Abstract
Amaç: Kliniğimizde uygulanan Lazer Hemoroidoplasti (LHP) işleminin sonuçlarını sunmayı amaçladık Yöntem: Bu retrospektif çalışmada, kliniğimizde 24 aylık bir dönemde yapılan LHP'nin sonuçlarını analiz ettik. Hastalar, ameliyat sonrası üç haftalık takip ziyaretleri planlandı, ardından üç ve altı aylık aralıklarla takip edildi. Bulgular: 112 hastanın 73'ü (%65.17) erkek, 39'u (%34.82) kadındı. Ortalama yaş 52.6 idi (aralık: 20-65). Ortalama operasyon süresi 18.3 dakika idi (aralık: 12-25). Yetmiş hasta grade 2 olarak sınıflandırılırken, 42 hasta grade 3 olarak sınıflandırıldı. Ortalama hastanede kalış süresi 1.16 gün idi. Grade 2 hemoroidli 70 hastanın 5'i takipten çıkarıldı, 24'ü 6 ay ve 41'i 1 yıl boyunca takip edildi. Bir (1.42%) hasta 1 yıl sonundaki takipte nüks gösterdi. Dört hasta (%9.52) nüks gösterdi. Grade 3 hemoroidli bir hasta, bir hafta süren postoperatif kanama yaşadı ve eritrosit süspansiyonu transfüzyon ihtiyacı oldu. Grade 3 hemoroidli bir başka hasta, konservatif tedavi ile çözülen bir hematom geliştirdi. Grade 3 hemoroidli sekiz hastada (%7.14) postoperatif ödem gelişti, hepsi konservatif tedavi ile iyileşti. Görsel Analog Skala (VAS) kullanılarak ölçülen ağrı değerleri, birinci postoperatif günün 2.03, ikinci postoperatif günün ise 1.49 olarak ölçüldü. Sonuç: LH tedavisi, Grade 2 ve Grade 3 hastalıklar için başarılı bir alternatif tedavi seçeneği olduğu düşünülmektedir ve LH tedavisinde hasta seçiminin kritik önem taşıdığı vurgulanmaktadır.
References
- Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol 2019; 17: 8–15.
- Ganz RA. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol 2013; 11: 593–603.
- Di Costanzo GG, Tortora R, D’Adamo G, De Luca M, Lampasi F, Addario L, et al. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol 2015; 30: 559–65.
- Lee T, Mendhiratta N, Sperling D, Lepor H. Focal laser ablation for localized prostate cancer: principles, clinical trials, and our initial experience. Rev Urol 2014; 16: 55–66.
- Salfi R. A new technique for ambulatory hemorrhoidal treatment. Coloproctology 2009; 31: 99–103.
- Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, et al. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 2009; 27: 819–23.
- Longchamp G, Liot E, Meyer J, Toso C, Buchs NC, Ris F. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 2021; 36: 485–96.
- Crea N, Pata G, Lippa M, Tamburini AM, Berjaoui AH. Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis. Lasers Med Sci 2022; 37: 309–15.
- Giamundo P, Braini A, Calabrò G, Crea N, De Nardi P, Fabiano F, et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term: results of a multicenter trial. Surg Endosc 2022; 36: 143–8.
- Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 2020; 72: 851–7.
- 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: 325–31.
- Poskus T, Danys D, Makunaite G, Mainelis A, Mikalauskas S, Poskus E, et al. Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy. Int J Colorectal Dis 2020; 35: 481–90.
- Karahaliloǧlu AF. Erste ergebnisse der laserobliteration von erst- bis zweitgradigen hämorrhoiden. Coloproctology 2007; 29(6): 327.
- Fathallah N, Barré A, Aubert M, de Parades V (2020) Minimally invasive hemorrhoidal surgery with laser hemorrhoidoplasty: a real alternative for hemorrhoidectomy? Colon Rectum 2020; 12(1): 693.
