Hemorrhoidal Dearterialization with Laser: Techniques and Results
Hemorrhoidal dearterialization with laser (HeLP) is a novel form of dearterialization to treat patients with symptomatic hemorrhoids. Terminal branches of the superior hemorrhoidal artery localized 3 cm above the dentate line are sealed by means of diode laser. Due to the restricted area of shrinkage elicited by the laser beam and the variable anatomic distribution of the vessels, the Doppler signal is deemed mandatory in order to locate the arteries.
The laser energy causes minimal discomfort to patients, therefore no anesthesia is required. Patients can be discharged 2 hours after the operation and are allowed to resume normal activities with no restrictions.
Long-term results show high success and low morbidity rates. The HeLP is mainly indicated in patients suffering from symptomatic hemorrhoids with minimal or moderate mucosal prolapse. In case of significant prolapse, a variation of the HeLP procedure has been proposed: the HeLPexx. In the HeLPexx, after sealing the hemorrhoidal arteries with laser, three to six running sutures are placed on the prolapsing mucosa causing lifting of hemorrhoidal plexus. The addition of mucosopexy to laser treatment has a clear advantage in terms of long-term resolution of mucosal prolapse.
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