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webmaster@sages.org Reimagining surgical care for a healthier world. Early evidence suggests that hemorrhoidal artery ligation has similar outcomes to stapled hemorrhoidopexy with less postoperative pain.28,37 Hemorrhoidal artery ligation appears to have overall outcomes approaching those of conventional hemorrhoidectomy with similar postoperative pain.28,37, Postoperative pain has historically been universal with surgical hemorrhoidectomy. Pictures of Medical Anatomy and Illustrations - Hemorrhoid This content does not have an English version. In: Conn's Current Therapy 2019. Hemorrhoidal disease: Diagnosis and management - Mayo Clinic Compared with office-based procedures, conventional hemorrhoidectomy is more painful and associated with more blood loss and longer recovery time, but it has significantly lower rates of recurrence.7,23,26, Conventional hemorrhoidectomy has been modified to include two alternative energy devices, Ligasure and Harmonic Scalpel, which use diathermy and ultrasonic energy, respectively, to limit blood loss and postoperative pain as the instruments cut through tissue.32,33 A Cochrane review of 10 studies demonstrated significantly lower pain scores (using a validated visual analog scale) on postoperative day 1 in patients receiving Ligasure vs. conventional hemorrhoidectomy (weighted mean difference = 2.07; 95% confidence interval, 2.77 to 1.38).34 Additionally, the Ligasure procedure took less time to complete (11 trials; 9.15 minutes; 95% confidence interval, 3.21 to 15.09).34, An additional surgical procedure is the stapled hemorrhoidopexy.25 This is often referred to as stapled hemorrhoidectomy, which is a misnomer because the excised tissue is not the actual hemorrhoid, but rather loose proximal mucosa that has contributed to the prolapsed hemorrhoid. Search dates: June 2, 2016, and June 25, 2017.