European Journal of Cardiovascular Medicine

Out of all the disorders affecting the rectum and large intestine, hemorrhoidal disease is the most common worldwide, with an estimated incidence of 2.9% to 27.9%, more than 4% of which are symptomatic (1, 2). Roughly one-third of these patients consult with doctors. The peak ofincidence is noted between 45 and 65 years of age, and then declining beyond 65 years of age (3, 4). Compared to women, men are more commonly impacted (5). By supporting soft tissues and keeping the anal canal closed, the internal anal sphincter and the anorectal vascular cushions play a crucial role in maintaining continence. It is believed that the downward displacement suspensory (Treitz) muscle causes haemorrhoids (6, 7). Over time, different approaches havebeen taken to treat haemorrhoids that cause symptoms. Various surgical procedures, non-surgicalband ligation (RBL), injectable sclerotherapy, cryotherapy, infrared coagulation, laser therapy,and diathermy coagulation are among the several non-surgical therapies that can be carried out asoutpatient procedures without the need for anaesthesia.(7) three (grade one to three), these nonsurgical techniques are thought to be the best options (8). Patientsmay be referred to a surgeon for surgical care if conservative approaches are ineffective in controlling their symptoms. A substantial external component, hypertrophied papillae, a concomitant fissure, widespread thrombosis, or a return of symptoms following repeated RBL are among the conditions that warrant surgical intervention. The implements utilized are a scalpel, scissor, electrocautery, or laser, and the procedure can be either open (Milligan–Morgan) or closed (Ferguson). The gold standard, often done technique in many affluent countries, including India, is the Milligan-Morgan hemorrhoidectomy (9). Pain following a hemorrhoidectomy is the most frequent issue related to the surgical methods. Urinary retention (20.1%), secondary or reactive bleeding (2.4%–6%), and subcutaneous abscess (0.5%) are the additional early problems. Anal fissure (1%–2.6%), anal stenosis (1%), incontinence (0.4%), fistula (0.5%), and haemorrhoid recurrence are among the long-term consequences (10, 11). Thepurpose of this study was to evaluate the two methods—laser hemorrhoidoplasty, or LHP, andsurgical open hemorrhoidectomy—in terms of pain and intervention length.

This prospective comparative study was done in Department of General Surgery, Saraswati Medical College, Unnao, Uttar Pradesh. In this study total of 104 individuals were enrolled; in which, 52 patients underwent open surgical hemorrhoidectomy and other 52 patients received treatment using laser haemorrhoidoplasty. Patients were divided into two groups by random allocation using a computer-based number generator. A thorough physical examination and proctoscopy were conducted before the diode laser operation was carried out.

Laser haemorrhoidoplasty: Two hours before the intervention, two proctoclysis enemas were given to ensure complete evacuation of the lower rectum. A specialized disposable 23 mm proctoscope was placed in the anal canal while the patient was in the lithotomy posture. To lessen unwanted periarterial normal 1000-nm optic fibre. The laser beam's power and duration can be adjusted to control the depth of shrinking. Tissues shrank to a depth of about 5 mm as a result of five laser beams fired at a power of 13 Wfor 1.2 s each, interspersed with a 0.6 s pause, through a 1000-micron optic fibre.

Milligan Morgan Haemorroidectomy: 52 patients received open surgical hemorroidectomy treatment while under saddle anaesthesia. After being monitored for problems and healing progress, patients were released from the hospital in 2-3 days. The length of the procedure and the patients' degree of postoperative painwere monitored. A 10-point visual analogue scale (VAS), with 0 denoting no pain and 10 denoting the worst possible agony, was used to record postoperative discomfort. The VASprotocol was check after 7 hours, one month, and six months later. The intervention's durationwas noted in minutes. Following statistical testing, the findings were displayed in the appropriatetables and visuals.

This study compared the difference between Laser Haemorrhoidoplasty and Open Milligan Morgan technique to treat grade 3 and 4 haemorrhoids (Goligher grading). We observed that the mean age of the study population between the two groups was comparable (37.1 +/- 11.93 vs 38.02+/- 12.03 years). The number of males in the LHP group was 38, while in the open group it was 36. The difference between the two groups was not statistically significant (p 0.081) Hence, we compared the age and sex matched population to reduce the confounding bias.

Table 1: Comparison of operative time

The operative time was significantly higher in patients undergoing open procedures (p value0.0032). Similarly, we found a significant difference in the length of stay in the hospital between the two groups. Open procedures are often more painful than laser, and the same holds true for this study. We found that the VAS score was significantly higher 24 hours post in open technique than laser. However, at the 1 month and 6 month follow-up, there was no significant difference.

Table 2: Comparison of VAS

In the table below, we observed that with a mean energy of the laser being 488.96, the operative time was optimal at 24.08 minutes.

Table3:-Operative time and energy generated by Laser

When we compared the recurrence and complications, we observed that in the laser group, only 2 patients had recurrence, one at the 1^st month follow-up, and next at the 6^th month follow-up.

Table 4:-Comparison of recurrence rates

The most common complication is persistent pain, followed by urinary retention.

The traditional classification of haemorrhoids (12), which is unrelated to the degree of symptoms, is used to determine the necessity for treatment, which is mostly dependent on the subjective assessment of the severity of symptoms. The variety of therapy options has made choosing a course of action more difficult. Despite the fact that the majority of treatment procedures are safe and offer good outcomes, the question of which technique is best remain unsolved. In most cases, a straightforward hemorrhoidectomy meets the needs of the patient and the surgeon. In a study from the University of Sao Paolo in Brazil, laser hemorrhoidectomy has the following benefits: it is quick healing, bactericidal, haemostatic, does not damage nearby structures, has fewer postoperative problems, and causes less stenosis and bleeding (14, 15). The most common surgical method for treating haemorrhoids is open surgical hemorrhoidectomy.

Hemorrhoidectomy, however, is linked to serious side effects such as discomfort, bleeding, and wound infection, all of which can lead to an extended hospital stay (16). When comparing the LHP group to the open hemorrhoidectomy operation group in the early postoperative period, we discovered that the pain scores were much lower in the former group (VAS score of 3.56 VS 5.61). The main consequence that worries our patients and discourages them from having Surgery is postoperative pain.

In our investigation, there was a statistically significant difference between lazer Hemorroidectomy and the traditional open surgical hemorrhoidectomy (p<0.05). According to our research, laser hemorrhoidoplasty is a safe operation with a lower rate of pain following surgery. When compared to open surgical hemorrhoidectomy, laser hemorrhoidectomy has a shorter recovery period (15.94 vs. 26.76 min and p<0.01), which is satisfactory for hemorrhoidal patients with III or IV stage symptoms. In a study by Maloku et al (17), the procedure time for LHP was 15.94 min vs. 26.76 min for open surgery (p<0.01), which was similar to the findings of our study

Laser haemorroidoplasty is associated with significantly lesser VAS and shorter operative time and hospital stay. Additionally, there are significantly higher incidence of recurrence and complication with open method.

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