Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy

Abstract

Purpose To compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP). Methods A randomized, parallel-group, double-blinded, single-center prospective study. Patients Symptomatic 2nd-or 3rd-degree hemorrhoids patients. Interventions Computer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year. Outcome measures Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment. Results A total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001. Patients after LHP returned to regular activity after 15 days, after MP after 22 days, and after EH after 30 days, p < 0.001. SF-36 scores were better after EH. Symptoms of fecal incontinence improved in all the groups. Patients evaluate LHP better than EH and MP. Limitations Single-center study. Conclusions Laser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.

Tissue coagulation in laser hemorrhoidoplasty – an experimental study

“…Similar results were reported by Weyand et al [7]. A randomized controlled trial performed by our group [8] has shown intrahemorrhoidal laser procedure to be more effective than hemorrhoidal artery ligation with a significantly shorter duration of postoperative pain and recovery.…”

Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature

“…Reviewing of references identified one study [ 9 ]. Finally, 14 studies [ 8 , 9 , 11 – 22 ] published between 2007 and 2020 were eligible for our review: seven studies [ 8 , 11 – 16 ] reported LH, and seven studies [ 9 , 17 – 22 ] reported HeLP (Fig. 1 ).…”

“…1 ). There were 10 cohorts (seven prospective [ 11 , 12 , 17 – 21 ], two retrospective [ 8 , 9 ], one not specified [ 13 ]), three randomized controlled trials (RCT) comparing LH with HC [ 14 – 16 ] and MP [ 16 ], and one RCT comparing HeLP with RBL [ 22 ]. Of the 1540 patients included in these studies, majority were classified as suffering from grades II and III HD (35.8% and 33.6%, respectively), while grades I and IV HD patients were less frequent (5.1% and 0.4%, respectively, grade unavailable for 25.1% of cases).…”

“…LH was performed under general anesthesia [ 11 , 14 , 16 ], spinal anesthesia [ 11 , 15 ], local anesthesia with [ 12 , 13 ] or without [ 8 ] sedation, or without anesthesia [ 8 ] (Table 2 ). Antibioprophylaxis was administered in three studies [ 12 , 14 , 16 ].…”

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

“…LHP showed the shortest procedure time, was significantly less painful than EH and return to work was possible 15 days earlier. Despite higher recurrence rates, LHP resulted in higher patient satisfaction than EH and MP [102]. Again, laser treatment might represent an attractive future treatment option.…”