The laser treatment of hemorrhoids: results of a study on 1816 patients

Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management

Hemorrhoids are a prevalent condition that significantly impacts the quality of life of affected individuals. Traditional treatment modalities range from conservative management to invasive surgical procedures, each with varying degrees of effectiveness and patient burden. Recently, laser treatment has emerged as a promising alternative, offering a minimally invasive approach with the potential for reduced complications and faster recovery. This comprehensive review aims to evaluate the role of laser treatment in hemorrhoidal management, exploring its mechanisms, clinical outcomes, safety, and economic implications. Through an extensive literature review and analysis of clinical trials, this paper assesses the efficacy of laser therapy compared to conventional treatments, highlighting its advantages in pain reduction, healing times, and patient satisfaction. The review also discusses the different types of lasers, including diode and Nd:YAG, and their specific applications in hemorrhoidal treatment. The findings indicate that laser treatment can be an effective and safe option for patients, encouraging its consideration as part of standard hemorrhoidal care protocols. However, gaps in long-term outcome data and the need for further studies on cost-effectiveness are identified. The review concludes with recommendations for future research, the advancement of laser technology, and the potential integration of laser treatment into clinical practice, aiming to enhance patient outcomes in hemorrhoidal management.

Endoscopic monopolar coagulation of internal haemorrhoids: a surgeon's experience of the first 100 cases

AIM

The purpose of this study was to evaluate one surgeon's initial experience with a novel technique of retroflexed endoscopic coagulation of internal haemorrhoids.

METHOD

Patients who presented with symptoms and signs indicating Grade II-III haemorrhoids were counselled before the procedure. Those who were assessed to require an examination of their colon, based on their age and symptoms, underwent a full colonoscopy before treatment of the haemorrhoids. After the procedure, patients were routinely prescribed nonsteroidal anti-inflammatory drugs, antibiotics and laxatives.

RESULTS

The first 100 patients of median age 52.0 (20.8-78.5) years included 65 (65%) women. Five (5%) patients suffered from postprocedural complications, of which three (3%) were postprocedural bleeding and two (2%) were postprocedural pain, all treated conservatively. The recurrence rate was 6% at a median follow-up time of 36 (6-76) months. The median duration of follow-up was 36.5 (8.5-57.0) months.

CONCLUSION

This novel technique appears to be safe and effective for the treatment of Grade II-III internal haemorrhoids, and can be incorporated seamlessly into the end of a colonoscopy for the evaluation of haematochezia. Comparative trials should be performed.

Morphine spinal block anesthesia in patients who undergo an open hemorrhoidectomy: a prospective analysis of pain control and postoperative complications

PURPOSE

This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy.

METHODS

Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded.

RESULTS

There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention.

CONCLUSION

A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.

Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a new minimally invasive method for haemorrhoidal disease treatment. Early results of a pilot study

INTRODUCTION

Haemorrhoidal disease is the most frequent benign anorectal disease. Conservative, minimally invasive and surgical methods are used in the treatment of haemorrhoidal disease. Radiofrequency thermoablation is a popular new technique in the treatment of varicose veins.

AIM

Assessment of the use of the method in the treatment of haemorrhoidal disease using bipolar radiofrequency-induced thermotherapy (RFITT or so-called Celon method).

MATERIAL AND METHODS

We used the CelonLab PRECISION (Celon AG medical instruments, Teltow, Germany) with the bipolar RFITT applicator Celon ProBREATH for the treatment of haemorrhoidal disease stages III and IV.

RESULTS

In the Department of Surgery at the Atlas Hospital in Zlin, Czech Republic, a total of 71 patients were treated from 9/2007 to 10/2010 with this new treatment approach. The success rate was 100%, local recurrence rate was 2.8%, and medium-term satisfaction of patients who underwent the procedure was 99.5%. Complications appeared in 4.26% of cases.

CONCLUSIONS

The new RFITTH technique for treatment of advanced stages of haemorrhoidal disease is a new treatment modality with good curative response, low level of complications, minimum pain and quick return of patients to their usual activities.

Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan-Morgan cold scalpel technique

OBJECTIVE

To prospectively compare immediate postoperative results of the surgical treatment of haemorrhoidal disease (HD) by Milligan-Morgan technique using either the CO(2) laser or cold scalpel.

