EC Clinical and Medical Case Reports

Introduction and Aim: Hemorrhoids disease is the commonest disease of the rectum and anal canal. The worldwide prevalence ranges from 2.9% to 27.9%, of which more than 4% are symptomatic. Bleeding from the rectum which is painless and associated with episodes of defecation is the most common complaint by patients with hemorrhoids. Multiple treatment options for symptomatic hemorrhoids are available worldwide which includes conservative medical management with dietary modifications and topical therapy using emollients, non-surgical treatments and various surgical techniques. But most of these surgical procedures are associated with significant postoperative pain, delayed return to normal activities and readmissions, that’s why the surgeons are shifting to minimally invasive laser therapy for symptomatic hemorrhoids as laser hemorrhoidoplasty is associated with less postoperative pain, shorter operative time and early return to work. The aim of this study was to evaluate the clinical results of Laser Hemorrhoidoplasty for symptomatic hemorrhoids.

Materials and Methods: This is a retrospective single center observational study of 70 patients who underwent laser hemorrhoidoplasty for symptomatic hemorrhoids in a period of 20 months between June 2021 to January 2023. All the laser hemorrhoidoplasty procedures were done by me personally at Phoenix Hospital Abu Dhabi, United Arab Emirates. Patients with symptomatic haemorrhoids of grade II - IV were included in the study. The patients were followed up after 1 week, 3 week and 3 months for the evaluation of clinical results.

Results: Most of the patients are in the age group of 24 - 47 years. In the study male patients were found to be more 90% as compared to female 10%. The most common severity of disease presentation was grade three (71.5%) followed by grade four (18%) then grade two (10.5%). The average operative time observed for the laser hemorrhoidoplasty was 34 minutes and the mean hospital stay was 18 hours. Postoperatively on the 1^st day 93% of patients developed mild pain after the procedure, only 7% of the patients have moderate to severe pain. Postoperatively after one week around 60% of the patients have mild pain and discomfort on defecation only, although 40% of the patients have no pain at all. At three week time only 5% of the patients have mild discomfort on defecation only, no patient have actual pain at this time. Post laser hemorrhoidoplasty mild bleeding in the form of spotting after defecation was seen in 60% of patients but only 12% continued spotting till one week, 35% of the patients had no bleeding after the procedure at all. No patient had bleeding complain at the three week time.

Conclusion: Our study demonstrated that the minimally invasive Laser hemorrhoidoplasty (LHP) technique for the management of hemorrhoids is associated with shorter operative time, less postoperative pain and bleeding, has the advantage of short hospital stay and faster recovery. However Larger randomized long term studies are required to demonstrate the exact recurrence rates and patient satisfaction.

Keywords: Laser Hemorrhoidoplasty (LHP); Symptomatic Hemorrhoids

1. Johanson JF and Sonnenberg A. “The prevalence of hemorrhoids and chronic constipation: an epidemiological study”. Gastroenterology2 (1990): 380-386.
2. Rogozina VA. “Hemorrhoids”. Eksperimental’ Naia i Klinicheskaia Gastroenterologiia 4 (2002): 93-96.
3. Johanson JF and Sonnenberg A. “The prevalence of hemorrhoids and chronic constipation: an epidemiological study”. Gastroenterology2 (1990): 380-386.
4. Parks AG. “De Hemorrhoids.A study in surgical history”. Guy's Hospital Report 104 (1995): 135-150.
5. Keighley MRB. Surgery of Anus, Rectum and Colon. Volume 1 WB Saunders publishers (1993): 295-298.
6. Rahman A., et al. “Comparative study of outcome of surgical treatment of haemorrhoid between open haemorrhoidectomy and stapled haemorhoidopexy”. East African Scholars Journal of Medical Sciences 6 (2023): 34-39.
7. Loder PB., et al. “Haemorrhoids: pathology, pathophysiology and aetiology”. British Journal of Surgery 81 (1994): 946-954.
8. Brisinda G. “How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators”. British Medical Journal 321 (2000): 582-583.
9. Haas PA., et al. “The Pathogenesis of hemorrhoids”. Diseases of the Colon and Rectum7 (1984): 442-450.
10. Thomson WHF. “The nature of Hemorrhoids”. British Journal of Surgery7 (1975): 542-552.
11. MacRae HM and McLeod RS. “Comparison of Hemorrhoidal Treatment Modalities. A meta-analysis”. Diseases of the Colon and Rectum7 (1995): 687-694.
12. Monson JRT., et al. “Procedures for Prolapsing Hemorrhoids (PPH) or Stapled Anopexy.Consensus Document for Association of Coloproctology of Great Britain and Ireland”. ACPGBI (2003).
13. Bleday R., et al. “Symptomatic Hemorrhoids: Current Incidence and Complications of Operative Therapy”. Diseases of the Colon and Rectum5 (1992): 477-481.
14. Sardinha TC and Corman ML. “Hemorrhoids”. The Surgical clinics of North America6 (2002): 1153-1167.
15. Laser Hemorrhoidoplasty: Experience at Aga Khan University Hospital”. Annals of African Surgery2 (2020): 76-79.
16. Schwesinger WH and Hunter JG. “Laser in general surgery”. Surgical Clinics of North America (1992).
17. Andersen K. “Laser technology-a surgical tool of the past, present, and future”. AORN Journal794-802 (2003): 805-807.
18. Lumb K., et al. “Stapled versus conventional surgery for hemorrhoids”. Cochrane Database of Systematic Reviews 4 (2006): CD005393.
19. Simillis C., et al. “Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids”. British Journal of Surgery13 (2015): 1603-1618.
20. Shanmugam V., et al. “Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids”. Cochrane Database of Systematic Reviews 3 (2005): CD005034.
21. Masson JL. “Outpatient hemorrhoidectomy using the CO2 laser”. Wiadomości Lekarskie 63 (2010): 27-32.
22. Sankar MY and Joffe SN. “Laser surgery in colonic and anorectal lesions”. Surgical Clinics of North America6 (2012): 1447-1469.
23. Jahanshahi A., et al. “Diode laser for treatment of symptomatic hemorrhoid: a short-term clinical result of a mini-invasive treatment, and one-year follow-up”. Polish Journal of Surgery 84 (2012): 329-332.
24. Shu Yu Lim., et al. “Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial”. BMC Surgery 22 (2022): 146.