Skip to main content

Advertisement

SpringerLink
Log in

Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

We aimed to analyze the results of 5-year consecutive use of the hemorrhoidal laser procedure (HeLP) in patients with second- to third-grade hemorrhoids with minimal or moderate mucosal prolapse. A total of 189 patients were treated between April 2012 and October 2017. We reported perioperative complications, postoperative pain, improvement of hemorrhoids grade, and relapse of hemorrhoidal disease (HD). Improvement of symptoms was assessed using the Patient Global Improvement (PGI) Scale. No severe intraoperative complications were observed. The median follow-up was 42 months (range 6–62 months). Pain after surgery was absent in 94% of patients. No cases of rectal tenesmus or alterations of defecation habits were reported. Symptoms and HD improvement reached a “plateau” at 3 to 6 months following surgery. We observed a significant decrease in HD degree, occurrence of bleeding, pain, itching, and acute HD. Complete resolution of HD was reported in > 60% of patients 1 year after surgery. The individual level of improvement in symptoms was consistent (very much and much improved, according to PGI-I score) for about 90% of patients during the follow-up. This study confirmed that the HeLP is a safe, painless, and effective procedure for the treatment of HD in selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Riss S, Weiser FA, Schwameis K, Mittlbock M, Steiner G, Stift A (2012) The prevalence of hemorrhoids in adults. Int J Color Dis 27:215–220

    Article  Google Scholar 

  2. Violán C, Foguet-Boreu Q, Hermosilla-Pérez E, Valderas JM, Bolibar B, Fabregas-Escurriola M et al (2013) Comparison of the information provider by electronic health records data and a population health survey to estimate prevalence of selected health conditions and multimorbidity. BMC Public Health 13:251

    Article  Google Scholar 

  3. Loder PB, Kamm MA, Nicholls RJ, Phillips RK (1994) Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 81:946–954

    Article  CAS  Google Scholar 

  4. Lohsiriwat V (2012) Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 18:2009–2017

    Article  CAS  Google Scholar 

  5. Gazet JC, Redding W, Rickett JW (1970) The prevalence of haemorrhoids. A preliminary survey. Proc R Soc Med 63 Suppl:78–80

    CAS  PubMed  Google Scholar 

  6. Giamundo P (2016 Jan) Adventages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg 27:1–4

    Article  Google Scholar 

  7. Milligan ETC, Morgan CN, Jones LE (1937) Surgical anatomy of the anal canal and the operative treatment of hemorrhoids. The Lancet 230(5959):1119–1124

    Article  Google Scholar 

  8. Ferguson JA, Heaton JR (1959) Closed hemorroidectomy. Dis Colon Rectum 2:176–179

    Article  CAS  Google Scholar 

  9. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118(4):934–944

    Article  Google Scholar 

  10. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemor-rhoids: ligation of the hemorrhoidal artery with a newly devised instru-ment (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613

    CAS  PubMed  Google Scholar 

  11. Sohn N, Aronoff JS, Cohen FS, Weinstein MA (2001) Transanal hemorrhoidal dearteri- alization: nonexcisional surgery for the treatment of hemorrhoidal dis-ease. Am J Surg 182:515–519

    Article  CAS  Google Scholar 

  12. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R et al (2011) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini- invasive treatment. Surg Endosc 25:1369–1375

    Article  Google Scholar 

  13. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54:693–698

    Article  Google Scholar 

  14. Jorge JM, Wexner SD (1993) Etiology and management of fecal inconti-nence. Dis Colon Rectum 36:77–97

    Article  CAS  Google Scholar 

  15. Osterberg A, Graf W, Karlbom U, Pahlman L (1996) Evaluation of a questionnaire in the assessment of patients with faecal incontinence and constipa-tion. Scand J Gastroenterol 31:575–580

    Article  CAS  Google Scholar 

  16. American Gastroenterological Association (AGA) (2004) American Gastroenterological Association medical position statement: diagnosis and treatment of hemorrhoids. Gastroenterology 126(2004):1461–1462

    Google Scholar 

  17. Crea N, Pata G, Lippa M, Chiesa D, Gregorini ME, Gandolfi P (2014) Hemorrhoidal laser procedure: short- and long-term results from a prospective study. Am J Surg 208(1):21–25

