Cemil Adas, Ugur Kesici, Salih Genc M, Merve Karadag, Guray Duman M, Emine Boluk S
Department of General Surgery, Health Science University, Sultan II. Abdulhamid Han, Training and Reseach Hospital, Istanbul, Türkiye.
Department of General Surgery, Health Science University, Prof. Dr. Cemil Tascioglu, Training, and Research Hospital, Istanbul, Türkiye.
Am Surg. 2024 Apr;90(4):662-671. doi: 10.1177/00031348231207301. Epub 2023 Oct 17.
The estimated prevalence of hemorrhoidal disease (HD) worldwide ranges from 2.9% to 27.9%. Conservative, medical, non-operative, and surgical therapy approaches are applied in HD treatment. Milligan-Morgan (MM) hemorrhoidectomy which is the most well-known and frequently applied surgical treatment method, and Laser hemorrhoidoplasty (LH) are among the accepted treatment methods in Grade 2-3 HD treatment where medical treatment is insufficient.
In this study, the early results of laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy techniques were compared.
A randomized clinical trial. The study included ASA 1-3, total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment. Fifty-four patients were allocated to Group L, whereas 31 were allocated to Group M. Age, gender, weight, body mass index, preoperative symptoms, presence of additional disease, use of anticoagulant medication, and length of hospital stay of the patients included in the study were recorded. Rescue analgesic used was recorded. Postoperative VAS score and complications were recorded within 10 days. The total energy numbers applied to all packages were recorded.
The incidence of minor perioperative hemorrhage was significantly lower in Group L compared to Group M ( = .035). The postoperative 3rd-hour VAS scores were statistically significantly lower in Group L compared to Group ( < .001). At the 3rd hour postoperatively, the need for rescue analgesia was statistically significantly higher in Group M compared to Group L. On the seventh postoperative day, Group M needed considerably more rescue analgesia compared to Group L ( < .001, = 1.00, = .035, respectively). The cut-off value of 571 J was calculated in Group L.
We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness, since postoperative pain, which is shown as the most important advantage of LH over conventional hemorrhoidectomy methods in the literature, can be relieved with simple NSA-I rescue analgesia in patients undergoing MM. Trial Registration: 03.06.2021/21-63.
全球痔病（HD）的估计患病率在2.9%至27.9%之间。HD治疗采用保守、药物、非手术和手术治疗方法。Milligan-Morgan（MM）痔切除术是最著名且应用最频繁的手术治疗方法，激光痔成形术（LH）是药物治疗不足时2-3级HD治疗中公认的治疗方法之一。
本研究比较了激光痔成形术和Milligan-Morgan痔切除术的早期结果。
一项随机临床试验。该研究纳入了年龄在18-70岁、ASA分级为1-3级、有症状的2级和3级痔病患者，这些患者尽管接受了至少1个月的药物治疗，症状仍持续存在。54例患者被分配到L组，31例被分配到M组。记录研究中患者的年龄、性别、体重、体重指数、术前症状、是否存在其他疾病、是否使用抗凝药物以及住院时间。记录使用的急救镇痛药。术后10天内记录视觉模拟评分（VAS）和并发症。记录应用于所有套餐的总能量数。
L组围手术期轻微出血的发生率显著低于M组（P = 0.035）。L组术后第3小时的VAS评分在统计学上显著低于M组（P < 0.001）。术后第3小时，M组对急救镇痛的需求在统计学上显著高于L组。术后第7天，M组比L组需要更多的急救镇痛（P < 0.001，RR = 1.00，OR = 0.035）。在L组中计算出571焦耳的临界值。
我们认为，与MM痔切除术相比，LH在患者舒适度和成本效益方面都不是一种优势方法，因为文献中显示LH相对于传统痔切除术方法的最重要优势——术后疼痛，在接受MM手术的患者中使用简单的非甾体抗炎药急救镇痛即可缓解。试验注册号：03.06.2021/21 - 63。
