Medica 2011

Laser Hemorrhoidoplasty (LHP)

Arne Wilhelm1, Volker Nutz1, Guido Weyand², Andreas Keerl³

1Enddarm- und Beckenbodenzentrum Köln

² Kreisklinikum Siegen

³ Kantonsspital Baden, Schweiz

Symtoms

• Bleeding

• Itching

• Soiling

• Burning

• Incontinence

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Therapeutic Goal

Do not get rid of the hemorrhoids ... Get rid of the symptoms !

3° Hemorrhoids

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3° hemorrhoids

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• Resection

– Open (Milligan Morgan)

– Cosed (Parks, Ferguson)

– Stapled hemorrhoidopexie (Koblandin, Pescatori, Longo)

• Non resection

– Hemorrhoidal-Artery-Ligation (HAL) with or without Recto-Anal-

Repair (RAR),

– Transanal Hemorrhoidal Dearterilisation (THD)

– Laserhemorrhoidoplastie (LHP)

Operative Techniques

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Laser Hemorrhoidoplasty - LHP

•Ceralas E diode laser

•1470 nm wave length

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LHP probe

• Sharp tip for improved

tissue penetration

• Radial laser energy

• Advantages:

– Homogeneous

applicationof energy

– Controlled tissue

infiltration

– No „hot spots“

– No carbonisation

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Treatment considerations

– Shrinking of hemorrhoidal segments

– Preserving of anal canal anoderm

– Restoring of normal anatomy

Energy: 8 W, pulse mode (3 sec)

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LHP –Video 1

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LHP – Video 2

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LHP – Data

Pat.

N=496

Age Segmental Circular Additional

ORs

Mucopexie/

HAL

Karahalioglu1

01/06 – 10/09

332 46 227 76 25 115

Wilhelm

12/10 – 8/11

10 46 5 5 - 10

Nutz

4/10 – 8/11

55 45 45 14 36 12 (HAL)

Weyand

11/10 – 7/11

64 55 35 29 22 29

Keerl

11/10 – 3/11

35 k. A. 16 29 k. A. -

1 Karahalioglu, Coloproctolgy 2010

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LHP – Complikationen

Bleedin

g

Thrombosis Nekrosis Fibroma Fistula Urinary

retention

Karahalioglu

n = 332

0,6 % 1,5 % 0,3 % 7,8 % 0,6 % 2,1 %

Wilhelm

n = 10

- - - 10 % - -

Nutz

n = 55

3,6 % - 3,6 % 9 % - -

Weyand

n = 64

1,5 % 4,6 % - - - 1,5 %

Keerl

N =35

5,7 % 2,8 % - - 2,8 % -

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AU / die Benefit Recommen

dation

Re-OR Ligatures Recurr

ence

Karahalioglu

n = 332

5,8 k. A. k. A. 1,8 % k. A. 5,8 %

Wilhelm

n = 10

16 90 % 90 % - - -

Nutz

n = 55

9 94 % k. A. - 6,2 % -

Weyand

n = 64

k. A. 92 % 95 % 3,6 % 5,4 % -

Keerl

N =35

4,2 94 % 94 % - k. A. -

LHP - Data

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LHP – Pain (VAS)

Day 1 Day 3 Day 7 No Pain

Karahaliloglu

n = 332

4,5

(1,5)

3,0

(0,5)

1,4

(0,1)

k. A.

Wilhelm

n = 10

4,5 5 2,1 10 days

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Conclusion

• Individual and stage adopted therapy of hemorrhiodal

disease

• Main therapeutic effect: Modulation of blood supply

• LHP :

Saving of hemorrhoidal tissue and anoderm

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Advantages

• Safe procedure

• Mild to moderate pain

• Low complication rate

• Early „Return to work“ (ca. 1-2 weeks)

• No incontinence

• High patient satisfaction

• Daycare or outpatient surgery possible

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Enddarm- und Beckenbodenzentrum Köln

www.ebzkoeln.de