الفهرس 
Diagnosis of Hemorrhoids
Blood Supply of the Anal CanalOnly 14 pages are availabe for public view
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Abstract
Introduction: Hemorrhoids is a common anal disease that can occur at any age in both sexes. It has been established that at least 50% of individuals over the age of 50 years have at some time experienced symptoms related to hemorrhoids. The harmonic scalpel hemorrhoidectomy is a newly introduced treatment modality aiming at avoiding the most common postoperative complications. Aim of work: Comparison between harmonic scalpel hemorrhoidectomy and the closed (Ferguson) hemorrhoidectomy as regard: (1) Operative time and blood loss. (2) Postoperative complications (pain, urinary retention, bleeding, stenosis, constipation and fecal incontinence). (3) Patient satisfaction. Patients and methods: This prospective randomized study was carried out on 40 patients suffering from III and IV degree piles. Patients were randomly divided into two groups, 20 patients in each, one group was managed by Harmonic scalpel hemorrhoidectomy and the other by closed (Ferguson) hemorrhoidectomy and the results were compared. Complete history taking, general, anorectal examination with proctoscopy and preoperative manometry were done for each patient before surgery. Follow up of pain score, analgesic requirements, postoperative complications and postoperative manometry was done for each patient after surgery. Results: The application of harmonic scalpel hemorrhoidectomy is associated with shorter operative time, almost bloodless operative field, smooth postoperative period with lower pain score and analgesic requirements and lower incidence of postoperative complications. Also it was found that patient satisfaction was significantly more superior after harmonic scalpel hemorrhoidectomy. Conclusions: Harmonic scalpel hemorrhoidectomy is virtually a bloodless operation with minimal tissue damage. The procedure is performed quickly and in an elegant fashion. It is associated with significant less postoperative pain and a fast return to normal activity, our preliminary results suggest that hemorrhoidectomy with the use of harmonic scalpel is a preferred surgical method. The disadvantage here is the increased cost of the instrument when compared to the cost of electrocautary. However. This increased operative cost might become insignificant if patients could return to work and resume duty earlier.