A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan–Morgan Hemorrhoidectomy

ABSTRACT

Purpose: To compare laser intra-hemorrhoidal coagulation with Milligan–Morgan (MM) hemorrhoidectomy. Method: Patients with symptomatic grade II or III internal hemorrhoids according to the Goligher's classification (refractory to medical treatment) were enrolled in this double-blinded randomized controlled trial study. In the laser group, hemorrhoidal columns were coagulated using a 980-nanometer (nm) radial laser emitting fiber (three, 15-W pulses of 1.2 s each, with 0.6-s intervals). Operative time, postoperative pain and complications, and recovery or resolution of symptoms were measured. Patients were followed up for at least one year for evaluating healing, resolution of symptoms, and late complications. Results: Postoperative pain scores (at 12, 18, and 24 hr after surgery) were significantly lower in the laser group compared with the MM group (p <.01). The operative time and intra-operative blood loss were more in the MM group (p <.001). The administration of analgesics was significantly reduced in the laser group (p <.05). Two patients in the laser group were presented with thrombosis of external hemorrhoid 7–10 days after the procedure, which was resolved with medical treatment, but no patients in the MM group developed hemorrhoidal thrombosis (p >.05). One-year follow-up showed comparable results in terms of the resolution of symptoms and sustainable cure. Conclusions: Intra-hemorrhoidal coagulation with 980-nm diode laser reduces postoperative pain, intra-operative bleeding, and administered analgesics with a comparable resolution rate of hemorrhoid symptoms. However, for the patients who experience complications, such as hemorrhoidal thrombosis, the overall pain may be equivalent to or even worse than conventional hemorrhoidectomy.

Keywords: :

• hemorrhoids
• duration time
• pain
• intra-hemorrhoidal coagulation
• 980-nm diode laser
• Milligan–Morgan hemorrhoidectomy

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. No funds, grants, or other support was received. This article has not been presented at a meeting or published or submitted for publication elsewhere. The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

AUTHOR'S CONTRIBUTION

Mohammad Naderan and Saeed Shoar analyzed the data, interpreted the results, drafted the article, and approved the final version. Mohammad Nazari did data acquisition, drafted the article, and approved the final version. Ahmed Elsayed participated in data acquisition, critically revising the manuscript for intellectual content, and did the final approval of the manuscript. Zhamak Khorgami designed the study, performed the procedures, interpreted the results, drafted the article, and approved the final version. Habibollah Mahmoodzadeh has done the data acquisition, drafted the article, and approved the final version.