Laser HemorrhoidoPlastyLaser Hemorrhoidectomy

Haemorrhoids:

Everybody has haemorrhoids

Fine tuning of the rectal closure

30-50% of the people over 50 have enlarged haemorrhoids

75% of the hemorrhoids progress in size if they are no treated

Causes for Haemorrhoids:

Wrong diet – too less fibers and liquids

Diarrhea

Misuse of laxative

Too much pressure, long toilet time

High sphincter tonus

Pregnancy

Pathogenesis

Usual treatment options :

Change of diet and lifestyle (Grade I)‏

Lotions, medicaments, ointments (Grade I)‏

Rubber band, sclerotherapy, infrared coagulation (Grade I + II)‏‏

Closed surgery: Stapler Hemorrhoidopexy (Grade III)‏‏

Open surgery: Milligan-Morgan, Parks (Grade III + IV)‏

Hemorrhoid Laser Procedure

Facts on Hemorrhoidoplasty:

Couple of days until a week in hospitalPain for 7-10 daysPostoperative bleedingInfectionsAbcesProblems with sittingOpen wounds need 4-6 weeks to heelNecessity of taking baths

Conventional Hemorrhoidoplasty

Three treatment principles with laser:

Reduction of the hemorrhoidal tissue, not total destruction/excision

Reconstruction of the natural anatomy

Non touch of the anoderm

Laser Hemorrhoidoplasty (LHP)‏

LHP Plattform

Diode Laser 980/1470nm

LHP Fiber : Delivery of energy in conical shape

Characteristics of lasers fibresStandard is bare fibre

Working mechanism: High temperatures on fibre tip lead to hot neadle effect. Temperature gradient to surrounding tissue structures.

Homogeneous radiation on certain tissue region. No hot spots. No carbonisation.

The influence of the laser wavelength

Better controlls on tissue depth

Laser Hemorrhoidoplasty (LHP)‏

Advantages:

•Painless procedure

•Outpatient or short hospital stay (overnight)

•Short down times

•No stenosis

•No incontinence

•No mucosa damaging

•No foreign body insertion (no clamp complications)‏

•No application of medicaments

•Less complications

•Several repetitions possible

Pilonidal cyst/ sinus

Symptoms

• Usually present with abcessformation

Traditional Excision

Less symptomatic disease

• Soiling

• Perineal mass

• itching

Pilonidal cyst

Therapeutic Goal

To treat as less invasive as possible

Laser Operative Technique

Laser Operative Technique

Operative Technique

Advantages

• Safe procedure

• Smaller wounds

• Less pain

• Low complication rate

• Early „Return to work“

• High patient satisfaction

• Daycare or outpatient surgery possible