Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids
Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids
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DOI：
10.1007/s13304-019-00694-5
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发表时间：
2019-11-23
影响因子：
2.6
通讯作者：
Docimo, Ludovico
中科院分区：
文献类型：
--
作者：
Brusciano, Luigi;Gambardella, Claudio;Docimo, Ludovico
痔病(HD)的治疗仍然存在争议。事实上，尽管手术取得了许多进展，但术后疼痛和不适仍然是主要的弱点。激光内痔成形术(LHP)是一种微创的HD治疗方法，利用半导体激光来确定内痔的收缩程度。本研究的目的是分析LHP治疗II-III度内痔的可行性和疗效。连续的II-III度内痔患者参加了这项研究，并接受了使用1470 nm半导体激光的LHP治疗。前瞻性评估手术时间、术后疼痛和并发症、症状缓解和恢复日常活动的时间。在至少6个月的随访期内评估脱垂性内痔的复发或症状。50例患者(男性28例，女性22例)参加了研究。未发生明显的术中并发症。术后疼痛评分(术后12、18、24小时)视觉模拟评分极低(平均值2)。术后无自发性出血发生。我们100%的人口在手术后2天恢复了日常活动。在平均8.6个月的随访期内，我们报告的复发率为0%。LHP在选定的患者中显示出很大的疗效。最大的优点是术后疼痛低，有轻微的肛周伤口，没有特殊的肛门卫生措施和手术时间短。因此，在HD的治疗中，LHP可以被认为是一种无痛和微创的技术，其术后不适可以忽略不计。
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.