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Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs Conventional Hemorrhoidectomy
Emile K. Tan, MBBS, MRCS;
Julie Cornish, MBBS, MRCS;
Ara W. Darzi, MD, FRCS, KBE;
Savas Papagrigoriadis, MD, FRCS;
Paris P. Tekkis, MD, FRCS
Arch Surg. 2007;142(12):1209-1218.
Objective To evaluate the short-term outcomes of hemorrhoidectomy performed using the LigaSure vessel sealing device (Valleylab, Boulder, Colorado) or the conventional approach.
Data Sources MEDLINE, EMBASE, Ovid, and Cochrane databases for studies published between 2002 and 2006.
Study Selection Randomized controlled trials published between 2002 and 2006 comparing short-term outcomes for LigaSure vs conventional hemorrhoidectomy.
Data Extraction Operative parameters, short-term complications, and postoperative recovery. Trials were assessed using a modified Jadad score. Random-effects meta-analytical techniques were used in the analysis.
Data Synthesis Nine randomized controlled trials with matched selection criteria reporting on 525 patients, of whom 266 (50.7%) underwent LigaSure and 259 (49.3%) underwent conventional hemorrhoidectomy. Operative time (weighted mean difference [WMD], – 8.67 minutes; 95% confidence interval [CI], – 15.34 to – 2.00 minutes), blood loss (WMD, – 23.08 mL; 95% CI, – 27.24 to – 18.92 mL), and pain the day after the operation measured by the visual analog scale (WMD, – 2.31; 95% CI, – 3.37 to – 1.26) were significantly reduced following LigaSure hemorrhoidectomy. There was a decrease in time taken to return to work or normal activity (WMD, – 3.49 days; 95% CI, – 7.40 to 0.43), which was of marginal significance (P = .08). Incidence of postoperative hemorrhage was comparable as was incidence of anal stenosis and fecal and flatus incontinence between the 2 groups.
Conclusions LigaSure hemorrhoidectomy results in a significant reduction in operative time and blood loss, but it may not confer any advantage over the conventional operation in terms of postoperative pain, length of hospital stay, or time taken to return to work or normal activity. The expediency of the device must be weighed against its additional cost. Long-term evaluation of outcomes and morbidity are still needed.
Author Affiliations: Department of Biosurgery and Surgical Technology, St Mary's Hospital, Imperial College (Drs Tan, Cornish, Darzi, and Tekkis), and Department of Surgery, King's College Hospital (Dr Papagrigoriadis), London, England.
RELATED ARTICLE
Meta-analysis of Short-term Outcomes of Randomized Controlled Trials of LigaSure vs Conventional Hemorrhoidectomy—Invited Critique
Susan Galandiuk
Arch Surg. 2007;142(12):1218.
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