- Brusciano L, Gambardella C, Terracciano G, Gualtieri G, di Visconte MS, Tolone S et al (2020) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 2020; 72(3): 851
- 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 Informatica Medica 2014; 22(6): 365.
- Jain A, Lew C, Aksakal G, Hiscock R, Mirbagheri N. Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study. Ann Coloproctol. 2024;40(1):52-61. https://doi.org/10.3393/ ac.2022.00164.0023.
- Koh FH, Foo FJ, Ho L, Sivarajah SS, Tan WJ, Chew MH. Study Protocol for the Use of Conventional Open Haemorrhoidectomy versus Laser Haemorrhoidoplasty in the Treatment of Symptomatic Haemorrhoids: A Randomized Controlled Trial. Eur Surg Res. 2020;61(6):201-208. doi:10.1159/000513844
- Roervik HD, Heiner Campos A, Ilum L, et al. Minimal open hemorrhoidectomy. Tech Coloproctol. 2019;23(1):73-77. doi:10.1007/s10151-018-1915-x
- Suh YJ, Ha HK, Oh HK, Shin R, Jeong SY, Park KJ. Rectal perforation caused by anal stricture after hemorrhoid treatment. Ann Coloproctol. 2013;29(1):28-30. doi:10.3393/ac.2013.29.1.28
- Danys D, Pacevicius J, Makunaite G, Palubeckas R, Mainelis A, Markevicius N et al. Tissue coagulation in laser hemorrhoidoplasty - an experimental study. Open Med (Wars) 2020; 8(15): 185– 189.
- Gupta K, Agarwal N, Mital K Clinical outcomes in patients with hemorrhoids treated by fnger guided hemorrhoidal artery ligation with laser hemorrhoidoplasty: a retrospective cohort study. JAMMR. 2021; 33(18): 143–152.
- Katdare MV, Ricciardi R. Anal stenosis. Surg Clin North Am. 2010; 90(1): 137–45.
- Lie H, Caesarini EF, Purnama AA, et al. Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci. 2022;37(9):3621-3630. doi:10.1007/s10103-022-03643-8
Abstract
Objective: We aim to present the outcomes of the Laser Hemorrhoidoplasty (LHP) procedure performed in our clinic. Methods: In this retrospective study, we analyzed the outcomes of LHP performed on 112 patients in our clinic over a 24-month period. Patients were scheduled for follow-up visits at three weeks post-surgery, followed by subsequent follow-ups at three and six-month intervals. Results: Of the 112 patients, 73 (65.17%) were male, and 39 (34.82%) were female. The mean age was 52.6 years (range: 20-65). The mean operation duration was 18.3 minutes (range: 12-25). Seventy patients were classified as grade 2, while 42 patients were classified as grade 3. The mean hospital stay was 1.16 days. While 5 of 70 patients with Grade 2 hemorrhoids could not be followed up after surgery, 24 were followed for 6 months and 41 for 1 year. One (1.42%) patient who attended the 1-year follow-up showed recurrence. Four patients (9.52%) showed recurrence. One patient with grade 3 hemorrhoids experienced postoperative bleeding lasting one week, requiring erythrocyte suspension transfusion. Another patient with grade 3 hemorrhoids developed a hematoma, which resolved with conservative treatment. Eight patients (7.14%) with grade 3 hemorrhoids developed postoperative edema, all of whom improved with conservative treatment. Pain, evaluated by the Visual Analog Scale, was measured as 2.03 on the first postoperative day and 1.49 on the second postoperative day. Conclusion: LH treatment has been found to be a successful alternative treatment option for Grade 2 and Grade 3 diseases. It is emphasized that patient selection is crucial in LH treatment.
References
- Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol 2019; 17: 8–15.
- Ganz RA. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol 2013; 11: 593–603.
- Di Costanzo GG, Tortora R, D’Adamo G, De Luca M, Lampasi F, Addario L, et al. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol 2015; 30: 559–65.
