Pathomorphological features of tissues after argon plasma versus monopolar coagulation in open hemorrhoidectomy: a comparative study

Introduction. Thermal tissue injury associated with the use of various energy modalities remains a major contributor to surgical trauma. Argon plasma coagulation (APC) is a non-contact energy delivery technique that transfers energy to tissue via ionized argon gas. APC is rarely used in the surgical treatment of hemorrhoids, and its histopathological effects on tissue remain unclear.
The purpose of the study. To evaluate the histopathological characteristics of hemorrhoidal tissue following open hemorrhoidectomy performed with argon plasma coagulation (APC) versus monopolar coagulation (MPC).
Materials and Methods. This study represents a continuation of a prospective randomized trial evaluating postoperative pain following open hemorrhoidectomy with APC versus MPC. The analysis included 76 hemorrhoidal tissue specimens (37 from the MPC group, 39 from the APC group). The following parameters were assessed: depth of coagulative necrosis, number and caliber of blood vessels, and number of nerve trunks, along with their association with the postoperative pain trajectory. Statistical analysis included the Mann–Whitney U test, Student's t-test, and mixed linear models.
Treatment results. No statistically significant differences were observed between groups in minimum (0,23 ± 0,17 vs. 0,21 ± 0,13 mm; p = 0,58) or maximum (1,37 ± 0,67 vs. 1,65 ± 0,87 mm; p = 0,12) depth of necrosis. The number and caliber of vessels and the number of nerve trunks within the coagulation zone did not differ significantly between groups (p > 0,05). The APC group demonstrated a faster decline in postoperative pain (p = 0,025). Depth of coagulative necrosis did not correlate with pain intensity (p = 0,262), and multivariate modeling confirmed that postoperative pain was independent of the morphological parameters assessed.
Conclusion: The pathomorphological effects of APC on tissue during open hemorrhoidectomy are comparable to those of MPC

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