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Hemorrhoid laser dearterialization: systematic review and meta-analysis

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Abstract

Hemorrhoidal disease is a common and troublesome condition. Excisional hemorrhoidectomy can assure the best chance of cure but it is hampered by postoperative pain and potential long-term morbidity therefore minimally invasive techniques have been developed. Since 2009 a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP) has been proposed to control symptoms without significant sequelae. The aim of this systematic review is to analyze the benefits and disadvantages of HeLP for symptomatic hemorrhoids. The Medline/PubMed, Embase, and Cochrane library databases were searched from January 2010 to March 2022, language was restricted to English and documents to the full text. Randomized and non-randomized, prospective and retrospective cohort studies were included. Risk of bias assessment was performed using the Risk of bias for non-randomized studies (ROBINS-I) and the RoB2 Tool for randomized clinical trial. Primary outcome was to assess the efficacy of HeLP on symptoms’ resolution. Secondary objectives were postoperative pain and complications, comparison with other interventional techniques, and evaluation of long-term recurrence. Whenever possible, a meta-analysis was conducted. The GRADE approach was employed to assess the certainty of evidence. We included six non-randomized and one randomized study. HeLP improved or resolved preoperative symptoms in 83.6 to 100% of patients during follow-up. In the randomized study symptoms resolved in 90% of patients after HeLP and 53.3% after rubber band ligation as comparator. Published data indicate that HeLP is effective, relatively safe, with limited recurrence rate, after a short to medium follow-up. The quality of evidence was however low. There is a paucity of studies assessing the benefits or harms of laser dearterialization for the treatment of hemorrhoids and randomized trials are furthermore rare, therefore trials with adequate power and proper design, assessing the advantages and disadvantages of HeLP versus other minimally invasive techniques, are needed. Furthermore, studies evaluating long-term follow-up are wanted.

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Acknowledgements

The authors wish to acknowledge Mr. Diego Bertini for assistance in the literature search

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Authors and Affiliations

  1. Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Paola De Nardi

  2. Oncologic Surgery, Policlinico Casilino, Rome, Italy

    Giulia Maggi

  3. Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Italy

    Michele Pagnanelli

  4. Vita-Salute University San Raffaele, Milan, Italy

    Iliyan Vlasakov

  5. Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Davide Corbetta

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Contributions

Paola De Nardi: conception, design and drafting of the work; Giulia Maggi, Michele Pagnanelli., Iliyan Vlasakov: acquisition, analysis and interpretation of data; Davide Corbetta: analysis and interpretation of data, drafting; all the authors revised the work critically for important intellectual content, approved the version to be published, agreed to be accountable for all aspects of the work.

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Correspondence to Paola De Nardi.

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De Nardi, P., Maggi, G., Pagnanelli, M. et al. Hemorrhoid laser dearterialization: systematic review and meta-analysis. Lasers Med Sci 38, 54 (2023). https://doi.org/10.1007/s10103-022-03703-z

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