Comparison between laser hemorrhoidoplasty procedure and conventional open surgical hemorrhoidectomy

Background: Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions.Objective: The present study aimed to compare between laser hemorrhoidoplasty and conventional open surgical hemorrhoidectomy in treatment of the hemorrhoidal diseases.Patients and methods: This study included 30 patients with symptomatizing hemorrhoidal diseases. They were divided into two groups: 15 patients underwent open method (MMH) and 15 patients underwent laser method (LHP). They were admitted to General Surgery Department, Faculty of Medicine, Zagazig University Hospitals with symptomatic hemorrhoidal diseases. Full history, clinical examination and pre- and post-operative assessment were performed.Results: The mean age was distributed as 36.03 ± 7.32 in the MMH group and 35.73 ± 8.39 years in the LHP group with no significant difference between both groups. The mean operative time was distributed as 29.53 ± 4.05 and 14.60 ± 3.13 minutes for MMH and LHP groups respectively. The mean hospital stay for MMH group was 36.25 ± 6.58 hours and 7.85 ± 2.11 hours for LHP, MMH group significantly associated with longer hospital stay. MMH group was significantly associated with more bleeding at 1st and 2nd week but no bleeding founded after 2nd week at both groups.Conclusion: laser hemorrhoidoplasty (LHP) technique for the management of hemorrhoids was, with shorter operative time, less postoperative pain, shorter hospital stay, and less postoperative complications than open surgical hemorrhoidectomy

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely