Laser hemorrhoidoplasty versus Milligan-Morgan hemorrhoidectomy - short term outcome

Abstract

Background/Aim. According to the "vascular" theory, arterial inflow into the upper hemorrhoidal artery leads to venous dilatation of the hemorrhoidal plexus. Laser hemorrhoidoplasty (LHP) is a new treatment applied to outpatients in whom the hemorrhoid arterial blood flow is coagulated (nourishes by hemorrhoidal plexus) by laser. The aim of this study was to compare two groups of patients treated by two different methods: by laser (LHP) and with open surgical procedure-the Milligan Morgan (MM) method. Methods. This study included 200 patients with grade 3 hemorrhoidal disease older than 18 years, divided into two groups: 100 patients treated with the LHP, while the other 100 patients with the MM hemorrhoidectomy. Parameters used to compare two applied surgical methods were: duration of hospitalization, postoperative pain, the presence of bleeding and time needed to return to normal life. Results. The results reveal a statistically significant difference between these two methods. The level of postoperative pain was lower in the group of patients treated with the LHP compared to the group of patients treated with the MM method (p < 0.0001). The group treated with the LHP manifested less bleeding in comparison with the group treated with the open surgical method (MM). Length of hospitalization and duration of surgery were significantly shorter in the group treated with the LHP method than in the group treated by the MM method. Conclusion. According to our results, it is clear that the LHP method has many advantages over the MM hemorrhoidectomy in patients with grade 3 hemorrhoidal disease.

Comparison between Laser Hemorrhoidoplasty Procedure and Conventional Open Surgical Hemorrhoidectomy

“…The operative time was also significantly shorter in the laser group than MMH group. Also, Maluku et al (8) stated that the procedure time for LHP was 15.94 min vs. 26.76 min for open surgery, which is in agreement with our results.…”

“…Naderan et al (10) conducted that postoperative pain was significantly lower in the laser group 12 to 24 hr after the procedure. In addition, Maloku et al (8) compared MMH and LHP and found significant difference between them regarding pain with mush less pain and early relief of pain in the laser group.…”

“…The presence of hemorrhoidal disease is evaluated to be between 2.9%-27.9% among the worldwide population and 4% are symptomatic. One third of the total number of patients ask for medical advice (8) .…”

Laser Hemorrhoidoplasty: Experience at Aga Khan University Hospital

“…Duration of hospital stay was similar in both laser and the comparative group. This was at variance to shorter hospital stay when comparing laser to conventional hemorrhoidectomy in grade 3 (19), or grades 3 and 4 hemorrhoids (14). This finding can be explained by the skewed data in patients who underwent LHP without pudendal blocks subsequently developed higher pain scores post-operatively, necessitating longer hospital stays.…”

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

“…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.…”