Yasin DURAN, Fatin Rüştü POLAT, Birol TOPÇU

HEMOROİD HASTALIĞI TEDAVİSİNDE MİNİMAL İNVAZİV TEDAVİ SEÇENEĞİ OLARAK LAZER PROSEDÜRÜ: İLK DENEYİMLERİMİZ

Amaç: Hemoroidal hastalık (HH) cerrahi tedavisinde ameliyat sonrası ağrı, rahatsızlık hissi ve diğer komplikasyonlar önemli sorun teşkil etmektedir. Bu nedenle son yıllarda ağrısız tedavi arayışı daha az invaziv tekniklerin ortaya çıkmasına ve yaygınlaşmasına yol açmıştır. Hemoroid lazer prosedürü (HeLP), hemoroid pakelerinin diyot lazerle büzülmesini sağlayarak tedavi eden minimal invaziv bir prosedürdür. Çalışmamızda II-III derece hemoroidli hastalarda HeLP’nün postoperatif ağrı ve diğer komplikasyonlar üzerine etkinliğini analiz etmeyi amaçladık. Materyal ve Metot: Çalışmaya 17 hasta dahil edildi. İşlem spinal anestezi altında uygulandı. II-III derece hemoroidli hastalara 1470nm diyot lazer kullanılarak bir HeLP uygulandı. Prosedür süresi, ameliyat sonrası ağrı ve komplikasyonlar, semptomların düzelmesi ve günlük aktiviteye dönüş süresi retrospektif olarak değerlendirildi. Ameliyattan sonra ortalama 18.5±9 ay takipte postoperatif ağrı, rahatsızlık hissi, kanama, komplikasyonlar ve nüks değerlendirildi. Bulgular: HeLP ortalama 22.9±5 (13-32) dakika sürdü. Vizüel analog skala (VAS) ile değerlendirilen postoperatif ağrı skoru son derece düşük olarak tesbit edildi. Ortalama VAS skoru (0-10) operasyon sonrası 6 saatte 1.058, Birgün sonra 0.588, 3 gün sonra 0.176 olarak tesbit edildi. Yedi, 14, 21, 30 günlerde ise ağrı olmadı. Bu nedenle analjezik ilaçlar sadece lüzumu halinde uygulandı. Postoperatif spontan kanama ve ödem ilk gün bir hastada görüldü, Hastanede yatış süresi ortalama 19.47±1,8 saat oldu. Hastaların tamamı 2 gün sonra günlük aktivitelerine döndü. Ortalama 18.588 aylık takip periyodunda 2 hastada nüks görüldü. Hastalara yapılan Likert tipi memnuniyet anketi ile tamamının HeLP prosedüründen memnun olduğu görüldü. Sonuç: HeLP düşük bir postoperatif ağrı, rahatsızlık oranları ve hastanede yatış süresinin kısa olması nedenleri ile HH tedavisinde ağrısız ve minimal invaziv teknik olarak düşünülebilir.

Laser Procedure as a Minimally Invasive Treatment Option in Treatment of Hemorrhoid Disease: Our First Experiences

Aim: The treatment of hemorrhoidal disease (HD) is still controversial. After surgery, pain and other uncomfortable complications still pose a significant problem. Therefore, the search for painless treatment in recent years has led to the emergence and popularization of various less invasive techniques. The hemorrhoid laser procedure (HeLP) is a minimally invasive procedure used in the treatment of HH by allowing hemorrhoid packets to shrink with a diode laser. The aim of this study was to analyze the effectiveness of help on postoperative pain, discomfort and other complications in patients with grade II-III hemorrhoids. Materials and Methods: 17 patients were included in the study. The procedure was performed under spinal anesthesia. Patients with grade II-III hemorrhoids were treated with a 1470 nm diode laser. The duration of surgery, post-operative pain and complications, recovery of symptoms and return to daily activity were evaluated retrospectively. Postoperative pain, discomfort, bleeding, complications and recurrence were evaluated at an average follow-up of 18.5±9 months after surgery. Results: The average operating time was 22,9±5 (13-32) minutes. Patients did not develop any intraoperative complications. The postoperative pain score, which was evaluated with visual analog scale, was found to be extremely low. The mean VAS Score (0-10) was 1.058 at 6 hours after the operation, 0.588 after 1 day and 0.176 after 3 days. On 7, 14, 21, 30 days, there was no pain. Therefore, analgesic drugs were administered only if necessary. Postoperative spontaneous hemorrhage and edema occurred in one patient on the first day. The average length of hospitalization of patients after the operation was 19.47±1 (17-23) hours. All patients returned to their daily activities 2 days after surgery. In an average follow-up period of 18,5±9.4(5-36) months, 2 patients (11,764%) had relapses. The Likert-type satisfaction survey conducted on the patients showed that they were all satisfied with the HeLP procedure. Conclusion: Due to very low postoperative pain, discomfort rates and short hospital stay, HeLP can be considered as a painless and minimally invasive technique in the treatment of HH.

