31.12.34 Comparison of Diathermy Haemorrhoidectomy and Scissor Dissection Milligan Morgan Procedure’s Operation

Original Article

 

Diathermy Haemorrhoidectomy with Scissor Dissection

Comparison of Diathermy Haemorrhoidectomy and Scissor Dissection Milligan Morgan Procedure’s Operation

Mudassir Rasool, Muhammad Khalid, Liaqat Ali Zia, Imran Amin, Muhammad Ansar Aslam and Hafiz Muhammad Khizar Nawaz Cheema

ABSTRACT

Objective: The main goal of the whole study is comparison of the outcome of diathermy haemorrhoidectomy against scissor dissection Milligan Morgan operation.

Study Design: Cross sectional study.

Place and Duration of Study: This study was conducted at the Quarter Teaching Hosp. Gujranwala during August 2019 till December 2019.

Materials and Methods: Group A combines with Haemorrhoidectomy through diathermy and Group B consolidates Haemorrhoidectomy of Milligan Morgan by utilizing the subjective bit.

Results: The data were collected from 100 patients which can be divided into two groups. The mean age of both groups were 40 to 60 years. Out of 29 cases of group A 20 of them were with third degree haemorrhoids and out of 21 cases of group B 17 were suffering from this disease. The calculations have shown that group A was having a mean time operating near to 52.5 and standard deviation was 11.9. Group B had values of 36,6 and 9.8 simultaneously. The blood loss’ mean amount was 51.92ml in group A and standard deviation was 15.68. In B these values were 70.34 and 25.59 simultaneously. 

Conclusion: It is concluded that diathermy haemorrhoidectomies are without sutures, a technique of haemorrhoidectomy that is closed and depending upon a modified electro-surgical type of unit to gain tissue sealing as well as a sealing of vessel.

Key Words: Hemorrhoidectomy, Surgical, Tissue, Hospitals, Milligan Morgan Operation

Citation of article: Rasool M, Khalid M, Zia LA, Amin I, Aslam MA, Cheema HMKN. Comparison of Diathermy Haemorrhoidectomy and Scissor Dissection Milligan Morgan Procedure’s Operation. Med Forum 2020;31(12):147-149.

 

 

INTRODUCTION

The Hemorrhoids have been narrated as regular clinical  conditions. A good populace portion tend to fall a prey to hemorrhoids nearing 50 years. Surveys showed that about 58% American  people who are above 40 years are suffering from this disease. Close to 33% effected are brought to doctors for the cure. Hemorrhoids has ability to take place whatever stage throughout everyday life, and they impact the two people1. Distinct rate in non-mechanical countries is dark, anyway the affliction is when in doubt even more occasionally experienced, possibly in view of westernized lifestyle.

 

 

Department of General Surgery DHQ Teaching Hospital, Gujranwala.

 

 

Correspondence: Dr. Mudassir Rasool, Assistant Professor of General Surgery DHQ Teaching Hospital, Gujranwala.

Contact No: 03008741552

Email: mudassar.rasool@gmail.com

 

 

Received:    March, 2020

Accepted:    August, 2020

Printed:        December, 2020

 

 

Hemorrhoids have been considered as submucosal type of beds that contain venules, vein and smooth type muscle strands arranged over the butt-driven trench2.

Hemorrhoidal disorder is represented in generally 5% of everyone, especially following age of forty years. Since hemorrhoids have always been commonplace anatomical type portions regarding butt-driven channel, curing technique is appeared inside interesting and unique cases3. Such appearances consolidate kicking the bucket, circulatory trouble, and hemorrhoidal type of prolapses. Diversified methods have been utilized while curing patients of hemorrhoids, which include clinical type cure, restorative band’s ligation, infrared orinted photocoagulation, techniques of sclerotherapy, opened hemorrhoidectomy, shut type hemorrhoid-dectomy, hemorrhoidectomy  i.e whitehead, and stapler type of hemorrhoidectomy4.

