Laserhämorrhoidoplastie mit dem 1470-nm-Diodenlaser in der Behandlung des zweit- bis viertgradigen Hämorrhoidalleidens – eine Kohortenstudie mit 497 Fällen

Abstract

Laser haemorrhoidoplasty (LHP) with the 1470 nm diode laser in minimally invasive surgery for advanced haemorrhoid disease has been studied with respect to clinical variables, such as pain and complications, and intraoperative characteristics such as mucopexia, number of treated knots and energy consumed per patient. The study also included patient satisfaction, symptom relevance and cost effectiveness. Between November 2010 and November 2016, 497 patients (age 55 ± 14 years) were submitted to laser haemorrhoidoplasty with a 1470 nm diode laser in the centre for minimally invasive proctology in Siegen District Hospital. All operated patients were included in the study. Perioperative clinical and technical data up to 6 weeks and follow-up data up to 6 months were analysed prospectively. The mean duration of operation was 14 min (± 5.2). A mean of 2.7 knots of 2.7 size were treated per patient. The mean postoperative pain was 2.5/10 (VAS). Long-term symptom relevance was 86%, and patient satisfaction 91%. Complications occurred in 49 patients (9.9%): bleeding 1.8%, infection 1%, urine retention 1.8%, oedema/thrombosis/prolapse 6.6%. 8.8% of patients suffered a relapse within 6 months. There were significant differences in pain on the day of the operation, and the parameters mucopexia, 3 treated segments and energy level > 500 J (p < 0.05). Complications were more common when mucopexia was performed, with 3 treated knots and energy consumed per patient > 500 J. The only significant difference was for energy level > 500 J (p < 0.05). LHP is a safe, low pain and minimally invasive surgical procedure with long-term good patient acceptance and satisfaction and is suited for routine work. The energy applied should be reduced to a minimum. Complication rates are largely comparable with those of other minimally invasive conventional methods. Additional prospective studies must be performed, particularly in comparison to the Parks method, which gives similar functional results. With circular confluent findings, LHP cannot replace stapler hemorrhoidopexia.

Tissue coagulation in laser hemorrhoidoplasty – an experimental study

“…We have reported our own experience of laser hemorrhoidoplasty in 229 patients with good short-and long-term outcomes [6]. Similar results were reported by Weyand et al [7]. A randomized controlled trial performed by our group [8] has shown intrahemorrhoidal laser procedure to be more effective than hemorrhoidal artery ligation with a significantly shorter duration of postoperative pain and recovery.…”

“…It involves the delivery of laser energy into the interstitial tissue and not into perianal vessels. This leads to retraction of perianal tissues and to the resolution of hemorrhoids with reduced intensity pain of short duration and satisfactory long-term outcomes [6][7]. We have reported our own experience of laser hemorrhoidoplasty in 229 patients with good short-and long-term outcomes [6].…”

Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy

“…Intrahemorrhoidal l aser coagulation or laser hemorrhoidoplasty (LHP) was first described in 2009 [4] and reported in larger series of patients in 2010 [5]. A few case series, including our own experience [6], as well as the experience of Weyand [7] suggested this method to be a technically simple, minimally invasive, safe, and effective procedure for symptomatic hemorrhoids.…”

Radiofrequenzablation (Rafaelo®-Prozedur) zur Therapie von prolabierenden Hämorrhoiden III°

“…This method is suitable for use in the outpatient sector and is only slightly restricting for patients. [6,8,9,14]. Die präoperativ geäußerten Hämorrhoidalbeschwerden konnten durch den Eingriff deutlich und statistisch signifikant gesenkt werden.…”