Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive
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ORIGINAL ARTICLE
Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids Luigi Brusciano1 · Claudio Gambardella1,2 · Gianmattia Terracciano1 · Giorgia Gualtieri1 · Michele Schiano di Visconte3 · Salvatore Tolone1 · Gianmattia del Genio1 · Ludovico Docimo1 Received: 29 August 2019 / Accepted: 16 November 2019 © Italian Society of Surgery (SIC) 2019
Abstract Hemorrhoidal disease (HD) treatment still remains controversial. In fact, despite many surgical progresses, postoperative pain, and discomfort remain the major weaknesses. Laser hemorrhoidoplasty (LHP) is a minimal invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser. The aim of the current study is to analyze the feasibility and efficacy of LHP in patients with II–III degrees hemorrhoids. Consecutive patients with II–III degree hemorrhoids were enrolled in the study and underwent an LHP treatment using a 1470-nm diode laser. Operative time, postoperative pain and complications, resolution of symptoms, and length of return to daily activity were prospectively evaluated. Recurrence of prolapsed hemorrhoid or symptoms at a minimum follow-up of 6 months was evaluated. Fifty patients (28 males and 22 females) were enrolled in the study. No significant intraoperative complications occurred. Postoperative pain score (at 12, 18, and 24 h postoperatively), evaluated through visual analogue scale, was extremely low (mean value 2). No postoperative spontaneous bleeding occurred. The 100% of our population came back to daily activity 2 days after surgery. At a mean follow-up period of 8.6 months, we reported a recurrence rate of 0%. LHP demonstrated a large efficacy in selected patients. The greatest strength points were low postoperative pain, the presence of slightly significant peri-anal wounds, no special anal hygienic measures and low surgical time. Thus, resulting in a negligible postoperative discomfort, LHP could be considered a painless and minimal invasive technique in the treatment of HD. Keywords Hemorrhoidal disease · Laser hemorrhoidoplasty · Postoperative pain · Postoperative discomfort
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-019-00694-5) contains supplementary material, which is available to authorized users. Luigi Brusciano and Claudio Gambardella contributed equally to the paper. * Ludovico Docimo [email protected] 1
University of Study of Campania “Luigi Vanvitelli”, via Luigi Pansini n° 5, 80131 Naples, Italy
2
Department of Cardiothoracic Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
3
“S. Maria dei Battuti” Hospital, Conegliano, Conegliano, TV, Italy
Hemorrhoidal disease (HD) is a widespread anorectal condition affecting millions of people around the world and representing a major medical and socioeconomic issue, severely influencing patients’ quality
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