ABSTRACT
The aim of this study was to compare the outcome of the patients receiving hemorrhiodectomy using harmonic scalpel, bipolar scissors, and conventional scissors excision-ligation technique. This study included forty five patients with irreducible prolapsing piles, selected from Al-Azhar University hospital,Damietta branch. between January 2008 to June 2009. They were randomly assigned to receive: 1] Milligan Morgan hemorrhiodectomy; 2] Bipolar scissors hemorrhiodectomy; 3] Harmonic scalpel hemorrhiodectomy. The measured outcomes included: 1]Operative time, 2]Blood loss, 3]postopenative hospital stay, 4]pain 4 scone,5]date of first bowel movement,6]number of nalbuphine HCL injection,7]number of diclofinac potassium injection,8] time need to return to work or normal activity, 9] wound healing, 10] satisfaction scone, 11] postoperative complications including anal stenosis and or flatus incontinence. Both harmonic scalpel hemorrhiodectomy and bipolar scissors hemorrhiodectomy were superior to Milligan Morgan hemorrhiodectomy in term of reduced blood loss. Harmonic scalpel hemorrhiodectomy had the best pain score when compared with bipolar scissors hemorrhiodectomy and Milligan-Morgan hemorrhiodectomy, and patients required significantly less nalbuphine HCL injection after harmonic scalpel hemorrhiodectomy than after Milligan Morgan hemorrhiodectomy also the time required to return to work or normal activity reduced in case of harmonic scalpel and bipolar scissors than Milligan Morgan hemorrhiodectomy so, the patient after harmonic scalpel hemorrhiodectomy had the best satisfaction score among three groups. This study shows that harmonic scalpel hemorrhiodectomy is as good as bipolar scissors hemorrhiodectomy in terms of reduced blood loss and operative time and time to return to normal activity but it is superior because it is associated with less postoperative pain and hence, better patients' satisfaction