- Lee T, Mendhiratta N, Sperling D, Lepor H. Focal laser ablation for localized prostate cancer: principles, clinical trials, and our initial experience. Rev Urol 2014; 16: 55–66.
- Salfi R. A new technique for ambulatory hemorrhoidal treatment. Coloproctology 2009; 31: 99–103.
- Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, et al. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 2009; 27: 819–23.
- Longchamp G, Liot E, Meyer J, Toso C, Buchs NC, Ris F. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 2021; 36: 485–96.
- Crea N, Pata G, Lippa M, Tamburini AM, Berjaoui AH. Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis. Lasers Med Sci 2022; 37: 309–15.
- Giamundo P, Braini A, Calabrò G, Crea N, De Nardi P, Fabiano F, et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term: results of a multicenter trial. Surg Endosc 2022; 36: 143–8.
- Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 2020; 72: 851–7.
- 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: 325–31.
- Poskus T, Danys D, Makunaite G, Mainelis A, Mikalauskas S, Poskus E, et al. Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy. Int J Colorectal Dis 2020; 35: 481–90.
- Karahaliloǧlu AF. Erste ergebnisse der laserobliteration von erst- bis zweitgradigen hämorrhoiden. Coloproctology 2007; 29(6): 327.
- Fathallah N, Barré A, Aubert M, de Parades V (2020) Minimally invasive hemorrhoidal surgery with laser hemorrhoidoplasty: a real alternative for hemorrhoidectomy? Colon Rectum 2020; 12(1): 693.
- Brusciano L, Gambardella C, Terracciano G, Gualtieri G, di Visconte MS, Tolone S et al (2020) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg 2020; 72(3): 851
- 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 Informatica Medica 2014; 22(6): 365.
- Jain A, Lew C, Aksakal G, Hiscock R, Mirbagheri N. Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study. Ann Coloproctol. 2024;40(1):52-61. https://doi.org/10.3393/ ac.2022.00164.0023.
- Koh FH, Foo FJ, Ho L, Sivarajah SS, Tan WJ, Chew MH. Study Protocol for the Use of Conventional Open Haemorrhoidectomy versus Laser Haemorrhoidoplasty in the Treatment of Symptomatic Haemorrhoids: A Randomized Controlled Trial. Eur Surg Res. 2020;61(6):201-208. doi:10.1159/000513844
- Roervik HD, Heiner Campos A, Ilum L, et al. Minimal open hemorrhoidectomy. Tech Coloproctol. 2019;23(1):73-77. doi:10.1007/s10151-018-1915-x
- Suh YJ, Ha HK, Oh HK, Shin R, Jeong SY, Park KJ. Rectal perforation caused by anal stricture after hemorrhoid treatment. Ann Coloproctol. 2013;29(1):28-30. doi:10.3393/ac.2013.29.1.28
- Danys D, Pacevicius J, Makunaite G, Palubeckas R, Mainelis A, Markevicius N et al. Tissue coagulation in laser hemorrhoidoplasty - an experimental study. Open Med (Wars) 2020; 8(15): 185– 189.
- Gupta K, Agarwal N, Mital K Clinical outcomes in patients with hemorrhoids treated by fnger guided hemorrhoidal artery ligation with laser hemorrhoidoplasty: a retrospective cohort study. JAMMR. 2021; 33(18): 143–152.
- Katdare MV, Ricciardi R. Anal stenosis. Surg Clin North Am. 2010; 90(1): 137–45.
- Lie H, Caesarini EF, Purnama AA, et al. Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci. 2022;37(9):3621-3630. doi:10.1007/s10103-022-03643-8
Details
| Primary Language | English |
|---|---|
| Subjects | General Practice, Patient Safety |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 29, 2024 |
| Submission Date | March 3, 2024 |
| Acceptance Date | March 23, 2024 |
| Published in Issue | Year 2024 |