STARR PLUS LASER-ASSISTED HEMORRHOIDOPEXY VERSUS. STAR ALONE FOR ODS PATIENTS WITH PROLAPSED HEMORRHOIDS waheebradman@yahoo.com

 

STARR PLUS LASER-ASSISTED HEMORRHOIDOPEXY VERSUS. STAR ALONE FOR ODS PATIENTS WITH PROLAPSED HEMORRHOIDS

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Yemen

Oral only

Obstructed defecation syndrome (ODS), often linked to rectal intussusception and advanced hemorrhoids, poses significant therapeutic challenges. While stapled transanal rectal resection (STARR) is widely used, recurrence and complications persist. This study compares STARR combined with laser-assisted 4th-degree hemorrhoidopexy versus STARR alone in ODS patients with prolapsed hemorrhoids. It evaluates efficacy, safety, and inflammatory outcomes of combined STARR-laser therapy versus STARR alone, focusing on symptom relief, recurrence, complications, and patient satisfaction.

In this prospective study (December 2019–January 2022), 200 patients with ODS and Grade III-IV hemorrhoids (Goligher’s classification) were randomized into Group A (STARR + laser hemorrhoidopexy, n=100) and Group B (STARR alone, n=100). Both groups underwent STARR using a CPH34HV stapler. Exclusion criteria included prior anorectal surgery, malignancies, or severe comorbidities. Follow-up spanned 12 months.

Group A demonstrated superior outcomes: higher success rate (96% vs. 80%, p<0.05), lower recurrence (3% vs. 20%, p<0.05), and fewer complications (5% vs. 30%, p<0.05), including reduced bleeding (1% vs. 11%) and fecal urgency (4% vs. 9%). Group B had higher reoperation rates (11% vs. 1%, p<0.05) and skin tag recurrence (30% vs. 2%). Pain scores and return-to-work timelines were comparable. Inflammatory markers (CRP, WBC) were significantly lower in Group A (p<0.05). Patient satisfaction (PGI-I) favored Group A (95% “very satisfied” vs. 70%, p<0.05).

STARR with laser-assisted hemorrhoidopexy significantly improves outcomes in ODS and prolapsed hemorrhoids, offering reduced recurrence, complications, inflammation, and higher patient satisfaction compared to STARR alone. Integration of laser techniques may optimize management of complex hemorrhoidal disease, though long-term studies are warranted.