Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV Hemorrhoids: A non-randomized prospective trial

Abstract

BackgroundThrough the past decades, various surgical methods have been introduced as new modalities for the management of grade III and IV hemorrhoidal disease HD, to provide an effective and less invasive operation in comparison with conventional haemorrhoidectomy which is the gold standard surgical treatment. MethodsThis study was conducted at Alexandria Main University Hospital. Ninety three patients with grade III and IV HD were enrolled in our study, thirty-one patients treated with diathermy hemorrhoidectomy DH (group A), thirty-one patients with LigaSure™ hemorrhoidectomy LH (group B),and thirty-one patients with Laser hemorrhoidoplasty LHP (group C). Assessment of postoperative pain, intra and postoperative bleeding, operative time, time to return to work, quality of life using Hemorrhoidal Disease Symptom Score HDSS, and Short Health Scale for hemorrhoidal disease SHSHD and patient satisfaction were recorded and analyzed. ResultsThe postoperative pain according to Visual analogue scale VAS scores from the evening of the procedure till the fourth week postoperatively were significantly higher in group A patients compared to group B and C patients, however, no significant statistical difference was found between group B and C patients. There was significant statistical difference between each group for intra-operative bleeding, operative time, and time to return to work with advantage for LHP. LH led to significant improvement in both HDSS, SHSHD when compared with LHP (p = 0.015*and p = p3<0.001*respectively) and when compared with DH, however, only SHSHD was statistical significance (p = 0.001*). The median score for patient satisfaction was 6 in the 3 groups (range: 3–7 group A, 3–7 group B and 2–6 group C) with no statistical significance. ConclusionLH and LHP are associated with significantly less postoperative pain and give superior results than DH in terms of less operative time, intraoperative blood loss, postoperative complications, and faster recovery time, with significantlys better health-related quality of life after LH.