A COMPARATIVE STUDY OF LASER HEMORRHOIDOPLASTY VERSUS OPEN HEMORRHOIDECTOMY [MILLIGAN MORGAN METHOD]

Abstract

Introduction: Hemorrhoidal disease is one of the most common proctological disease and affects between 7 and 30% of the general population. It is a consequence of an increased blood flow to the superior rectal artery, which causes dilatation of the hemorrhoidal plexus. There is also degradation of the supportive tissue that results in sliding down of haemorrhoids.1 Open hemorrhoidectomy was first described in 1937 by Milligan-Morgan and is still considered as the gold standard therapy. However, it is associated with significant pain, bleeding and wound infection which can result in prolonged hospital stay. Materials and Methods: A Prospective Study was conducted for a period of 3 years (with follow up period of 1 year) (January 2022 To December 2024) at Shivamogga Institute of Medical Sciences, Shimoga. All patients aged 21–90 years who were reviewed for symptomatic haemorrhoids were considered for inclusion. All of them underwent a clinical and proctoscopic assessment to ascertain that haemorrhoids are the only cause of their symptoms. A Randomized prospective study comparing LHP and open surgical methods for hemorrhoidal disease was conducted at Shivamogga Institute of Medical Sciences, Shimoga. All the surgeries were performed by Surgeons with good experience and skills at performing both the methods of surgery included in the study. Double Blinding was done for both the patients and the operating surgeon to rule out the “bias”. Results: The LHP procedure was performed on 28 consecutive patients with mean age 47 ± 12.6 (range, 24–70) years. There were 14 men and 14 women. The open surgical procedure was performed on 26 patients with mean age 49 ± 12.3 (range 28-72) years. There were 13 men and 13 women. As far as pain is concerned, early postoperative pain is dominantly lower in the LHP group compared with surgical group. The same values also resulted for the period of one month. These results are presented in tables and in figures. The post operative bleeding episodes were relatively lower in the LHP group compared with the open surgical group consistently at different post operative period. These results are presented in the tables and figures. Conclusion: In summary, laser hemorrhoidoplasty procedure is more preferred in comparison with conventional open surgical hemorrhoidectomy. Postoperative pain is significantly lesser in LHP compared with surgical procedure (p<0.05). Intra operative duration time is significantly shorter in LHP (p<0.01). Post operative bleeding is relatively less in LHP than open surgery assessed at different intervals. However, there was no significant difference in the recurrence rate at the of 1 year post operatively. Therefore, laser hemorrhoidoplasty procedure was more effective than open surgical hemorrhoidectomy.