학술논문
Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend.
Document Type
Academic Journal
Author
Gambardella C; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy. claudiog86@hotmail.it.; Brusciano L; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Brillantino A; Department of Emergency Surgery, 'A. Cardarelli' Hospital, Via A. Cardarelli 9, Naples, Italy.; Parisi S; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Lucido FS; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Del Genio G; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Tolone S; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Allaria A; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.; Di Saverio S; Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OQQ, UK.; Pizza F; Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy.; Sturiale A; Proctological and Perineal Surgical Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy.; Docimo L; Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania 'Luigi Vanvitelli', via Luigi Pansini n° 5, 80131, Naples, Italy.
Source
Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 9808285 Publication Model: Electronic Cited Medium: Internet ISSN: 1435-2451 (Electronic) Linking ISSN: 14352443 NLM ISO Abbreviation: Langenbecks Arch Surg Subsets: MEDLINE
Subject
Language
English
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.
(© 2023. The Author(s).)
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.
(© 2023. The Author(s).)