Is the combination of laser hemorrhoidoplasty and Ferguson hemorrhoidectomy superior to conventional surgical techniques in terms of postoperative pain in hemorrhoid patients? A retrospective comparative analysis

This study aimed to evaluate early and long-term results of three surgical methods (Ferguson hemorrhoidectomy, laser hemorrhoidoplasty, and the combined method), especially for pain management in hemorrhoidal disease. Between January 2018 and January 2020, 154 patients diagnosed with symptomatic grade II–III hemorrhoid disease were treated with three surgical techniques: (1) Ferguson hemorrhoidectomy (FH);(2) laser hemorrhoidoplasty (LHP); (3) combined (Ferguson hemorrhoidectomy + laser hemorrhoidoplasty) method. Patients were retrospectively evaluated for duration of surgery, recovery time of symptoms, postoperative pain, early and late complications, and recurrence. When the postoperative early and mid-term pain levels of the patients were compared, the results showed that patients treated with the Ferguson technique had the most severe pain scores after surgery at postoperative 6th, 12th, 24th hours, and 1st week, compared to the other techniques (LHP and combined method) (p < 0.001). The LHP method had the lowest pain levels when compared to the Ferguson and the combined methods (p < 0.001). The combined method had significantly lower pain scores than the Ferguson method in all periods after surgery (p < 0.001). Upon the development of postoperative perianal thrombosis in two patients in the LHP group, one patient underwent thrombectomy, and the other patient underwent medical treatment. There were two hemorrhoid disease recurrences, with a median follow-up period of 24 (12–36) months in the LHP group. In the FH group, reoperation and hemostasis were done for bleeding on the postoperative sixth day in one patient, and a Foley catheter was applied due to urinary retention in one patient. Two anal fissures were seen postoperatively in one month in the FH group and recovered with medical treatment. In patients with multiple hemorrhoid packages, the combined method can be better used safely and effectively, with significantly lower pain scores than the Ferguson method only.

Hemorrhoids; Laser hemorrhoidoplasty; Hemorrhoidectomy; Pain; Recurrence

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