hemorrhoids accompanies by a large external component or constantly prolapsed grade four hemorrhoids. All patients signed a written well informed consent
Forty consecutive suitable patients were randomly chosen using sealed envelopes in the operating theatre into one of two groups:
group 1, (LSH, n=20): Hemorrhoidectomy using the LigaSure™.
group 2, (DH, n=20): Open Hemorrhoidectomy (Milligan-Morgan’s Operation) with Diathermy.
Patients received spinal anasthesia and were in lithotomy position during the procedure.
Inspection of wound in the outpatient clinic after 1, 2, 4, 6 weeks consecutively is the main method of follow up .
Demographic data, duration of surgery, intraoperative bleeding, duration of hospital accommodation as well as time needed to return to regular physical activity were all recorded and statistically analyzed. In addition, degree of pain postoperatively according to the VAS, early during the first 24 hours after the operation and late during the follow up period, analgesic requirements and incidence of early and late postoperative complications were all recorded and statistically analyzed.
There was no significant difference between the two groups regarding age, sex distribution and grade of hemorrhoids.
The operative time revealed that hemorrhoidectomy using the LigaSure™ is statistically significant faster than hemorrhoidectomy using diathermy, with better hemostasis and significant less intraoperative bleeding.
The duration of post-operative hospital stay, patients from both groups stayed for one day after surgery, so there was no difference statistically.
Post-operative pain, according to VAS; the use of the LigaSure caused statistically significant reduced post-operative pain during the first twenty four hours post operative and significant reduced number of Pethidine injections, while the use of diathermy caused more pain post-operative and more number of Pethidine injections.
During the late follow up period there was no significant difference in pain between both groups.
The incidence of post-operative early and late complications; six patients in DH group had post-operative complications, two patients had post-operative urine retention, one patient had early post-operative hemorrhage, one patient had late hemorrhage during the follow up period and needed to be readmitted to the hospital, one patient had frequent exudation from the wound, and one patient had incontinence to gas.
While in LSH group, only two patients had postoperative complications. A single case suffered from acute urine retention and another case was complicated by stenosis of anal canal which needed readmission
There was no statistically significant difference between the two groups as regards the incidence of postoperative complications.
The time to return to normal activity, there was statistically significant difference between both groups. In LSH group, 90% of patients were back to their daiy activities within two weeks after surgery. on the other hand thirty five percent of patients in DH group got back to their normal physical activity level within two weeks postoperatively.