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1. Crea N, Pata G, Lippa M, Chiesa D, Gregorini ME, Gandolfi P. Hemorrhoidal laser procedure: short- and long-term resultsfrom a prospective study. Am J Surg. 2014;208(1):21–5.
2. Maloku H, Gashi Z, Lazovic R, Islami H, Juniku-Shkololli A. Laser hemorrhoidoplasty procedure vs open surgical hemorrhoidectomy: a trial comparing 2 treatments for hemorrhoids of third and fourth degree. Acta Inform Med. 2014;22(6):365–7.
3. Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215-20.
4. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation: an epidemiological study. Gastroenterology. 1990;98(2):380-6.
5. Rogozina VA. Hemorrhoids. Eksperimental’ Naia i Klinicheskaia Gastroenterologiia. 2002;4:93–6.
6. Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-17.
7. Ram E , Bachar GN, Goldes Y, Joubran S , Rath-Wolfson L. Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids. Laser Therapy. 2018;27(2):137-42.
8. Çetinkaya E, Sözen İ, Hatipoğlu ND: Anorektal Hastalıklar. In: M.Mahir Özmen(Ed), Schwartz-Cerrahinin İlkeleri. Ankara: Güneş Kitabevi, 2016;1222-33.
9. MacRae HM, McLeod RS. Comparison of Hemorrhoidal Treatment Modalities. A meta-analysis. Dis Colon Rectum. 1995; 38(7):687-94.
10. Brusciano L, Gambardella C, Terracciano G, Gualtieri G, di Visconte MS, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Updates Surg. 2020;72(3):851-7.
11. Milligan ET, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet. 1937;11:1119-94.
12. Ferguson JA, Heaton JR. Closed hemorroidectomy. Dis Colon Rectum. 1959; 2(2):176-9.
13. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelan LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures .Anesthesiology. 2013;118(4):934-44.
14. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic Hemorrhoids: Current Incidence and Complications of Operative Therapy. Diseases of the colon and rectum. 1992;35(5):477-81.
15. Sardinha TC, Corman ML. Hemorrhoids. The Surgical Clinics of North America. 2002;82(6):1153-67.
16. Taviloğlu K: Hemoroid. In: Taviloğlu K(Ed,. Kolorektal Hastalıklar ve Proktoloji. İstanbul: Cinius Yayınları, 2016;339-56.
17. Naderan M, Shoar S, Nazari M, Elsayed A, Mahmoodzadeh H, Khorgami Z. A randomized controlled trial comparing laser intra-hemorrhoidal coagulation and Milligan–Morgan hemorrhoidectomy. J Invest Surg. 2017;30(5):325–31.
18. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, et al. Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini invasive treatment. Surg Endosc.2011;25(5):1369-75.
19. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M. The hemorrhoid laser procedure technique vs rubber band ligation: a randomized. trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum .2011;54(6):693-8.
20. Turan İ, Şimşek Ü, Arslan H. Eğitim Araştırmalarda Likert Ölçeği ve Likert Tipi Soruların Kullanımı ve Analizi. Sakarya Üniversitesi Eğitim Fakültesi Dergisi. 2015; 30:186-203.
21. Giamundo P, Braini A, Calabr G, Crea N, De Nardi P, Fabiano F, et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Techniques in Coloproctology. 2018;22:635–43.
22. Voigtsberger A, Popovicova L, Bauer G, Werner K, Weitschat Benser T, Petersen S. Stapled hemorrhoidopexy: functional results, recurrence rate, and prognostic factors in a single center analysis. Int J Colorectal Dis.2016;31(1):35–9.
23. Naldini G. Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis. 2011;13(3):323–7
24. Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, et al. A new method for hemorrhoidsurgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg. 2009;27(5):819–23.
25. Dal Monte PP, Tagariello C, Sarago M, Giordano P, Shafi A, Cudazzo E, et al. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2007;11(4):333–8.
26. Brusciano L, Limongelli P, del Genio G, Di Stazio C, Rossetti G, Sansone S, et al. Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction. Int J Colorectal Dis. 2013;28(6):783–93.
27. Weyand G, Theis CS, Fofana AN, Rüdiger F, Gehrke T. Laserhemorrhoidoplasty with 1470 nm diode laser in the treatment of second to Fourth degree hemorrhoidal disease a Cohort study with 497 patients. Zentralbl Chir. 2019;144(4):355–63.
28. Jahanshahi A, Mashhadizadeh E, Sarmast MH. Diode laser for treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012;84(7):329-32.