European Journal of Cardiovascular Medicine

Hemorrhoidal disease represents one of the most common benign anorectal conditions, affecting nearly 40% of the adult population worldwide, with a higher prevalence among individuals aged 45 to 65 years (1). It is characterized by symptomatic enlargement and distal displacement of the anal cushions, leading to symptoms such as bleeding, pain, prolapse, and pruritus (2). Although conservative management including dietary modification, topical agents, and lifestyle changes remains the first line of treatment, surgical intervention becomes necessary in cases of persistent symptoms, particularly in grade II to IV hemorrhoids (3).

Conventional open hemorrhoidectomy, including techniques like the Milligan-Morgan procedure, is widely considered the gold standard for definitive surgical management. However, it is often associated with substantial postoperative pain, longer hospital stays, delayed return to work, and higher complication rates, such as urinary retention and anal stenosis (4,5). These drawbacks have prompted the development of less invasive alternatives aimed at reducing perioperative morbidity.

Laser hemorrhoidoplasty (LHP) is a relatively recent, minimally invasive technique that uses a diode laser to coagulate the hemorrhoidal vascular supply without excising tissue. This results in the shrinkage of hemorrhoidal masses while preserving the surrounding anatomy, thus reducing postoperative pain and facilitating faster recovery (6,7). Several studies have suggested that LHP may offer comparable efficacy to open surgery with significantly better patient comfort and fewer complications (8).

Given the growing interest in minimally invasive anorectal procedures, this study aims to compare the clinical outcomes of laser hemorrhoidoplasty with those of traditional open hemorrhoidectomy in the treatment of grade II–III hemorrhoids. The parameters assessed include operative time, intraoperative blood loss, postoperative pain, duration of hospital stay, time to resume normal activity, and postoperative complications.

A total of 60 patients aged 18 to 60 years, diagnosed with symptomatic grade II or III internal hemorrhoids, and requiring surgical intervention were included in the study. Patients with coexisting anal fissure, fistula-in-ano, inflammatory bowel disease, bleeding disorders, pregnancy, or previous anorectal surgery were excluded.

Study Design and Group Allocation:
Eligible patients were randomly allocated into two equal groups using a computer-generated randomization table:

• Group A: Underwent Laser Hemorrhoidoplasty (LHP) using a 1470 nm diode laser.
• Group B: Underwent conventional open hemorrhoidectomy (Milligan-Morgan technique).

Surgical Procedure:
All procedures were performed under spinal anesthesia with the patient in lithotomy position. In the laser group, hemorrhoidal pedicles were coagulated by inserting the laser fiber into the hemorrhoidal mass, causing controlled shrinkage of vascular tissue without excision. In the open technique, excision of the hemorrhoidal tissue was performed with electrocautery, followed by ligation of vascular pedicles.

Data Collection and Outcome Measures:
The following parameters were recorded:

• Duration of surgery (in minutes)
• Intraoperative blood loss (measured in mL)
• Postoperative pain assessed by Visual Analog Scale (VAS) on postoperative days 1, 3, and 7
• Length of hospital stay (in days)
• Time to return to normal activity (in days)
• Complications such as bleeding, infection, urinary retention, and wound healing issues

Patients were followed up at 1 week, 1 month, and 3 months after surgery. Any signs of recurrence or persistent symptoms were documented.

Statistical Analysis:
Data were analyzed using SPSS version 25. Continuous variables were expressed as mean ± standard deviation and compared using Student’s t-test. Categorical data were analyzed using the Chi-square test. A p-value <0.05 was considered statistically significant.

A total of 60 patients were enrolled in the study, with 30 patients each in Group A (Laser Hemorrhoidoplasty) and Group B (Open Hemorrhoidectomy). Both groups were comparable in terms of age, gender distribution, and grade of hemorrhoids, with no statistically significant difference (p > 0.05).

Operative Parameters:
The mean operative time in the laser group was significantly shorter compared to the open group. Blood loss was also observed to be lower in the laser group. These findings are summarized in Table 1.