METHODS

Forty patients with grade III/IV HD were prospectively randomized to undergo surgical treatment (Milligan-Morgan) using either the CO(2) laser (group A) or the cold scalpel method (group B). Data were compared regarding postoperative pain, complications, healing time, return to normal activity and patient satisfaction. Patients were blinded to treatment method until the completion of the study. Postoperative outcomes were assessed by patient questionnaire and outpatient follow-up visits. Pain was assessed by Visual Analogue Scale and analgesic consumption.

RESULTS

Twenty patients were randomized into each group and were comparable relative to mean age, gender and grade of HD. There were no statistically significant differences regarding postoperative pain measured (P =0.17) or consumption of oral (P = 0.741) and parenteral analgesics (P = 0.18) between the two groups. Mean pain score at the first bowel movement was significantly higher in group A (P = 0.035), although the use of analgesics was similar in both the groups. There were no differences regarding complications, mean healing time, return to normal activities and patient satisfaction.

CONCLUSION

There were no differences in the immediate results after Milligan-Morgan haemorrhoidectomy using either the CO(2) laser or cold scalpel regarding postoperative pain, complications, healing time, return to normal activities or patient satisfaction.

Hemorroidectomia: estudo de 2.417 pacientes submetidos à cirurgia para tratamento da doença hemorroidária

Em 34.000 pacientes coloproctológicos foi feito o diagnóstico de DH, como doença coloproctológica principal, em 9.289 pacientes (27,3%), dos quais 2.417 (26,0%) foram submetidos à hemorroidectomia. O objetivo deste trabalho é estudar estes 2.417 pacientes submetidos à hemorroidectomia, com análise dos aspectos epidemiológicos (idades, sexos), dos aspectos envolvendo a cirurgia (posições do pacientes, anestesias usadas e técnicas cirúrgicas praticadas e complicações cirúrgicas), comparando os achados com os da literatura correlata. Dos 2.417 pacientes operados a maioria apresentava hemorróidas de terceiro (30,5%) e de quarto (60,2%). Predominou, de forma estatisticamente significativa, a incidência de DH entre mulheres (5.007 mulheres, 53,9%) sobre homens (4.282 homens, 46,1%), bem como de cirurgias (1.330 mulheres ou 26,6% de 9.289 portadores de DH ou 55,0% dos 2.417 operados). A média etária dos pacientes por ocasião do diagnóstico foi 39,9 anos, sendo 74,8% entre 21 e 50 anos de idade; e a média etária por ocasião da cirurgia foi 41,6 anos, sendo 71,8% entre 21 e 50 anos de idade. Foram encontradas, por ocasião do diagnóstico da DH 1.122 casos (12,1%) de doenças anais concomitantes, sobretudo fissuras anais (5,8%) e hipertrofia de papilas anais (3,4%). A incidência de DAC operadas foi de 30,1% (729 pacientes), sendo a fissurectomia (13,1%) e a papilectomia (11,0%) as duas DAC mais comumente operadas em concomitância à DH. Dos 2.417 pacientes operados de DH 45 pacientes (1,9%) foram operados de outras doenças que não no ânus, sobretudo plástica de períneo e varizes de membros inferiores, tendo, ainda, 26 pacientes (2,0%) sido operados em situações patológicas e fisiológicas especiais, sobretudo gravidez (8 casos, 0,3%). A anestesia mais usada foi a peridural (42,3%) e a local associada à analgesia (34,9%); as posições na mesa cirúrgica mais usadas foram o decúbito lateral esquerdo de Sims (58,4%) e "em canivete" (40,1%); e a técnica cirúrgica mais usada foi a técnica aberta (Milligan-Morgan) (2.014 casos, 83,3%). Foram observadas 76 complicações (3,1%), sobretudo estenoses anais (40 casos, 1,8%) e hemorragia anal (21 casos, 0,9%).

350 ambulatory hemorrhoidectomies using a scanner coupled to a CO2 laser

OBJECTIVE

The purpose of this study was to investigate how a scanner device would improve the outcome of laser hemorrhoidectomy regarding pain, healing, secretion, and hemostasis.

