Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids

Ali Kemal Taşkin 1 * , Bülent Özçetin 1
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1 Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 4, pp. 33-37. https://doi.org/10.23950/jcmk/13503
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ABSTRACT

Aim: The aim of this study is to compare the efficacy of LigaSure and LH procedures in the treatment of grade 2-3 hemorrhoids.
Material and methods: Demographic and clinical data of the patients were recorded retrospectively. A visual analogue scale (VAS) was used to evaluate the pain intensity of the patients after the procedure and a Likert-type scale was used to evaluate patient satisfaction surveys 6 months after the procedure.
Results: Of the 66 patients, (mean age: 42.12±11.92 years, %72,7 male) 34 underwent LH procedure whereas 32 underwent LigaSure procedure. Spinal anesthesia was applied for 64 patients and general anesthesia was applied for 2 patients. Procedure time and time to return to work were significantly shorter in the LH group compared to the LigaSure group (900 vs. 1200 seconds, p<0.001, and 3.64±1.29 vs. 14.46±3.73 days, p<0.001). Late complications (abscess, relapse, pruritus, and seromucous discharge) were more common in the LH group, but the difference was not statistically significant (23.5% vs. 6.3%, p=0.08). VAS pain scores were significantly lower in the LH group (p<0.001). Although there was no significant difference between the treatment groups in terms of patient satisfaction, relapse was significantly less common in the LigaSure group (p=0.045).
Conclusion: In patients with grade 2-3 hemorrhoids, LH may be preferred over LigaSure due to greater patient comfort, higher satisfaction rates, and fewer early complications. However, close follow-up of these patients is important due to the higher incidence of late complications with LH.
Keywords: hemorrhoidal disease, visual analog scale, Likert measurement system, LigaSure, laser

CITATION

Taşkin AK, Özçetin B. Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids. J CLIN MED KAZ. 2023;20(4):33-7. https://doi.org/10.23950/jcmk/13503

