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Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial

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Abstract

Background

Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy. Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up. Primary endpoint was resolution of symptoms and secondary endpoints were recurrence rate, type of recurrences, re-operation rate, and potential predictive factors for failure.

Methods

Bleeding was assessed on a score from 0 to 4 (none = 0; < 1/month = 1; 1/week = 2; > 1/week = 3; 3–4/week = 4), frequency of hemorrhoid-related symptoms with a score of 0–3 (2/year = 1; 3–5/year = 2; < 5/year = 3). Constipation and fecal incontinence were assessed by means of validated scores. Quality of life and pain at defecation were assessed using a visual analog scale of 0–10 (0 = worst possible–10 = best possible quality of life and 0 = no pain–10 = worst pain imaginable, respectively). Recurrence rate and need for re-operation were reported. Potential predictive factors of failure were analyzed by means of univariate analysis.

Results

Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial; 8 patients were lost at follow-up. Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients. Statistically significant improvement of quality of life, pain reduction, bleeding and frequency of acute symptoms were reported. Of 28 patients with persistent or recurrent symptoms, 12 had pain (4.35%), 10 had bleeding (3.6%) and 6 had increasing prolapse at defecation (2.2%). Eleven out of twenty-eight patients required additional surgery. Constipation and III–IV grade hemorrhoids were associated with statistically significant higher failure rates (p = 0.046 and 0.012, respectively). Better results were reported in patients reporting preoperative high-grade pain at evacuation.

Conclusions

The Doppler-guided hemorrhoidal laser procedure showed efficacy at long-term follow-up. It can be considered as ‘first-line’ treatment in patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms in whom conservative treatment failed.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Policlinico di Monza, Monza, Italy

    Paolo Giamundo

  2. Department of General Surgery, AAS5 Friuli occidentale, Pordenone, Italy

    Andrea Braini

  3. Humanitas Gavazzeni Institute, Bergamo, Italy

    Giuseppe Calabrò

  4. Department of General Surgery, Sant’Anna Clinic, Brescia, Italy

    Nicola Crea & Mauro Lippa

  5. Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Paola De Nardi & Andrea M. Tamburini

  6. Department of General Surgery, Evangelic International Hospital, Genoa, Italy

    Fabio Fabiano

  7. Vascular Surgery, San Salvatore Hospital, L’Aquila, Italy

    Alessandro Mastromarino

  8. Via Rolfi 4/E, 12069, Santa Vittoria d’Alba, CN, Italy

    Paolo Giamundo

Authors
  1. Paolo Giamundo
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  2. Andrea Braini
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  3. Giuseppe Calabrò
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  4. Nicola Crea
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  5. Paola De Nardi
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  6. Fabio Fabiano
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  7. Mauro Lippa
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  8. Alessandro Mastromarino
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  9. Andrea M. Tamburini
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Corresponding author

Correspondence to Paolo Giamundo.

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Disclosures

Paolo Giamundo has been hired as “surgical trainer” for live surgery demonstrations by Biolitec Italia. Andrea Braini, Giuseppe Calabrò, Nicola Crea, Paola De Nardi, Fabio Fabiano, Mauro Lippa, Alessandro Mastromarino, Andrea M. Tamburini have no conflicts of interest or financial ties to disclose.

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Giamundo, P., Braini, A., Calabrò, G. et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial. Surg Endosc 36, 143–148 (2022). https://doi.org/10.1007/s00464-020-08248-2

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  • DOI: https://doi.org/10.1007/s00464-020-08248-2

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