Hemorrhoid laser dearterialization: systematic review and meta-analysis

The LHP Recommendation Development Group, Ambe PC, Martin-Martin GP, Vasas N, Piponski I, Roman IH, Hernandez JDP, Ma H, Lin H, Weyand G, Mazlan L, García Flórez LJ, Wolff K, Dessily M, Wang C, Dobricanin V, Yang W, Bruketa T, Zeng X, Avdicausevic S, Zhang Z, Wais S, Kalaskar S, Cui Z, Pestonit IB, Cao Y, Suárez Sánchez A, Ren D, Vargas Castillo E, Zheng D, Bogdanic B, Wölk A, Yao Y, Issaad S, Nasser T, Guo X, Nagar MM, Merkle M, Ruiz-Lopez M, Zhang Y, Blumberg C, Alam AA, Acosta AC, Schouten R, Istok P, Demtröder C, Wang Z, Dong Q, Wu J. Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations

BACKGROUND

Laser hemorrhoidoplasty (LHP) has emerged as a novel, minimally invasive technique for managing symptomatic hemorrhoids, gaining popularity among clinicians. Despite its increasing adoption, significant variations exist in the application of LHP across different practices.

PURPOSE

The aim of these recommendations was to spell out some basic principles and recommendations for performing a standard LHP procedure.

METHODS

The Recommendation Development Group (RDG) consisting of surgeons with experience in LHP were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above.

RESULTS

The RDG developed 21 recommendations that were voted upon by 49 panelists. Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus.

CONCLUSION

The RDP offers a comprehensive suite of guidelines to enhance the safety and efficacy of standard LHP procedures. Out of 21 detailed recommendations, 16 reached strong consensus, collectively addressing the full spectrum of LHP procedures-from laser settings and preoperative preparations to perioperative strategies and postoperative care. This coherent framework is anticipated not only to standardize but also to refine the LHP technique across the board, thereby elevating the management of symptomatic hemorrhoidal disease.

Bio-thermal response during laser haemorrhoidoplasty: an exclusive analytical and numerical approach for theoretical investigation

Haemorrhoidal disease is identified by declension of the inflamed and bleeding of vascular tissues of the anal canal. Traditionally, haemorrhoids are associated with chronic constipation and the most common symptoms are irritation in anus region, pain and discomfort, swelling around anus, tender lumps around the anus and rectal bleeding (depending upon the grade of haemorrhoid). Among the several conventional treatment procedures (commonly mentioned as, rubber band litigation, sclerotherapy and electrotherapy), laser haemorrhoidoplasty is an out-patient and less-invasive laparoscopic procedure. From literature survey it has been observed that an exclusive theoretical model depicting the impact of 1064 nm wavelength laser wave on living tissues subjected to haemorrhoid therapy is not available. This research work is a pioneering attempt to develop a theoretical study attributing specifically on laser therapy of haemorrhoid treatment based on Pennes' biological heat transfer model. The corresponding mathematical model has been solved by analytical method to establish thermal response of tissue during the treatment and also the same has been solved a numerical approach based on finite difference method to validate the feasibility of former method due to unavailability of any theoretical model. Impact of variation of blood perfusion term, laser pulse time and optical penetration depth on temperature response of skin tissue is captured. The tissue temperature decreases along with time of laser exposure with increasing the blood perfusion rate as it carries away large amount of heat. With the increase in laser pulse time, tissue temperature declines due to shorter pulse time resulting in higher energy consumed by electrons. The research outcome is successfully validated with less than 1% of error observed between the appointed analytical and numerical scheme.

Toward less invasive coloproctology: The future is out there

Medical care has undergone remarkable improvements over the past few decades. One of the most important innovative breakthroughs in modern medicine is the advent of minimally and less invasive treatments. The trend towards employing less invasive treatment has been vividly shown in the field of gastroenterology, particularly coloproctology. Parallel to foregut interventions, colorectal surgery has shifted towards a minimally invasive approach. Coloproctology, including both medical and surgical management of colorectal diseases, has undergone a remarkable paradigm shift. The treatment of both benign and malignant colorectal conditions has gradually transitioned towards more conservative and less invasive approaches. An interesting paradigm shift was the trend to avoid the need for radical resection of rectal cancer altogether in patients who showed complete response to neoadjuvant treatment. The trend of adopting less invasive approaches to treat various colorectal conditions does not seem to be stopping soon as further research on novel, more effective and safer methods is ongoing.