The importance of surgeon experience for assessment of the outcomes of minimally invasive treatment for chronic haemorrhoids

Introduction . The impact of surgeon experience, changing during a study, on the characteristics of transmucosal laser vaporization and dearterialization of hemorrhoidal arteries has not been sufficiently studied. Aim . To determine the impact of the surgeon experience on the objectivity of the assessment of outcomes of treatment using hemorrhoidal dearterialization and hemorrhoidal laser ablation techniques in patients with chronic grade 2–3 haemorrhoids. Materials and methods . Ninety-five patients underwent transmucosal laser thermal ablation, and 132 underwent dearterialization. All operations were performed by the same surgeon. The following properties for the treatment techniques were assessed: operation duration, pain intensity and duration, and postoperative haemorrhages. The learning curve was studied by grouping patients into quartiles. Results . The attainment of mastery in laser vaporization required 23 operations, and that in dearterization required 33 operations. The characteristics of the treatment techniques that were studied with and without regard to the surgeon experience differed from each other according to all indications. The trend of their changes had the same pattern: all patients operated during the experience consolidation phase had better outcomes. The statistical significance remained after comparison of operation duration and assessment of pain syndrome, but ceased to be found after assessment of the number of complications. Discussion . The outcomes of treatment of chronic grade 2–3 haemorrhoids using hemorrhoidal dearterialization and laser thermal ablation techniques, which were measured by analysed characteristics, depend on the surgeon experience, and are more objective in patients who were operated during the surgeon experience consolidation. Conclusions . When assessing the outcomes of treatment of chronic haemorrhoids to establish the statistical significance of the analysis performed, it is important to take into account the surgeon experience in mastering these treatments.