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Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard

PURPOSE: Haemorrhoidal 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 co...

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Autores principales: Tan, Varen Zhi Zheng, Peck, Ern-wei, Sivarajah, Sharmini S., Tan, Winson J., Ho, Leonard M. L., Ng, Jia-Lin, Chong, Cheryl, Aw, Darius, Mainza, Franky, Foo, Fung-Joon, Koh, Frederick H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388431/
https://www.ncbi.nlm.nih.gov/pubmed/35906356
http://dx.doi.org/10.1007/s00384-022-04225-4
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author Tan, Varen Zhi Zheng
Peck, Ern-wei
Sivarajah, Sharmini S.
Tan, Winson J.
Ho, Leonard M. L.
Ng, Jia-Lin
Chong, Cheryl
Aw, Darius
Mainza, Franky
Foo, Fung-Joon
Koh, Frederick H.
author_facet Tan, Varen Zhi Zheng
Peck, Ern-wei
Sivarajah, Sharmini S.
Tan, Winson J.
Ho, Leonard M. L.
Ng, Jia-Lin
Chong, Cheryl
Aw, Darius
Mainza, Franky
Foo, Fung-Joon
Koh, Frederick H.
author_sort Tan, Varen Zhi Zheng
collection PubMed
description PURPOSE: Haemorrhoidal 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). METHOD: A 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. RESULTS: A 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. CONCLUSION: Our 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00384-022-04225-4.
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spelling pubmed-93884312022-08-20 Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard Tan, Varen Zhi Zheng Peck, Ern-wei Sivarajah, Sharmini S. Tan, Winson J. Ho, Leonard M. L. Ng, Jia-Lin Chong, Cheryl Aw, Darius Mainza, Franky Foo, Fung-Joon Koh, Frederick H. Int J Colorectal Dis Review PURPOSE: Haemorrhoidal 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). METHOD: A 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. RESULTS: A 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. CONCLUSION: Our 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00384-022-04225-4. Springer Berlin Heidelberg 2022-07-29 2022 /pmc/articles/PMC9388431/ /pubmed/35906356 http://dx.doi.org/10.1007/s00384-022-04225-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Tan, Varen Zhi Zheng
Peck, Ern-wei
Sivarajah, Sharmini S.
Tan, Winson J.
Ho, Leonard M. L.
Ng, Jia-Lin
Chong, Cheryl
Aw, Darius
Mainza, Franky
Foo, Fung-Joon
Koh, Frederick H.
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title_full Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title_fullStr Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title_full_unstemmed Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title_short Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
title_sort systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus milligan-morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388431/
https://www.ncbi.nlm.nih.gov/pubmed/35906356
http://dx.doi.org/10.1007/s00384-022-04225-4
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