Laser Hemorrhoidoplasty (LHP) Twisting Trend: A Study in a Small Town Hospital
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Abstract
Objective: To determine the outcomes of Laser Hemorrhoidoplasty in terms of early post-operative pain, bleeding, postoperative hospital stay, and operative time.
Methodology: The quasi-experimental study was conducted at Brigadier Shafique Trust Hospital. The duration of the study was four months from September 2023 to December 23. A total of 150 patients were enrolled in the study through a probability consecutive sampling method. After complete history, examination, and baseline investigations, patients underwent LHP. The procedure was performed using a radially emitting laser fiber with a 600 um diameter and a 1470 nm diode continuous wavelength. The average energy delivered to each hemorrhoid was 210 J to 240 J. Mucopexy was done for grade 3 hemorrhoids with prolapse and all grade 4 hemorrhoids. All patients were regularly followed for early postoperative pain at 12 hours, 7 days, 4 weeks, and then at 6 weeks, using a visual analog scale. All the data were collected using a structured questionnaire and analyzed using SPSS V26.
Results: The studied patients had a male preponderance of 65.5% (n=97/150). The mean age of the patients was 45.09 with a standard deviation (SD) of 13.2 (45.09 ± 13.2). Most patients had grade 2 and grade 3 hemorrhoids, 97.6 % (n=107/150). The most common indications for surgery were per rectal bleeding at 76.1 %( 110/150) and nodules at 37.4 %( 55/150). The primary outcomes were early post-operative pain and bleeding, which were significantly reduced. By the end of week 6, 90% of patients reported no pain and bleeding. Secondary outcomes included an intraoperative time of 34.2 minutes and a postoperative hospital stay of 18 hours. Patients having grade 3 nodules and grade 4 hemorrhoids treated with mucopexy had negligible prolapse in the post-op period.
Conclusion: Laser Hemorrhoidoplasty is a minimally invasive day-care procedure with a short operative time and a shorter hospital stay with significantly reduced early post-op pain and bleeding. It has a definite edge in the management of Grade 3 and 4 hemorrhoids.
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