الفهرس 
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Abstract
Hemorrhoids are considered the most common and troublesome anal disorders. They can slide down, prolapse, dilate, and bleed occasionally. Hemorrhoids can be internal or external. External hemorrhoids are distal to dentate line and are covered with endoderm.
Millions of people are affected around the world. It is a major medical and socioeconomic problem. The etiology of hemorrhoids includes many factors such as constipation and prolonged straining.
The commonest symptom of third degree and fourth hemorrhoids is bright red blood covering the stool or found on toilet paper after defecation or in the toilet bowl. Other symptoms include sensation of a hard lump around the anus, protrusion, and/or mucous discharge. Frequent rubbing of the anus causes exacerbation of the symptoms with vicious cycle of irritation, itching, and bleeding, which is called pruritus ani. They are liable to thrombosis, causing severe pain.5
Hemorrhoids are classified into four degrees. The first and second degrees require conservative. The third and fourth degrees include severe prolapse and usually require surgical intervention.
The indication for hemorrhoidectomy includes third and fourth degree hemorrhoids, when external hemorrhoids is well defined and the other strong indication for surgery is haemorrhoidal bleeding sufficient to cause anemia.
Hemorrhoidectomy can be performed using an open hemorrhoidectomy (Milligan-Morgan) or closed hemo-rrhoidectomy (Ferguson technique). Both involve ligation and excision of hemorrhoids. In Milligan and Morgan technique the anal mucosa and skin are left open to heal by secondary intention but in closed technique the wound is sutured. Although hemorrhoidectomy is the most effective treatment, the presence of postoperative pain and complications as bleeding is the main reason of the patients refused for operation.
There are many reports on advantages of harmonic scalpel technique for the treatment of hemorrhoids such as Intra operative time reducer, less blood loss and better post -operative out comes as less pain , less tissues oedema ,less risk factor of infection and better wound healing.
The harmonic scalpel is an ultrasonically activated instrument with sound waves as its source of power, which vibrates at a rate of 55,000 per second. It is known for its ability to coagulate small and medium-sized vessels thus, potentially it may minimize postoperative swelling and edema to the surrounding tissue.
The Harmonic Scalpel possesses the unique advantage of causing very little lateral thermal injury in the tissues. A decreased lateral thermal injury (<1.5 mm) at the surgical site is translated into decreased postoperative pain.
Consequently, this study was conducted and aimed to evaluate the role of harmonic scalpel in open and closed hemorrhidectomy.
This prospective randomized controlled clinical trial was conducted at general surgery department, Faculty of Medicine, Ain Shams University Maternity Hospitals from December 2022 until July 2023.
Most of studies that disagreed with our results were due to several causes as different study methodology, outcomes, sample size and different medical conditions and degree of hemorrhoids of studied cases at time of enrollment.
Our study revealed that there were no statistically significant differences between groups according to baseline characteristics (age, sex and grade of hemorrhoids).
Harmonic scalpel group had shorter operative time, lesser intra and post-operative bleeding, shorter hospital stay, lower post-operative Visual Analog Scale score 24 hours and one week”
Finally, no differences were noted between study groups as regard post-operative infection and vitality of patient.
In conclusion, hemorrhoidectomy using an harmonic scalpel is an effective and safe procedure. The harmonic scalpel reduces the operation time, the intra and postoperative blood loss, and the postoperative pain. Harmonic scalpel hemorrhoidectomy appears to be a better procedure for symptomatic grades III and IV hemorrhoids with ease of operating due to less bleeding, less postoperative pain, and patient acceptance. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with harmonic scalpel