Long-Term Results of Laser Submucosal Destruction in the Treatment of Grade 2–3 Hemorrhoids

Aim: improvement the results of treatment in patients with Grade 2–3 of hemorrhoids. Materials and methods. A single-center prospective study included 90 patients with Grade 2–3 haemorrhoidal disease who met the inclusion criteria. All patients underwent transdermal laser submucosal destruction of internal hemorrhoids with a water-absorbed laser with a wavelength of 1940 nm according to the method proposed by us. In the course of the procedure the laser effect is applied both to the cavernous tissue of hemorrhoidal nodes and to the terminal branches of the superior rectal artery. The primary endpoints of the study were destruction of the cavernous tissue of internal hemorrhoidal nodes and the frequency of recurrence of the disease. The effectiveness of the technique was assessed using anoscopy, ultrasound examination with a rectal sensor with spectral-wave Dopplerography 1, 3, 6 and 12 months after surgery. At the same time, the quality of life and the severity of hemorrhoidal disease symptoms were assessed using the SF-36 scale and a point assessment of the clinical manifestations of hemorrhoids. In the first 7 days after surgery, the intensity of the pain syndrome was analyzed using the Visual Analog Scale (VAS). In order to determine the safety of the technique with respect to the effect on the locking apparatus of the rectum, sphincterometry was performed in all patients. Intra- and postoperative complications and recurrences of the disease within 1 year were also recorded, the causes of the return of clinical manifestations of hemorrhoidal disease were analyzed. Results. The level of pain syndrome by day 7 after surgery corresponded to 0 points on the VAS in 52 (58 %) patients. Intraoperatively, bleeding occurred in 3 (3.3 %) patients and submucous hematoma formed in 15 (16.7 %) patients. In the early postoperative period, thrombosis of external hemorrhoids developed in 5 (5.6 %) patients, two of these patients developed acute urinary retention. Internal hemorrhoids determined before surgery were not visualized one month after surgery either by anoscopy or by ultrasound examination with a rectal sensor. According to the results of spectral wave Dopplerography, a persistent decrease in blood flow along the terminal branches of the superior rectal artery is noted for up to 12 months after the intervention. According to sphincterometry, no changes in the parameters of the anal sphincter function were noted compared with the preoperative parameters. 18 and 24 months after the operation, two patients were diagnosed with recurrence of hemorrhoidal disease. The analysis showed that the reason for the return of clinical manifestations of the disease was the supply of insufficient laser energy. Conclusion. Laser submucosal destruction of internal hemorrhoids using a laser with a wavelength of 1940 nm is a minimally invasive method for treating Grade 2–3 of hemorrhoidal disease, which has demonstrated high efficiency (good results) in the late postoperative period. Thus, according to the results of our study, the return of clinical manifestations of hemorrhoidal disease was revealed only in 2 patients after 18 and 24 months. A repeated laser destruction procedure allowed us to achieve a good result in these patients.