A prospective randomized comparative study between Stapler hemorrhoidopexy and laser hemorrhoidoplasty in the management of third-degree piles
Authors: Sabry Ahmed M. , Zaid Mohamed H. , Khalil Ahmed 
Published: October 2023

Background
Hemorrhoidectomies are considered one of the most commonly performed procedures worldwide. Advances in techniques and technology have emerged new modalities in the management of piles with different grades.

Aim
The aim of this study is to weigh the advantages and disadvantages of laser hemorrhoidoplasty (LH) versus Stapler hemorrhoidopexy (SH).

Methods
A prospective randomized trial with 120 patients with symptomatic third degree hemorrhoidal disease who presented with pain and bleeding was undertaken in March 2020 and followed patients for two years in Ain Shams University Hospitals until March 2022. The remaining 60 patients (group B) had SH, while the first 60 patients (group A) got LH. The following factors were evaluated: preoperative complaints (bleeding Per rectum, rectal/perianal pain, mass coming out of anus), operative and postoperative outcomes, operative time, postoperative pain, bleeding, urinary retention, fecal/flatus incontinence, thrombosis of external haemorrhoids, anal/rectal stenosis, wound issues, and recurrence. The visual analog scale (VAS), which is based on a numeric pain rating scale with 0 denoting no pain and 10 denoting severe pain, was used to record postoperative discomfort.

Results
Operative time and blood loss were significantly better in LH than SH with Operative time 23.04±3.42 min in LH compared with SH 33.72±4.48 min (P < 0.001) and Operative blood loss in LH 5.61±1.06 ml compared with SH 11.67±1.92 ml (P < 0.001). There was less postoperative hospital stay in LH group.
Postoperative pain was significantly higher in SH verses LH in the first 12 h (5.83±0.86 in stapler vs 5.02±0.6 in laser in the first 12 h) (P < 0.001). Postoperative VAS score at 24 h and 1 week the VAS score was higher for LH in comparison with SH (3.86±0.48 in laser vs 3.39±0.56 in SH at 24 h), (1.59±0.37 in laser vs 1.01±0.43 at 1 week).
As regard Returning to activities SH was significantly better than LH.
Regarding early postoperative complications like early Postoperative bleeding and urinary retention we found no statistically significant difference between SH and LH in our study. As regard Late Postoperative complications SH was significantly better regarding recurrence after 2 years with only one case of recorded recurrence verses 7 cases in LH group Also, SH was significantly better regarding postoperative flatus incontinence and late anal stenosis with only one patient of Flatus incontinence and late anal stenosis in SH group verses 6 patients of Flatus incontinence and 4 patients of anal stenosis in LH group. While other late postoperative complications were better in SH Group but were not statistically Significant.

Conclusions
Both SH and LH are probably equally valuable techniques in modern haemorrhoid surgery. However, SH has an advantage because of lower pain after 24 h better, faster recovery and Return to activities and less postoperative complications so SH is a better technique with overall better outcomes. Results of LH showed be revised, liberal use of LH in third degree hemorrhoidal disease according to patient preference should be regulated. LH should be evaluated in depth in a large-volume studies.