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Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease

Abstract

Background

The hemorrhoid laser procedure with suture-pexy (HeLPexx), consisting of Doppler-guided hemorrhoidal dearterialization with laser and the addition of anal mucopexy, is a novel non-excisional procedure to treat hemorrhoids. The aim of the present study was to describe the technique and report the clinical and long-term results.

Methods

A prospective study was conducted on patients with grade III hemorrhoids who had HeLPexx from January 2012 to February 2018. Pre- and postoperative assessment included a thorough clinical examination, constipation and incontinence scoring systems and a symptom questionnaire which was administered at all patients before surgery and at each follow-up visit to evaluate bleeding, prolapse, manual reduction, discomfort or pain, and impact on quality of life. Each symptom had a score between 0 and 4, (0 indicates no symptoms and 4 indicates daily symptoms). The sum of the score for each symptom constituted the Hemorrhoid Symptom Score. Resolution of symptoms, pain, morbidity, need for further medical and/or surgical therapy were also recorded.

Results

One hundred and seventy consecutive patients with grade III hemorrhoids [74 females; mean age 49.5 years (range 22–79) years] were included. Median length of follow-up was 36 (range 12–72) months. Postoperative morbidity included urinary retention (7 patients, 4.1%), bleeding not requiring transfusion (1 patient, 0.6%) and thrombosis of hemorrhoidal piles (2 patients, 1.2%). The mean postoperative pain VAS score at 1 week postoperatively was 1.8 ± 1.1 (range 0–5) and 12 (7%) patients used pain medications for more than 1 week postoperatively while none of the patients reported any pain by the end of the third week postoperatively. The Hemorrhoid Symptom Score significantly improved from 15.83 ± 3.04 to 1.3 ± 2.4 (p ≤ 0.001) and showed a statistically significant improvement in all items. Recurrent symptoms were reported in 12 patients (7%) who required further treatment. Severe chronic constipation prior to surgery was found to be a predictive factor of failure (p = 0.04).

Conclusions

HeLPexx appears to be safe and effective for treatment of symptomatic hemorrhoids. Further studies are needed to confirm our results.

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References

  1. 1.

    Giamundo P, Cecchetti W, Esercizio L, Valente M et al (2011) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 25:1369–1375

  2. 2.

    Crea N, Pata G, Lippa M, Chiesa D, Gregorini ME, Gandolfi P (2014) Hemorrhoidal laser procedure: short- and long-term results from a prospective study. Am J Surg 1:21–25

  3. 3.

    De Nardi P, Tamburini AM, Gazzetta PG, Lemma M, Pascariello A, Asteria CR (2016) Hemorrhoid laser procedure for second and third-degree hemorrhoids: results from a multicenter prospective study. Tech Coloproctol 20(7):455–459

  4. 4.

    Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54:693–698

  5. 5.

    Goligher JC (1980) Hemorrhoid or piles. In: Goligher JC (eds) Surgery of the anus rectum and colon. Bailliere Tindall, London

  6. 6.

    Altomare D, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statistical validation of a new scoring system for obstructed defecation syndrome. Colorectal Dis 1:84–88

  7. 7.

    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97

  8. 8.

    Giordano P, Nastro P, Davies A, Gravante G (2011) Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialization for stage II and III haemorrhoids: 3-year outcomes. Tech Coloproctol 15:67–73

  9. 9.

    Aigner F, Bodner G, Conrad F, Mibaka G, Koreczy A, Fritsch H (2004) The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 187:102–108

  10. 10.

    Schuurman JP, Go PM, Bleys RL (2009) Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 11:967–971

  11. 11.

    Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR (2018) The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Dis Colon Rectum 61:284–292

  12. 12.

    Franklin EJ, Seetharam S, Lowney J, Horgan PG (2003) Randomized, clinical trial of Ligasure vs. conventional diathermy in hemorrhoidectomy. Dis Colon Rectum 46:1380–1383

  13. 13.

    Kwok SY, Chung CC, Tsui KK, Li MKW (2005) A double-blind, randomized trial comparing Ligasure and Harmonic scalpel hemorrhoidectomy. Dis Colon Rectum 48:344–348

  14. 14.

    Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 13:1603–1618

  15. 15.

    Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613

  16. 16.

    Dal Monte PP, Tagariello C, Sarago M (2007) Transanal haemorrhoidal dearterialization:nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–339

  17. 17.

    Giordano P, Tomasi A, Pascariello A, Mills E, Elahi S (2014) Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis 16:373–376

  18. 18.

    Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 54:226–231

  19. 19.

    Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671

  20. 20.

    Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P (2013) Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 15:e284–e294

  21. 21.

    Ratto C, Parello A, Veronese E et al (2014) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicenter trial. Colorectal Dis 17:10–19

  22. 22.

    NICE Interventional Procedure Guidance 342, N2155 12 May 10. http://www.nice.org.uk/nicemedia/live/12236/48673/48673.pdf. Accessed May 2010

  23. 23.

    Denoya PI, Kakhoury M, Chang K, Fakhoury J, Bergamaschi R (2013) Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial. Colorectal Dis 15:1281–1288

  24. 24.

    Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E (2017) Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol 5:337–344

  25. 25.

    Brown SR, Tieman JP, Watson AJM et al (2016) Haemorrhoidal artery ligation in the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicenter, open-label randomized trial. Lancet 10042:356–364

  26. 26.

    Infantino A, Altomare DF, Bottini C et al (2011) Prospective randomized multicenter study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis 14:2015–2213

  27. 27.

    Gupta PJ, Kalaskar S, Taori S, Heda PS (2011) Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 hemorrhoids. Tech Coloproctol 15:439–444

  28. 28.

    Basile M, Di Resta V, Ranieri E (2016) Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up. Tech Coloproctol 20:353–359

  29. 29.

    Masson JL (1990) Outpatient hemorrhoidectomy using CO2 laser. J Chir 127:227–229

  30. 30.

    Ram E, Bachan GR, Goldes Y, Joubran S, Rath-Wolfson L (2018) Modified Doppler-guided laser procedure for the treatment of second- and third-degree hemorrhoids. Laser Ther 27:137–142

  31. 31.

    Giamundo P, Braini A, Calabro G, Crea N, De Nardi P, Fabiano F, Lippa M, Mastromarino A, Tamburini AM (2018) Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Tech Coloproctol 22:636–643

  32. 32.

    Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305

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Author information

Correspondence to P. Giamundo.

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Conflict of interest

PG: Surgical Trainer for Biolitec, Biomedical Technology (no financial interests); MDA: no conflict of interest; AM: No conflict of interest.

Ethical approval

The study was conducted in accordance with the ethical standards reported in the Declaration of Helsinki.

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All patients provided written informed consent.

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Giamundo, P., De Angelis, M. & Mereu, A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol 24, 199–205 (2020). https://doi.org/10.1007/s10151-020-02152-6

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Keywords

  • Hemorrhoids
  • Laser therapy
  • HeLP
  • Dearterialization
  • Anal mucopexy