Our Summary

This research paper presents a comparison between conventional surgery and laser surgery for treating hemorrhoids. Traditional surgery methods like the Milligan-Morgan and Ferguson techniques are often used to treat severe hemorrhoids, but they can lead to various complications after the surgery. However, laser surgery, being less invasive, has the potential to reduce such problems.

The researchers analyzed 17 trials involving 1196 patients, half of whom had undergone laser surgery and the other half who had conventional surgery. They were mainly interested in blood loss during surgery, bleeding after surgery, operation time, pain after surgery, complications, and reoccurrence of hemorrhoids.

The study found that laser surgery had several advantages over conventional surgery, including less blood loss during surgery, less bleeding after surgery, shorter operation time, and less severe pain the day after surgery. It also found that it lowered the risk of anal stenosis (narrowing of the anal canal, which can lead to constipation and discomfort). However, there was no significant difference between the two methods in terms of the risk of fecal or gas incontinence (loss of control over bowel movements or gas), urinary retention (difficulty emptying the bladder), and reoccurrence of hemorrhoids.

These findings were consistent across several further analyses, including those with a low risk of bias, those using different types of lasers, and those conducted in various geographical locations (Asia, Europe, and America).

FAQs

  1. What are the main advantages of laser surgery over conventional surgery for treating hemorrhoids?
  2. Was there any significant difference found between laser surgery and conventional surgery in terms of postoperative complications like fecal or gas incontinence, urinary retention, and reoccurrence of hemorrhoids?
  3. Was the effectiveness of laser surgery consistent across various geographical locations and different types of lasers used in the studies?

Doctor’s Tip

A doctor might tell a patient considering a hemorrhoidectomy to consider laser surgery as it has been shown to have advantages over traditional surgery methods in terms of less blood loss, less bleeding, shorter operation time, and less severe pain after surgery. It may also lower the risk of complications such as anal stenosis. It is important for patients to discuss the options with their doctor to determine the best treatment plan for their individual situation.

Suitable For

Based on the results of this study, patients who are recommended for hemorrhoidectomy are those with severe hemorrhoids who may benefit from less invasive laser surgery. Patients who are concerned about potential complications such as blood loss, post-operative bleeding, longer operation times, and severe pain may be good candidates for laser surgery. Additionally, patients who are at risk of developing anal stenosis may also benefit from laser surgery. However, it is important to note that the risk of fecal or gas incontinence, urinary retention, and reoccurrence of hemorrhoids appears to be similar between laser and conventional surgery methods. Ultimately, the decision to undergo hemorrhoidectomy should be made in consultation with a healthcare provider based on individual circumstances and preferences.

Timeline

  • Before hemorrhoidectomy:
  1. Patient experiences symptoms of hemorrhoids such as itching, pain, bleeding, and swelling in the anal area.
  2. Patient consults a doctor or specialist who recommends a hemorrhoidectomy as a treatment option.
  3. Patient undergoes pre-operative evaluations such as physical examination, blood tests, and possibly a colonoscopy.
  4. Patient receives instructions on pre-operative preparation, which may include dietary changes, bowel preparation, and cessation of certain medications.
  5. Patient undergoes the hemorrhoidectomy procedure, which can be either conventional surgery or laser surgery.
  • After hemorrhoidectomy:
  1. Patient experiences pain, discomfort, and swelling in the anal area immediately after the surgery.
  2. Patient is given pain medications and instructions on post-operative care, including wound care and hygiene.
  3. Patient may experience some bleeding and discharge from the surgical site in the days following the surgery.
  4. Patient is advised to follow a specific diet and lifestyle modifications to prevent constipation and promote healing.
  5. Patient attends follow-up appointments with the doctor to monitor healing, manage any complications, and discuss long-term care for preventing recurrence of hemorrhoids.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a hemorrhoidectomy procedure?

  2. How does laser surgery compare to traditional surgery methods for treating hemorrhoids in terms of recovery time and post-operative pain?

  3. Will I need to take any special precautions or follow a specific diet before or after the surgery?

  4. How long is the typical recovery time after a hemorrhoidectomy procedure, and when can I expect to return to my normal activities?

  5. Are there any specific lifestyle changes or habits that I should adopt to prevent the reoccurrence of hemorrhoids after the surgery?

  6. What are the expected outcomes of the procedure in terms of symptom relief and improvement in quality of life?

  7. How often will I need to follow up with you after the surgery, and what signs or symptoms should I watch out for that may indicate a complication?

  8. Are there any alternative treatment options for hemorrhoids that I should consider before opting for a hemorrhoidectomy?

  9. Can you provide me with information about your experience and success rates with performing hemorrhoidectomy procedures, particularly with laser surgery?

  10. Are there any specific instructions or guidelines that I should follow before and after the surgery to ensure a successful outcome?

Reference

Authors: Cheng PL, Chen CC, Chen JS, Wei PL, Huang YJ. Journal: Asian J Surg. 2024 Nov;47(11):4681-4690. doi: 10.1016/j.asjsur.2024.04.156. Epub 2024 May 18. PMID: 38762410