Ligasure™ vs conventional diathermy haemorrhoidectomy:: long-term follow-up of a randomised clinical trial

Objective: Ligasur (TM) haemorrhoidectomy has short-term benefits over conventional diathermy haemorrhoidectomy. The current study aimed to determine the long-term efficacy of Ligasure (TM) haemorrhoidectomy. Subjects and methods: Forty patients, previously randomised to Ligasure (TM) or diathermy haemorrhoidectomy in 2002, were invited to participate in the study. Haemorrhoidal symptoms and patient satisfaction were recorded. Incontinence was quantified and sphincter anatomy and function assessed by endoanal ultrasound and anorectal manometry. Results: Thirty (75%) patients participated in the study (14 Ligasure (TM), 16 conventional). There was no difference in age, sex distribution, or length of follow-up (Ligasure (TM): 37 months; conventional: 36 months) between the groups. Both techniques achieved good symptom control, but with a trend to less recurrent bleeding following Ligasure (TM). Incontinence scores and patient satisfaction were similar. A significant difference was observed in internal sphincter thickness (Ligasur (TM): 2.5 mm, 2.2-2.8 (mean, 95%CI) vs conventional: 1.88 mm, 1.7-2.1, P = 0.005) and rectal urge sensation (Ligasure (TM): 284 mls, 211-378 vs conventional: 173 mls, 129-217, P = 0.08). Conclusion: Ligasure (TM) is as effective as conventional diathermy haemorrhoidectomy in achieving long-term symptom control. Less radical haemorrhoidal excision with the Ligasure (TM) could explain the differences in internal sphincter thickness and urge sensation, and might make it the preferred method for patients with compromised sphincter function.