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LHP vs Milligan and Morgan Hemorrhoidectomy
March 2011 and March 2013 and followed for 6 months at Ghaem Then the hemorrhoidal packet was measured from the proximal
and Sina Hospitals in Mashhad, Iran. Inclusion criteria are having part to the distal part using the LHP technique. In the next step,
been diagnosed with hemorrhoids grade II or III. Those who hemorrhoidopexy was done with running suture using 2.0 vicryl
refused to follow-up were excluded from the study. The estimation (absorbable sutures catgut sutures 0–4 Turkey) performed from the
of sample size was done using the result of Palper et al., type I proximal to the distal part of the packet. At the end of the procedure,
error of 5%, power of 90%, and statistical software of PASS version two or three packets were treated at a time. After performing the
11.0.4 (Fig. 1). LHP, cold compression was done by placing ice over each packet for
Based on permuted block randomization with block size of four, 3 minutes.
patients were randomly assigned to two groups with an allocation In the Milligan and Morgan method, after prep and drep, the
ratio of 1. The intervention patient groups underwent LHP and patients were under either general or spinal anesthesia. Afterward, they
those in control group were treated with Milligan and Morgan were placed in the lithotomy position. By this method, three hemorrhoid
hemorrhoidectomy by the same surgeon (Flowchart 1). packets with at an angle of about 60° were selected. Then the packet
In LHP, Diode Laser 1470 (CERALAS model; Biolitec Company) was had to be eliminated below the tooth line of the anus while the skin and
used. In this method, the patient was first put under general anesthesia. the mucous bridges between the packets stayed preserved.
After prep and drep (decrease the number of microorganisms at the The main outcome variables included pain, delayed bleeding,
operative site), special optical fiber entered the hemorrhoidal packet. the presence of urinary retention, painful defecation, fistula,
acute infection fissure, anal stenosis, fecal incontinence, and
postoperative thrombosis. The length of hospitalization and
quality of life of patients 6 months after operation were evaluated
using SF-36 questionnaire. The 36-item SF-36 includes several
domains of health-related quality of life, namely, general health,
limitations of activities, physical health problems, emotional
health problems, social activities, pain, and energy and emotions.
A higher score indicates a better quality of life. The validity
and reliability of the questionnaire were approved in Iranian
population. 4
This study had been approved by the ethics committee and
the institutional review board of Mashhad University of Medical
Sciences (IR.MUMS.REC.1391.93), and informed consent was
obtained before enrollment. Registration ID of this study in the
Iranian Registry of Clinical Trial is “IRCT20180204038605N1.”

Statistical Analysis
Data were analyzed by R software version 3.5.1. The differences
Fig. 1: Box plot for total score of 36-item Short Form Health Survey among groups in terms of ordinal or scale variables were analyzed
(SF-36) questionnaire for two groups using the Mann–Whitney nonparametric test or independent t test.
Flowchart 1: CONSORT flow diagram: laser hemorrhoidoplasty vs Milligan and Morgan hemorrhoidectomy

60 World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019)