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Treatment of advanced hemorrhoidal disease: A prospective, randomized comparison of cold scalpelvs. contact Nd:YAG laser

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Recently, laser technology has been advocated for the treatment of hemorrhoids. However, there has been little scientific evaluation of the use of the Nd:YAG laser for excisional treatment of hemorrhoidal disease. The purpose of this study was to perform a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy. METHODS: Patients presenting for internal-external hemorrhoidectomy were eligible for study. Hemorrhoidectomies were performed under epidural or caudal blocks. The standard Ferguson closed hemorrhoidectomy technique was used. Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work. Eighty-six patients were eligible for study (laser, N=51; scalpel, N=35). RESULTS: There were no significant differences between the groups, except for a greater degree of wound inflammation and dehiscence at the 10 day postoperative visit for the laser group (laser, 1.7±.2; scalpel, 0.8±.2;P <0.05,t-test). The use of the Nd:YAG laser added $480 per case; as a result, the treatment cost for the laser group was $15,360 higher than that of the conventional group. CONCLUSION: The results indicate that there are no patient care advantages associated with the use of the Nd:YAG laser for excisional hemorrhoidectomy compared with scalpel excision. As new technology becomes available, surgeons must rigorously assess therapeutic efficacy and cost-benefit ratio before deciding to employ this technology for patient care.

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Authors and Affiliations

  1. Department of Surgery, Ferguson Hospital, Grand Rapids, Michigan

    Anthony Senagore M.D., M.S., W. Patrick Mazier M.D., Martin A. Luchtefeld M.D., John M. MacKeigan M.D. & Timothy Wengert M.D.

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  1. Anthony Senagore M.D., M.S.
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  2. W. Patrick Mazier M.D.
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  3. Martin A. Luchtefeld M.D.
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  4. John M. MacKeigan M.D.
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  5. Timothy Wengert M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 12 to 17, 1992. Winner of the New England Society of Colon and Rectal Surgeons Award.

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Senagore, A., Mazier, W.P., Luchtefeld, M.A. et al. Treatment of advanced hemorrhoidal disease: A prospective, randomized comparison of cold scalpelvs. contact Nd:YAG laser. Dis Colon Rectum 36, 1042–1049 (1993). https://doi.org/10.1007/BF02047297

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