الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hemorrhoidal disease is ranked first amongst diseases of the rectum and large intestine, and the estimated worldwide prevalence ranges from 2.9% to 27.9%, which more than 4% are symptomatic. Approximately, one third of these patients seek physicians for advice. Age distribution of a peak incidence between 20 and 65 years with subsequent decline after 65 years and rarely below 20 years.
Milligan Morgan hemorrhoidectomy is the gold standard and frequently procedure. Post hemorrhoidectomy pain is the commonest problem associated with the surgical techniques. The other early complications are urinary retention, bleeding (secondary or reactionary) and subcutaneous abscess. The long term complications include anal fissure, anal stenosis, incontinence, fistula and recurrence of hemorrhoids. Aim of the study:
To evaluate the safety and efficacy of intrahemorrhoidal diode laser treatment in comparison to Milligan Morgan hemorrhoidectomy.
Setting of the study:
The present study was carried out in the department of Surgery of Menoufia university hospital after approval of the Ethics Committee had been obtained during a period started on April 2016 to september 2017.
The studied samples were selected according to the inclusion criteria:
It included all patients diagnosed to have hemorrhoids grades II, and A written informed consent was obtained from all patients.
Sample Size:
Sixty consecutive eligible patients were randomly assigned using sealed opaque envelopes in the operating room into one of two groups:
group A (Intrahemorrhoidal diode laser treatment n= 30)
group B (Milligan Morgan Hemorrhoidectomy n= 30)
The operations were performed under spinal anesthesia with the patient in the lithotomy position. Technically, both techniques was done
Follow-up was performed by inspection of the wound in the outpatient clinic after one week, one month, and three months postoperative assessing patients’ outcome, symptoms control and complications.
Demographic data, operative time, intraoperative bleeding, length of postoperative hospital stay and time to return to normal activity were all recorded and statistically analyzed. In addition, degree of pain postoperatively according to the VAS, early during the first 24 hours after the operation and late during the follow up period, analgesic requirements and incidence of early and late postoperative complications were all recorded and statistically analyzed.
There was no significant difference between the two groups regarding age, sex distribution and grade of hemorrhoids.
The operative time revealed that hemorrhoidectomy using the dode laser is statistically significant shorter than Milligan Morgan hemorrhoidectomy with better hemostasis and significant less intraoperative bleeding.
The length of postoperative hospital stay is longer in Milligan Morgan hemorrhoidectomy than Intrahemorrhoidal diode laser treatment.
Postoperative pain, the VAS score was used to evaluate the pain; the use of the diode laser caused statistically significant less postoperative pain during the first 24 hours after the surgery and significant less number of Pethidine injections, while in Milligan Morgan hemorrhoidectomy caused more pain after the surgery and more number of Pethidine injections.
The incidence of postoperative early and late complications; three patients in the laser group experienced thrombosis 3 to 4 days after the surgery that were medically treated.
The two groups were different in term of the prevalence of postoperative urinary retention as urine retention was more in Milligan Morgan group, the number of regressed hemorrhoidal pockets, and also improvement of clinical signs within three months follow up time.
The estimated blood loss is increased in Milligan Morgan hemorrhoidectomy than in diode laser group, postoperative bleeding was occur in one patient in Milligan Morgan hemorrhoidectomy group and treated by compression with packing and haemostatic drugs.
Late postoperative complication is occurring in Milligan Morgan hemorrhoidectomy more than diode laser group, as three patients had anal discharge and four patients had anal stenosis post Milligan Morgan hemorrhoidectomy, and in our study anal incontinence and recurrence had not occurring.
The time to return to normal activity, there was statistically significant difference between both groups. In diode laser group 90% of patients restored their activity within two weeks postoperatively while only 35% of patients in Milligan Morgan hemorrhoidectomy group backed to their activity within two weeks postoperatively.