Standardization reduces recurrence and overall complication rate in Laser Haemorrhoidoplasty: Retrospective Cohort Study

Document Type : Research/Original Article

Authors

Junankar Surgical Nursing Home, Nagpur, Maharashtra, India

Abstract

Background: The Laser Haemorrhoidoplasty (LHP) procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of this study was to assess the safety of laser haemorrhoidoplasty and to study long term recurrence rates and other complications. Methods: In this retrospective, single-centre study, 250 consecutive symptomatic patients of internal haemorrhoids of grade I-IV underwent laser haemorrhidoplasty. The procedure was done using 15 W,1470 Nm diode laser machine (Lasotronix). All the preoperative and postoperative variables were analyzed, with special emphasis on post-procedural pain, complications and recurrence rate. Follow-up was scheduled at 4th,7th and 30thday and then at 3, 6 and 12 months, and once a year thereafter. Complications were recorded. Results: There were 250 patients ( 134 male and 116 female; mean age: 43.72 18.34 years, range 16-85 years). Short-term follow-up was achieved for all patients. Patient satisfaction in terms of pain at rest and post-defaecation pain was 100%. Twenty eight patients (11.2 %) had complications.10 patients (4%) had postoperative bleeding,3 patients (1.2 %) had infection,1 patient (0.4 %) developed a fistula-in-ano,1 patient (0.4 %) developed a thrombosed haemorrhoid,1 patient (0.4 %) had prolapsed haemorrhoid,5 patients (2 %) had incomplete regression,1 patient (0.4 %) had fissure in ano. Ulceration occurred in 1 patient (0.4 %) and 2 patients (0.8 %) developed recurrence. No anal stenosis or faecal incontinence occurred in any of the patients. Conclusion: This study shows that LHP gave 100% patient satisfaction in terms of post-procedure pain at rest and post-defaecation pain. With standardisation, LHP is a safe procedure with good short term and long term results with minimal recurrence rate.

Keywords


1.Agbo SP. Surgical management of hemorrhoids. J Surg Tech Case Rep. 2011;3(2):68-75.
2. Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis.
2012;27(2):215-20.
3. Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-Shkololli A. Laser Hemorrhoidoplasty Procedure vs Open Surgical Hemorrhoidectomy: a Trial Comparing 2 Treatments for Hemorrhoids of Third and Fourth Degree. Acta Inform Med. 2014 Dec;22(6):365-7.
4. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev.
2006(4):CD005393.
5. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. A nesthesiolog y. 2013;118(4):934-44.
6. Cerato MM, Cerato NL, Passos P, Treigue A, Damin DC. Surgical treatment of hemorrhoids: a critical appraisal of the current options. Arq
Bras Cir Dig. 2014;27(1):66-70.
7. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31):9245-52.
8. Faes S, Pratsinis M, Hasler-Gehrer S, Keerl A, Nocito A. Short- and long-term outcomes of laser haemorrhoidoplasty for grade II-III
haemorrhoidal disease. Colorectal Dis. 2019 Jun;21(6):689-696.
9. 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 Aug;144(4):355-363.
10. Maloku H, Lazović R, Terziqi H. Laser hemorrhoidoplasty versus Milligan-Morgan hemorrhoidectomy– short-term outcome. Vojnosanit
Pregl 2019;76(1)8-12 .