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. 2023 Apr 5;408(1):140.
doi: 10.1007/s00423-023-02879-4.

Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

Claudio Gambardella  1 , Luigi Brusciano  2 , Antonio Brillantino  3 , Simona Parisi  2 , Francesco Saverio Lucido  2 , Gianmattia Del Genio  2 , Salvatore Tolone  2 , Alfredo Allaria  2 , Salomone Di Saverio  4 , Francesco Pizza  5 , Alessandro Sturiale  6 , Ludovico Docimo  2
Affiliations

Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

Claudio Gambardella et al. Langenbecks Arch Surg. .

Abstract

Purpose: Hemorrhoidal disease (HD) is a common condition, and several surgical techniques have been proposed to date without being able to achieve definitive consensus on their use and indications. Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser limiting the postoperative discomfort and pain. The aim of the current study was to evaluate the postoperative outcomes of HD patients undergoing LHP vs conventional Milligan-Morgan hemorrhoidectomy (MM).

Method: Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity of grade III symptomatic HD patients undergoing LHP vs MM were retrospectively evaluated. The patients were followed-up for recurrence of prolapsed hemorrhoid or symptoms.

Result: From January 2018 to December 2019, 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment using a 1470-nm diode laser. No significant intraoperative complications occurred in both groups. Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management. After 25 ± 8 months follow-up, the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05) with a similar Rorvik score (7.8 ± 2.6 in LHP group vs 7.6 ± 1.9 in MM group, p = 0.12).

Conclusion: LHP demonstrated high efficacy in selected HD patients guaranteeing lower postoperative pain, easier wound care, higher rate of symptoms resolution, and greater patient appreciation compared to MM, even though it had a higher recurrence rate. Larger comparative studies are needed to address this issue.

Keywords: Excisional hemorrhoidectomy; Hemorrhoidal disease; Hemorrhoidal recurrence; Laser hemorrhoidoplasty; Postoperative pain.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Hemorrhoidal Disease Symptom Score. HDSS, Hemorrhoidal Disease Symptom Score; SHSHD, Short Health Scale adapted for hemorrhoidal disease
Fig. 2
Fig. 2
Ninety-three patients received conventional MM (MM group), and 81 patients received minimal invasive LHP procedure (LHP group)
See this image and copyright information in PMC

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