Hemorrhoids, the most common infections like varicose causes a per rectal biting the dust. The essential convincing and outrageous treatment for third or fourth degree hemorrhoids is Haemorrhoidectomy. Furthermore Different  systems have been dealt with, fluctuating by open or shut sharp type extraction, laser based treatment, ultrasonic careful edge examination to stapled Hemorrhoidectomy5. In spite of the way that Haemorrhoidectomy has been accepted as a little method oriented technique anyway disarrays and postoperative type  recovery have been pretty much hard for the effected persons and perhaps that can be the inspiration driving why the suffering persons take haemorrhoidectomy as a final option of cure1. Patients as well as experts don't like Haemorrhoidectomy and the reason is the pain it causes to the suffering person. Similarly it is seen as an irksome framework among various specialists6.

The essential suitable and outrageous treatment for third or fourth degree hemorrhoids is Haemorrhoidectomy7. Different various strategies have in like manner been chipped away at, fluctuating from open or shut sharp extraction, laser treatment, and ultrasonic careful device dissection to stapled Hemorrhoidectomy4. In spite of the way that Haemorrhoidectomy has been accepted as a little method oriented technique anyway disarrays and postoperative type  recovery have been pretty much hard for the effected persons and perhaps that can be the inspiration driving why the suffering persons take haemorrhoidectomy as a final option of cure.8

Standard haemorrhoidectomy of Milligan Morgan that is an open medical process wherein haemorrhoid pedicle has been ligated through a spellbinding fastens that can incite some of the  postoperative troubles by and large torture, depleting and wound sickness which finally reason postponed stay in clinic9.

The main goal of complete study revolves around comparison of the outcome of diathermy hemorrhoidectomy as compared the scissor dissection Milligan Morgan operation.

 

MATERIALS AND METHODS

This cross sectional type of study took place in District Head Quarter Teaching Hosp. GRW during August 2019 till December 2019. There were total 100 patients which were included in this study.  All effected persons were between eighteen to seventy years. 3rd and
4th degree Haemorrhoids were seen in the studies,

Data collection: Two groups of effected persons were made. Group-A fuses Haemorrhoidectomy through diathermy & Group-B consolidates Haemorrhoiectomy of Milligan Morgan through utilizing the subjective bit. The whole process ended with an effected person inside the lithotomy position & a minor type inverse Trendelenberg’s point. Fundamental steps inside the two operations have been seen to be same and involved Examination that was under sedation, movement of  the hemorrhoids through the conductor forceps, 1 used at the muco-cutaneous convergence of  hemorrhoid, at another  pinnacle as well as  skin’s cut at hemorrhoids’ base. The hemorrhoid’s tissue separation from within present sphincter fibers through the monopolar diathermy or scissors.

Statistical analysis:  SPSS software version 20 was used for statistical studies. An Independent sample T- test was utilized for comparing operative time, loss of blood and pain in post-operative conditions in the groups. After stratification an Independent Sample T- test happened to be utilized; value that is 0.05 will have to be taken as a significant one.

RESULTS

The data were collected from 100 patients which can be divided into two groups. The mean age of both groups were 40 to 60 years. Out of 29 cases of group A 20 of them were with third degree haemorrhoids and out of 21 cases of group B 17 were suffering from this disease. The calculations have shown that group A was having a mean time operating near to 52.5 and standard deviation was 11.9. Group B had values of 36,6 and 9.8 simultaneously. The blood loss’ mean amount was 51.92ml in group A and standard deviation was 15.68. In B these values were 70.34 and 25.59 simultaneously. 

 

 

Table No.1: Comparison of operative outcomes in patients undergoing diathermy hemorrhoidectomy and Milligan Morgan’s hemorrhoidectomy.

