Introduction
Management of hemorrhoidal disease had been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay.
Patients and methods
This prospective study was carried out on 104 patients with second, third and fourth grades of hemorrhoids in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (18 months, from February 2021 to August 2022). All patients underwent laser hemorrhoidoplasty lasotronix device, bare fibers, wavelength 1470 nm and 8 watts of power. Mucopexy was added in 28 patients with grade 4 hemorrhoids.
Results
Postoperative pain was evaluated using VAS score, in the first 6 h VAS ranged from 4-9 with mean of 5.81±1.23 SD, after 12 h ranged from 1 to 7 with mean of 4.19±1.70 SD. There was significant relation between the grade of hemorrhoid and postoperative edema ( value was less than 0.001) as all of the 24 patients who developed edema, they were grade 4 hemorrhoids. Also, there was relation between grade 4 hemorrhoid and the development of other postoperative complications but value was not significant (0.066 in infection and 0.260 in recurrence). There was no incontinence or stenosis in all of the 104 patients and recurrence occurred only in 4 cases (3.8%) and underwent conventional hemorrhoidectomy after six months of follow up.
Conclusion
Diode laser is a safe minimally invasive procedure for the treatment of second, third and fourth grades of hemorrhoids with less postoperative pain and early return to normal activities but high cost remains the only limitation.