Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature

Abstract

Non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD). However, so far, their efficiency is based on low-level evidence. Therefore, we aimed to systematically review the efficiency of non-excisional laser therapies for HD. MEDLINE/Pubmed, Web of science, Embase, and Cochrane were searched from database implementation until the April 17th, 2020. We included studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies, encompassing laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP). Fourteen studies describing LH and HeLP were included, representing 1570 patients. The main intraoperative complication was bleeding (0–1.9% of pooled patients for LH, 5.5–16.7% of pooled patients for HeLP). Postoperative complications occurred in up to 64% of patients after LH and 23.3% after HeLP. Resolution of symptoms ranged between 70 and 100% after LH and between 83.6 and 90% after HeLP. Moreover, four randomized controlled trials included in our review reported similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation. Recurrence rate was reported to range between 0 and 11.3% after LH and between 5 and 9.4% after HeLP. When compared with hemorrhoidectomy, LH showed conflicting results with one randomized controlled trial reporting similar recurrence rate, but another reporting decreased recurrences associated with hemorrhoidectomy. Laser therapies showed lower postoperative pain than hemorrhoidectomy or rubber band ligation. LH and HeLP are safe and effective techniques for the treatment of grades II and III HD.

Laser treatment of pilonidal disease: a systematic review

“…The application of laser in proctology was first described by Karahaliloglu in 2007, who reported the first results of nonexcisional therapy of hemorrhoidal disease (HD) called laser hemorrhoidoplasty (LHP). Since then, many relevant studies, including randomized controlled trials, demonstrated that LHP is safe and effective for the treatment of HD while it provides a very low pain and discomfort period [27][28][29][30][31][32][33].…”

Clinical Outcomes in Patients with Hemorrhoids Treated by Finger Guided Hemorrhoidal Artery Ligation with Laser Hemorrhoidoplasty: A Retrospective Cohort Study

“…Moreover, the three RCTs had a significantly shorter operation time with LH versus open HC (mean 33.1 min ± 7.3 vs. mean 52.6 min ± 15.6, p < 0.001; mean 30.6 min ± 4.9 vs. mean 50.5 min ± 12.1, p < 0.001; mean 15 min±5.6 vs. mean 29 min±10.3, p < 0.001, respectively). Four studies described the hospitalization duration, which ranged from 3 to 48 h and was similar to open HC [19].…”

Comparison of post-operative bleeding incidence in laser hemorrhoidoplasty with and without hemorrhoidal artery ligation: a double-blinded randomized controlled trial

“…These reported approximations do not include haemorrhoid sufferers who evade medical help and rely on over-the-counter medications [ 2 , 3 ]. Non-excisional hemorrhoidal procedures have been gaining popularity as a treatment for these symptomatic haemorrhoids as these procedures are significantly less painful as minimally invasive procedure [ 4 – 6 ]. Furthermore, post-operative complications and recurrence rates are comparatively low for non-excisional procedures [ 7 ].…”

“…On the other hand, Laser Hemorrhoidoplasty (LHP) utilizes diode lasers, in a non-excisional manner, and is associated with reduced post-operative pain. It is particularly useful for grade 1–2 haemorrhoids, where prolapse is less significant [ 6 , 9 ]. However, a relatively common complication is post-operative bleeding, with Clavien-Dindo Class III bleeding in the region of 1–5% [ 10 ].…”