Comparison of Intrahemorrhoidal Coagulation with 980 Nanometer Diode Laser and Milligan Morgan hemorrhoidectomy: a Randomized Clinical Trial
Puropse: we compared the efficacy and complications of intrahemorrhoidal coagulation with 980 nanometer diode laser and Milligan Morgan hemorrhoidectomy.
Methods: Fifty-nine consecutive adult patients above 18 years of age with symptomatic internal hemorrhoid disease were scheduled for hemorrhoidectomy surgery between January 2010 and January 2011 were included in this randomized double-blind placebo controlled trial. The patients were randomly allocated through block randomization to undergo either Milligan-Morgan hemorrhoidectomy (n=30) or intrahemorrhoidal coagulation with 980 nanometer diode laser (n=30).
Results: With respect to the postoperative pain severity based on VAS score within 24 hours after the operation, although pain severity during the first 6 hours was nonsignificantly higher in the diode laser group, pain severity decreaseed significantly more in this group compared with the surgical hemorrhoidectomy group. Both intraoperative and postoperative bleeding were more severe in the Milligan-Morgan hemorrhoidectomy group. Moreover, hospital stay was longer in Milligan-Morgan hemorrhoidectomy group. The dose of consumed morphine after the procedure was also significantly lower in those treated with coagulation by 980 nanometer diode laser. The two groups were not different in terms of the prevalence of postoperative urinary retention, the number of regressed hemorrhoidal pockets, and improvement of clinical signs within six months follow-up time. According to the multivariable linear regression analysis, postoperative pain severity and bleeding were significantly lower in the patients treated with intrahemorrhoidal coagulation with 980 nanometer diode laser than Milligan-Morgan hemorrhoidectomy.
Conclusion: Intrahemorrhoidal coagulation with 980 nanometer diode laser is associated with reduced postoperative pain, intraoperative and postoperative bleeding, hospital stay, and dose of consumed morphine, and therefore it has more efficiency compared with the Milligan-Morgan hemorrhoidectomy.