Laser therapy for wounds after open hemorrhoidectomy (a single-center prospective randomized study)

AIM: to assess the effect of laser therapy on wounds healing after open hemorrhoidectomy.

PATIENTS AND METHODS: a single-centre, prospective, randomised study included 86 patients who underwent open hemorrhoidectomy using an ultrasound scalpel. In addition to the standard use of water-based ointments daily from days 1 to 7 after surgery and then once a week until the wounds were fully healed, laser treatment was performed on the wounds in patients in the main group (n = 46). Patients in the control group (n = 40) received only standard therapy (water-based ointments). Laser treatment was performed using a fibre laser with a wavelength of 970 nm in a non-contact manner with a defocused beam. The beam power was 20 W, the power density was 0.038 W/cm² and the mode was pulsed-periodic (impulse duration 50 ms, pause 100 ms). Each session lasted 4 minutes. Pain intensity was assessed with visual analogue scale (VAS). The rate of wound epithelialisation on the 30th day after and QoL using the SF-36 questionnaire. The microbiome of surgical wounds at various stages of treatment, a microbiological study was studied as well.

RESULTS: on the 30th day after surgery, planimetric and cytological characteristics of wounds corresponded to complete epithelization in 42/46 (91%) patients of the main group and in 7/40 (18%) controls, p < 0,001. The pain intensity in the main group already from the 2nd day after surgery was 4 (4; 6) points and was significantly lower than in the control group — 6 (5; 7) points, p < 0,001. When comparing the patients’ quality of life indicators by SF-36 questionnaire on the 30th day after surgery, significant differences were revealed: physical functioning (PF) — 85 (75; 95) points in the main group, 80 (70; 85) — in the control group (p = 0.030); pain intensity (BP): 51 (41; 64) in the main group, vs 41 (22; 51) in the control, (p = 0.008); and role functioning conditioned by emotional state (RE) — 100 (66; 100) points vs 66 (17; 67), (p = 0.002). Microbiology showed that laser therapy already on the 7th day contributes to a significant reduction of postoperative wound infestation in the patients of the main group compared to the control group, and on the 21st day the difference becomes statistically significant — positive growth was noted in 23/42 (54.8%) patients of the main group and in 38/40 (95.0%) of the control group, p < 0.0001.

CONCLUSION: the use of laser therapy for wounds after open hemorrhoidectomy allows to achieve good clinical results in healing time, decreased intensity of pain syndrome, decreased bacterial contamination of wounds, which, in turn, contributes to the improvement of the quality of life of operated patients and shortening of rehabilitation.

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