Prospective, Randomized Trial Comparing Diathermy Excision and Diathermy Coagulation for Symptomatic, Prolapsed Hemorrhoids

This study was designed to compare diathermy excision and diathermy coagulation in the treatment of symptomatic prolapsed piles.

Forty-five consecutive patients were randomly assigned to diathermy excision hemorrhoidectomy (Group A, n = 25) and diathermy coagulation (Group B, n = 20) under general anesthesia.

The median duration of surgery was ten minutes for both groups. There was no statistical difference in the severity of postoperative pain at rest between the two groups, but Group A patients felt less pain during defecation on the third postoperative day (median, 5 (interquartile range, 3–7) vs. 8 (4–9); P = 0.04) and on the sixth postoperative day (median, 5 (interquartile range, 2–6) vs. 9 (5–10); P = 0.02). There was, however, no statistical difference in postoperative oral analgesics use and patients’ satisfaction scores between the two groups. Complication rates were similar except that diathermy coagulation tended to leave some residual skin components of external hemorrhoid especially in very large prolapsed piles. Group A patients resumed work earlier (mean, 12 (range, 4–20) vs. 17 (11–21) days); however, this was not statistically significant (P = 0.1).

Diathermy coagulation of hemorrhoids is a simple technique and may be considered in suitable cases.