الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Haemorrhoids are one of the most common ailments to afflict mankind, its treatment depends on the severity of symptoms and clinical grading of the hemorrhoids, in grade I and II conservative treatment and outpatient procedures are sufficient but it failed in treatment in grade III and IV hemorrhoids, surgery is the effective way to control the symptoms of these haemorrhoids, but it is usually associated with very troublesome side effects such as severe pain, bleeding and impairment of defecation. Modern methods of haemorrhoid surgery such as ligation anopexy, stapled haemorrhoidopexy and transanal haemorrhoidal dearterialization are associated with a lower rate of complications.
The aim of this study was to compare the preliminary results of diathermy hemorrhoidectomy versus ligation anopexy in management of advanced (grade III and IV) haemorrhoids.
The study included randomly collected forty patients complaining of advanced haemorrhoidal disease grade III and grade IV admitted to unit of colorectal surgery, Alexandria Main University Hospital and Medical Research Institute Alexandria University from December 2010 to January 2012, Preoperative assessment included history taking, clinical examination and PR examination and routine laboratory investigation was done for each patient, they were randomly assigned by closed envelop technique into two groups, Group A: 20 patients were treated by diathermy haemorrhoidectomy and Group B: 20 patients were treated by ligation anopexy.
Distribution of age, sex, onset of symptoms, grade of hemorrhoids and symptoms before surgery were compared in both group without significant difference. Then they were evaluated on the basis of the following main outcomes: mean operative time, postoperative pain according to VAS, day of discharge, wound condition, early complications and the time off work.
Ligation anopexy was shorter duration than diathermy hemorrhoidectomy (22 vs 15min), with less intra and extra operative bleeding, less pain according to VAS (3 vs 5) which was accepted by 90% of the patients, less postoperative complication, less postoperative bleeding, less incidence of urine retention (10%)vs (15%), less postoperative discharge and fecal impaction.
Thrombosed external pile was reported in (15%) with LA and residual skin tags in (30%) in 1stand 2nd week, and in three patients (15%) in 3rdweek, and in two patients(10%) in 4th week especially in grade IV hemorrhoids, these complications were not reported with diathermy hemorrhoidectomy.
There was no significant difference in the hospital stay time between the two groups. Time off work in patients treated with ligation anopexy was significantly shorter than diathermy hemorrhoidectomy (7.25 ± 1.55 days) vs (10.40 ± 1.85days).
Ligation anopexy for prolapsing hemorrhoids was less invasive, shorter duration, less pain, less analgesia requirement, less postoperative complication, less hospital stay and time off work.