Laser removal of external haemorrhoids

Laser removal of external haemorrhoids is a method of surgical treatment of the disease, which involves local exposure to infrared radiation on pathological formations. The surgical intervention technique is a minimally invasive procedure, performed on an outpatient basis or as a “one-day surgery”. It is characterized by the ability to control pain, low risk of complications, and a short rehabilitation period.

Operation principle

The use of laser in medical practice is based on:

• local tissue destruction;
• aseptic burn (no inflammation);
• sterilization (removal of pathogenic microorganisms at the surgical site, which reduces the risk of complications).
• limited necrosis of the skin and subcutaneous fat (the area is replaced by connective tissue);
• cauterization of blood vessels (hemostatic effect);
• destruction of nerves.

A laser is a scalpel with analgesic and hemostatic properties.

Treatment

Options for surgical techniques:

• classical haemorrhoidectomy, closed or open;
• interstitial coagulation (minimally invasive surgery);
• combined techniques (combination with sclerotherapy or desarterization).

The latter technique involves suturing the vessels supplying the haemorrhoids, which leads to drying out and death of the formations. They are replaced by connective tissue. The advantages of the technique include short operation time, minimal invasiveness, quick recovery and low risk of complications.

Tactics for patient management are determined by the attending physician after an initial consultation, obtaining data from laboratory and instrumental research methods, the severity and extent of pathological changes.

Indications and contraindications

Clinical situations for the use of laser removal of external haemorrhoids:

• I-III stage of the disease (size of nodes 0.2-3 centimeters);
• severe pain syndrome;
• thrombosis of haemorrhoids (after relief of acute symptoms);
• formation of cracks;
• haemorrhoids that interfere with everyday activities, walking, sitting;
• risk of complications (strangulation, thrombosis, infection);
• combined removal of haemorrhoids and fissures, fistula or rectal polyp;
• large non-reducible haemorrhoids.

Surgical treatment is refused in the following situations:

• active infection;
• inflammation at the surgical site;
• disorders of the hemostatic system (increased bleeding, tendency to thrombosis);
• decreased immune response (HIV, AIDS, tuberculosis);
• pregnancy;
• secondary forms of the disease that arose against the background of decompensation of the cardiovascular system, cirrhosis of the liver, malignant neoplasms, portal hypertension;
• diabetes mellitus in the stage of decompensation;
• acute thrombosis of nodes;
• severe concomitant pathology (severe cardiovascular, respiratory, renal or liver failure).

The effectiveness of the technique is 85-95%.

Advantages

Advantages of laser removal of external haemorrhoids:

• outpatient or “one-day surgery”;
• anesthesia – regional methods (low risk of postoperative complications, patient comfort, early activation);
• precise impact on the pathological focus (minimal surgical trauma);
• no scars, cicatrices, swelling;
• combined treatment of other pathologies;
• pain control (installation of an epidural catheter);
• hemostatic effect of rays (cauterization of blood vessels);
• surgical intervention time – up to 30 minutes;
• short rehabilitation period;
• small list of restrictions;

The patient’s ability to work is not impaired: only excessive physical activity is prohibited.

Preparation

List of laboratory and instrumental examination methods prescribed before surgery:

• General analysis of blood and urine;
• Biochemical blood test (total protein, albumin, urea, creatinine, bilirubin, ALT, AST, sodium, potassium, chlorine);
• Coagulogram (APTT, PT, fibrinogen, INR);
• Electrocardiogram (ECG);
• X-ray of the OGK;
• Consultation with a proctologist;
• Anoscopy;
• Sigmoidoscopy;
• Gynecologist (women).

According to indications, the list is supplemented by ultrasound of the abdominal cavity and retroperitoneal space, CT and MRI of the abdominal cavity.

A week before surgical treatment, a diet that provides soft stools is recommended: porridge, fermented milk products, sufficient fluid intake (2-3 liters per day). An enema is indicated for excision of internal formations.

Operation progress

The patient is located on a couch or gynecological chair. The doctor removes formations with a laser (3-4 pieces per procedure). Surgical treatment time is 15-30 minutes.

Anesthesia can be local, regional or other, depending on the scope of the intervention and the patient’s condition. An epidural catheter allows pain medication to be administered and controlled, but is not suitable for everyone. With regional anesthesia, the patient may remain conscious; the need for sedation is discussed separately. The anesthesiologist evaluates contraindications, medications and possible complications. Pain management and early mobilization are part of postoperative care, but do not guarantee the absence of pneumonia or thromboembolism.

Postoperative and rehabilitation period

Recommendations:

• The patient is allowed to carry out normal activities and return to work the next day.
• Limit excessive physical activity to 7 days.
• Careful observance of personal and intimate hygiene (washing the anal area after defecation).
• Taking analgesics for pain.
• Local treatment (dressings, suppositories). Prescribed by a doctor before discharge.
• You should refrain from eating spicy and fried foods and alcoholic beverages for up to 14 days. Include fermented milk products and a large amount of fiber in your diet. Maintain adequate drinking regime – 2-3 liters of fluid per day.
• It is allowed to take laxatives for constipation and stool softeners.
• Repeat visit to your doctor on days 7-10 to monitor the recovery period.

In case of bleeding, intense pain, fever, local swelling, you should contact the clinic to exclude complications.