Long-Term Results of Laser Submucosal Destruction in the Treatment of Grade 2–3 Hemorrhoids

Aim: improvement the results of treatment in patients with Grade 2–3 of hemorrhoids.
Materials and methods. A single-center prospective study included 90 patients with Grade 2–3 haemorrhoidal disease who met the inclusion criteria. All patients underwent transdermal laser submucosal destruction of internal hemorrhoids with a water-absorbed laser with a wavelength of 1940 nm according to the method proposed by us. In the course of the procedure the laser effect is applied both to the cavernous tissue of hemorrhoidal nodes and to the terminal branches of the superior rectal artery. The primary endpoints of the study were destruction of the cavernous tissue of internal hemorrhoidal nodes and the frequency of recurrence of the disease. The effectiveness of the technique was assessed using anoscopy, ultrasound examination with a rectal sensor with spectral-wave Dopplerography 1, 3, 6 and 12 months after surgery. At the same time, the quality of life and the severity of hemorrhoidal disease symptoms were assessed using the SF-36 scale and a point assessment of the clinical manifestations of hemorrhoids. In the first 7 days after surgery, the intensity of the pain syndrome was analyzed using the Visual Analog Scale (VAS). In order to determine the safety of the technique with respect to the effect on the locking apparatus of the rectum, sphincterometry was performed in all patients. Intra- and postoperative complications and recurrences of the disease within 1 year were also recorded, the causes of the return of clinical manifestations of hemorrhoidal disease were analyzed.
Results. The level of pain syndrome by day 7 after surgery corresponded to 0 points on the VAS in 52 (58 %) patients. Intraoperatively, bleeding occurred in 3 (3.3 %) patients and submucous hematoma formed in 15 (16.7 %) patients. In the early postoperative period, thrombosis of external hemorrhoids developed in 5 (5.6 %) patients, two of these patients developed acute urinary retention. Internal hemorrhoids determined before surgery were not visualized one month after surgery either by anoscopy or by ultrasound examination with a rectal sensor. According to the results of spectral wave Dopplerography, a persistent decrease in blood flow along the terminal branches of the superior rectal artery is noted for up to 12 months after the intervention. According to sphincterometry, no changes in the parameters of the anal sphincter function were noted compared with the preoperative parameters. 18 and 24 months after the operation, two patients were diagnosed with recurrence of hemorrhoidal disease. The analysis showed that the reason for the return of clinical manifestations of the disease was the supply of insufficient laser energy.
Conclusion. Laser submucosal destruction of internal hemorrhoids using a laser with a wavelength of 1940 nm is a minimally invasive method for treating Grade 2–3 of hemorrhoidal disease, which has demonstrated high efficiency (good results) in the late postoperative period. Thus, according to the results of our study, the return of clinical manifestations of hemorrhoidal disease was revealed only in 2 patients after 18 and 24 months. A repeated laser destruction procedure allowed us to achieve a good result in these patients.

1. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist's view. World J Gastroenterol. 2015;21(31):9245–52. DOI: 10.3748/wjg.v21.i31.9245

2. Milito G., Cadeddu F., Muzi M.G., Nigro C., Farinon A.M. Haemorrhoidectomy with LigaSure vs conventional excisional techniques: Meta-analysis of randomized controlled trials. Colorectal Dis. 2010;12(2):85–93. DOI: 10.1111/j.1463-1318.2009.01807.x

3. Cocorullo G., Tutino R., Falco N., Licari L., Orlando G., Fontana T., et al. The non-surgical management for hemorrhoidal disease. A systematic review. Il Giornale di Chirurgia — Journal of the Italian Association of Hospital Surgeons. 2017;38(1):5–14. DOI: 10.11138/gchir/2017.38.1.005

4. Miyamoto H. Minimally invasive treatment for advanced hemorrhoids. J Anus Rectum Colon. 2023;7(1):8–16. DOI: 10.23922/jarc.2022-068

5. 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(1):143–8. DOI: 10.1007/s00464-020-08248-2

6. 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

7. Ferhatoglu M.F., Kıvılcım T., Ekici U., Kebudi A. Laser hemorrhoidoplasty procedure for grade two and three hemorrhoidal disease. A retrospectively prospective study, analysis of forty-seven patients. OSP J Surg. 2019;1:101. DOI: 10.18203/2349-2902.isj20213978

8. Karahaliloğlu A. First results after laser obliteration of first and second-degree hemorrhoids. Coloproctology. 2007;29(6):327–36. DOI: 10.1007/s00053-007-7029-y

9. Khitaryan A.G., Alibekov A.Z., Kovalev S.A., Orekhov A.A., Burdakov I.u., Golovina A.A., et al. Results of the use of intranodal laser coagulation in patients with chronic internal hemorrhoids stage III. Koloproktologia. 2021;20(1):33–40. (In Russ.). DOI: 10.33878/2073-7556-2021-20-1-33-40

10. Durgun C., Yiğit E. Laser hemorrhoidoplasty versus ligasure hemorrhoidectomy: A comparative analysis. Cureus. 23;15(8):e43119. DOI: 10.7759/cureus.43119

11. Żywicka B., Rybak Z., Janeczek M., Czerski A., Bujok J., Szymonowicz M., et al. Comparison of a 1940 nm thulium-doped fiber laser and a 1470 nm diode laser for cutting efficacy and hemostasis in a pig model of spleen surgery. Materials (Basel). 2020;13(5):1167. DOI: 10.3390/ma13051167

12. Frolov S.A., Vyshegorodtsev D.V., Kuzminov A.M., Trubacheva Yu.L., Korolik V.Yu., Bogormistrov I.S., et al. Laser submucous destruction in the treatment of hemorrhoids. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2023;33(2):70–8. (In Russ.). DOI: 10.22416/1382-4376-2023-33-2-70-78

13. Frolov S.A., Kuzminov A.M., Vyshegorodtsev D.V., Mainovskaya O.A., Trubacheva Yu.L., Fomenko O.Yu., et al. The opportunity of using diode laser with the length of 1940 nm in the treatment of hemorrhoids. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(2):63–72. (In Russ.). DOI: 10.22416/1382-4376-2022-32-2-63-72

14. Cemil A., Ugur K., Salih G.M., Merve K., Guray D.M., Emine B.S. Comparison of laser hemorrhoidoplasty and Milligan — Morgan hemorrhoidectomy techniques in the treatment of Grade 2 and 3 hemorrhoidal disease. Am Surg. 2024;90(4):662–71. DOI: 10.1177/00031348231207301

15. Crea N., Pata G., Lippa M., Chiesa D., Gregorini M.E., Gandolf P. Hemorrhoidal laser procedure: Short- and long-term results from a prospective study. Am J Surg. 2014;208(1):21–5. DOI: 10.1016/j.amjsurg.2013.10.020

16. Jahanshahi A., Mashhadizadeh E., Sarmast M.H. Diode laser for treatment of symptomatic hemorrhoid: A short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012;84(7):329–32. DOI: 10.2478/v10035-012-0055-7

17. 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. DOI: 10.1007/s13304-019-00694-5

18. Gambardella C., Brusciano L., Brillantino A., Parisi S., Lucido F.S., Del Genio G., et al. Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: The twisting trend. Langenbecks Arch Surg. 2023;408(1):140. DOI: 10.1007/s00423-023-02879-4