Outcomes of Diode Laser in Treatment of Common Anal Surgical Lesions (Haemorrhoids, Chronic Fissure and Fistula): A Prospective Study
Asian Journal of Research in Surgery, Volume 5, Issue 2,
Page 116-135
Abstract
Introduction: Management of anorectal disorders has been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to the 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 76 patients with common anal surgical lesions categorized into 3 groups. Group 1 included 26 patients with hemorrhoids and underwent laser hemorrhoidoplasty, group 2 included 24 patients with chronic anal fissure and underwent closed laser lateral internal sphincterotomy whereas group 3 included 26 patients with perianal fistula and underwent either fitula laser closure (FILAC) or laser fistulotomy in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (12 months, from February 2021 to February 2022 on 76 patients).
Results: Regarding group1, laser hemorrhoidoplasty (LHP) was associated with minimal postoperative pain using VAS score, minimal bleeding with no serious bleeding requiring intervention, short hospital stay and only one case of recurrence. There was significant relation between postoperative edema and grade 4 hemorrhoids. Regarding group 2, closed laser lateral internal sphincterotomy was associated with no complications except for postoperative itching in five cases and was treated by local soothing agents. As for group 3, success rate was 73.9% among cases who underwent fistula laser closure (FILAC) and overall success rate was 76.9%. There was significant relation between recurrence and posterior position of the fistulous track of the intersphincteric type and significance between wide caliber of the track (more than 7mm) and recurrence.
Conclusion: Diode laser is a safe minimally invasive procedure for treatment of hemorrhoids, chronic anal fissure and perianal fistula.
- Haemorrhoids
- chronic anal fissure
- perianal fistula
- diode laser
- laser hemorrhoidoplasty
- FILAC
How to Cite
References
Gopal DV. Diseases of the rectum and anus: a clinical approach to common disorders. Clin Cornerstone. 2002;4(4):34-48.
Crea N, Pata G, Lippa M, Chiesa D, Gregorini ME, Gandolfi P. Hemorrhoidal laser procedure: short- and long-term results from a prospective study. Am J Surg. 2014;208(1):21-5.
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.
Kelli M, Bullard K, Rothenberger D. Colon rectum and anus in: Schwartz’s Principles of Surgery. 9th ed. New York: McGraw-Hill. 2010;1059-60.
Sugrue J, Nordenstam J, Abcarian H, Bartholomew A, Schwartz JL, Mellgren A, et al. Pathogenesis and persistence of cryptoglandular anal fistula: a systematic review. Tech Coloproctol. 2017;21(6): 425-32.
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 prz chir. 2012;84(7):329-32.
Giamundo P, Geraci M, Tibaldi L, Valente M. Closure of fistula‐in‐ano with laser–FiLaC™: an effective novel sphincter‐saving procedure for complex disease. Colorectal Dis. 2014;16(2):110-5.
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.
Salfi R. A new technique for ambulatory hemorrhoidal treatment. Coloproctology. 2009;31(2):99-103.
Brusciano L, Gambardella C, Terracciano G, Gualtieri G, Schiano di Visconte M, Tolone S, et al. Postoperative discomfort and pain in the management of hemorrhoidal disease: laser hemorrhoidoplasty, a minimal invasive treatment of symptomatic hemorrhoids. Update Surg. 2020;72(3):851-7.
Weyand G, Theis CS, Fofana AN, Rüdiger F, Gehrke T. Laser hemorrhoidoplasty 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.
Poskus T, Danys D, Makunaite G, Mainelis A, Mikalauskas S, Poskus E, et al. Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy. Int J Colorectal Dis. 2020;35(3):481-90.
Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol. 2020;24(2):199-205.
Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, et al. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg. 2009;27(5):819-23.
Nagdy m. Comparative study between Milligan Morgan Haemorrhoidectomy and Laser ablation for the Management of third and fourth Degree of hemorrhoids [journal]. Al-Azhar International Medical Journal. 2022;3(3):49-58.
Esfahani MN, Madani G, Madhkhan S. A novel method of anal fissure laser surgery: a pilot study. Lasers Med Sci. 2015;30(6):1711-7.
