Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis

Po-Lung Cheng; Chang-Cyuan Chen; Juan-Syun Chen; Po-Li Wei; Yan-Jiun Huang

doi:10.1016/j.asjsur.2024.04.156

Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis

Asian J Surg. 2024 May 17:S1015-9584(24)00838-8. doi: 10.1016/j.asjsur.2024.04.156. Online ahead of print.

Authors

Po-Lung Cheng¹, Chang-Cyuan Chen², Juan-Syun Chen³, Po-Li Wei⁴, Yan-Jiun Huang⁵

Affiliations

¹ Department of General Medicine, Taipei Medical University Hospital, Taipei City, Taiwan.
² Department of Medical Education, Chang Gung Memorial Hospital, Chiayi County, Taiwan.
³ Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei City, Taiwan.
⁴ Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan; Cancer Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Translational Laboratory, Department of Medical Research, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei City, Taiwan.
⁵ Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei City, Taiwan. Electronic address: d622101001@tmu.edu.tw.

PMID: 38762410
DOI: 10.1016/j.asjsur.2024.04.156

Abstract

Conventional hemorrhoidectomy is the mainstay of treatment for symptomatic haemorrhoids, but reported postoperative complications remains the main concern. On the contrary, with its minimally invasive nature, laser hemorrhoidoplasty showed the potential to reduce postoperative complications and discomfort. Therefore, we performed a systemic review and meta-analysis to evaluate the postoperative outcome of laser hemorrhoidoplasty compared to conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques. Of all studies from PubMed, EMBASE, Cochrane database, and Google Scholar, we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy. The primary outcomes were operative blood loss and postoperative haemorrhage, and the secondary outcomes were the operative time, postoperative pain score, complications, and haemorrhoid recurrence. In this study, we found that laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy. However, incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups. Consistent results were found in 5 subgroup analyses, including studies with low risk of bias, studies using 1470 nm laser, and studies using 980 nm laser, studies conducted in Asia, and studies conducted in Europe and America.

Keywords: Ferguson hemorrhoidectomy; Laser hemorrhoidoplasty; Milligan-morgan hemorrhoidectomy; Postoperative outcom.

Publication types

Review