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Review
. 2023 Feb 7;15(2):e34734.
doi: 10.7759/cureus.34734. eCollection 2023 Feb.

Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials

Ebraheem Albazee  1 , Abdulaziz Alenezi  1 , Maryam Alenezi  2 , Reham Alabdulhadi  1 , Rawan J Alhubail  1 , Khaled Ahmad Al Sadder  3 , Fatma AlDabbous  1 , Abdulrahman N Almutairi  2 , Saad N Almutairi  4 , Abdullah N Almutairi  1 , Mujahed S Alenezi  5
Affiliations
Review

Efficacy of Harmonic Scalpel Versus Bipolar Diathermy in Hemorrhoidectomy: A Systematic Review and Meta-Analysis of Nine Randomized Controlled Trials

Ebraheem Albazee et al. Cureus. .

Abstract

Hemorrhoidectomy is one of the most common surgical interventions to remove the third and fourth degrees of prolapse hemorrhoid. We carried out this systematic review and meta-analysis of the randomized controlled trials (RCTs) to comprehensively evaluate the efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy. Suitable citations were found utilizing digital medical sources, including the CENTRAL, Web of Science, PubMed, Scopus, and Google Scholar, from inception until December 2022. Only RCTs that matched the inclusion requirements were selected. We used the updated Cochrane risk of bias (ROB) tool (version 2) to assess the quality of the involved citations. The Review Manager (version 5.4 for Windows) was used to perform the pooled analysis. Data were pooled and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in random-effects models. Overall, there was no significant difference between HS and BD in terms of decreasing intraoperative morbidities like operative time, intraoperative blood loss, mean duration of hospital stay, and mean duration of first bowel movement (P>0.05). Similarly, the rate of postoperative complications like pain, bleeding, urinary retention, anal stenosis, flatus incontinence, and wound edema; was similar in both groups with no significant difference (P>0.05). In conclusion, our pooled analysis revealed there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints. Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.

Keywords: bipolar; haemorrhoid; harmonic; piles; systematic review and meta-analysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram.
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Figure 2
Figure 2. Risk of bias summary.
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Figure 3
Figure 3. Risk of bias graph.
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Figure 4
Figure 4. Meta-analysis of the mean change in [A] operative time (minutes), [B] intraoperative blood loss (ml), [C] duration of hospital stays (days), [D] duration of first bowel movement (days).
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Figure 5
Figure 5. Meta-analysis of the mean change in postoperative pain (10-points scale).
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Figure 6
Figure 6. Meta-analysis of the rate of postoperative complications.
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See this image and copyright information in PMC

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