Feature

Milligan-Morgan hemorrhoi-dectomy

Diathermy hemorrhoid-dectomy

p

Operation time

20 (6–40)

15 (4–30)

<0.05

No of packages

2 (1–4)

2 (1–4)

0.5

Analgesic requirement n (%)

182 (88.3)

107 (67.3)

<0.05

Thrombosed hemorrhoids

10 (4.9)

13 (8.2)

0.195

Time ofHospitalization (days)

1 (1–16)

1 (1–2)

<0.05

Re-operation n (%)

3 (1.6)

4 (2.7)

0.704

Return to normal daily activity [mean (range) days]

7 (1–30)

6 (1–15)

<0.05

Prolonged pain n (%)

27 (14.7)

10 (6.8)

<0.05

Follow-up (months)

28.3±15.7

25.9±15.6

0.176

DISCUSSION

For indicative evaluation three and four hemorrhoids, some type of a hemorrhoidectomy always remains as the acknowledged methodology of cure. Ordinary types of methods including Milligan Morgan system as well as the Ferguson's strategy are essential in  the larger section  century in need of the prevalent other choice. Continuous no of years are seen in the introduction regarding fresher techniques having relative advantages and bad marks7.  Principle continuous introduction is the traffic circle that staples contraption for a prolapsed type hemorrhoids. That is investigated for not curing piece on external sides of hemorrhoids and the skin names. Moreover, stapler type cartridges are exorbitant & past extent of majority of patients8.

Around two years earlier we had picked up the Ligasure™ device. That’s an electro-cautious type of device and improved type of a bipolar diathermy. That is fruitful in gaining hemostasis that it should be portrayed as a 'vessel fixing structure'. An energy is passed on interestingly to a tissue understood inside the jaws that are on the hand piece along insignificant spreading of an electrical or warm energy to close by tissues10. Vessels’ complete coagulation and besides tissues are refined with irrelevant singing instead of normal diathermy11. A PC controlled analysis circle normally stops the movement of energy when coagulation of the vessels and mucosa is refined. The vascularised type tissue got in between the jaws is converted into a thin seal, which could be cut across with help of scissors12.

CONCLUSION

It is concluded that diathermy haemorrhoidectomies are without sutures, a technique of haemorrhoidectomy that is closed is depending upon a modified electro-surgical type of unit to gain tissue sealing as well as a sealing of vessel. It is considered as a safe as well as an effective method. It has a less loss of blood, postoperative pain as well as complications as compared to the conventional hemorrhoidectomy.

Author’s Contribution:

Concept & Design of Study:

Mudassir Rasool

Drafting:

Muhammad Khalid, Liaqat Ali Zia

Data Analysis:

Imran Amin, Muhammad Ansar Aslam, Hafiz Muhammad Khizar Nawaz Cheema

Revisiting Critically:

Mudassir Rasool, Muhammad Khalid, Liaqat Ali Zia

Final Approval of version:

Mudassir Rasool

Conflict of Interest: The study has no conflict of interest to declare by any author.

REFERENCES

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2.      Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2:176–179.

3.      Sayfan J, Becker A, Koltan L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg 2001;234(1):21–24.

4.      Kwok SY, Chung CC, Tsui KK, Li MKW. A double—blind randomized trial comparing Ligasure™ and Harmonic Scalpel™ hemorrhoid-dectomy. Dis Colon Rectum 2005;48(2):344–348.

5.      Gentile M, De Rosa M, Pilone V, Mosella F, Forestieri P. Surgical treatment for IV-degree hemorrhoids: LigaSurehemorroidectomy vs. conventional diathermy. A prospective, randomized trial. Minerva Chir 2011;66(3):
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9.      Peker K, İnal A, Güllü H, Gül D, Sahin M, Özcan AD, et al. Comparison of Vessel Sealing Systems with Conventional. Iranian Red Crescent Med J 2013;15:488–496.

10.  Sayfan J, Becker A, Koltun L. Sutureless closed hemorrhoidectomy: a new technique. Ann Surg 2001;234:21–24.

11.  Filingeri V, Gravante G, Baldessari E, Craboledda P, Bellati F, Casciani CU. Prospective randomized trial of submucosalhemorrhoidectomy with radiofrequency bistoury vs. conventional Parks’ operation. Techniques in Coloproctol 2004;8:
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12.  Andrew BT, Layer GT, Jackson BT, Nicholls RJ. Randomized trial comparing diathermy hemorrhoidectomy with the scissor dissection Milligan-Morgan operation. Dis Colon Rectum 1993;36:580