الفهرس 
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Abstract
Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They affect millions of people around the world, and represent a major medical and socioeconomic problem.
Multiple factors have been claimed to be the etiologies of hemorrhoidal development, including constipation and prolonged straining -causing sliding of the anal cushions- the abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal region. Also, inflammatory reactions and vascular hyperplasia may be evident in hemorrhoids.
The most common manifestation of hemorrhoids is painless rectal bleeding associated with bowel movement, described by patients as blood drips into toilet bowl. The blood is typically bright red as hemorrhoidal tissue has direct arteriovenous communication, hemorrhoidal prolapse, pain, discomfort may also present.
Management of haemorrhoids varies from conservative treatment up to surgery which is actually indicated for patients with grade III and IV haemorrhoids.
The most effective hemorrhoidectomy methods are the Milligan-Morgan open hemorrhoidectomy and the Ferguson closed one. These methods are similar and are recognized as traditional methods. However, although they may be the most effective treatment for hemorrhoids, complications such as postoperative bleeding, surgical-site anal pain, anal stenosis, incontinence, and peri-anal fistula can occur after the surgery.
In particular, postoperative pain and bleeding are experienced by many patients after undergoing a hemorrhoidectomy, and many patients complain of discomfort for a long time.
As a result, various surgical equipment, surgical methods, and supportive therapies have been introduced to overcome those postoperative complications. In recent years, several pieces of surgical equipment have been developed due to advances in technology, many of them are useful in hemorrhoidectomies, such as bipolar electro-thermal devices, ultrasonic scalpels, and circular staplers.
Among those new devices is the LigaSureTM, which became a popular choice for hemorrhoidectomy. It is so effective in achieving haemostasis, it is best described as a ‘vessel sealing system’. The energy is delivered only to the tissue grasped within the jaws of the hand piece with minimal spread of electrical or thermal energy to adjacent tissues.
In our study, an objective comparison was made between the closed hemorrhoidectomy, Ferguson’s method, and LigaSureTM hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence.
The study was conducted over 40 patients with Hemorrhoids grade III and IV, randomly divided into 2 nearly equal groups (22 Ferguson’s vs. 18 LigaSureTM), who underwent hemorrhoidectomy in either methods.
Although an overall favourable trend exists toward LigaSureTM, as regards the postoperative complications, conclusions are not univocal and definitive; this creates some uncertainty, also considering the increasing cost for the use of the disposable device; thus, it is essential to keep on experimenting to determine whenever a true advantage exists.