Laser Hemorrhoidoplasty: Experience at Aga Khan University Hospital

Abstract

<jats:p>Background: Hemorrhoidal disease is the commonest benign anal condition diagnosed in the outpatient setup. Interventional treatment options range widely, from office-based procedures to hemorrhoidectomy. Laser technology increasingly is in use in the field of proctology. We present our index clinical outcomes following laser haemorrhoidoplasty (LHP).&#x0D; Methodology: Retrospective cross-sectional study of 21 consecutive patients who underwent LHP between 2015 and 2018 under a single surgeon. Their outcomes were compared with a group of patients who underwent the standard open hemorrhoidectomy over the same period of time.&#x0D; Results: Postoperatively, 85.7% of patients post-LHP had a better pain score (mild) compared with 66.7% in the open hemorrhoidectomy group. The mean operative time in minutes was shorter for LHP, 29.67±17.50 versus 39.20±20.77 in the open group. Duration of hospital stay in days between the two groups were similar; LHP group median=1(1–3), open group median =1(1–3). Rates of infection, recurrence and urinary complications were however higher in the laser group, 4.8%, 9.5% and 9.5% respectively compared with the open hemorrhoidectomy group that were 0%, 6.7% and 6.7 % respectively. Both groups had no reported cases of stool or flatus incontinence.&#x0D; Conclusion: Laser haemorrhoidoplasty is associated with reduced pain scores and shorter operative time than open hemorrhoidectomy. Duration of hospital stay was similar in both groups. The rate of complications was high in the study group.&#x0D; Keywords: Laser haemorrhoidoplasty, Pain score, Complications, Open hemorrhoidectomy</jats:p>

Clinical Outcomes and Effectiveness of Laser Treatment for Hemorrhoids: A Systematic Review

“…Doppler‐guided localization was performed in 6 studies ( n = 579, 29.8%) [18–20, 23, 27, 28]. Twelve studies including 926 patients reported the mean duration of 15.4 min for the procedure [15, 16, 19, 20, 22, 24–27, 29–32]. Three studies concluded that the operative time for laser procedures was significantly shorter than the other techniques [25, 26, 31].…”

“…Finally, data from 19 studies including 1937 patients who underwent laser treatment for hemorrhoids were analyzed. Fourteen were prospective studies [14][15][16][17][18][19][20][21][22][23][24][25][26][27], four were randomized control trials [28][29][30][31], and one was a retrospective study [32]. According to the Downs and Black scoring system, the quality of the studies was graded as ''Fair'' (n = 13) or ''Good'' (n = 6).…”

Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis

“…One specific concern related to intrahemorrhoidal laser treatment is thrombosis of external hemorrhoids. However, the incidence of thrombosis was found to be low, and even if present, thrombosis can be managed successfully with medical treatment [10,23,26].…”

“…Six publications were excluded for reasons stated in Fig. 1, while 9 [10,12,18,[23][24][25][26][27][28] were included after the final review, of which 3 were RCTs [10,18,27], 4 were prospective cohort studies [23][24][25]28], and 2 were retrospective studies [12,26]. Notably, of the 6 studies excluded, the decision to exclude that of Mohammed et al [29] was largely based on a lack of clear data reporting and a high risk of reporting bias, despite a large sample size of 1,000 patients, which would have strengthened our study's power and external validity.…”

“…also reported significantly lower VAS scores in the LH group than in the CH group up to POD 30. Abdulkarim et al[26] assessed pain symptoms postoperatively between the LH and CH groups and classified the pain www.coloproctol.org Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis Ian Jun Yan Wee, et al Baseline characteristics and operative techniques of the included studies…”