HEMOROİD HASTALIĞI TEDAVİSİNDE MİNİMAL İNVAZİV TEDAVİ SEÇENEĞİ OLARAK LAZER PROSEDÜRÜ

Year 2020, Volume: 8 Issue: 3, 443 - 449, 20.12.2020

Yasin Duran , Fatin Rüştü Polat , Birol Topcu

https://doi.org/10.37696/nkmj.759403

Abstract

ÖZ
Amaç
Hemoroidal hastalık(HH) cerrahi tedavisinde ameliyat sonrası ağrı, rahatsızlık hissi ve diğer komplikasyonlar önemli sorun teşkil etmektedir. Bu nedenle son yıllarda ağrısız tedavi arayışı daha az invaziv tekniklerin ortaya çıkmasına ve yaygınlaşmasına yol açmıştır. Hemoroid lazer prosedürü(HeLP), hemoroid pakelerinin diyot lazerle büzülmesini sağlayarak tedavi eden minimal invaziv bir prosedürdür. Çalışmamızda II-III derece hemoroidli hastalarda HeLP’nün postoperatif ağrı ve diğer komplikasyonlar üzerine etkinliğini analiz etmeyi amaçladık.
Materyal ve Metod
Çalışmaya 17 hasta dahil edildi. İşlem spinal anestezi altında uygulandı. II-III derece hemoroidli hastalara 1470nm diyot lazer kullanılarak bir HeLP uygulandı. Prosedür süresi, ameliyat sonrası ağrı ve komplikasyonlar, semptomların düzelmesi ve günlük aktiviteye dönüş süresi retrospektif olarak değerlendirildi. Ameliyattan sonra ortalama 18.5±9 ay takipte postoperatif ağrı, rahatsızlık hissi, kanama, komplikasyonlar ve nüks değerlendirildi.
Bulgular
HeLP ortalama 22.9±5(13-32) dakika sürdü. Vizüel analog skala(VAS) ile değerlendirilen postoperatif ağrı skoru son derece düşük olarak tesbit edildi. Ortalama VAS skoru(0-10) operasyon sonrası 6 saatte 1.058, Birgün sonra 0.588, 3 gün sonra 0.176 olarak tesbit edildi. Yedi, 14, 21, 30 günlerde ise ağrı olmadı. Bu nedenle analjezik ilaçlar sadece lüzumu halinde uygulandı. Postoperatif spontan kanama ve ödem ilk gün bir hastada görüldü, Hastanede yatış süresi ortalama 19.47±1,8 saat oldu. Hastaların tamamı 2 gün sonra günlük aktivitelerine döndü. Ortalama 18.588 aylık takip periyodunda 2 hastada nüks görüldü. Hastalara yapılan Likert tipi memnuniyet anketi ile tamamının HeLP prosedüründen memnun olduğu görüldü.
Sonuç
HeLP düşük bir postoperatif ağrı ve rahatsızlık oranları ve hastanede yatış süresinin kısa olması nedenleri ile , HH tedavisinde ağrısız ve minimal invaziv teknik olarak düşünülebilir.
ABSTRACT
Objective
The treatment of hemorrhoidal disease(HD) is still controversial. After surgery, pain and other uncomfortable complications still pose a significant problem. Therefore, the search for painless treatment in recent years has led to the emergence and popularization of various less invasive techniques. The hemorrhoid laser procedure(HeLP) is a minimally invasive procedure used in the treatment of HH by allowing hemorrhoid packets to shrink with a diode laser. The aim of this study was to analyze the effectiveness of help on postoperative pain, discomfort and other complications in patients with grade II-III hemorrhoids.
Material and Method
17 patients were included in the study. The procedure was performed under spinal anesthesia. Patients with grade II-III hemorrhoids were treated with a 1470 nm diode laser. The duration of surgery, post-operative pain and complications, recovery of symptoms and return to daily activity were evaluated retrospectively. Postoperative pain, discomfort, bleeding, complications and recurrence were evaluated at an average follow-up of 18.5±9 months after surgery.
Results
The average operating time was 22,9±5(13-32) minutes. Patients did not develop any intraoperative complications. The postoperative pain score, which was evaluated with visual analog scale, was found to be extremely low. The mean VAS Score(0-10) was 1.058 at 6 hours after the operation, 0.588 after 1 day and 0.176 after 3 days. On 7, 14, 21, 30 days, there was no pain. Therefore, analgesic drugs were administered only if necessary. Postoperative spontaneous hemorrhage and edema occurred in one patient on the first day. The average length of hospitalization of patients after the operation was 19.47±1(17-23) hours. All patients returned to their daily activities 2 days after surgery. In an average follow-up period of 18,5±9.4(5-36) months, 2 patients (11,764%) had relapses. The Likert-type satisfaction survey conducted on the patients showed that they were all satisfied with the HeLP procedure.
Conclusion
Due to very low postoperative pain and discomfort rates and short hospital stay, HeLP can be considered as a painless and minimally invasive technique in the treatment of HH.

Keywords

Hemoroid hastalığı, Postoperatif ağrı, Lazer, Postoperatif kanama, hemorrhoid disease, postoperative pain, laser, postoperative bleeding

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

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