Abstract
Background
Doppler-guided hemorrhoidal laser procedure (HeLP) is a new minimally invasive technique to treat symptomatic hemorrhoids. The aim of this multicenter study was to prospectively assess clinical results and patients’ satisfaction in patients treated with HeLP.
Methods
Indications for HeLP included patients with symptomatic hemorrhoids resistant to medical therapy, with low-grade prolapse. Clinical efficacy was evaluated assessing resolution of symptoms and patient satisfaction. Frequency of bleeding and frequency of acute hemorrhoid-related symptoms were given a score of 0 to 4 (where 4 = more than 3 episodes/week) and 0 to 3 (where 3 = more than 5 episodes/year), respectively. Quality of life, pain at rest, and pain with evacuation were scored using a visual analogue scale (VAS) of 0 to 10. Intra- and postoperative complications were recorded. Potential predictive factors for failure were assessed.
Results
Two hundred and eighty-four patients (183 males, 101 females) with a mean age of 47.5 years were included in the study. At 6-month follow-up, symptoms had completely resolved in 257/284 (90.5%) and 275/284 (96.8%) patients were satisfied with the results. An analysis of a subgroup of 144 patients followed up for a minimum of 12 months revealed a resolution of symptoms in 130/144 (90.3%) and satisfaction in 139/144 (96.5%). There was a statistically significant improvement of the bleeding score (from 2.4 ± 1.07 to 0.36 ± 0.49; p < 0.0001), acute symptoms score (from 2.03 ± 0.16 to 0.61 ± 0.59; p < 0.0001), quality of life (from 4.63 ± 1.32 to 8.96 ± 1.35; p < 0.0001), pain at rest (from 3.0 ± 2.05 to 1.1 ± 0.99; p < 0.0006), and pain with evacuation (from 4.8 ± 1.22 to 1.7 ± 1.15; p < 0.0001). No significant changes in continence and constipation were observed. Univariate analysis failed to show factors significantly associated with failure.
Conclusions
The HeLP procedure seems to be safe and effective in patients with symptomatic hemorrhoids. It is simple, minimally invasive, and relatively pain free. It can be performed in an ambulatory setting without anesthesia, and it achieves high patient satisfaction. It may, therefore, be considered a “first-line treatment” in all patients without significant hemorrhoidal prolapse in whom medical therapy has failed.
Similar content being viewed by others
References
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 conjuction with a Doppler flowmeter. Am J Gastroenterol 90:610–613
Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritsch H (2004) The superior rectal artery and its branching pattern with regard to its clinical influence in ligation techniques for internal hemorrhoids. Am J Surg 187:102–108
Schuurman JP, Go PM, Bleys RL (2009) Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 11:967–971
Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pitaluga M, Tibaldi L, Torre G, Valente M (2011) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental beckground and short-term clinical results of e new mini-invasive treatment. Surg Endosc 5:1369–1375
Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97
Altomare D, Spazzafumo L, Rinaldi M, Dodi G, Ghiselli R, Piloni V (2008) Set-up and statisticl validation of a new scoring system for obstructed defecation syndrome. Colorectal Dis 1:84–88
Goligher JC (1980) Hemorroid or piles. In: Goligher JC (ed) Surgery of the Anus Rectum and Colon. 4th Edition, Bailliere Tindall, London
Gerjy R, Lindhoff-Larson A, Nystrom PO (2008) Grade of prolapse and symptoms of hemorrhoids are poorly correlated: results of a classification algorithm in 270 patients. Colorectal Dis 10:694–700
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
Dal Monte PP, Tagariello C, Sarago M, Giordano P, Shafi A, Cudazzo E, Franzini M (2007) Transanal haemorrhoidal dearterialization; nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338
Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal haemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671
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
NICE Interventional Procedure Guidance (2010) 342,N2155 12 May. http://www.nice.org.uk/nicemedia/live/12236/48673/48673.pdf
Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S, Yalti T, Giamundo P, Hoch J, El Gaddal A, Pagano C (2011) Prospective randomized multicenter study comparing stapler hemorrhoidopexy with Doppler-guided transanal hemorrhoid dearterialization for third-degree hemorrhoids. Colorectal Dis 14:205–213
Denoya PI, Fakhoury 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
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 May 21(5):337–344
De Nardi P, Capretti G, Corsaro A.Staudacher C (2014) A prospective, randomized trial comparing the short-and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum 57(3):348–353
Brown SR, Tieman JP, Watson AJM, BIGGS K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, HubBle Study team (2016) Haemorrhoidal artery ligation versus rubber band ligation in the management of symptomatic second- degree and third-degree haemorrhoids (HuBble): a multicenter, open-lable randomized trial. Lancet 23(10042):356–364
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
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
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
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
Giamundo P. Geraci M, Tibaldi L, Esercizio L, Agostini S, Testore P, Valente M (2014) Laser hemorrhoidal arterial closure (HeLP) with recto-anal-repair (RAR): a novel procedure for the treatment of advanced hemorrhoidal disease (Abstract). Colorectal Dis 3:21–36
Gallo G, Podzemny V, Pescatori M (2016) Intestinal obstruction requiring fecal diversion due to rectal hematoma following a hemorrhoid laser procedure (HeLP). Tech Coloproctol Jul 20(7):507–508
Giamundo P, De Nardi P (2016) Intestinal obstruction following a hemorrhoid laser procedure (HeLP). Tech Coloproctol 20(10):727–728
Funding
No funding was obtained for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Compliance with ethical standards
Conflict of interest
The first author declares that he is a “Surgical Trainer” for Biolitec Biomedical Technology with no financial interests; the other authors declare that they have no conflict of interest.
Ethical approval
This type of study is exempt from IRB approval in all of the participating institutions.
Informed consent
Informed consent was obtained from all individual participants in the study.
Rights and permissions
About this article
Cite this article
Giamundo, P., Braini, A., Calabro’, G. et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Tech Coloproctol 22, 635–643 (2018). https://doi.org/10.1007/s10151-018-1839-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-018-1839-5