Comparison of Mean Pain in Conventional Milligan Morgan Versus Harmonic Scalpel Technique in The Treatment of Hemorrhoidectomy
Keywords:
Hemorrhoidectomy, Harmonic scalpel, Morgan-Milligan technique, Postoperative painAbstract
Objectives: To compare mean pain in conventional Milligan Morgan technique versus harmonic scalpel technique in patients undergoing hemorrhoidectomy for 3rd and 4th degree hemorrhoids.
Study design: Randomized controlled trial.
Setting: Department of Surgery, Lady Reading Hospital, Peshawar.
Duration: Six months from 12th August 2020 till 11th February 2021.
Materials & Methods: A total of 142 patients of both genders, between 18-65 years of age, diagnosed as cases of 3rd and 4th degree hemorrhoids were divided into two equal groups by lottery method. Patients in group A underwent hemorrhoidectomy by the conventional Milligan Morgan technique while patients in group B were subjected to harmonic scalpel hemorrhoidectomy. All patients were followed up at one month of surgery for evaluation of mean post-operative pain score. Data analysis was carried out by SPSS 23 taking p value ≤0.05 as significant.
Results: The mean age was 54.13±17.33 years. The mean body mass index was 23.92±2.82 kg/m2. The mean Evans’ ratio was 0.30±0.07. A total of 99 (46%) patients developed some degree of hydrocephalus while 116 (56%) had no evidence of the condition. The presence of hydrocephalus demonstrated a significant relationship with advancing age and high body mass index, with p values of 0.066 and 0.015, respectively.
Conclusion: Harmonic scalpel technique was significantly better than conventional Morgan Milligan technique in terms of lesser post-operative pain in patients undergoing hemorrhoidectomy for 3rd and 4th degree hemorrhoids.
Downloads
References
Lunsford TN, Atia MA, Kagbo-Kue S, Harris LA. A pain in the butt: hemorrhoids, fissures, fistulas, and other anorectal syndromes. Gastroenterology Clinics. 2022;51(1):123-44.
2. Ashburn JH. Hemorrhoidal disease: a review. JAMA. 2025.
3. Du T, Quan S, Dong T, Meng Q. Comparison of surgical procedures implemented in recent years for patients with grade III and IV hemorrhoids: a network meta-analysis. International journal of colorectal disease. 2019;34(6):1001-12.
4. Aibuedefe B, Kling SM, Philp MM, Ross HM, Poggio JL. An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis. International Journal of Colorectal Disease. 2021;36(9):2041-9.
5. Long Q, Wen Y, Li J. Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study. BMC gastroenterology. 2025;25(1):355.
6. Yu Q, Zhi C, Jia L, Li H. Efficacy of Ruiyun procedure for hemorrhoids combined simplified Milligan–Morgan hemorrhoidectomy with dentate line-sparing in treating grade III/IV hemorrhoids: a retrospective study. BMC surgery. 2021;21(1):251.
7. McCarus SD, Parnell LK. The origin and evolution of the HARMONIC® Scalpel. Surg Technol Int. 2019;35(20):1-13.
8. Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z. A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and Milligan–Morgan hemorrhoidectomy. Journal of investigative surgery. 2017;30(5):325-31.
9. Pawar PM. Harmonic scalpel compared with conventional open (Milligan-Morgan) method in surgical management of symptomatic haemorrhoids. International Surgery Journal. 2017;4(6):2010.
10. Ahmed SZ, ul Mobeen N, Ahmed B. Hemorrhoidectomy in Patients with Grade III and IV Disease: Harmonic Scalpel compared with Conventional technique. The Professional Medical Journal. 2020;27(05):929-34.
11. Lim DR, Cho DH, Lee JH, Moon JH. Comparison of a hemorrhoidectomy with ultrasonic scalpel versus a conventional hemorrhoidectomy. Annals of coloproctology. 2016;32(3):111.
12. Fayyaz MU, Shafique MS, Khan JS, Ahmad R, Fayyaz SMU, Shafique MS, et al. Harmonic scalpel hemorrhoidectomy vs milligan-morgan hemorrhoidectomy. Journal of Rawalpindi Medical College. 2017;21(3)...
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
