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Laser hemorrhoidoplasty for II–IV grade hemorrhoids: should we treat them the same?

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Abstract

Laser Hemorrhoidoplasty (LHP) is a novel therapeutic option for hemorrhoids. In this study, we aimed to evaluate the post-operative outcomes of patients undergoing LHP surgery based on hemorrhoid grade. A retrospective analysis of a prospective database of all patients who underwent LHP surgery between September 2018 and October 2021 was performed. Patients’ demographics, clinical perioperative data, and post-operative outcomes were recorded and analyzed. One hundred and sixty two patients that underwent laser hemorrhoidoplasty (LHP) were included. Median operative time was 18 min (range 8–38). Median total energy applied was 850 Joule (450–1242). Complete remission of symptoms following surgery was reported by 134 patients (82.7%), while 21 patients (13%) reported partial symptomatic relief. Nineteen patients (11.7%) presented with post-operative complications, and 11 patients (6.75%) were re-admitted following surgery. Post-operative complication rate was significantly higher in patients with grade 4 hemorrhoids compared to grades 3 or 2, due to a higher rate of post-operative bleeding (31.6% vs. 6.5% and 6.7%, respectively; p = 0.004). Furthermore, post-operative readmission rate (26.3% vs. 5.4% and 6.2%; p = 0.01) and reoperation rate were also significantly higher in grade IV hemorrhoids (21.1% vs. 2.2% and 0%; p = 0.001). Multivariate analysis found that grade IV hemorrhoids had a significantly higher risk for post-operative bleeding (OR 6.98, 95% CI 1.68–28.7; p = 0.006), 30-day readmission (OR 5.82, 95% CI 1.27–25.1; p = 0.018), and hemorrhoids recurrence (OR 11.4, 95% CI 1.18–116; p = 0.028). LHP is an effective treatment for hemorrhoids grades II–IV, but carries significant risk for bleeding and re-intervention in patients with grade IV hemorrhoids.

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Author notes

  1. Edward Ram and Matan Kayzer have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Edward Ram, Matan Kayzer, Yaniv Zager, Roi Anteby, Ido Nachmany & Nir Horesh

  2. Department of Gastroenterology Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Dan Carter

  3. Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Faculty Of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Raanan Meyer

  4. Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Nir Horesh

  5. Department of Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel

    Nir Horesh

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  1. Edward Ram
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  2. Matan Kayzer
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  3. Yaniv Zager
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Correspondence to Nir Horesh.

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Ethical approval was waived by the hospitals local Ethics Committee in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Ram, E., Kayzer, M., Zager, Y. et al. Laser hemorrhoidoplasty for II–IV grade hemorrhoids: should we treat them the same?. Updates Surg 75, 635–642 (2023). https://doi.org/10.1007/s13304-023-01480-0

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  • DOI: https://doi.org/10.1007/s13304-023-01480-0

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