    Article  Google Scholar 

  18. De Nardi P, Tamburini AM, Gazzetta PG, Lemma M, Pascariello A, Asteria CR (2016) Hemorroid laser procedure for second- and third degree hemorrohids: results from a multicenter prospective study. Tech Coloproctol 20(7):455–459

    Article  Google Scholar 

  19. Chew SS, Marshall L, Kalish L, Tham J, Grieve DA, Douglas PR et al (2003) Short-term and long-term results of combined sclerotherapy and rubber band ligation of hemorrhoids and mucosal prolapse. Dis Colon Rectum 46:1232–1237

    Article  Google Scholar 

  20. Dal Monte PP, Tagariello C, Sarago M, Cudazzo E, Shafi A, Sarago M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemor- rhoidal disease. Tech Coloproctol 11:333–338

    Article  CAS  Google Scholar 

  21. Gaj F, Trecca A (2004) PATE 2000 Sorrento: a modern, effective instrument for defining haemorrhoids. A multicentre observational study conduct- ed in 930 symptomatic patients. Chir Ital 56:509–515

    PubMed  Google Scholar 

  22. Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritsch H (2004) The superior rectal artery and its branching pattern with regard to its clinical influence on liga- tion techniques for internal hemorrhoids. Am J Surg 187:102–108

    Article  Google Scholar 

  23. Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R et al (2006) The vascular nature of hemorroids. J Gastrointest Surg 10:1044–1050

    Article  Google Scholar 

  24. Schuurman JP, Go PM, Bleys RL (2009) Anatomical branches of the su- perior rectal artery in the distal rectum. Color Dis 11:967–971

    Article  CAS  Google Scholar 

  25. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB (2010) Evaluation of transanal hemor- rhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum 53:803–811

    Article  Google Scholar 

  26. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dear- terialization: a systematic review. Dis Colon Rectum 52:1665–1671

    Article  Google Scholar 

  27. Karahaliloglu AF (2007) First results after laser obliteration of first and second degree hemorrhoids. Coloproctology 29:329–336

    Article  Google Scholar 

  28. Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S et al (2020) Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updat Surg 72:851–857

    Article  Google Scholar 

  29. Plaper H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C et al (2009) A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg 25:819

    Article  Google Scholar 

  30. Giamundo P, Braini A, Calabro’ G, Crea N, De Nardi P, Fabiano F et al (2018) Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Tech Coloproctol 22(8):635–643

    Article  CAS  Google Scholar 

  31. Gambardella C, Brusciano L, Del Genio G, Tolone S, Terracciano G, Gualtieri G et al (2019) Predictive parameters to identify incontinent patients amenable for rehabilitation treatment: the muscular synergies evaluation. Arq Gastroenterol 56:452–453

    Article  Google Scholar 

  32. Srikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21:523–528

    Article  Google Scholar 

  33. Tincello D, Owen R, Slack M, Abrams K (2013) Validation of the Patient Global Impression scales for use in detrusor overactivity: secondary analysis of the RELAX study. BJOG 120:212–216

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Sant’Anna Clinic Institute, Via del Franzone 31, Brescia, Italy

    Nicola Crea, Mauro Lippa & Abdul Halim Berjaoui

  2. General Surgery 2 Unit, University Hospital ASST Spedali Civili of Brescia, P.le Spedali Civili 1, 25125, Brescia, Italy

    Giacomo Pata

  3. Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy

    Andrea Marco Tamburini

Authors
  1. Nicola Crea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giacomo Pata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mauro Lippa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Marco Tamburini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Abdul Halim Berjaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors gave the same contribution in terms of data collecting, statistical analysis, and surgical performance.

Corresponding author

Correspondence to Nicola Crea.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The institutional review board has approved this study.

Consent to participate

All patients included in the study gave their informed consent for this procedure, treatment of data and follow-up. All the procedures were performed according to the ethical standards of our internal committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards.

Consent for publication

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crea, N., Pata, G., Lippa, M. et al. Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis. Lasers Med Sci 37, 309–315 (2022). https://doi.org/10.1007/s10103-021-03249-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-021-03249-6

Keywords

Search

Navigation