A Prospective Comparative Study: Stapler Hemorrhoidopexy vs Laser Hemorrhoidoplasty in the Treatment of Hemorrhoids

Main Article Content

Anshuman Kaushal
Aakanksha Aggarwal
Amanpriya Khanna
Rajesh Agarwal
Dhruv N. Kundra
T. K. Thusoo

Abstract

Aims: Stapler hemorrhoidopexy (SH) has evolved over time as a procedure of choice over conventional surgery due to less postoperative pain. Laser hemorrhoidoplasty (LH) is a novel procedure aimed at shrinking the terminal branches of hemorrhoidal arteries with fewer complications. The present study is aimed to compare these procedures (SH and LH).

Study Design: Prospective comparative study.

Place and Duration of Study: Patients operated for hemorrhoids at the Department of General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon from April 2018 to March 2019.

Methodology: 50 patients with grade II-III hemorrhoids were allocated to two groups: Stapler hemorrhoidopexy (SH) and Laser hemorrhoidoplasty (LH) with 25 patients in each group. Results were compared and patients were followed up for minimum period of 3 months.

Results: The mean operative time was 24.6 min (LH) and 28.6 min (SH) (P =.122). The average blood loss was 8.32 ml (LH) and 11.64 ml (SH) (P <.05). The mean hospital stay 21.44 hours (LH) and 32.64 hours (SH) (P <.05). Mean postoperative pain score (VAS) at 12 hours was 2.64 (LH) and 4.76 (SH) (P <.05), at 24 hours was 1.88 (LH) and 3.6 (SH) (P <.05), at 1 week was 0.36 (LH) and 0.88 (SH) (P =.054) and at 3 months 0.04 (LH) and 0.12 (SH) (P =.53). One patient in LH (4%) had postoperative bleeding on 4th postoperative day. In SH group, 2 (8%) had severe postoperative pain with VAS > 8, requiring longer hospital stay, 2 (8%) had bleeding on the same day, 1 (4%) had bleeding on follow up and 1 (4%) had recurrence.

Conclusion: In terms of early postoperative pain and complications, LH offers better results as compared to SH. It was associated with a shorter hospital stay and early return to work. No significant complications were noted in LH compared to SH. LH is an extremely viable alternative to the popular SH for grade II-III hemorrhoids.

Keywords:
Hemorrhoids, stapler hemorrhoidopexy, laser hemorrhoidoplasty, anal canal, anorectal diseases.

Article Details

How to Cite
Kaushal, A., Aggarwal, A., Khanna, A., Agarwal, R., Kundra, D. N., & Thusoo, T. K. (2020). A Prospective Comparative Study: Stapler Hemorrhoidopexy vs Laser Hemorrhoidoplasty in the Treatment of Hemorrhoids. Journal of Advances in Medicine and Medical Research, 32(9), 10-23. https://doi.org/10.9734/jammr/2020/v32i930477
Section
Original Research Article

References

Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380–6.

Rogozina VA. [Hemorrhoids]. Eksp Klin Gastroenterol Exp Clin Gastroenterol. 2002;(4):93–6, 134.

Cohen Z. Symposium on outpatient anorectal procedures. Alternatives to surgical hemorrhoidectomy. Can J Surg J Can Chir. 1985;28(3):230–1.

Bartolo DCC. Surgery of the anus, rectum and colon. Vols 1 and 2. M. R. B. Keighley and N. S. Williams. 282 × 205 mm. Pp. 2448. Illustrated. 1993. London: W. B. Saunders. £280. BJS Br J Surg. 1994; 81(7):1085–1085.

Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL, et al. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011;54(9):1059–64.

Picchio M, Greco E, Di Filippo A, Marino G, Stipa F, Spaziani E. Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review. Indian J Surg. 2015;77(S3):1301–7.

Khubchandani I. Internal Sphincterotomy With Hemorrhoidectomy Does Not Relieve Pain: A Prospective, Randomized Study. Dis Colon Rectum. 2002;45(11):1452–7.

Hwang DY, Yoon S-G, Kim HS, Lee JK, Kim KY. Effect of 0.2 percent glyceryl trinitrate ointment on wound healing after a hemorrhoidectomy: Results of a randomized, prospective, double-blind, placebo-controlled trial. Dis Colon Rectum. 2003;46(7):950–4.

Chen HH, Wang J-Y, Changchien CR, Chen J-S, Hsu K-C, Chiang J-M, et al. Risk factors associated with post hemorrhoidectomy secondary hemorrhage: a single-institution prospective study of 4,880 consecutive closed hemorrhoidec-tomies. Dis Colon Rectum. 2002;45(8): 1096–9.

Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: Current incidence and complications of operative therapy. Dis Colon Rectum. 1992;35(5):477–81.

Stapled Hemorrhoidopexy: The Argument for Usage. Clin Colon Rectal Surg. 2004;17(2):131–42.

Sutherland LM, Burchard AK, Matsuda K, Sweeney JL, Bokey EL, Childs PA, et al. A Systematic Review of stapled hemorrhoi-dectomy. Arch Surg. 2002; 137(12):1395–406.

Touzin E, Hegge S, McKinley C. Early experience of stapled hemorrhoidectomy in a community hospital setting. Can J Surg. 2006;49(5):316–20.

Oughriss M, Yver R, Faucheron J-L. Complications of stapled hemorrhoi-dectomy: A French multicentric study. Gastroenterol Clin Biol.2005;29(4):429–33.

Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Phillips RK. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet Lond Engl. 2000;356(9231):730–3.

Nyström P-O, Qvist N, Raahave D, Lindsey I, Mortensen N. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. BJS Br J Surg. 2010;97(2):167–76.

Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: Laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updat Surg; 2019.

Danys D, Pacevicius J, Makunaite G, Palubeckas R, Mainelis A, Markevicius N, et al. Tissue Coagulation in Laser Hemorrhoidoplasty - An Experimental Study. Open Med Wars Pol. 2020;15:185–9.

Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-Shkololli A. Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: A Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree. Acta Inform Medica AIM J Soc Med Inform Bosnia Herzeg Cas Drustva Za Med Inform BiH. 2014;22(6):365–7.

Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M. The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum. 2011;54(6):693–8..

Kim R, Ferrara A, Soliman M, Stevens R, DeJesus S, Williamson P et al. Comparison of Results and Complications of Stapled Hemorrhoidopexy Performed With the Ethicon and Covidien Staplers - SAGES.

[cited 2019 Dec 19]

Available:https://www.sages.org/meetings/annual-meeting/abstracts-archive/comparison-of-results-and-complications-of-stapled-hemorrhoidopexy-performed-with-the-ethicon-and-covidien-staplers/

Bellio G, Pasquali A, Schiano di Visconte M. Stapled Hemorrhoidopexy: Results at 10-Year Follow-up. Dis Colon Rectum. 2018;61(4):491–8.

Ram E, Bachar GN, Goldes Y, Joubran S, Rath-Wolfson L. Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids. Laser Ther. 2018 ;27(2):137–42.

Peker K, Inal A, Güllü H, Gül D, Sahin M, Ozcan AD, et al. Comparison of vessel sealing systems with conventional. Iran Red Crescent Med J. 2013;15(6):488–96.