Hussein BG, Azzawi JI, Hussein RA. Diode laser & conventional surgery treatment, A comparative study in anal diseases. Medico-Legal Update. 2020;20(1):250-5.
Alam AJ. Laser surgery for treatment of haemorrhoid and anal fissure and its outcome. App Sci. 2021;5:663-9. Sch J.
Mitalas LE, Van Wijk JJ, Gosselink MP, Doornebosch P, Zimmerman DD, Schouten WR. Seton drainage prior to transanal advancement flap repair: useful or not? Int J Colorectal Dis. 2010;25(12):1499-502.
Sygut A, Mik M, Trzcinski R, Dziki A. How the location of the internal opening of anal fistulas affect the treatment results of primary transsphincteric fistulas. Langenbecks Arch Surg. 2010;395(8):1055-9.
Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol. 2011;15(4):445-9.
Doganci S, Demirkilic U. Comparison of 980-nm laser and bare-tip fibre with 1470-nm laser and radial fibre in the treatment of great saphenous vein varicosities: a prospective randomised clinical trial. Eur J Vasc Endovasc Surg. 2010;40(2):254-9.
Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the Closure PLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg. 2010;52(3):645-50.
Öztürk E, Gülcü B. Laser ablation of fistula tract: a sphincter-preserving method for treating fistula-in-ano. Dis Colon Rectum. 2014;57(3):360-4.
Giamundo P, Esercizio L, Geraci M, Tibaldi L, Valente M. Fistula-tract Laser Closure (FiLaC™): long-term results and new operative strategies. Tech Coloproctol. 2015;19(8):449-53.
Wilhelm A, Fiebig A, Krawczak M. Five years of experience with the FiLaC™ laser for fistula-in-ano management: long-term follow-up from a single institution. Tech Coloproctol. 2017;21(4):269-76.
Carvalho ALd, Alves EF, Alcantara RSMd, et al. FILAC-Fistula-Tract Laser Closure: a sphincter-preserving procedure for the treatment of complex anal fistulas. J Coloproctol. 2017;37:160-2.
Lauretta A, Falco N, Stocco E, Bellomo R, Infantino A. Anal fistula laser closure: the length of fistula is the Achilles’ heel. Tech Coloproctol. 2018;22(12):933-9.
Terzi MC, Agalar C, Habip S, Canda AE, Arslan NC, Obuz F. Closing perianal fistulas using a laser: long-term results in 103 patients. Dis Colon Rectum. 2018;61(5):599-603.
Gorgun E, Sengun B. Laser fistula surgery [Filac]: when and how? Semin Colon Rect Surg. 2019;30(4):104-5..
Marref I, Spindler L, Aubert M, Lemarchand N, Fathallah N, Pommaret E, et al. The optimal indication for FiLaC® is high trans-sphincteric fistula-in-ano: a prospective cohort of 69 consecutive patients. Tech Coloproctol. 2019;23(9): 893-7.
Elfeki H, Shalaby M, Emile SH, Sakr A, Mikael M, Lundby L. A systematic review and meta-analysis of the safety and efficacy of fistula laser closure. Tech Coloproctol. 2020;24(4): 265-74.
Serin KR, Hacim NA, Karabay O, Terzi MC. Retrospective analysis of primary suturing of the internal orifice of perianal fistula during FiLaC procedure. Surg Laparosc Endosc Percutan Tech. 2020;30(3):266-9.
Ahmad A, Kumar A, Sonkar AA, Kumar P, Varma SK. A prospective study of combined sphincter preserving procedure (LIFT+ VAAFT+ FiLAC) in complex anal fistula. Indian J Surg. 2022:1-6.
Giamundo P. Laser treatment for anal fistulas: what are the pitfalls?. Tech Coloproctol. 2020;24(7): 663-5.
Giamundo P, De Angelis M. Treatment of anal fistula with FiLaC®: results of a 10-year experience with 175 patients. Tech Coloproctol. 2021;25(8): 941-8.
-
Abstract View: 170 times
PDF Download: 0 times
