A Randomized Clinical Trial of Laser Hemorrhoidoplasty vs Milligan and Morgan Hemorrhoidectomy

Abstract

Introduction: Hemorrhoidectomy is one of the most common surgical procedures, and other treatments such as laser hemorrhoidectomy had been used as an alternative. The aim of this study was to determine the outcome and postoperation complications of treatment by laser compared with open hemorrhoidectomy. Materials and methods: In this randomized clinical trial (RCT), 85 cases with a second or third degree of hemorrhoids were assigned to two groups at random and followed for 6 months. Those patients in the intervention group were treated by laser hemorrhoidoplasty (LHP) and those in the control group underwent Milligan and Morgan hemorrhoidectomy. At the end of follow-up, 80 cases remained in the trial on whom postoperative pain [visual analog scale (VAS)], complications, and quality of life according to the 36-item Short Form Health Survey (SF-36) questionnaire were studied. Data were analyzed using R 3.5.1 software and p value <0.05 was considered significant. Results: The most common complaints were bleeding (57%) and pain (41%). Postoperative pain immediately and after 6 months was not significantly different between the two groups (p > 0.05). No complications were seen in any groups in follow-up. All eight scales of SF-36 questionnaire, except general health, were significantly different in the two groups. Physical functioning was lower in patients who underwent LHP, whereas the patients' quality of life in other scales was better in the laser group. The total score of SF-36 was 66.1 ± 3.6 and 56.0 ± 3.3 in laser and surgery groups, respectively (p < 0.001). Conclusion:Laser hemorrhoidectomy is a safe procedure, not associated with any excessive postoperative complications. It improves patients' quality of life and can be a substitution of other surgical methods.

Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard

“…Crucially, there was no significant difference between the rate of recurrence between the two groups from the pooled estimate of 7 studies (n = 1379), with a HR of 0.72 (CI: [46] result also favoured LHP at 6 months post-operation, where patients' QoL was significantly better in their LHP cohort for all domains except for physical functioning.…”

“…Crucially, these advantages were accompanied by the major issue of higher recurrence rates [14,22,[49][50][51]. Therefore, given equivalent recurrence rate between LHP and CoH, evidenced by consistent results from independent institutions across 9 countries, LHP may potentially be superior to CoH by providing greater tolerability whilst maintaining CoH's standard-defining efficacy in the moderate term [44][45][46][54][55][56][57][58][59][60][61][62].…”

Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management

“…The parameters studied encompassed demographics, medical history, symptoms, hemorrhoidal grade, intraoperative details, and short- to medium-term outcomes [ 5 ]. A randomized clinical trial comparing LHP to Milligan and Morgan hemorrhoidectomy demonstrated that LHP induces less postoperative pain over a shorter period and effectively resolves hemorrhoidal symptoms with lower morbidity [ 23 ]. Additionally, a double-blind controlled trial comparing LHP, excisional hemorrhoidectomy, and recto-anal repair found LHP to be a safe and effective treatment for symptomatic hemorrhoids, resulting in less postoperative pain and an earlier return to work compared to excisional hemorrhoidectomy [ 23 ].…”

“…A randomized clinical trial comparing LHP to Milligan and Morgan hemorrhoidectomy demonstrated that LHP induces less postoperative pain over a shorter period and effectively resolves hemorrhoidal symptoms with lower morbidity [ 23 ]. Additionally, a double-blind controlled trial comparing LHP, excisional hemorrhoidectomy, and recto-anal repair found LHP to be a safe and effective treatment for symptomatic hemorrhoids, resulting in less postoperative pain and an earlier return to work compared to excisional hemorrhoidectomy [ 23 ]. Moreover, a pilot Australian study investigating LHP in the treatment of symptomatic hemorrhoids concluded that it represents a safe and effective treatment option, yielding minimal postoperative pain and favorable short- and long-term outcomes.…”

The role of laser technologies in coloproctology

“…Лазер для лечения геморроя может быть использован двумя способами: в одном случае выполняется лазерная дезартеризация, т. е. коагуляция терминальных ветвей верхней прямокишечной артерии с применением специального ультразвукового (УЗ) допплеровского датчика; в другом случае выполняется лазерная геморроидопластика (ЛГ), или дозированное внутритканевое нагревание геморроидального узла, в результате чего происходит вапоризация (деструкция) геморроидальной ткани с последующей фиксацией слизистой оболочки к подлежащим тканям [14,15,[21][22][23]. Надо отметить, что в настоящий момент отсутствуют единые рекомендации по использованию лазерного излучения в лечении геморроя, не указана ни предпочтительная методика, ни длина волны.…”