Usporedba kratkoročnog ishoda nakon laserske hemoroidoplastike i klasične hemoroidektomije po Morgan-Milliganu

Ludvig Letica, Ilija Perutina

Cilj: Cilj ovog istraživanja jest usporediti kratkoročni ishod nakon laserske procedure u odnosu na Morgan- Milliganovu proceduru odstranjenja hemoroidalnih čvorova. Metode: Studija uključuje bolesnike s dijagnosticiranom hemoroidalnom bolesti III. i IV. stadija. Njih 25 je kirurški liječeno Morgan-Milliganovom metodom na Klinici za kirurgiju Sveučilišne kliničke bolnice Mostar, a 25 laserskom hemoroidoplastikom u privatnoj poliklinici u Mostaru. Dio podataka prikupljen iz bolničkoga informacijskog sustava te povijesti bolesti iz poliklinike daje podatke o spolu, vrsti operativnog pristupa, trajanju hospitalizacije te cijeni kirurškog postupka. Drugi dio se sastoji od odgovora na telefonski upitnik o poslijeoperativnom intenzitetu boli, mjerenom numeričkom ljestvicom boli, 1., 7. i 14. dana nakon operacije, o duljini trajanja boli te duljini trajanja oporavka. Rezultati: Studija pokazuje kako je hemoroidalna bolest kirurški tretirana više kod muškaraca (74%) nego žena (26%). Trajanje hospitalizacije je dva sata nakon laserske procedure, u odnosu na prosječno 7 dana nakon Morgan-Milliganove procedure. Postoji statistički značajna razlika između grupe s Morgan Milliganovom hemoroidektomijom (KHE) i grupe s laserskom hemoroidoplastikom (LHP) prema kratkoročnom ishodu. Poslijeoperativni intenzitet boli, mjeren numeričkom ljestvicom boli, tijekom prvog dana je 6,20 kod KHE i 3,48 kod LHP grupe, nakon sedam dana 3,44 kod KHE i 1,12 kod LHP grupe, te nakon četrnaest dana 1,52 kod KHE i 0,44 kod LHP grupe. Duljina trajanja boli je 14 dana kod KHE grupe u odnosu na 3 dana kod LHP. Duljina trajanja oporavka je u prosjeku 30 dana kod KHE te 5 kod LHP. Zaključak: Minimalno invazivna laserska hemoroidoplastika rezultira boljim kratkoročnim ishodom, ali je skuplja metoda nego klasična hemoroidektomija. Naši rezultati predlažu unutarhemoroidalno liječenje laserom umjesto klasične hemoroidektomije, ako je dostupno, zbog manjega poslijeoperativnog intenziteta boli, duljine trajanja boli, duljine trajanja oporavka te hospitalizacije u vremenu od dva sata.

Aim: The aim of this study is to compare hemorrhoid laser procedure with Morgan-Milligan surgical procedure for short-term outcome. Methods: The research sample included patients with verified 3rd or 4th stage hemorrhoidal disease. Twenty-five of them were provided surgical Morgan-Milligan treatment at the Clinic for Surgery at the University Clinical Hospital Mostar, and 25 underwent laser hemorrhoidoplasty treatment in a private polyclinic in Mostar. The part of the data collected from the hospital network system and medical history from the polyclinic supplied information about gender, operative technique, duration of hospitalization, and surgical treatment price. The other part of the data is composed of phone answers of patients about postoperative pain on the 1st, 7th, and 14th day after the procedure, pain duration, and recovery time duration. Results: The study has shown that more men (74%) were surgically treated for hemorrhoidal disease than women (26%). Hospitalization time was two hours after laser procedure, but about seven days after Morgan-Milligan procedure. There was a statistically significant difference between classic Morgan-Milligan hemorrhoidectomy (CHE) group and laser hemorrhoidoplasty (LHP) group regarding the short-term outcome. Pain intensity, measured by numerical rating scale, during the first day was 6.20 in CHE, and 3.48 in LHP group, after seven days 3.44 in CHE and 1.12 in LHP, and after 14 days 1.52 in CHE and 0.44 in LHP group. Pain duration after procedures was 14 days in CHE group compared to three in LHP. Recovery time duration was about 30 days in CHE group and five in LHP. Conclusion: Minimally invasive laser hemorrhoidoplasty procedure results in better short-term outcome than open surgical hemorrhoidectomy, but is more expensive. Our results suggest that intrahemorrhoidal diode laser treatment, if available, is preferred to open hemorrhoidectomy due to lower postoperative pain intensity, pain duration time, recovery time period, and hospitalization of two hours.