Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a ... View Full Text


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Article Info

DATE

2022-07-29

AUTHORS

Varen Zhi Zheng Tan, Ern-wei Peck, Sharmini S. Sivarajah, Winson J. Tan, Leonard M. L. Ho, Jia-Lin Ng, Cheryl Chong, Darius Aw, Franky Mainza, Fung-Joon Foo, Frederick H. Koh

ABSTRACT

PurposeHaemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH).MethodA comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications.ResultsA total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21–2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP’s postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis.ConclusionOur study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care. More... »

PAGES

1759-1771

References to SciGraph publications

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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00384-022-04225-4

    DOI

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    28 schema:description PurposeHaemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH).MethodA comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications.ResultsA total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21–2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP’s postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis.ConclusionOur study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care.
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    36 ConclusionOur study
    37 EMBASE
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    39 HD care
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    41 MethodA comprehensive search
    42 Milligan-Morgan haemorrhoidectomy
    43 ResultsA total
    44 Secondary outcomes
    45 analgesia use
    46 blood loss
    47 care
    48 characteristics
    49 cohort study
    50 comparative cohort study
    51 complications
    52 comprehensive search
    53 control
    54 conventional open haemorrhoidectomy
    55 days
    56 differences
    57 disease
    58 dosage
    59 duration
    60 efficacy
    61 findings
    62 first day
    63 follow
    64 haemorrhoidectomy
    65 hemorrhoids
    66 intraoperative characteristics
    67 life
    68 loss
    69 lower blood loss
    70 mean difference
    71 mean dosage
    72 mean follow
    73 min
    74 modalities
    75 months
    76 new standard
    77 novel option
    78 open haemorrhoidectomy
    79 options
    80 outcomes
    81 pain
    82 patients
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    84 plethora
    85 postoperative analgesia use
    86 postoperative pain
    87 postoperative quality
    88 postoperative recovery time
    89 potential
    90 primary outcome
    91 quality
    92 recovery time
    93 recurrence
    94 reduced postoperative pain
    95 review
    96 risk
    97 safety
    98 scholars
    99 search
    100 standards
    101 study
    102 surgical treatment modalities
    103 symptomatic hemorrhoids
    104 systematic review
    105 thrombosis
    106 time
    107 tolerability
    108 total
    109 treatment modalities
    110 trials
    111 understanding
    112 use
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