Radiofrequency versus conventional diathermy Milligan-Morgan hemorrhoidectomy: a prospective, randomized study.

Franceschilli, Luana; Stolfi, Vito M; D' Ugo, Stefano; Angelucci, Giulio P; Lazzaro, Sara; Picone, Emanuele; Gaspari, Achille; Sileri, Pierpaolo

BACKGROUND In the past decade, several new surgical tools have revived the hope for an improved technique to treat radically hemorrhoids with less postoperative pain. Among these radiofrequency (RF), excisional surgery seems to be safe, fast, and accompanied by less postoperative pain. The aim of this study was to evaluate and compare RF (ligasure TM) to conventional diathermy Milligan-Morgan hemorrhoidectomy (MMH). PATIENTS AND METHODS Between January 2003 and July 2009, 210 symptomatic patients were randomized to undergo RF (118 patients) or diathermy MMH (92 patients). Mean follow-up was 39 ± 16 months. Clinical outcome was assessed by validated questionnaire on postoperative symptoms and satisfaction. Primary endpoints were pain and wound healing. Secondary endpoints were operative time, early and late complications (including recurrences), and patient satisfaction. Data was analyzed using chi-squared test and Fisher's exact test. RESULTS Despite postoperative pain was less after RF, this difference was significant only for severe pain (expressed as VAS score >7). Significant differences were observed in terms of wound healing. The two techniques were similar in terms of early and late complications. CONCLUSIONS RF hemorrhoidectomy is followed by reduced severe pain and better wound healing. However, in our experience, this is not followed by earlier return to daily activities.