Laser Therapy for Grade II and III Hemorrhoids: Threeyear Clinical Experience

Öz

Aim: Hemorrhoids are difficult to treat. Multiple treatment options are available, supported by heterogeneous evidence. In our study, we aimed to analyze laser therapy’s clinical outcomes and effectiveness. Material and Method: Our study was conducted on 1096 patients who underwent Hemorrhoidal Laser Procedure (HeLP) and were diagnosed with grade II and III hemorrhoids in our general surgery clinic between 2018 and 2021. The patients pre- and postoperative clinical data were obtained from patient files, electronic records, and telephone interviews. Results: Bleeding and urinary retention were the most common complications in the early period. In the long term, the anal fissure was found to be the most common complication. We detected hemorrhoidal diseases 1.25 times more frequently in males. The patients presented to our clinic with the most common complaints of bleeding and hemorrhoidal syndrome. Conclusion: The use of laser therapy is an appropriate procedure for grade II and grade III hemorrhoids that do not respond to conservative approaches, which require minimal analgesic use, less need for wound care and very short duration of pain and discomfort, with high patient satisfaction.

Anahtar Kelimeler

• hemorrhoids
• laser therapy;
• prognosis

Kaynakça

1. 1. Ram E, Bachar GN, Goldes Y, Joubran S, Rath-Wolfson L. Modified Doppler-guided laser procedure 8ort he treatment of second- and third-degree hemorrhoids. Laser Ther. 2018;27(2):137–142. Doi: 10.5978/islsm.18-OR-14. PMID: 30087534; PMCID: PMC6062676.
2. 2. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, et al. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–44. Doi: 10.1097/ ALN.0b013e31828866b3. PMID: 23392233.
3. 3. Weyand G, Theis CS, Fofana AN, Rüdiger F, Gehrke T. Laser hämorrhoidoplastie mit dem 1470-nm-Diodenlaser in der Behandlung des zweit- bis viertgradigen Hämorrhoidalleidens - eine Kohortenstudie mit 497 Fällen [Laser hemorrhoidoplasty with 1470 nm Diode Laser in the Treatment of Second to Fourth Degree Hemorrhoidal Disease - a Cohort Study with 497 Patients]. Zentralbl Chir. 2019;144(4):355–363. German. doi: 10.1055/s-0043-120449. Epub 2017 Nov 29. PMID: 29186745.
4. 4. El Nakeeb AM, Fikry AA, Omar WH, Fouda EM, El Metwally TA, et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol. 2008;14(42):6525–30. doi: 10.3748/wjg.14.6525. PMID: 19030206; PMCID: PMC2773340.
5. 5. Karahaliloglu AF. “First results after laser obliteration of f irst-and second-degree hemorrhoids. ” Coloproctology 29. 6(2007):327–336.
6. 6. Altomare DF, Giuratrabocchetta S. Conservative and surgical treatment of haemorrhoids. Nat Rev Gastroenterol Hepatol. 2013;10(9):513–21. doi:10. 1038/nrgastro. 2013. 91. Epub 2013 Jun 11. PMID: 23752820.
7. 7. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009;52(9):1665–71. doi: 10.1007/ DCR.0b013e3181af50f4. PMID: 19690499.
8. 8. De Nardi P, Tamburini AM, Gazzetta PG, Lemma M, Pascariello A, et al. Hemorrhoid laser procedure for second- and thirddegree hemorrhoids: results from a multicenter prospective study. Tech Coloproctol. 2016;20(7):455–9. Doi: 10.1007/ s10151-016-1479-6. Epub 2016 May 11. PMID: 27164931.

9. 9. Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg. 2019;11(3):117–121. Doi: 10.4240/wjgs.v11.i3.117. PMID: 31057696; PMCID: PMC6478596.
10. 10. Hardy A, Chan CL, Cohen CR. The surgical management of haemorrhoids—a review. Dig Surg. 2005;22(1–2):26–33. Doi: 10.1159/000085343. Epub 2005 Apr 14. PMID: 15838168.
11. 11. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009–17. Doi: 10.3748/wjg.v18.i17.2009. PMID: 22563187; PMCID: PMC3342598.
12. 12. Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg. 1994;81(7):946–54. Doi: 10.1002/bjs.1800810707. PMID: 7922085.
13. 13. Pigot F, Siproudhis L, Allaert FA. Risk factors associated with hemorrhoidal symptoms in specialized consultation. Gastroenterol Clin Biol. 2005;29(12):1270–4. Doi: 10.1016/ s0399-8320(05)82220-1. PMID: 16518286.
14. 14. Johanson JF, Sonnenberg A. Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents. Am J Gastroenterol. 1994;89(11):1981–6. PMID: 7942722.
15. 15. Longchamp G, Liot E, Meyer J, Toso C, Buchs NC, Ris F. Nonexcisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci. 2021;36(3):485–496. doi: 10.1007/s10103-020-03142-8. Epub 2020 Sep 10. PMID: 32914275; PMCID: PMC7952353.
16. 16. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, et al. The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum. 2011;54(6):693–8. Doi: 10.1007/DCR.0b013e3182112d58. Erratum in: Dis Colon Rectum. 2012;55(4):497. PMID: 21552053.
17. 17. Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z. A Randomized Controlled Trial Comparing Laser Intra-Hemorrhoidal Coagulation and Milligan-Morgan Hemorrhoidectomy. J Invest Surg. 2017;30(5):325–331. doi: 10.1080/08941939.2016.1248304. Epub 2016 Nov 2. PMID: 27806213.
18. 18. Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx) : a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol. 2020;24(2):199–205. doi: 10.1007/s10151-020-02152-6. Epub 2020 Jan 28. PMID: 31993838.
19. 19. Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev. 2005;(3): CD005034. doi: 10.1002/14651858.CD005034.pub2. PMID: 16034963.
20. 20. Faes S, Pratsinis M, Hasler-Gehrer S, Keerl A, Nocito A. Short- and long-term outcomes of laser haemorrhoidoplasty for grade IIIII haemorrhoidal disease. Colorectal Dis. 2019;21(6):689–696. doi: 10.1111/codi.14572. Epub 2019 Feb 20. PMID: 30702197.