Table 1: Comparison of Operative Parameters Between the Two Groups

(Table 1: Operative time and intraoperative blood loss were significantly lower in Group A.)

Postoperative Pain:
Pain scores measured using the Visual Analog Scale (VAS) were consistently lower in the laser group at all follow-up points. The highest pain scores were reported on day 1, which gradually decreased over time in both groups (Table 2).

Table 2: Postoperative VAS Pain Scores

(Table 2: VAS scores were significantly lower in Group A across all postoperative days.)

Recovery and Hospital Stay:
Group A patients had a significantly shorter hospital stay and earlier return to routine activities compared to Group B (Table 3).

Table 3: Postoperative Recovery Parameters

(Table 3: Laser-treated patients recovered faster and had shorter hospital stays.)

Postoperative Complications:
Minor complications such as urinary retention, secondary bleeding, and wound infection were more common in the open hemorrhoidectomy group. No major complications or mortality occurred in either group. Details are presented in Table 4.

Table 4: Postoperative Complications

(Table 4: Although not statistically significant, complications were fewer in Group A.)

Hemorrhoidal disease remains a prevalent anorectal condition, often necessitating surgical intervention in symptomatic grade II–III cases unresponsive to conservative management. The traditional open hemorrhoidectomy, although effective, is associated with significant postoperative pain, longer recovery time, and increased morbidity (1,2). This has led to a growing interest in minimally invasive procedures like laser hemorrhoidoplasty (LHP), which aim to reduce tissue trauma and postoperative discomfort while maintaining therapeutic efficacy.

In our study, LHP demonstrated several advantages over the conventional open technique. Operative time was significantly shorter in the laser group. This is consistent with findings from Khafagy et al., who reported reduced procedural duration with laser techniques due to less dissection and simpler technique (3). Intraoperative blood loss was also markedly lower in the LHP group, likely owing to the coagulative effect of the laser on hemorrhoidal

vessels (4).

Postoperative pain remains a critical determinant of patient satisfaction and early recovery. Our data indicated significantly lower VAS scores in the LHP group on all evaluated days, aligning with the findings of Giamundo et al. and Maloku et al., who reported minimal postoperative pain and analgesic requirement following laser treatment (5,6). The laser technique avoids excisional trauma and preserves the anoderm and mucosa, which may explain the favorable pain profile (7).

Hospital stay and time to return to normal activities were also significantly shorter in the LHP group. These outcomes are corroborated by studies such as that of Placer et al. and Singla et al., who highlighted the shorter convalescence period and faster return to work after LHP (8,9). In modern surgical practice, reducing inpatient duration and facilitating early rehabilitation are essential for improving cost-effectiveness and patient throughput (10).

Postoperative complications such as urinary retention, bleeding, and wound infection were more frequent in the open hemorrhoidectomy group, though the differences were not statistically significant in our cohort. This observation mirrors that of El Nakeeb et al., who reported higher complication rates in conventional surgeries (11). Furthermore, laser techniques have shown to cause minimal sphincter irritation and avoid wound dehiscence, leading to reduced morbidity (12).

No significant difference was noted in recurrence rates between the two groups during the 3-month follow-up, suggesting that laser hemorrhoidoplasty is comparable in efficacy to open hemorrhoidectomy in the short term. However, longer follow-up is required to assess long-term recurrence and durability of symptom relief (13).

The main limitations of our study include a relatively short follow-up period and a limited sample size, which may underpower the detection of rare complications or long-term recurrence. Nevertheless, the strengths of this study lie in its randomized design and uniform operative protocols, which minimize bias and improve internal validity (14,15).

In conclusion, laser hemorrhoidoplasty appears to be a safe, less painful, and efficient alternative to conventional open hemorrhoidectomy for the treatment of grade II–III hemorrhoids. It significantly improves postoperative outcomes and patient comfort while maintaining therapeutic efficacy. Further multicentric trials with longer follow-up are warranted to validate these findings and explore cost-benefit implications in different healthcare settings.

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