BACKGROUND DATA

The technology of the laser has been applied since the 1960s in several clinical and surgical specialties. The inherent advantages, due to the biological characteristics of this instrument are: (1) it does not affect the neighborning tissues, (2) it is hemostatic, (3) it favors healing, (4) it is bactericidal, and (5) it presents less postoperative pain. Several authors have questioned these supposed advantages. After scanners were introduced, better results were accomplished, including in proctological surgery.

METHODS

A total of 350 patients, consecutively, went through a laser hemorrhoidectomy using a CO2 laser coupled to a scanner device in a 3-year period. Patients were monitored for pain, healing, bleeding, and local secretion for up to 36 months.

RESULTS

Almost 13% of the patients required bondage of arteries during the operation; 96% used analgesics for up to 3 days; and 5 patients (1.42%) complained of strong pain for several days. Only 2 patients (0.6%) reported intense pain for more than 7 days. All patients presented complete healing between the 30th and the 40th POD. In the 90th POD tissue regeneration appeared healthy. The immediate complications included 2 cases of nipple hemorrhage that demanded a review. Stenosis occurred in 4 patients. Residual "plicoma" was often present with the laser technique (20%). Return to work, regardless of its nature, was an average, on the 3rd postoperative day.

CONCLUSIONS

Our evaluation of the results led to the conclusion that the scanner coupled to the CO2 laser was fundamental for better postoperative outcome in our patients, at least compared to other laser techniques.

Lasers in anorectal surgery

Laser technology has been applied widely in the treatment of hemorrhoids, condylomas, and anorectal neoplasms. It is claimed by its proponents to result in less pain, improved healing, and more rapid recovery as compared with conventional surgery. Laser therapy, however, is expensive and potentially dangerous, and advantages generally have not been substantiated by controlled clinical trials. The possible benefits and potential risks of laser treatment of anorectal disorders are examined.

Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser

PURPOSE

Recently, laser technology has been advocated for the treatment of hemorrhoids. However, there has been little scientific evaluation of the use of the Nd:YAG laser for excisional treatment of hemorrhoidal disease. The purpose of this study was to perform a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy.

METHODS

Patients presenting for internal-external hemorrhoidectomy were eligible for study. Hemorrhoidectomies were performed under epidural or caudal blocks. The standard Ferguson closed hemorrhoidectomy technique was used. Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work. Eighty-six patients were eligible for study (laser, N = 51; scalpel, N = 35).

RESULTS

There were no significant differences between the groups, except for a greater degree of wound inflammation and dehiscence at the 10 day postoperative visit for the laser group (laser, 1.7 +/- .2; scalpel, 0.8 +/- .2; P < 0.05, t-test). The use of the Nd:YAG laser added $480 per case; as a result, the treatment cost for the laser group was $15,360 higher than that of the conventional group.

CONCLUSION

The results indicate that there are no patient care advantages associated with the use of the Nd:YAG laser for excisional hemorrhoidectomy compared with scalpel excision. As new technology becomes available, surgeons must rigorously assess therapeutic efficacy and cost-benefit ratio before deciding to employ this technology for patient care.

Hemorrhoidectomy--laser vs. nonlaser: outpatient surgical experience

Two hundred twenty-six patients underwent operative hemorrhoidectomy by a single surgeon in a three-year period. In 170 patients (75.2 percent), the operation was performed utilizing the CO2 laser. Standard closed hemorrhoidectomy was done in the rest. Patients were monitored prospectively for postoperative pain, wound healing, and complications. The feasibility of undergoing operative hemorrhoidectomy as an outpatient was also monitored. No differences were seen between laser and nonlaser hemorrhoidectomy. Outpatient surgery was done in over 72 percent of the patients without any added risk to them.

Hemorrhoidectomy with lasers and other contemporary modalities

Hemorrhoids should be classified so that the treatment can be individualized. Minor or asymptomatic hemorrhoids usually do not require any treatment. Diet modification is a useful adjunct in all degrees of hemorrhoids. Fixation procedures may be employed in the office for first-, second-, and minor third-degree hemorrhoids. These techniques are valuable in elderly and poor-risk patients. Excisions may be performed by standard instruments or lasers with good results. These techniques may be employed with local anesthesia and in an outpatient setting. Lasers may be effective as either a fixation device or an excisional tool. The problem is cost and maintenance of the equipment and the cost of the disposable apparatus. If the equipment is already available or can be shared for multidisciplinary use, hemorrhoidectomy can be accomplished in a cost-effective manner with excellent results.