Complications, Hemorrhoidectomy, Laser, Quality of life
Citation Information :
Shabahang H, Maddah G, Mofidi A, Nooghabi MJ, Khaniki SH. A Randomized Clinical Trial of Laser Hemorrhoidoplasty vs Milligan and Morgan Hemorrhoidectomy. World J Lap Surg 2019; 12 (2):59-63.
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.
Corman ML. Colon & rectal surgery 5th ed., vol. 12. Lippincott Williams & Wilkins; 2005. pp. 177–248.
Schwesinger WH, Hunter JG. Laser in general surgery. Surgical Clinics of North America 1992.
Andersen K. Laser technology–a surgical tool of the past, present, and future. AORN J 2003;78(794–802):805–807. DOI: 10.1016/S0001-2092(06)60639-X.
Montazeri A, Goshtasebi A, Vahdaninia M, et al. The short form health survey (SF-36): translation and validation study of the Iranian version. Qual Life Res 2005;14(3):875–882. DOI: 10.1007/s11136-004-1014-5.
MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. a meta-analysis. Dis Colon Rectum 1995;38(7):687–694. DOI: 10.1007/BF02048023.
Balfour L, Stojkovic SG, Botterill ID, et al. A randomized double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy. Dis Colon Rectum 2002;45(9):1186–1190. DOI: 10.1007/s10350-004-6390-y.
Bonica J. The management of pain. Philadelphia: Lea & Feblger; 1990. p. 26–27.
Chung YC, Hou YC, Pan AC, et al. CD105 expression in the development of haemorrhoids. Eur J Clin Invest 2004;34(2):107–112. DOI: 10.1111/j.1365-2362.2004.01305.x.
Arbman G, Krook H, Haapaniemi S. Closed vs. Open hemorrhoidectomy is there any difference? Dis Colon Rectum 2012;43(1):31–34. DOI: 10.1007/BF02237240.
Walfisch S, Ohana N, Charuzi E. Nd: YAG laser for anorectal surgery: initial experience in Israel. Harefuah 2010;126(1–4):56.
Zahir KS, Edwards RE, Vecchia A, et al. Use of the nd-YAG laser improves quality of life and economic factors in the treatment of hemorrhoids. Conn Med 2007;64(4):199–203.
Sankar MY, Joffe SN. Laser surgery in colonic and anorectal lesions. Surg Clin North Am 2012;68(6):1447–1469. DOI: 10.1016/S0039-6109(16)44700-6.
Masson JL. Outpatient hemorrhoidectomy using the CO2 laser. Wiad Lek 2010;63:27–32.
Plapler H, Hage R, Duarte J, et al. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 2009;27(5):819–823. DOI: 10.1089/pho.2008. 2368.
Leff EI. Hemorrhoidectomy–laser vs. nonlaser: outpatient surgical experience. Dis Colon Rectum 2011;35(8):743–746. DOI: 10.1007/BF02050322.
Erdoğdu A, Sipahioglu NT, Erginoz E, et al. Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire. Ulusal cerrahi dergisi 2013;29(2):59–62. DOI: 10.5152/UCD.2013.37.
Sowula A. The role of laser CO2 in proctology. J Chir (Paris) 2010;127(4):227–229.
Skobelkin OK, Brekhov EI, Ul'ianov VI, et al. Experience in the use of laser instruments in surgery of the anorectal region. Khirurgiia (Mosk) 2008;10:65–68.
Bouchard D, Abramowitz L, Castinel A, et al. One-year outcome of haemorrhoidectomy: a prospective multicentre French study. Colorectal Dis 2013;15(6):719–726. DOI: 10.1111/codi.12090.