Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis

Ian Jun Yan Wee; Chee Hoe Koo; Isaac Seow-En; Yvonne Ying Ru Ng; Wenjie Lin; Emile John Kwong-Wei Tan

doi:10.3393/ac.2022.00598.0085

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자료유형: 학술저널

저자정보: Ian Jun Yan Wee (Department of Colorectal Surgery Singapore General Hospital) Chee Hoe Koo (Department of Colorectal Surgery Singapore General Hospital) Isaac Seow-En (Department of Colorectal Surgery Singapore General Hospital) Yvonne Ying Ru Ng (Department of Colorectal Surgery Singapore General Hospital) Wenjie Lin (Department of Colorectal Surgery Singapore General Hospital) Emile John Kwong-Wei Tan (Department of Colorectal Surgery Singapore General Hospital)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.39 No.1

발행연도: 2023.2

수록면: 3 - 10 (8page)

DOI: 10.3393/ac.2022.00598.0085

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Purpose: This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids. Methods: PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities. Results: Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], –2.09; 95% confidence interval [CI], –3.44 to –0.75; P=0.002) and postoperative day 7 (MD, –3.94; 95% CI, –6.36 to –1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42–0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12– 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240). Conclusion: LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

#Hemorrhoids #Laser therapy #Hemorrhoidectomy #Blood coagulation

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