Page 13 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
A Randomized Clinical Trial of Laser Hemorrhoidoplasty vs

Milligan and Morgan Hemorrhoidectomy

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Hossein Shabahang , Ghodratollah Maddah , Ahmadali Mofidi , Mahdi Jabbari Nooghabi , Saeedeh Hajebi Khaniki 5
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.
Keywords: Complications, Hemorrhoidectomy, Laser, Quality of life.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1373

IntroductIon 1–3 Endoscopic and Minimally Invasive Surgery Research Center,

Hemorrhoid is one of the most common side effects of urbanization. Mashhad University of Medical Sciences, Mashhad, Iran
More than 50% of people are affected by this disease over the past 4 Department of Statistics, Ferdowsi University of Mashhad, Iran
50 years, and the disease has been seen in both sexes and across 5 Student Research Committee, Department of Epidemiology and
wide age ranges. As of today, signs of hemorrhoids are seen in 4.4% Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran
of the American population. Corresponding Author: Saeedeh Hajebi Khaniki, Student Research
Hemorrhoid is a familiar cause of admission to surgical clinics Committee, Department of Epidemiology and Biostatistics, Mashhad
and its treatment requires medical and surgical procedures, many of University of Medical Sciences, Mashhad, Iran, Phone: +98 5138012806,
which are performed for hemorrhoids of grades II, III, and IV. One of e-mail: Hajebis951@mums.ac.ir
the most prominent surgical procedures for hemorrhoids is Milligan How to cite this article: Shabahang H, Maddah G, Mofidi A, et al.
and Morgan hemorrhoidectomy. Other techniques of hemorrhoid A Randomized Clinical Trial of Laser Hemorrhoidoplasty vs Milligan
surgery involve using devices such as stapler or procedures such and Morgan Hemorrhoidectomy. World J Lap Surg 2019;12(2):59–63.
as laser therapy. 1 Source of support: Mashhad University of Medical Sciences, Iran

Using lasers was primarily recognized by Maymen in 1960 upon Conflict of interest: None
the construction of the ruby laser. In the following years, various
types of lasers were designed and built, and with the discovery of Using lasers in the treatment of hemorrhoid leads to minimal
laser, a remarkable revolution was created in industrial, military, tissue damage and good hemostasis, and it can also reduce the
and medical world. duration of surgery and hospital stay. However, against all the benefits,
The laser was first used in medicine and ophthalmology. specific training and precaution measurements are required to use
Today, laser treatment is not uncommon in the treatment of lasers in therapy. Moreover, to protect their eyes from invisible lights
hemorrhoids for outpatients. During the treatment process, produced by laser, it is a must that the surgeons use goggles. 2,3
the arterial blood flow of hemorrhoids is halted using Doppler In this study, the effects of two surgical methods of Milligan
laser coagulation. In another method, laser is projected into the and Morgan and the use of lasers in the treatment of hemorrhoids
hemorrhoidal packet, causing subsequent fibrosis upon which were evaluated in terms of the effectiveness of the treatment, the
the hemorrhoidal packet shrinks and sticks to the anal canal wall duration of surgery, and the possible complications caused by such
to prevent its prolapse. medical methods.
Various types of lasers are of great benefit in the field medicine.

Their different wavelengths can exert different effects in the tissues. MAterIAls And Methods
The most popular lasers are the carbon dioxide laser, argon laser, This study was a phase 3, randomized open blind trial. It consisted
and neodymium: yttrium–aluminum garnet. of two parallel groups. Eighty patients were studied between

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