REFERENCES

  • Kim JH, Kim DH, Lee YP, Suh KW. Long-term follow-up of Starion™ versus Harmonic Scalpel™ hemorrhoidectomy for grade III and IV hemorrhoids. Asian J Surg. 2019;42(1):367-372. https://doi.org/10.1016/j.asjsur.2018.05.002
  • Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 1990;98(2):380-6. https://doi.org/10.1016/0016-5085(90)90828-o
  • Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL . Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011;54(9):1059-64. https://doi.org/10.1097/DCR.0b013e318225513d
  • Goligher J, Duthie H, Nixon H. Anus, Rectum and Colon Surgery .5th edition. London: Balliere Tindall; 1984.
  • Duran Y, Polat FR, Topçu B. Laser Procedure as A Mınımal Invasıve Treatment Optıon ın The Treatment of Hemoroıd Dısease. Namık Kemal Medical Journal. 2020;8(3): 443-449. https://doi.org/10.37696/nkmj.759403
  • Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2015;25(2):106-110. https://doi.org/10.1097/SLE.0000000000000136
  • Sobrado CW, Klajner S, Hora JAB, Mello A, Silva FMLD, Frugis MO, et al. Transanal Haemorrhoıdal Dearterıalızatıon wıth Mucopexy (Thd-M) for Treatment of Hemorrhoıds: Is It Applıcable In All Grades? Brazılıan Multıcenter Study. Arq Bras Cir Dig. 2020;33(2):e1504. https://doi.org/10.1590/0102-672020190001e1504
  • Jain A, Lew C, Aksakal G, Hiscock R, Mirbagheri N. Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: A pilot Australian study [published online ahead of print, 2022 May 19]. Ann Coloproctol. 2022. https://doi.org/10.3393/ac.2022.00164.0023
  • Danys D, Pacevicius J, Makunaite G, Palubeckas R, Mainelis A, Markevicius N, et al. Tissue Coagulation in Laser Hemorrhoidoplasty - An Experimental Study. Open Med (Wars). 2020;15:185-189. https://doi.org/10.1515/med-2020-0027
  • Wang JY, Lu CY, Tsai HL, Chen FM, Huang CJ, Huang YS, et al. Randomized controlled trial of LigaSure with submucosal dissection versus Ferguson hemorrhoidectomy for prolapsed hemorrhoids. World J Surg. 2006;30 (3):462–6. https://doi.org/10.1007/s00268-005-0297-1
  • Zhang L, Xie Y, Huang D, Ma X, Wang W, Xiao H, et al. LigaSure hemorrhoidectomy versus the procedure for prolapse and hemorrhoids: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2022;101(3):e28514. https://doi.org/10.1097/MD.0000000000028514
  • De Nardi P, Tamburini AM, Gazzetta PG, Lemma M, Pascariello A, Asteria CR. Hemorrhoid laser procedure for second- and third-degree hemorrhoids: results from a multicenter prospective study. Tech Coloproctol. 2016;20 (7):455-459. https://doi.org/10.1007/s10151-016-1479-6
  • Lumb KJ, Colquhoun PH, Malthaner RA, Jayaraman S. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev.2006; (4): CD005393. https://doi.org/10.1002/14651858
  • Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. https://doi.org/10.1016/0304-3959(83)90126-4
  • Likert, R. A technique for measuring attitudes. Psychology Archives, 1932; 140: 5-55.
  • Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol. 2015;21(31):9245-9252. https://doi.org/10.3748/wjg.v21.i31.9245
  • Feo CF, Ninniri C, Tanda C, Deiana G, Porcu A. Open Hemorrhoidectomy With LigasureTM Under Local or Spinal Anesthesia: A Comparative Study. The American Surgeon. 2021; 0(0). https://doi.org/10.1177/00031348211038590
  • Aibuedefe B, Kling SM, Philp MM, Ross HM, Poggio JL. An update on surgical treatment of hemorrhoidal disease: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36(9):2041-2049. https://doi.org/10.1007/s00384-021-03953-3
  • Haksal MC, Çiftci A, Tiryaki Ç, Yazıcıoğlu MB, Özyıldız M, Yıldız SY. Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids. Turk J Surg. 2017;33(4):233-236. https://doi.org/10.5152/turkjsurg.2017.3493
  • Gentile M, De Rosa M, Carbone G, Pilone V, Mosella F, Forestieri P. Ligasure Haemorrhoidectomy versus Conventional Diathermy for IV-Degree Haemorrhoids: Is It the Treatment of Choise? A Randomized, Clinical Trial. ISRN Gastroenterology. 2011; Article ID 467258. 6 pages. https://doi.org/10.5402/2011/467258
  • Khanna R, Khanna S, Bhadani S, Singh S, Khanna AK. Comparison of Ligasure Hemorrhoidectomy with Conventional Ferguson's Hemorrhoidectomy. Indian J Surg. 2010; 72: 294-297. https://doi.org/10.1007/s12262-010-0192-3
  • Fareed M, El-Awady S, Abd-El MH, Aly A. Randomized trial comparing LigaSure to closed Ferguson hemorrhoidectomy. Tech Coloproctol. 2009;13(3):243-6. https://doi.org/10.1007/s10151-009-0520-4
  • Lie H, Caesarini EF, Purnama AA. Irawan A, Sudirman T, Jeo WS, et al. Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci. 2022;37:3621–3630 https://doi.org/10.1007/s10103-022-03643-8
  • Tan VZZ, Peck EW, Sivarajah SS, Tan WJ, Ho LML, Ng JL, et al. Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: A new standard. Int J Colorectal Dis. 2022;37(8):1759-1771. https://doi.org/10.1007/s00384-022-04225-4
  • Oter V, Oter S. A comparison between Milligan-Morgan and Ferguson procedures for Hemorrhoidectomy. Kocaeli Med J. 2018; 7(3): 172-177. https://doi.org/10.5505/ktd.2018.30092
  • Jahanshahi A, Mashhadizadeh E, Sarmast MH. Diode laser for treatment of symptomatic hemorrhoid: A short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012;84(7):329-332. https://doi.org/10.2478/v10035-012-0055-7
  • Elnaim ALK, Musa S, Wong MP, Sagap IA, Ismail S. A Prospective Interventional Study on LigaSureTM Haemorrhoidectomy as a Daycare Procedure. Malays J Med Sci. 2021;28(5):102-107. https://doi.org/10.21315/mjms2021.28.5.10
  • Karahaliloğlu AF. Laser hemorrhoidoplasty (LHP): A new surgical procedure for the treatment of advanced hemorrhoidal illness. Coloproctology. 2010; 32: 116-23. https://doi.org/10.1007/s00053-010-0084-9
  • Rho M, Guida AM, Materazzo M, Don CP, Gazia C, Ivanikhin AM, et al. Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience. Rev Recent Clin Trials. 2021;16(1):101-108. https://doi.org/10.2174/1574887115999201006201926
  • Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg. 2020;72(3):851-857. https://doi.org/10.1007/s13304-019-00694-5
  • Eberspacher C, Mascagni P, Di Nardo D, Pironi D, Pontone S, Martellucci J, et al. Caiman Versus LigaSure Hemorrhoidectomy: Postoperative Pain, Early Complications, Long-Term Follow-up, and Costs. Surg Innov. 2020;27(3):272-278. https://doi.org/10.1177/1553350620908388
  • Ural B. A Minimally Invasive, Safe, New Method in Hemorrhoidal Disease: Laser Hemorrhoidoplasty. Haydarpaşa Numune Training and Research Hospital Medical Journal. 2015; 55 (3)
  • Bessa SS. Ligasure vs conventional diathermy in excisional hemorrhoidectomy: a prospective, randomized study. Dis Colon Rectum. 2008;51:940-4. https://doi.org/10.1007/s10350-008-9214-7
  • Weyand G, Theis CS, Fofana AN, Rüdiger F, Gehrke T. Laser hemorrhoidoplasty with 1470 nm Diode Laser in the Treatment of Second to Fourth Degree Hemorrhoidal Disease - a Cohort Study with 497 Patients. Zentralbl Chir. 2019;144(4):355-363. https://doi.org/10.1055/s-0043-120449
  • Faes S, Pratsinis M, Hasler-Gehrer S, Keerl A, Nocito A. Short- and long-term outcomes of laser haemorrhoidoplasty for grade II-III haemorrhoidal disease. Colorectal Dis. 2019;21(6):689-696. https://doi.org/10.1111/codi.14572