Prospective, randomized, controlled trial of Starion vs Ligasure hemorrhoidectomy for prolapsed hemorrhoids.

PURPOSE This study was designed to evaluate the efficacy and outcome of the Starion and Ligasure vessel sealing systems for sutureless hemorrhoidectomy. METHODS Sixty-four patients with Grades III and IV hemorrhoids were randomized into two groups: 1) Starion hemorrhoidectomy (32 patients), and 2) Ligasure hemorrhoidectomy (32 patients). The patient demographics, operative details, numbers of parenteral analgesic injections, postoperative pain scores (assessed by an independent assessor), operating time, intraoperative blood loss, hospital stay, early and delayed complications, and time off from work or normal activity were recorded. The patients were regularly followed-up at 1, 2, 4, 6, 8, and 12 weeks after surgery. RESULTS The mean blood loss, mean operating time, duration of hospital stay, and time off from work or normal activity were not significantly different between the two methods (all P > 0.05), except for a lower pain score (P = 0.032) and reduced numbers of parenteral analgesic injections (P < 0.001) in Starion hemorrhoidectomy. In addition, there were no differences in the early and delayed postoperative complications between the two methods (all P > 0.05). Unfortunately, two patients with symptomatic anal stenosis requiring treatment were encountered by Ligasure hemorrhoidectomy, but none by Starion hemorrhoidectomy. CONCLUSIONS Starion hemorrhoidectomy with submucosal dissection is a safe and effective procedure, comparable to Ligasure hemorrhoidectomy. Patients derive a short-term benefit of less pain and reduced parenteral analgesic use by Starion hemorrhoidectomy. The superiority of no cases complicated with symptomatic anal stenosis requiring treatment by Starion hemorrhoidectomy seems to offer a better therapeutic alternative for prolapsed hemorrhoids.