Page 15 - World Journal of Laparoscopic Surgery

LHP vs Milligan and Morgan Hemorrhoidectomy
The Chi-square or Fisher’s exact test was used for comparison of In addition, we evaluated the health of patients through the
the categorical variables between groups. The p value <0.05 was study of emotions and their ability to perform daily tasks by means
considered as statistically significant. of SF-36 questionnaire 6 months after operation. In the first step,
patients were asked how they feel now and in comparison to the
results past year. In the laser group, 87.5% answered they are excellent or
The mean age of the patients in the laser and the surgery groups good now, while 47.5% of patients in the surgery group felt good.
Nonetheless, the general health of patients regarding how they
group was 38.13 ± 8.29 years and 38.73 ± 9.53 years, respectively. feel about 1 year ago and how they seem to be were the same
Thirty-six (45%) patients were male [18 patients (45.0%) in the (p = 0.094). The total score of role limitations due to physical health
surgery group and 18 patients (45.0%) in the laser group]. The main scale was higher in those patients who were treated with laser (63.4
cause of referring to hospital in both groups was bleeding (65% vs vs 56.9) (p = 0.002). In the field of physical health problem, patients
50%) and hemorrhoids of grade II was more common. No significant evaluated in the terms of having difficulty with their work or other
difference was observed between the two groups regarding sex, regular daily activities during the 4 last weeks, which was 84.5 ± 10.5
grade of hemorrhoid, and cause of referring to hospital (Table 1). in the surgery group and 80.2 ± 4.3 in the laser group (p < 0.001).
The pain severity based on VAS score immediately after surgery Moreover, emotional health problems were less in laser group
for half of the patients was more than 3 of 10 and for laser group (p < 0.001). In the seventh scale of questionnaire, two groups were
2 of 10. The median pain in laser and surgery groups was 2 and compared regarding the pain of patients during the past 4 weeks
3, respectively, which were not statistically different (p = 0.198). and how much this pain interfered with their normal work, and it
6 months after surgery the pain intensity reduced dramatically, was revealed that pain in surgery group was significantly much
resulting in the median pain of 1 of 10 in both the groups, but the more than that in the laser group (p < 0.001), and two groups were
mean of pain was 1.20 ± 0.40 in the laser group and 1.37 ± 0.58 not comparable in the field of energy and emotions (p < 0.001).
in those who underwent Milligan and Morgan surgery (Table 2). Finally, contrary to all other scales, the mean of physical functioning
The length of hospitalization after surgery was 1.70 ± 0.65 was higher in the surgery group and this difference was significant
days for the surgery group and 1.50 ± 0.55 days for the laser group. (p < 0.001) (Table 3).
According to the result, no statistically significant difference was To sum up, the difference between two groups concerning
found between the two groups in this regard (p = 0.142).
mental component summary (MCS) was higher than the physical
component summary (7.5 and 12.6). However, both were meaningful
Table 1: Demographic characteristics of patients (p < 0.001). The difference in total score of quality of life was
2.2 ± 1.0, which is in favor of the laser group (p = 0.037) (Fig. 1).
Group
Milligan and
Variable Laser (n = 40) Morgan (n = 40) p value dIscussIon
Gender a An uncomplicated hemorrhoidectomy is desirable for both the
Male 18 (45%) 18 (45%) 0.99 ‡ patient and the surgeon. Almost all the proposed hemorrhoidectomy
Age (year) b 38.12 ± 8.29 38.72 ± 9.52 0.76 † techniques are expected to reduce postoperative pain, bleeding,
Cause of referring b
Pain 14 (35%) 19 (47.5%) 0.26 § Table 3: Comparison of patient’s quality of life 6 months after operation
Bleeding 26 (65%) 20 (50%) Group
Itching 0 1 (2.5%) Milligan and
Grade of hemorrhoid b Scale a Laser (n = 40) Morgan (n = 40) p value ‡
II 29 (72.5%) 25 (62.5%) 0.34 ‡ Physical functioning 80.2 ± 4.3 84.5 ± 10.5 <0.001
III 11 (27.5%) 15 (37.5%) 80 (70–87) 86.7 (47–93)
a Frequency, %
b Mean ± standard deviation (SD) Role limitations due to 63.4 ± 9.1 56.9 ± 9.4 0.002
‡ Based on Pearson’s Chi-square test physical health 62.5 (50–75) 50 (50–75)
† Based on independent t test Role limitations due to 81.2 ± 14.2 57.9 ± 8.4 <0.001
§ Based on Fisher’s exact test mental health 83 (50–100) 50 (50–67)
Energy/fatigue 57.5 ± 10.6 47.9 ± 5.2 <0.001
Table 2: Visual analog scale (VAS) pain immediately and 6 months after 58 (37–97) 50 (37–67)
operation Emotional 57.7 ± 10.4 48.3 ± 5.5 <0.001
Group well-being 60 (40–77) 47 (40–63)
Milligan and Social functioning 72.5 ± 10.8 64.5 ± 10.1 0.002
VAS pain a Laser (n = 40) Morgan (n = 40) p value ‡ 70 (50–90) 60 (40–80)
Immediately 2.35 ± 0.80 2.57 ± 0.93 0.198 Pain 57.5 ± 11.2 31.6 ± 10.3 <0.001
after operation 2 (1–4) 3 (1–5) 59 (27–82) 27 (18–54)
6 months 1.20 ± 0.40 1.37 ± 0.58 0.174 General health 58.7 ± 6.6 56.7 ± 3.1 0.094
postoperative 1 (1–2) 1 (1–3) 58 (43–73) 57 (50–63)
a Mean ± standard deviation (SD), median (min–max) a Mean ± standard deviation (SD), median (min–max)
‡ Based on Mann–Whitney test ‡ Based on Mann–Whitney test

World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019) 61