Others, 20 patients were treated with open surgical hemorroidectomy in the local anesthesia. Two enemas were administered 2 hours before the intervention. This procedure was performed as an outpatient procedure. Through a 1000-micron optic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. The depth of shrinkage can be regulated by the power and duration of the laser beam. Laser shots were delivered with a 980-diode laser through a 1000-nm optic fiber in a pulsed fashion to reduce undesired degeneration of periarterial normal tissue. With the patient in the lithotomy position, a dedicated disposable proctoscope with a diameter of 23 mm was inserted in the anal canal. After a detailed physical examination and proctoscopy, the laser procedure was performed with Biolitec. This study was performed in ALOKA surgical center in Kosovo, from January 2012 to June 2014. Patients were allocated in different groups, according to the stage of hemorrhoids: patients with stage III and minimal prolapse of mucosa were treated with LHP and patients with stage IV and prolapse, with open surgical method. In this comparative and prospective study 40 patients were included, of which, 20 patients were treated with laser hemorhoidoplasty method and 20 patients were treated with open surgical hemorrrhoidectomy. The aim of this study was to compare pain and duration time of intervention between of the two methods, laser hemorrhoidoplasty (LHP) and surgical open hemorrhoidectomy. The long-term complications include anal fissure (1% -2.6%), anal stenosis (1%), incontinence (0.4%), fistula (0.5%) and recurrence of hemorrhoids ( 10, 11). The other early complications are urinary retention (20.1%), bleeding (secondary or reactionary) (2.4%–6%) and subcutaneous abscess (0.5%). Post hemorrhoidectomy pain is the commonest problem associated with the surgical techniques. Milligan-Morgan hemorrhoidectomy is the gold standard and frequently performed procedure in the United Kingdom ( 9). The technique employed may be open (Milligan–Morgan) or closed (Ferguson) and the instruments used are scalpel, scissor, electrocautery or laser. The indications for the surgical treatment include the presence of a significant external component, hypertrophied papillae, associated fissure, extensive thrombosis or recurrence of symptoms after repeated RBL. If conservative measures fail to control symptoms, patients may be referred to a surgeon for operative management. These nonsurgical methods are considered to be the primary option for grades one to three (grade I-III) hemorrhoids ( 8). The various non-surgical treatments include rubber band ligation (RBL), injection sclerotherapy, cryotherapy, infrared coagulation, laser therapy and diathermy coagulation all of which may be performed as out patient procedures without anaesthesia. Measures have included conservative medical management, non-surgical treatments and various surgical techniques. The treatment options for symptomatic hemorrhoids have varied over time. Hemorrhoids are considered to be due to the downward displacement suspensory (Treitz) muscle ( 6, 7). The anorectal vascular cushions along with the internal anal sphincter are essential in the maintenance of continence by providing soft tissue support and keeping the anal canal closed tightly. Men are more frequently affected than women ( 5). Age distribution demonstrates a Gaussian distribution with a peak incidence between 45 and 65 years with subsequent decline after 65 years ( 3, 4). Approximately, one third of these patients seek physicians for advice. 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%, of which more than 4% are symptomatic ( 1, 2).
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