Conventional Hemorrhoidectomy Research Articles

Conventional excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for haemorrhoids - a systematic review and meta-analysis.

Introduction Although effective, conventional excisional haemorrhoidectomy (CEH) may be associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain, but may result in higher recurrence rates. We aimed to compare short and long-term outcomes of CEH and THD in the present meta-analysis. Methods A PRISMA-compliant meta-analysis was performed, searching PubMed, EMBASE and CENTRAL databases for randomized controlled trials (RCTs) from 1995 until December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed. Results 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group.. On random effects analysis, THD had a higher recurrence rate (OR = 2.76, 95% CI = 1.03 to 7.38, p = 0.04) albeit a shorter return to baseline comparative to CEH (MD = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19) or LOS (p = 0.22). Results remained similar on subgroup analysis. Conclusions CEH is associated with lower recurrence rates and no difference in complication rate to THD, although patients take longer to return to baseline function postoperatively.

Laser Hemorrhoidoplasty vs Conventional Milligan-Morgan Hemorrhoidectomy for Treatment of Third and Fourth Degree Hemorrhoids: A Prospective Comparative Study

Abstract Background Hemorrhoids are the most common disease of anal canal affecting a large number of people at least once during their lifetime and can interfere with their daily functioning. Surgical treatment is the best available option for symptomatic hemorrhoid cases, which are refractory to medical treatment. In spite of many modifications made to the hemorrhoid surgical techniques, postoperative pain and discomfort remain the major concern for patients, which is why they often refuse to undergo surgical treatment. Laser ablation has opened new possibilities for the minimally invasive treatment of hemorrhoids. Objective To compare the outcomes between laser hemorrhoidoplasty and the conventional Milligan-Morgan hemorrhoidectomy for treatment of third and fourth degree haemorrhoids especially postoperative pain, bleeding, and recurrence. Patients and Methods Recent studies have proven that laser ablation was much better regarding postoperative pain and hemorrhage in the various degrees of hemorrhoids. Our study also confirmed that laser ablation technique has shorter operative time, less severe postoperative pain, bleeding and comparable regression of hemorrhoid columns. Studies with longer follow-up period (around 2 years) have also reported effectiveness of laser for the treatment of hemorrhoids which was confirmed in our study over 6 months. Results Although some studies showed that wound inflammation or hemorrhoid thrombosis could be a problem however our study showed no postoperative local infection in the group treated with laser ablation and only two patients were presented with thrombosis of external hemorrhoid 7–10 days after the surgery, which was resolved with medical treatment. Conclusion Laser hemorroidoplasty has better outcomes than the traditional surgical resection of hemorrhoid disease for the control of grade III and IV symptomatic refractory hemorrhoids specially regarding post-operative pain and bleeding which are the main concerns for most patients.

Systematic Review and Meta-Analysis of Laser Haemorrhoidectomy versus Conventional Surgical Haemorrhoidectomy in Management of II- and III-Degree Haemorrhoid.

Systematic Review and Meta-Analysis of Laser Haemorrhoidectomy versus Conventional Surgical Haemorrhoidectomy in Management of II- and III-Degree Haemorrhoid.

Evaluation of Pain Post Stapling and Conventional Hemorrhoidectomy

Evaluation of Pain Post Stapling and Conventional Hemorrhoidectomy

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

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.

Comparative study of rubber band ligation versus surgical excision in the treatment of second-degree haemorrhoids

Our study focused on comparing the efficacy of Rubber Band Ligation (banding), a day-care and cost-effective procedure, with conventional haemorrhoidectomy in the treatment of haemorrhoids. The study included 120 patients diagnosed through proctoscopic examination, with 60 assigned to each group. Patients were randomly selected through simple alternation for banding or haemorrhoidectomy after receiving procedural explanations and providing consent. Banding, utilizing Barron's band applicator and Hemoband suction device under local anaesthesia, demonstrated notable advantages. Comparison parameters included bleeding, pain, prolapse, and overall relief during follow-ups. Banding showed significantly lower bleeding persistence at 4 weeks compared to haemorrhoidectomy (p &lt; 0.001). Prolapse rates were comparable between the two groups (10%). Complete relief was observed in 1.66% of patients in both groups at the first follow-up (p = 0.929). Banding resulted in moderate pain levels compared to haemorrhoidectomy. Hospital stay duration favoured banding, with 71.66% discharged in 1-3 days, while haemorrhoidectomy had longer stays (3-6 days: 26.66%, &gt;6 days: 1.66%). In conclusion, Rubber Band Ligation emerged as a more effective and preferable method for second-degree haemorrhoids, providing better outcomes, reduced bleeding, and shorter hospital stays compared to conventional haemorrhoidectomy.

A comparative study between laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation and conventional (Milligan-Morgan) hemorrhoidectomy

Background: Hemorrhoids have a much higher incidence than rectum and colon diseases worldwide. The prevalence was estimated to be between 2.9% and 27.9% among the worldwide population, of which 4% are symptomatic. Based on the Gauss method, the highest incidence was present in patients aged between 45 and 65 years. Aims and Objectives: To compare laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation (DGHAL) and conventional (Milligan-Morgan) open hemorrhoidectomy procedures. Materials and Methods: A prospective follow-up study was undertaken in the Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, from January 2020 to June 2021. In this comparative and prospective study, 60 patients were included, of whom 30 were treated with open surgical hemorrrhoidectomy (Milligan-Morgan) and 30 were treated with laser hemorrhoidoplasty with the DGHAL method. Results: Male patients numbered 41 and female patients numbered 19. Between laser hemorrhoidoplasty with DGHAL and the open surgical hemorrrhoidectomy (Milligan-Morgan) approach, there were significant differences in operating time, blood loss, bleeding; and early postoperative pain. In terms of early postoperative pain, there were statistically significant differences between the two groups (P&lt;0.001). The mean operational time for laser hemorrhoidoplasty with DGHAL was 22.57±1.794 min, compared to 29.43±3.664 min for the open surgical hemorrrhoidectomy (Milligan-Morgan) method (P&lt;0.002). Conclusion: Laser hemorrhoidoplasty with Doppler-guided hemorrhoidal artery ligation (DGHAL) is safe and effective in cases of all grades of hemorrhoids as compared to open surgical (Milligan-Morgan) hemorrhoidectomy.

Comments on "Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis".

Comments on "Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis".

Comparison of Pedicle Coagulation Hemorrhoidectomy With LigaSure Versus Conventional Milligan Morgan Hemorrhoidectomy in Reducing Post-operative Pain: A Randomized Controlled Trial.

Background Hemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan-Morgan open hemorrhoidectomy with pedicle ligation with LigaSure (Medtronic, Dublin, Ireland) in terms of postoperative pain on day 1 and day 7. It is important to assess the technique that is associated with lower postoperative pain because both of these techniques are still practiced in the developing world. Methods It was a randomized controlled trial conducted in the Department of Surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aged from 15 to 60 years who presented with symptomatic third and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Pain was assessed using the Visual Analogue scale (VAS). Data was entered and analyzed using SPSS v. 23.0 (IBM Corp., Armonk, USA). Chi-square tests were applied. P-value <0.05 was taken as statistically significant. Results Out of 100 patients, 68 (68%) were males while 32 (32%) were females. The mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64 (p<0.0001). Postoperative pain at day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group (p<0.0001). Conclusion LigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. Pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative painhelps in greater patient satisfaction and lesser requirement of analgesiaamong patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.

Comparison of Postoperative Complications between Conventional Diathermy Haemorrhoidectomy and Harmonic Scalpel Haemorrhoidectomy

Abstract Background For symptomatic grade III and IV haemorrhoids, some form of hemorrhoidectomy remains the accepted modality of treatment. The traditional methods like the Milligan-Morgan method and the Ferguson‟s method have been in practice for more than half a century. Recently we acquired the Harmonic system. It is an ultrasonic dependent technology, using waves to both seal and cut vessels and tissues in a hypothermic condition, now widely used for hemorrhoidectomy. This study will give a comprehensive overview on differences between conventional diathermy haemorrhoidectomy and Harmonic scalpel haemorrhoidectomy focusing on post-operative complications mainly postoperative pain, bleeding, anal stenosis and peri-anal fistulae occurrence. Objective To compere between conventional diathermy hemorrhoidectomy and Harmonic scalpel hemorrhoidectomy as regards post-operative pain, bleeding, anal stenosis and peri-anal fistula occurrence. Patients and Methods It is a prospective study conducted over 40 patients with grade III and IV hemorrhoids, randomly divided into two groups to compare between conventional diathermy hemorrhoidectomy, Harmonic scalpel hemorrhoidectomy as regards post-operative pain, bleeding, anal stenosis and peri-anal fistula occurrence. Results An overall favorable trend exists toward Harmonic scalpel hemorrhoidectomy in all parameters of the current study, in another word, the postoperative complications mainly pain, bleeding, anal stenosis and peri-anal fistula occurrence was much lesser in the Harmonic group. Conclusion Harmonic scalpel hemorrhoidectomy is a sutureless, hemorrhoidectomy technique dependent on an ultrasonic unit to achieve vessel and tissue sealing. It is safe and effective, has less blood loss, postoperative pain, bleeding, anal stenosis and perianal fistula occurrence compared to conventional diathermy hemorrhoidectomy.

Laser technology in proctological diseases: is it really the wave of the future?

Different types of lasers have been applied for various proctological conditions. We discuss about published articles regarding the application of lasers, with concern about evidence-based use of these techniques and technologies. We performed a literature search about laser treatments for proctological conditions. 55 studies were included for the final revision. Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures. A scoping review was performed. Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes. FiLaC (fistula laser closure) was initially described in 2011 for the treatment of anal fistula. In the published studies the reported healing rates vary between 20 and 82%, and the ideal indication is yet to be defined. Studies with long-term follow-up are lacking. SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease. This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques. Available data is very limited, and no randomized trials are published to date. Laser assisted techniques are a viable, minimally invasive, but expensive option for the treatment of several proctological conditions. Further researches are needed to assess if patients could benefit of their use, and for what indication.

Outcomes of diode laser haemorrhoidoplasty in treatment of second, third and fourth grades of haemorrhoids. a retrospective study

Introduction Management of hemorrhoidal disease had been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay. Patients and methods This prospective study was carried out on 104 patients with second, third and fourth grades of hemorrhoids in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (18 months, from February 2021 to August 2022). All patients underwent laser hemorrhoidoplasty lasotronix device, bare fibers, wavelength 1470 nm and 8 watts of power. Mucopexy was added in 28 patients with grade 4 hemorrhoids. Results Postoperative pain was evaluated using VAS score, in the first 6 h VAS ranged from 4-9 with mean of 5.81±1.23 SD, after 12 h ranged from 1 to 7 with mean of 4.19±1.70 SD. There was significant relation between the grade of hemorrhoid and postoperative edema (P value was less than 0.001) as all of the 24 patients who developed edema, they were grade 4 hemorrhoids. Also, there was relation between grade 4 hemorrhoid and the development of other postoperative complications but P value was not significant (0.066 in infection and 0.260 in recurrence). There was no incontinence or stenosis in all of the 104 patients and recurrence occurred only in 4 cases (3.8%) and underwent conventional hemorrhoidectomy after six months of follow up. Conclusion Diode laser is a safe minimally invasive procedure for the treatment of second, third and fourth grades of hemorrhoids with less postoperative pain and early return to normal activities but high cost remains the only limitation.

Comparative Study of Short-Term Outcome between Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy

Background: Due to the fear of postoperative pain and complications associated with open Milligan-Morgan (MM) surgery, mildly symptomatic patients often hesitate and delay undergoing surgical treatment for internal haemorrhoids. Laser Hemorrhoidoplasty (LHP) has been gaining popularity recently in the management of hemorrhoid. This study aimed to evaluate the efficacy of the LHP compared with MM surgery in the management of internal haemorrhoids. Materials and methods: This multi-center, open label, randomized controlled trial included 60 patietns with secondand third-degree internal haemorrhoids. The patients were randomized in a 1:1 ratio to receive either LHP (Group I) or conventional MM hemorrhoidectomy (Group II). Primary outcome parameter was postoperative pain assessed by Visual Anlougue Scale (VAS) at 24 hours, 7 days and 30 postoperative days. Results: Both the groups were comparable in terms of the demographic characteristics. The mean operation time was significantly lower in group I than group II (19.13±3.42 vs. 28.67±4.54 minutes, p&lt;0.001). The mean VAS score of pain at 24 hours and 7 days postoperative were significantly lower in group I than in group II (p&lt;0.001 and p&lt;0.004, respectively). At postoperative, 30 days the mean VAS scores were similar in both groups (p=0.722). The mean total days of consumed analgesic were significantly shorter in group I than in group II (7.94±5.79 vs. 11.01±2.96 days, p&lt;0.001). The mean time to return to regular activity was significantly earlier in group I than in group II (8.76±3.58 vs. 13.6±3.47, p&lt;0.001). Postoperative bleeding was less in group I than in group II (6.6% vs. 26.7%). The mean length of hospital stay, rate of complete resolution and need for medical treatment for residual symptom and repeated surgery were similar between two groups. Conclusion: LHP was associated with reduction of postoperative pain, postoperative bleeding, and administered with analgesics. So, if available LHP is preferred to open hemorrhoidectomy. IAHS Medical Journal Vol 5(2), Dec 2022; 15-19

LigaSure hemorrhoidectomy vs Milligan morgan hemorrhoidectomy: A Quasi-Experimental Study.

Objective: To explore the efficacy of two surgical procedures by comparing the mean operative time, average blood loss and postoperative pain score during conventional and LigaSure. Study Design: Quasi-experimental study. Setting: Department of Surgery, Aziz Fatimah Hospital, to compare the efficacy of two surgical procedures regarding perioperative and postoperative variables. Period: One Year (1st July 2020 -30th June 2021). Material &amp; Methods: Sixty patients with grade three and four haemorrhoids were randomized into two groups with 30 patients each. A questionnaire comprising all the variables was filled out and analyzed in SPSS 21. Results: Thirty patients were randomized into two groups, with group A comprising 21 (70%) females and, 9 (30%) males and 24 (80%) females, 6(20%) males in group B undergoing conventional hemorrhoidectomy. The study was single-blind, as the patients were unaware of the procedure they underwent. The mean age in group A was 39 years, and in group, B was 43 years. The mean operative time calculated was 38.4±2.77 and 51.7±2.60 in LigaSure and Milligan Morgan Hemorrhoidectomy, respectively, with a P-value calculated &lt;0.00001. The average blood loss in LigaSure was 31.3 ± 5.76 and 49 ± 7.11 in Milligan morgan hemorrhoidectomy. Moreover, the pain assessment score on day one and all other variables were statistically significant, with a P-value of &lt;0.00001. Conclusion: Ligasure hemorrhoidectomy is a safer surgical procedure associated with less operative time, blood loss and postoperative pain with shorter hospital stay and rapid wound healing.

Comparative study of Ligasure Haemorrhoirdectomy with conventional Milligan-Morgan Haemorrhoidectomy

AIM: Comparison of Ligasure hemorrhoidectomy with conventional Milligan Morgan hemorrhoidectomy for the treatment of grade III and IV hemorrhoids. Material and Methods: The current study was achieved between December 2020 to December 2022. A total of 64 Patients of grade III and IV hemorrhoids were randomized into two groups, Group A- Ligasure hemorrhoidectomy (32 patients) and Group B- Milligan Morgan hemorrhoidectomy (32 patients). The hemorrhoidal predicle was coagulated with Ligasure in Group A and transfixed with 1/0 Vicryl in Group B. Procedure time, the amount of lost blood, postoperative pain, and duration of hospitalization were recorded. Result: Out of 64 patients, there were 38 males and 26 females. The mean age of all patients for group A was 42 years, and for group B, was 48 years. The average procedure time in both group A was 23.6±8 min and in group B 53.5±9 min respectively. The average amount of lost blood was 12.50 ml in group A and 29.40 ml in group B. The VAS pain scores on the 0 day and 7th day in group A were 4.8, and 1.2 respectively and in group B were 7.2, and 2.6 respectively. The duration of hospitalization was 1.4 days and, 3.2 days in both groups, respectively. Conclusion: The submucosal dissection technique with Ligasure coagulation of the hemorrhoidal pedicle is safe and effective. Suturing is not required as the mucosal tissue over the pedicle is sealed off with the current. There is minimal lateral spread of either thermal or electrical energy. Because of its ease of use and less postoperative pain and complication Ligasure hemorrhoidectomy can be preformed as a day-care procedure.

Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend

PurposeHemorrhoidal 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).MethodPostoperative 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.ResultFrom 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).ConclusionLHP 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.

Prevalence of Obstructed Defecation among Patients Who Underwent Hemorrhoidectomy and Correlation between Preoperative Constipation Score and Postoperative Patients' Satisfaction: A Prospective Study in Two Centers.

obstructed defecation syndrome (ODS) is a common but underestimated condition that may affect the outcomes after hemorrhoidectomy. Therefore, the aim of this study was to determine the prevalence of obstructed defecation syndrome (ODS) among patients who underwent hemorrhoidectomy and to assess the correlation between preoperative constipation score and postoperative patients' satisfaction. This prospective study included adult patients who underwent hemorrhoidectomy for 3rd and 4th-grade hemorrhoidal diseases. All participant patients underwent an assessment of functional OD severity by the Agachan-Wexner Constipation Scoring System. All patients were subjected to conventional hemorrhoidectomy. At 6 months postoperatively, patients were assessed again for their constipation score and postoperative patients' satisfaction. The study included 120 patients (62 males and 58 females) with a mean age of 38.7 ± 12.1 years. About one-quarter of patients (24.2%) had obstructed defecation (constipation score ≥12). ODS (constipation score ≥12) was found to be significantly more among older patients, female patients, especially those with multiple pregnancies and multiple labors, and those with perineal descent. The postoperative constipation score (5.6 ± 3.3 mean ± SD) showed significant improvement (p = 0.001) compared to (9.3 ± 3.9 mean ± SD) preoperatively. Postoperative patients' satisfaction (mean 12.3 ± 3.0) at 6 months had a negative correlation with preoperative total constipation score (r = -0.035, p = 0.702). The prevalence of obstructed defecation among patients with hemorrhoids was higher than reported among the general population. High preoperative constipation scores had a negative correlation with postoperative patients' satisfaction. Routine preoperative measurement of ODS can allow the detection of this particular group of patients who require a more physical and psychological evaluation, in addition to special preoperative counseling.

Minimally Invasive Treatment for Advanced Hemorrhoids.

Hemorrhoids, the most common anorectal disease, give rise to symptoms such as bleeding, prolapse, and pruritus. The treatment for advanced hemorrhoids (Grade III or IV) is gradually shifting toward minimally invasive procedures. These procedures focus on reduction of blood flow in hemorrhoids. Conventional hemorrhoidectomy (CH), also known as Milligan-Morgan or Ferguson hemorrhoidectomy, is considered as the standard treatment for Grade III and IV hemorrhoids because it achieves the lowest recurrence rate. Over the years, alternative minimally invasive techniques such as stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization (THD) have been developed. A new, effective sclerosant, aluminum potassium sulfate and tannic acid (ALTA), has been developed in Japan and has been used for all grades of hemorrhoids; however, its effectiveness declines over time. Other minimally invasive, nonsurgical procedures, including rubber band ligation, endoscopic injection sclerotherapy, and infrared coagulation, have also been performed for Grade III hemorrhoids. Those minimally invasive treatments improve bleeding and prolapse and are highly recommended for patients who are unfit for CH. THD with mucopexy or ALTA sclerotherapy has also been performed for Grade IV hemorrhoids. However, the recurrence rate after ALTA sclerotherapy for Grade IV hemorrhoids was higher than that for Grade III lesions in our case study. In conclusion, minimally invasive treatments are a valid alternative for patients with advanced hemorrhoids after clear explanation of recurrence rates and possible complications.

Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis.

This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids. PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities. Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], -2.09; 95% confidence interval [CI], -3.44 to -0.75; P=0.002) and postoperative day 7 (MD, -3.94; 95% CI, -6.36 to -1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42-0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12- 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240). LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

SURGICAL APPROACH AND OUTCOMES AFTER HAEMORRHOIDECTOMY

Purpose: The present study aims to compare and analyze the results of conventional and stapled haemorrhoectomy in patients with haemorrhoidal disease undergoing operative treatment in UMHATEM "N.I.Pirogov" and to determine the accurate surgical approach. Material and Methods: 207 patients with the haemorrhoidal disease (3rd and 4th degree) were operated on for a period of one year from 1.1.2015 to 31.12.2015 in the Department of General, Visceral and Emergency surgery of the University Hospital "Pirogov". In 106 of these stapled haemorrhoidectomy was performed, with the remaining 101- conventional haemorrhoidectomy was performed. Out of the haemorrhoidectomy with a stapler (group S), women were 49 (46.23%), men 57 (53.77%). In the conventional surgery (group C), women were 41 (40.59%), men 60 (59.41%). The age in this retrospective analysis varied from 18 to 81 (average 46 years). Results: From group S there was no post-operative pain reported in 32 (30.19%) patients, 64 (60.38%) complained of moderate pain and 10 (9.43%) of significant pain. From Group C 21 (20.79%) had no post-operative pain, 54 (53.47%) complained of moderate pain and 26 (25.74%) of significant pain. Regarding postoperative haemorrhage from group S, it was minimal to absent in 85.85% (91 patients) of the cases and significant in 15 patients (14.15%). From group C, 68 patients (67.33%) had minimal to absent haemorrhage and 33(32.67%) with significant haemorrhage. Group S morbidity was 9.43% - 10 patients (indication for prolapse, fissure and 2 cases of anal stenosis due to improper manipulation with the stapler). From group C the incidence was 14 patients (13.86%). There were no deaths in both groups-mortality-0%. Conclusion: Compared to literature data, analyzed results indicate that stapled hemorrhoidectomy is the optimal surgical approach to reduce postoperative pain and early recovery to normal activity.