COMPARISON OF OUTCOMES OF MONOPOLAR DIATHERMY VERSUS SUTURED PEDICLE LIGATION IN MILLIGAN MORGAN HEMORRHOIDECTOMY IN THE TERTIARY CARE HOSPITAL OF LAHORE PAKISTAN

Abstract

Background: Surgical hemorrhoidectomy remains the standard treatment for symptomatic grade III and IV hemorrhoidal disease. Various surgical modifications have been introduced to reduce postoperative pain, bleeding, and other complications. Objective: To compare the outcomes of pedicle ligation versus monopolar diathermy coagulation during Milligan Morgan hemorrhoidectomy in patients with third- and fourth-degree hemorrhoids. Methods: This randomized controlled trial was conducted in Surgical Unit II, Shalamar Institute of Health Sciences, Lahore, from June 21, 2024, to December 20, 2024. A total of 140 patients fulfilling the inclusion criteria were enrolled and randomly allocated into two groups of 70 patients each. Group A underwent pedicle ligation, while Group B underwent monopolar diathermy coagulation. Outcomes included intraoperative blood loss, postoperative pain at 24 hours, urinary retention, and anal stenosis assessed on the 15th postoperative day. Data were analyzed using IBM SPSS Statistics version 25.0. Continuous variables were compared using the independent-samples t-test, while categorical variables were compared using the chi-square test. Results: In Group A, 44 (62.9%) patients were male and 26 (37.1%) were female, compared with 40 (57.1%) males and 30 (42.9%) females in Group B. The mean age was 41.6 ± 7.6 years in Group A and 42.8 ± 8.2 years in Group B. Mean intraoperative blood loss was significantly higher in the pedicle ligation group than in the diathermy coagulation group (13.34 ± 3.74 mL vs. 9.80 ± 2.88 mL; p=0.001). The mean postoperative pain score at 24 hours was 3.19 ± 1.02 in Group A and 3.26 ± 0.87 in Group B, with no statistically significant difference between the groups (p=0.659). Conclusions: Monopolar diathermy coagulation during Milligan-Morgan hemorrhoidectomy was associated with significantly lower intraoperative blood loss compared with conventional pedicle ligation, while postoperative pain was comparable between the two techniques. Diathermy coagulation may therefore provide a safe and effective alternative for the surgical management of symptomatic third- and fourth-degree hemorrhoids.