Background:
Minimally-invasive treatments for hemorrhoids should be encouraged as they
cause low morbidity, reasonable discomfort and quicker return to work. According to the
“vascular theory” hemorrhoidal disease is mainly caused by blood overflow into hemorrhoidal
plexus deriving from the superior hemorrhoidal arteries.
Introduction:
Many different procedures have been described in the literature with the common
goal of reducing the blood flow into the hemorrhoidal piles. ‘HeLP’ (Hemorrhoids Laser
Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic
hemorrhoids.
Methods:
The procedure consists of the closure of the terminal branches of the superior rectal
artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode
laser platform. The arteries, at that level, have variable location and distribution. Therefore, a
doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed
otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required
in most cases and the procedure allows a quick return to daily activities. In case of concomitant
severe mucosal prolapse, the laser treatment can be combined with suture mucopexy. Three to
six running sutures allow a complete lifting of hemorrhoidal piles, securing long-term resolution
of symptoms.
Results and Conclusions:
‘HeLP’ is indicated in patients with symptomatic hemorrhoids where
conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The
addition of mucopexy to laser treatment (HeLPexx) contributes to overall resolution of
symptoms when mucosal prolapse is an issue,
Emborrhoid is another novel, ‘hi-tech’ form of selective dearterialization used in selected case of
hemorrhoids where main symptom is bleeding. It is generally used in cases where surgery is
contraindicated due to severe concomitant diseases.
Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS)