Comparative Outcome of Laser Hemorrhoidoplasty Versus Conventional Hemorrhoidectomy for Grade II/III Hemorrhoids
DOI:
https://doi.org/10.54112/bcsrj.v6i5.1824Keywords:
Hemorrhoids, Laser Hemorrhoidoplasty, Conventional Hemorrhoidectomy, Operative Time, Postoperative Pain, Hospital Stay, Randomized Controlled TrialAbstract
Hemorrhoids are a prevalent anorectal condition with significant morbidity when symptomatic. Conventional hemorrhoidectomy remains the gold standard for grade II/III hemorrhoids but is associated with notable postoperative discomfort and extended hospital stays. Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative with potentially better outcomes, though limited evidence exists in the local Pakistani population. Objective: To compare mean operative time, postoperative pain, and hospital stay between laser hemorrhoidoplasty and conventional Milligan-Morgan hemorrhoidectomy in patients with grade II/III hemorrhoids. Methods: This randomized controlled trial was conducted at the Department of General Surgery, Gulab Devi Hospital, Lahore, from January to March 2025. A total of 100 patients with symptomatic grade II/III hemorrhoids were enrolled using non-probability consecutive sampling and randomized equally into two groups: Group A underwent conventional open hemorrhoidectomy, and Group B received laser hemorrhoidoplasty. Key outcomes measured included operative time (in minutes), pain at one week post-operatively (VAS score), and hospital stay (in hours). Data were analyzed using SPSS version 26.0, and independent t-tests were applied with p < 0.05 considered statistically significant. Results: The mean age of the study participants was 42.6 ± 11.3 years. Male patients constituted 62% of the sample. The LHP group had significantly reduced mean operative time (14.8 ± 3.2 min vs. 30.2 ± 4.1 min, p < 0.001), lower postoperative pain scores (3.7 ± 0.7 vs. 6.5 ± 0.6, p < 0.001), and shorter hospital stays (8.1 ± 2.0 hrs vs. 36.4 ± 6.3 hrs, p < 0.001) compared to the conventional group. These differences remained significant across stratified analyses for hemorrhoid grade, comorbidities, and lifestyle factors. Conclusion: Laser hemorrhoidoplasty is superior to conventional hemorrhoidectomy in terms of operative efficiency, reduced postoperative pain, and shorter hospitalization. These findings advocate for the adoption of LHP as a first-line surgical intervention for grade II/III hemorrhoids in the Pakistani healthcare setting.
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References
José MMB. Initial experience of anorectal surgery with laser technique. EC Gastroenterol Dig Syst. 2020;7:1–11.
Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist's view. World J Gastroenterol. 2015;21(31):9245–52. https://doi.org/10.3748/wjg.v21.i31.9245
Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg. 2016;29(1):22–9. https://doi.org/10.1055/s-0035-1568144
Fontem RF, Eyvazzadeh D. Internal Hemorrhoid. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2025 Jul 12]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537182/
Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol. 2019;17(1):8–15. https://doi.org/10.1016/j.cgh.2018.03.020
Lee JM, Kim NK. Essential anatomy of the anorectum for colorectal surgeons focuses on the gross anatomy and histologic findings. Ann Coloproctol. 2018;34(2):59–71. https://doi.org/10.3393/ac.2017.12.15
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009–17. https://doi.org/10.3748/wjg.v18.i17.2009
Longchamp G, Liot E, Meyer J, Toso C, Buchs NC, Ris F. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci. 2021;36(3):485–96. https://doi.org/10.1007/s10103-020-03142-8
Lie H, Caesarini EF, Purnama AA, et al. Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci. 2022;37:3621–30. https://doi.org/10.1007/s10103-022-03643-8
Dekker L, Bak MTJ, Bemelman WA, Felt-Bersma RJF, Han-Geurts IJM. Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up. Ann Coloproctol. 2022;38(2):146–52. https://doi.org/10.3393/ac.2020.01011.0144
Long Q, Wen Y, Li J. Milligan-Morgan hemorrhoidectomy combined with non-Doppler hemorrhoidal artery ligation for the treatment of grade III/IV hemorrhoids: a single centre retrospective study. BMC Gastroenterol. 2023;23:293. https://doi.org/10.1186/s12876-023-02933-x
Yahya WN, Refaat DO, AbdElhady WA, Elsayed WA. Comparison between laser hemorrhoidoplasty procedure and conventional open surgical hemorrhoidectomy. Egypt J Hosp Med. 2022;86(1):112–6. https://dx.doi.org/10.21608/ejhm.2022.210781
Wee I., Koo C., Seow‐En I., Ng Y., Lin W., & Tan E. Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis. Annals of Coloproctology 2023;39(1):3-10. https://doi.org/10.3393/ac.2022.00598.0085
Hossain M., Bhuiyan M., Nahid S., Anwar S., Khan H., & Nipa S.. Comparative study of short-term outcome between laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy. Iahs Medical Journal 2023; 5(2): 15-19. https://doi.org/10.3329/iahsmj.v5i2.66822
Poškus T., Danys D., Makūnaitė G., Mainelis A., Mikalauskas S., Poškus E.et al.. Results of the double-masked randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy. International Journal of Colorectal Disease 2020;35(3):481-490. https://doi.org/10.1007/s00384-019-03460-6
Chaudhary D., Tekam V., Mishra S., & Singh P. Comparative study between conventional hemorrhoidectomy and electrothermal bipolar vessel sealer for grade IV hemorrhoids. Asian Journal of Medical Sciences 2022;13(9):238-243. https://doi.org/10.3126/ajms.v13i9.44804
Gallo G., Grossi U., Tanna G., Santoro G., Paola G., Clerico G.et al.. Short-term outcomes of polycarbophil and propionibacterium acnes lysate gel after open hemorrhoidectomy: a prospective cohort study. Journal of Clinical Medicine 2020;9(12):3996. https://doi.org/10.3390/jcm9123996
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Copyright (c) 2025 Muhammad Hasant Ul Hassan, Khalil Ahmed, Hamail Khanum, Muhammad Arslan, Qaim Din, Asad Javed
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