Guido Weyand1, Claudia Susanne Theis2, Aboubacar Nzambi Fofana3, Felix Rüdiger4, Thomas Gehrke3. 1. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Zentrum für minimalinvasive Proktologie, Kreisklinikum Siegen gGmbH, Deutschland. 2. Klinik für Kinderchirurgie und Kinderproktologie, DRK-Kinderklinik Siegen gGmbH, Deutschland. 3. Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Kreisklinikum Siegen gGmbH, Deutschland. 4. Klinik für Allgemeinchirurgie, St. Josefs-Hospital Wiesbaden/Rheingau, Deutschland.
Abstract
BACKGROUND: Laser haemorrhoidoplasty (LHP) with the 1470 nm diode laser in minimally invasive surgery for advanced haemorrhoid disease has been studied with respect to clinical variables, such as pain and complications, and intraoperative characteristics such as mucopexia, number of treated knots and energy consumed per patient. The study also included patient satisfaction, symptom relevance and cost effectiveness. PATIENTS AND METHODS: Between November 2010 and November 2016, 497 patients (age 55 ± 14 years) were submitted to laser haemorrhoidoplasty with a 1470 nm diode laser in the centre for minimally invasive proctology in Siegen District Hospital. All operated patients were included in the study. Perioperative clinical and technical data up to 6 weeks and follow-up data up to 6 months were analysed prospectively. RESULTS: The mean duration of operation was 14 min (± 5.2). A mean of 2.7 knots of 2.7 size were treated per patient. The mean postoperative pain was 2.5/10 (VAS). Long-term symptom relevance was 86%, and patient satisfaction 91%. Complications occurred in 49 patients (9.9%): bleeding 1.8%, infection 1%, urine retention 1.8%, oedema/thrombosis/prolapse 6.6%. 8.8% of patients suffered a relapse within 6 months. There were significant differences in pain on the day of the operation, and the parameters mucopexia, 3 treated segments and energy level > 500 J (p < 0.05). Complications were more common when mucopexia was performed, with 3 treated knots and energy consumed per patient > 500 J. The only significant difference was for energy level > 500 J (p < 0.05). CONCLUSION: LHP is a safe, low pain and minimally invasive surgical procedure with long-term good patient acceptance and satisfaction and is suited for routine work. The energy applied should be reduced to a minimum. Complication rates are largely comparable with those of other minimally invasive conventional methods. Additional prospective studies must be performed, particularly in comparison to the Parks method, which gives similar functional results. With circular confluent findings, LHP cannot replace stapler hemorrhoidopexia. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Laser haemorrhoidoplasty (LHP) with the 1470 nm diode laser in minimally invasive surgery for advanced haemorrhoid disease has been studied with respect to clinical variables, such as pain and complications, and intraoperative characteristics such as mucopexia, number of treated knots and energy consumed per patient. The study also included patient satisfaction, symptom relevance and cost effectiveness. PATIENTS AND METHODS: Between November 2010 and November 2016, 497 patients (age 55 ± 14 years) were submitted to laser haemorrhoidoplasty with a 1470 nm diode laser in the centre for minimally invasive proctology in Siegen District Hospital. All operated patients were included in the study. Perioperative clinical and technical data up to 6 weeks and follow-up data up to 6 months were analysed prospectively. RESULTS: The mean duration of operation was 14 min (± 5.2). A mean of 2.7 knots of 2.7 size were treated per patient. The mean postoperative pain was 2.5/10 (VAS). Long-term symptom relevance was 86%, and patient satisfaction 91%. Complications occurred in 49 patients (9.9%): bleeding 1.8%, infection 1%, urine retention 1.8%, oedema/thrombosis/prolapse 6.6%. 8.8% of patients suffered a relapse within 6 months. There were significant differences in pain on the day of the operation, and the parameters mucopexia, 3 treated segments and energy level > 500 J (p < 0.05). Complications were more common when mucopexia was performed, with 3 treated knots and energy consumed per patient > 500 J. The only significant difference was for energy level > 500 J (p < 0.05). CONCLUSION: LHP is a safe, low pain and minimally invasive surgical procedure with long-term good patient acceptance and satisfaction and is suited for routine work. The energy applied should be reduced to a minimum. Complication rates are largely comparable with those of other minimally invasive conventional methods. Additional prospective studies must be performed, particularly in comparison to the Parks method, which gives similar functional results. With circular confluent findings, LHP cannot replace stapler hemorrhoidopexia. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Paolo Giamundo; Andrea Braini; Giuseppe Calabrò; Nicola Crea; Paola De Nardi; Fabio Fabiano; Mauro Lippa; Alessandro Mastromarino; Andrea M Tamburini Journal: Surg Endosc Date: 2021-01-07 Impact factor: 4.584
Authors: Donatas Danys; Julius Pacevicius; Gabija Makunaite; Rolandas Palubeckas; Antanas Mainelis; Narimantas Markevicius; Kestutis Strupas; Tomas Poskus Journal: Open Med (Wars) Date: 2020-03-08