Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Colorectal Dis. 2021 Oct;23(10):2699-2705. doi: 10.1111/codi.15808. Epub 2021 Jul 31.
LigaSure™ is an electro-surgical device that has increasingly been utilized in haemorrhoid surgery. However, recent literature has highlighted a possible increased risk of delayed postoperative bleeding following LigaSure haemorrhoidectomy (LH). We aim to evaluate the rates of postoperative bleeding following LigaSure compared to Ferguson (closed) haemorrhoidectomy (FH).
A retrospective cohort study was undertaken at our single academic safety-net county hospital from August 2016 through July 2019 evaluating patients who received FH or LH. Patient demographics, surgical data, postoperative emergency department visit for pain or bleeding within 30 days and resulting transfusion requirement, and rates of readmission and interventions within 30 days were collected.
Sixty-one FH and 66 LH patients were identified. The groups had no difference in demographics. The LH group and FH group had similar rates of postoperative emergency department visits (29% vs. 23%, P = 0.454), as well as visits for bleeding (20% vs. 11%, P = 0.204). The average operating time was also significantly shorter with LH (14.5 min vs. 24.9 min, P ≤ 0.001). On multivariate analysis, male sex (OR 7.28, 95% CI 1.88-28.25) and haemorrhoid grade ≤2 (OR 4.64, 95% CI 1.31-16.49) were significantly associated with postoperative bleeding on multivariate analysis. Use of LH was not independently associated with postoperative bleeding risk (OR 1.89, 95% CI 0.70-5.11).
LH and FH have similar risks for postoperative bleeding and other complications. Male sex and haemorrhoid Grades 1 or 2 may be associated with increased postoperative bleeding risk. Excisional haemorrhoidectomy should be undertaken with caution for male patients with lower internal haemorrhoid grades.
LigaSure™ 是一种电外科设备，已越来越多地用于痔手术。然而，最近的文献强调了 LigaSure 痔切除术（LH）后延迟性术后出血的风险可能增加。我们旨在评估 LigaSure 与 Ferguson（闭合）痔切除术（FH）相比，术后出血的发生率。
我们在单家学术性安全网县医院进行了一项回顾性队列研究，该研究评估了 2016 年 8 月至 2019 年 7 月期间接受 FH 或 LH 的患者。收集了患者人口统计学、手术数据、术后 30 天内因疼痛或出血而就诊于急诊部的情况以及输血需求，以及 30 天内再入院和干预的发生率。
共确定了 61 例 FH 和 66 例 LH 患者。两组在人口统计学方面无差异。LH 组和 FH 组术后急诊就诊率相似（29%比 23%，P=0.454），出血就诊率也相似（20%比 11%，P=0.204）。LH 的平均手术时间也明显较短（14.5 分钟比 24.9 分钟，P≤0.001）。多变量分析显示，男性（OR 7.28，95%CI 1.88-28.25）和痔等级≤2（OR 4.64，95%CI 1.31-16.49）是多变量分析中术后出血的显著相关因素。多变量分析显示，LH 的使用与术后出血风险无独立相关性（OR 1.89，95%CI 0.70-5.11）。
LH 和 FH 术后出血和其他并发症的风险相似。男性和痔等级 1 或 2 可能与术后出血风险增加相关。对于男性和较低的内痔等级的患者，应谨慎进行痔切除术。
