Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study

Background
Laser hemorrhoidoplasty is a relatively new management option for symptomatic hemorrhoids. Although its advantages over the Milligan–Morgan approach were highlighted in previous trials, the combination of laser and mucopexy (hemorrhoidal artery ligation) is scarcely discussed in the literature. Herein, the author compared the outcomes of the previous combination with the traditional Milligan–Morgan procedure in cases with second and third-degree piles.
Methods
The 66 included patients were randomly divided into two groups; group A underwent the combined approach, while group B underwent the Milligan–Morgan procedure. Postoperative pain, satisfaction, and complications were assessed.
Results
Preoperative data, including patient presentation and the degree of piles, were comparable between the two groups. Nonetheless, operative time and hospitalization period showed a significant increase in group B ( = 0.004 and < 0.001). Group A patients expressed significantly lower pain scores during rest and defection, as well as a better satisfaction level, compared with group B patients. The incidence of postoperative complication did not differ between the two interventions, except for urine retention, which was more frequently encountered in group B cases. An earlier return to normal daily activities was noted in group A. 1-month Wexner scores did not differ between the two groups, and no cases developed recurrence during the 1-year follow-up.
Conclusion
The combination of laser with hemorrhoidal artery ligation is associated with multiple advantages over surgical hemorroidectomy manifested in a better analgesic profile, better satisfaction, and an early restoration to daily activities.