LigaSure Hemorrhoidectomy and Nerve Damage Risk
LigaSure hemorrhoidectomy does not typically cause altered sensations or nerve damage as a direct result of the device itself; however, any hemorrhoidectomy technique—including LigaSure—carries up to a 12% risk of sphincter defects and 2–12% incidence of incontinence due to excessive retraction, dilation, or improper surgical technique. 1
Device-Specific Safety Profile
LigaSure technology seals vessels through controlled thermal energy without causing direct nerve injury, distinguishing it from techniques that rely on extensive tissue manipulation or aggressive sphincter stretching. 2, 3
Multiple randomized trials comparing LigaSure to conventional diathermy and Ferguson hemorrhoidectomy demonstrate no increase in incontinence scores or sphincter dysfunction attributable to the LigaSure device itself. 2, 4, 5, 6
The primary advantage of LigaSure is reduced operative time (6–15 minutes vs. 11–34 minutes for conventional techniques) and decreased postoperative pain, which may actually reduce the risk of complications by minimizing tissue trauma. 2, 3, 4, 5, 6
Universal Hemorrhoidectomy Risks (All Techniques)
Sphincter defects occur in up to 12% of patients after any hemorrhoidectomy when documented by ultrasonography and anal manometry, primarily due to excessive retraction with extensive dilation of the anal canal rather than the cutting/sealing method used. 1
Incontinence rates range from 2–12% across all hemorrhoidectomy techniques, with the mechanism being sphincter injury from over-aggressive tissue handling, not device-specific thermal injury. 1
The use of excessive retraction with extensive dilation is the primary culprit for sphincter injury and subsequent altered sensation or incontinence, not the energy source (LigaSure, diathermy, or scalpel). 1
Long-Term Sensory Complications
Chronic perianal pain persisting ≥3 years after any hemorrhoidectomy most often reflects permanent nerve injury or scar-related sensory alteration rather than reversible sphincter hypertonicity. 7
Altered sensation from scar tissue or nerve injury is a recognized complication of the surgical dissection itself, not the vessel-sealing technology; this occurs when dissection extends too close to sensory nerve endings below the dentate line. 7
Biofeedback and sensory retraining are unlikely to correct scar-related sensory defects, as these interventions do not address the underlying anatomical changes from surgery. 7
Critical Technical Factors to Prevent Nerve Damage
Avoid anal dilation entirely—this outdated technique causes a 52% incontinence rate at 17-year follow-up and direct sphincter injuries. 1, 8
Limit sphincter manipulation during hemorrhoidectomy; performing lateral internal sphincterotomy as an adjunct has been shown to increase incontinence rates rather than reduce them. 1
Maintain dissection in the correct plane between hemorrhoidal tissue and the internal sphincter to avoid inadvertent sphincter injury, regardless of the energy device used. 1
Comparative Evidence: LigaSure vs. Other Techniques
A meta-analysis of randomized controlled trials found no significant difference in postoperative complications including incontinence between LigaSure and conventional excisional techniques. 3
Postoperative bleeding rates are similar between LigaSure and conventional methods (no significant difference, P = 0.056), indicating equivalent tissue handling safety. 3
Early complications (urinary retention 2–36%, bleeding 0.03–6%, infection 0.5–5.5%) occur at comparable rates across all hemorrhoidectomy techniques, with no evidence that LigaSure increases these risks. 1
Common Pitfall to Avoid
Do not attribute chronic perianal pain or altered sensation to "normal healing" without proper workup; anoscopy, anorectal manometry, and endoanal ultrasound are required to document sphincter defects or stenosis (reported in 0–6% of cases). 7
Never assume LigaSure eliminates the risk of sphincter injury—the surgeon's technique (avoiding excessive retraction and dilation) is far more important than the energy device selected. 1