The Opportunity of Using Diode Laser with the Length of 1940 nm in the Treatment of Hemorrhoids

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.

Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.

Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.

Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis. 

1. Chmylov L.M. Hemorrhoidectomy with an ultrasound scalpel. Abstract of the dissertation of the Candidate of medical Sciences. Мoscow, 2006 (In Russ.).

2. Bessa S.S. Ligasure vs. conventional diathermy in excisional hemorrhoidectomy: a prospective, randomized study. Dis Colon Rectum. 2008;51(6):940–4. DOI: 10.1007/s10350-008-9214-7

3. Chen J.S., You J.F. Current status of surgical treatment for hemorrhoids — systematic review and meta-analysis. Chang Gung Med J. 2010;33(5):488–500. PMID: 20979699

4. Johannsson H.O., Pahlman L., Graf W. Randomized clinical trial of the effects on anal function of Milligan–Morgan vs. Ferguson haemorrhoidectomy. Br J Surg. 2006;93(1):1208–14. DOI: 10.1002/bjs.5745

5. Khanna R., Khanna S., Bhadani S., Singh S., Khanna K.A., et al. Comparison of ligasure hemorrhoidectomy with conventional Ferguson’s hemorrhoidectomy. Indian J Surg. 2010;72(4):294–7. DOI: 10.1007/s12262-0100192-3

6. Kwok S.Y., Chung C.C., Tsui K.K., Li M.K. A double blind randomized trial comparing Ligasure and Harmonic Scalpel hemorrhoidectomy. Dis Colon Rectum. 2005;48(2):344–8. DOI: 10.1007/s10350-004-0845-z

7. Milito G., Cadeddu F., Muzi M.G., Nigro C., Farinon A.M., et al. 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

8. Ommer A., Hinrichs J., Mollenberg H., Marla B., Walz M.K., et al. Long-term results after stapled hemorrhoidopexy: a prospective study with a 6 year follow-up. Dis Colon Rectum. 2011;54(5):601–18. DOI: 10.1007/DCR.0b013e3182098df2

9. Kostarev I.V. Sclerosing treatment of hemorrhoids in combination with ultrasound cavitation. Diss. of the candidate of medical sciences. Мoscow, 2008 (In Russ.).

10. Moser K.H., Mosch C., Walgenbach M., Bussen D.G., Kirsch J., Joos A.K., et al. Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial. Int J Colorectal Dis. 2013 Oct;28(10):1439–47. DOI: 10.1007/s00384-013-1729-2

11. Choi J., Freeman J.B., Touchette J. Long-term follow-up of concomitant band ligation and sclerotherapy for internal hemorrhoids. Surg. 1985 Nov;28(6):523–4. PMID: 4063892

12. Dodi G., Pirone E., Cavallari F. Sclerotherapy and elastic ligation of hemorrhoids. Ann Ital Chir. 1995 NovDec;66(6):769–73. PMID: 8712588

13. Abritsova M.V. Doppler controlled dearterization of hemorrhoids with mucopexia at stage 3–4a hemorrhoids. Diss. of the candidate of medical sciences. Мoscow, 2016 (In Russ.).

14. Sobrado C.W., Klajner S., Hora J.A.B., Mello A., Luciano da Silva F.M., Frugis M.O., et al. Transanal haemorrhoidal dearterializationwith mucopexy (THD-M) for treatment of hemorrhoids: is it applicable in all grades? Brazilian multicenter study. Arq Bras Cir Dig. 2020;33(2):e1504. DOI: 10.1590/0102-672020190001e1504

15. Ferrandis C., De Faucal D., Fabreguette J.M., Borie F. Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease. Tech Coloproctol. 2020 Feb;24(2):165–71. DOI: 10.1007/s10151-019-02136-1

16. Ratto C., de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future. J Visc Surg. 2015 Apr;152(2 Suppl):S15–21. DOI: 10.1016/j.jviscsurg.2014.08.003

17. Ul Ain Q., Bashir Y., Eguare E. Evaluation of the effectiveness and patients’ contentment with transanal haemorrhoidal artery dearterialisation and mucopexy (THD) for treatment of haemorrhoidal disease: a 6-year study. Ir J Med Sci. 2018 Aug;187(3):647–55. DOI: 10.1007/s11845017-1715-8

18. Sobrado C.W., Bacchi Hora J.A., Sobrado L.F., Frugis M.O., Nahas S.C., Cecconello I., et al. Transanal hemorrhoidal dearterialization: Lessons learned from a personal series of 200 consecutive cases and a proposal for a tailor-made procedure. Ann Med Surg (Lond). 2020 May 29;55:207–11. DOI: 10.1016/j.amsu.2020.05.036

19. Giordano P., Tomasi I., Pascariello A., Mills E., Elahi S., et al. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis. 2014 May;16(5):373–6. DOI: 10.1111/codi.12574

20. Ratto C. Early Postoperative Outcomes of a Novel Nonexcisional Technique Using Aluminum Potassium Sulfate and Tannic Acid Sclerotherapy With Mucopexy on Patients With Grade III Hemorrhoids. Tech Coloproctol. 2014 Mar;18(3):291–8. DOI: 10.1007/s10151-0131062-3