Page 16 - World Journal of Laparoscopic Surgery

LHP vs Milligan and Morgan Hemorrhoidectomy
and length of stay and facilitate the timely return of the patient The common postoperative complications in laser surgeries
to daily activities and, thus, enhance the quality of life for the include delayed bleeding, presence of urinary retention, painful
patients after surgery. Since the complications of such surgeries defecation, fistula, acute infection fissure, anal stenosis, fecal
might be quite destructive and cause severe bleeding, using these incontinence, and postoperative thrombosis. None of mentioned
techniques requires high proficiency and training. While selecting complications were observed in any of our patients within 6 months
the surgical procedure, the skills and experiences of the surgeon after surgery. Many studies support our findings. Sowula reports no
need to be taken into account, so that the results of the surgery cases of postoperative bleeding during the follow-up. He states that
5
could be satisfactory and healthful. In addition, the most common the patients who were treated with laser therapy had a much more
problem among patients after the surgery of hemorrhoidectomy facilitated postoperative period and that the complications of these
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is the acute pain during the first and second days after surgery. It methods were very rare. Also Leff claimed that wound healing was
is likely for the pain to trouble the patient for some days and this observed in all cases, and it was inferred that hemorrhoidectomy
can be a matter of concern for the patient. 6 with lasers did not promote any adverse effects of surgery on the
15
Pain is a major cause that puts off patients from undergoing a patients. In another experiment performed by Zahir on 50 patients
hemorrhoidectomy. Beside the fact that pain itself is annoying, it is treated by laser therapy, pain alleviation was reported to be up to
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likely to cause certain problems such as urinary retention and fecal 65%. On the contrary, the result of some RCTs demonstrated the
compaction. On the other hand, because postoperative pain is a lower frequency of well treated by laser. As an example, in the study
very common side effect of hemorrhoidectomy, not many patients by Arbman, 86% of the hemorrhoidectomy patients who were treated
consider it as a surgical complication, but they see it as a predictable with lasers had complete healing of their wounds within a follow-up
consequence of the surgery. 7,8 of 3 weeks and no one developed symptoms of any sorts of infection.
We evaluated the postoperative pain in two time points which Of those patients who had a surgery with Milligan and Morgan
were immediately and 6 months after surgery based on VAS. The mean method, only 18% had complete healing of wounds and symptoms
VAS score in patients who were treated with laser was 0.22 and 0.17 of delayed improvement were detected in several cases. One of
after surgery and in the 6 months follow-up, respectively. Moreover, their patients had a minor wound infection, and even after 1 year,
these differences were not considered statistically significant. more than 10% of the hemorrhoid patients still showed symptoms
9
Similar to our result, Arbman et al. claimed no significant of the disease. In addition, Plapler counts a number of side effects
9
differences between the two groups in terms of VAS. Also in the for laser-based therapy. For instance, burning lesions and residual
study by Walf isch, no differences with regard to postoperative plicoma (skin tag) were detected in five patients under treatment
pain were observed between the laser-based method and with lasers due to the impairment of the laser system. However, even
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hemorrhoidectomy or any other nonlaser methods. In another in this study practical and complete improvements were reported
experiment by Zahir on 50 patients treated with laser-based within a short period compared to hemorrhoidectomy. 14
techniques, the pain alleviation frequency was reported to be as In the present study, redoing the operation was not required
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much as up to 65% compared to the control group. However, in in any of patients in either group during the 6-month follow-up.
the study by Sankar, postoperative pain was significantly lower than Moreover, there was no recurrence of the disease during the
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that of other surgical procedures such as open surgery. In another 6 months and a complete remission was observed in all cases.
study by Masson, hemorrhoidectomy with lasers is known to cause However, Skobelkin pointed out that the recurrence was two times
less postoperative pain compared to other surgical methods such more in open surgery of Milligan and Morgan. 18
13
as open hemorrhoidectomy. Besides in the study by Plapler, Clearly, those patients in the laser group had an easier recovery.
the mean pain severity has been reported as 1.13 (of 10) that was Similar to our study, in the study by Sankar, postoperative recovery
significantly lower than that in the control group who underwent period was significantly lower than other surgical procedures such
Milligan and Morgan method or cold scalpel method. 14 as open surgery. 12
In our study, the length of hospitalization after surgery in the
patients was 1.70 ± 0.65 days for the surgery group and 1.5 ± 0.55 conclusIon
for the laser group, and the two groups were not significantly Hemorrhoidectomy through laser-based methods does not
different in terms of the time they were hospitalized. Nonetheless, aggrandize the side effects of surgery in the patients. Furthermore,
in the study by Sankar, the lower length of hospitalization in the due to the ease of implementation and not imposing any additional
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laser group was significant. Also in the study by Masson, it was risks to the patient at the time of performing and because of the
concluded that hemorrhoidectomy patients treated with laser- possibility of performing it as outpatient surgery, these methods
based methods had none or minimal need for hospitalization and can be greatly beneficial and practical. They can be an alternative
lower costs, and they made a faster return to daily tasks. 13 to the usual hemorrhoidectomy. Lasers are effective and safe in
Our finding revealed that the quality of life in the LHP group case of anal lesions and are comparable with other conventional
in terms of both physical and MCS was relatively better (p < 0.05). methods of surgery. Effective methods with lasers, along with other
These results were similar to other studies. 5,15 Erdoğdu et al. also available treatments, could expand new horizons in the treatment
evaluated the quality of life after stapler hemorrhoidectomy of anorectal diseases like hemorrhoidectomy. Nonetheless, further
by using SF-36 questionnaire. They demonstrated that physical studies in this field are to be done. 19
health (physical functioning, physical role restriction, and bodily
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pain) scores significantly improved after surgery. Bouchard coMplIAnce wIth ethIcAl stAndArds

et al. in a multicenter trial followed patients who underwent

hemorrhoidectomy for 1 year and reported that all physical and Informed Consent
mental domains of quality of life significantly improved, and 88% Informed consent was obtained from all individual participants
of patients were satisfied or very satisfied by the surgery. 15–18 included in the study.
62 World Journal of Laparoscopic Surgery, Volume 12 Issue 2 (May–August 2019)