The Comparison of Hemorrhoidal Laser Procedure and Classical(Ferguson) Surgical Hemorrhoidectomy Methods

Year 2023, Volume: 14 Issue: 1, 37 - 42, 23.03.2023

Bülent Hallaçlar Özgür Albuz

https://doi.org/10.18663/tjcl.1241303

Abstract

Background:Generally, pathological hemorrhoids are more common in patients aged 45-65 years. Treatment options may vary according to the degree of hemorrhoids.We aimed to compare surgical treatment with classical surgical hemorrhoidectomies(CH,Ferguson procedure) and hemorrhoidal laser procedur methods(HeLP)in the treatment of grade III and grade IV hemorrhoids.
Methods:Univariate analyses were performed using the Student’s t test for continuous variables and chi-squared test for dichotome variables.Data were analyzed with SPSS™for Windows18(SPSS, Chicago,IL).All cases over the age of 18 and under the age of 65 without any malignancy diagnosis who underwent HeLP and CH methods due to gradeIII, gradeIV hemorrhoid disease were included in the study.
Results:Totally 187 cases included in this study.The patients was 66.8%(n:125,male)vs.female 33.2%(62)(p<0.05).The distribution of patients according to who underwent HeLP by gender,it was found as[71.8%(n:89)male vs. female28.2%(35)(p<0.05)].For CH this distrubition rate was[male57.1%(n=36)vs.female42.9%(n=27)P<0.05].The complication rates between for procedures weren’t found statistically different from each other.CH[(n=66)(Complicative cases 9.5%(n:6)vs. HeLP[(n=116)complicative cases6.9%(n:8)(p=0.56)].
The difference between complication rates according to gender is examined;The complication rates of both procedures were similar in both gender too[64.3%(9)vs.35.7%(5)(p=0.8)].There wasn’t statistically significant results found in the comparison made in terms of the choice of procedure in terms of the average age.The patients who underwent CH(40,9±13.7)years old vs.HeLP(38,2±13,4)years old(p:0.2)was found.The bleeding complications were found significantly higher in the HeLP than in the CH[HeLp vs.CH for hematoma;8(89.9%)vs1(11.1%)(p<0.02)].The effects of HeLP on complications in terms of number of laser shots,wavelength,energy and application time were examined, statistically significant results weren't.
Conclusion:The male population applying for hemorrhoid treatment was found to be significantly younger than females.The male gender preferred the HeLP procedure significantly compared to the females and the complication of hemorrhage was significantly higher in the laser procedure.

Keywords

hemorrhoids, laser, classical hemorrhoidectomy, comparison, HeLP

Supporting Institution

Herhangibir destekleyen kurum veya kuruluş yoktur

Project Number

Etik kurul onay numarası: 124

References

• 1. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380–6. 10.1016/0016-5085(90)90828-o
• 2. Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritsch H (2004) The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 187(1):102–108
• 3. Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg. 2016 Mar;29(1):22-9. doi: 10.1055/s-0035-1568144. PMID: 26929748; PMCID: PMC4755769.
• 4. Parks AG. De Hemorrhoids. A study in surgical history. Guy’s Hospital Report. 1955; 104: 135-150.
• 5. Keighley MRB. Surgery of Anus, Rectum and Colon. 1. Vol. 1, WB Saunders publishers, 1993: 295-298.
• 6. Van Tol RR, Kleijnen J, Watson AJM, Jongen J, Altomare DF, Qvist N et al (2020) European society of ColoProctology: guideline for haemorrhoidal disease. Color Dis.
• 7. Milligan ETC, Naunton Morgan C, Jones LE, Officer R (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet. 230(5959):1119–1124
• 8. Longchamp, G., Liot, E., Meyer, J. et al. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 36, 485–496 (2021). https://doi.org/10.1007/s10103-020-03142-8
• 9.Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR (2018) The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the management of hemorrhoids. Dis Colon Rectum 61(3):284–292
• 10. Barr LL, Jantz TA (1998) Effects of various laser wavelengths and energy levels on pig rectal submucosal tissue. J Laparoendosc Adv Surg Tech A 8(2):83–87
• 11. Karahaliloglu A (2007) First results after laser obliteration of first and second-degree hemorrhoids. Coloproctology. 29:327–336
• 12. Keighley MRB. Surgery of Anus, Rectum and Colon. 1. Vol. 1, WB Saunders publishers, 1993: 295-298.
• 13. Sheikh, P., Régnier, C., Goron, F., & Salmat, G. (2020). The prevalence, characteristics and treatment of hemorrhoidal disease: results of an international web-based survey. Journal of Comparative Effectiveness Research, 9(17), 1219–1232. doi:10.2217/cer-2020-0159
• 14. Senagore, A., Mazier, P. W., Luchtefeld, M. A., MacKeigan, J. M., & Wengert, T. (1993). Treatment of advanced hemorrhoidal disease. Diseases of the Colon & Rectum, 36(11), 1042–1049. doi:10.1007/bf02047297
• 15. Ismail SA, Yusuf M, Eren T , Ankarali H , Alimoglu O. Frequency of Hemorrhoids in Madina and Osman Fiqi Hospitals of Somalia June 2018International Journal of Human and Health Sciences (IJHHS) 2(3):140-144. DOI: 10.31344/ijhhs.v2i3.42 LicenseCC BY-ND 4.0
• 16. Maloku, H., Gashi, Z., Lazovic, R., Islami, H., & JunikuShkololli, A. (2014). Laser hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree . Acta Informatica Medica, 22(6), 365. doi:10.5455/aim.2014.22.365-367
• 17. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic Hemorrhoids: Current Incidence and Complications of Operative Therapy. Diseases of the colon and rectum. 1992; 35 (5): 477-481.
• 18. Sardinha TC, Corman ML. Hemorrhoids. The Surgical clinics of North America. 2002; 82(6): 1153-1167
• 19. Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S et al (2019) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updat Surg
• 20. Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z (2017) A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and Milligan-Morgan hemorrhoidectomy. J Investig Surg Off J Acad Surg Res 30(5): 325–331
• 21. Alsisy A, Alkhateep YM, Salem IA (2019) Comparative study between intrahemorrhoidal diode laser treatment and Milligan– Morgan hemorrhoidectomy. Menoufia Med J 32(2):560–565
• 22. Salfi R (2009) A new technique for ambulatory hemorrhoidal treatment. Coloproctology 31(2):99–103
• 23. Lim, S.Y., Rajandram, R. &amp; Roslani, A.C. Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial. BMC Surg 22, 146 (2022). https://doi.org/10.1186/s12893-022-01594-z
• 24. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R et al (2011) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 25(5):1369–1375
• 25. Giamundo, P. (2017). Hemorrhoidal Dearterialization with Laser: Techniques and Results. Coloproctology, 1–9. doi:10.1007/978-3-319-51989-0_35-1