A New Technique for Ambulatory Hemorrhoidal Treatment

Doppler-Guided Laser Photocoagulation of Hemorrhoidal Arteries*

Neue Methode zur ambulanten Behandlung von Hämorrhoiden – Dopplerunterstützte Laserphotokoagulation von Hämorrhoidalerterien

Abstract

Background and Purpose:

A new technique for the treatment of hemorrhoids is described using a 980-nm diode laser coupled with Doppler for photocoagulation of the distal branches of hemorrhoidal arteries. This painless, ambulatory treatment does not necessitate anesthesia or sedation and is based on the same principles as Doppler-guided ligation of the distal branches of hemorrhoidal arteries, a recent, innovative technique for the treatment of hemorrhoids achieving good results. Unfortunately, the latter technique requires local, general or epidural anesthesia, and ambulatory treatment is difficult.

Patients and Methods:

In the past 3 years, 200 patients were treated with Doppler-guided laser photocoagulation of hemorrhoidal arteries. In all cases, treatment was performed on an outpatient basis and anesthesia or analgesia was not necessary.

Results:

Mild intra- and postoperative complications were seen. 91% of the patients showed an improvement of hemorrhoidal symptoms 1–12 months after treatment.

Conclusion:

Doppler-guided laser photocoagulation of hemorrhoidal arteries is a good and safe method for the ambulatory treatment of hemorrhoids.

Zusammenfassung

Hintergrund und Ziel:

Beschrieben wird eine neue Technik zur Behandlung von Hämorrhoiden unter Verwendung eines 980-nm-Diodenlasers mit Doppler für die Photokoagulation der distalen Äste der Hämorrhoidalarterien. Es handelt sich um eine schmerzfreie ambulante Behandlung ohne Anästhesie oder Sedierung, die auf den gleichen Prinzipien wie die dopplerunterstützte Ligatur der distalen Äste der Hämorrhoidalarterien basiert, eine relativ neue Technik für die erfolgreiche Behandlung von Hämorrhoiden. Leider erfordert letztgenannte Technik eine Lokal-, Allgemein- oder Epiduralanästhesie, und eine ambulante Behandlung ist schwierig.

Patienten und Methodik:

In den letzten 3 Jahren wurden 200 Patienten einer dopplersonographisch unterstützten Hämoorhoidenarterien-Laserphotokoagulation unterzogen. Die Behandlung aller Patienten fand ambulant statt. Anästhesien oder Analgetika waren nicht notwendig.

Ergebnisse:

Es traten nur geringfügige intra- und postoperative Komplikationen auf. Bei 91% der Patienten kam es 1–12 Monate nach der Behandlung zu einer Besserung der Hämorrhoidensymptome.

Schlussfolgerung:

Die dopplersonographisch unterstützte Laserbehandlung von Hämorrhoidalarterien ist somit eine gute und sichere Methode zur ambulanten Behandlung von Hämorrhoiden.

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References

  1. 1.

    Morinaga K, Hasuda K, Ikeda Y. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 1995;90:610–3.

    PubMed  CAS  Google Scholar 

  2. 2.

    Sowula A, Szymala B, Pabian J. [Ambulatory haemorrhoidectomy using laser CO2.] Wiad Lek 2005;58:137–41.

    PubMed  Google Scholar 

  3. 3.

    Damianov N, Poleganova IU. [Laser hemorrhoidectomy.] Khirurgiia (Sofiia) 1993;46:22–4.

    CAS  Google Scholar 

  4. 4.

    Hodgson WJ, Morgan J. Ambulatory hemorrhoidectomy with CO2 laser. Dis Colon Rectum 1995;38:1265–9.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Leff EI. Hemorrhoidectomy — laser vs. nonlaser: outpatient surgical experience. Dis Colon Rectum 1992;35:743–6.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Pandini LC, Nahas SC, Nahas CS, et al. Surgical treatment of haemorrhoidal disease with CO2 laser and Milligan-Morgan cold scalpel technique. Colorectal Dis 2006;8:592–5.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Plapler H, de Faria Netto AJ, da Silva Pedro MS. 350 ambulatory hemorrhoidectomies using a scanner coupled to a CO2 laser. J Clin Laser Med Surg 2000;18:259–62.

    PubMed  CAS  Google Scholar 

  8. 8.

    Chia YW, Darzi A, Speakman CT, et al. CO2 laser haemorrhoidectomy — does it alter anorectal function or decrease pain compared to conventional haemorrhoidectomy? Int J Colorectal Dis 1995;10:22–4.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Wang D, Zhong KL, Chen JL, et al. [Effect of diode laser coagulation treatment on grade III internal hemorrhoids.] Zhonghua Wei Chang Wai Ke Za Zhi 2005;8:325–7.

    PubMed  Google Scholar 

  10. 10.

    Davis RC Jr. Use of Nd:YAG laser therapy for treatment of hemorrhoidal disease. Clin Laser Mon 1992;10:161–2.

    PubMed  Google Scholar 

  11. 11.

    Romanos G, Nentwig GH. Diode laser (980 nm) in oral and maxillofacial surgical procedures: clinical observations based on clinical applications. J Clin Laser Med 1999;17:193–7.

    CAS  Google Scholar 

  12. 12.

    Scheyer M, Antonietti E, Rollinger G, et al. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006;191:89.

    PubMed  Article  Google Scholar 

  13. 13.

    Ramírez JM, Aguilella V, Elía M, et al. Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Rev Esp Enferm Dig 2005;97:97.

    PubMed  Google Scholar 

  14. 14.

    Tagariello C, Dal Monte PP, Saragò M. Doppler-guided transanal haemorrhoidal dearterialisation. Chir Ital 2004;56:693–7.

    PubMed  Google Scholar 

  15. 15.

    Lienert M, Ulrich B. [Doppler-guided ligation of the hemorrhoidal arteries. Report of experiences with 248 patients.] Dtsch Med Wochenschr 2004;129:947–50.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Thomson WHF. The nature of hemorrhoids. Br J Surg 1975;62:542–52.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Jaspersen D. Doppler sonographic diagnostics and treatment control of symptomatic first-degree hemorrhoids. Preliminary report and results. Dig Dis Sci 1993;38:1329–32.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Aigner F, Bodner G, Conrad F, et al. The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 2004;187:102.

    PubMed  Article  Google Scholar 

Download references

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Correspondence to Raffaele Salfi.

Additional information

* Presented at the International Congress of Laser in Medicine and Surgery, Milan, Italy, September 12, 2008.

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Salfi, R. A New Technique for Ambulatory Hemorrhoidal Treatment. Coloproctol 31, 99–103 (2009). https://doi.org/10.1007/s00053-009-0009-7

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Key Words:

  • Hemorrhoids
  • Laser
  • Hemorrhoidal arteries

Schlüsselwörter:

  • Hämorrhoiden
  • Laser
  • Hämorrhoidalarterien