Tissue coagulation in laser hemorrhoidoplasty – an experimental study

BackgroundLaser hemorrhoidoplasty (LHP) is a new technique for treatment of hemorrhoids. The exact extent of coagulation is not visible at the time of the procedure. There currently is no experimental or clinical data on the subject.ObjectiveTo evaluate the length of coagulation defect according to power and activation time of 1470nm diode laser on the perianal tissue model.MethodsFresh anorectal tissue of twenty-four pigs was used to produce 54 experimental samples. Each sample was randomly assigned to the laser power of 6, 8 and 10 W and 1, 2 or 3-second pulses. The procedure was performed using Biolitec Ceralas © diode laser with 1.85 mm optical fiber. The fiber was inserted in a manner, similar to intrahemorrhoidal laser application. Samples were evaluated using low-power and high-power light microscopy by a single pathologist. The length of tissue injury was measured on high-magnification microscopy.ResultsThe longest tissue injury (mean 3.93 mm) was caused by the longest laser exposure time (3 sec) with no significant difference between laser power used.Conclusions8 W 3-second application of the 1470nm diode laser results in coagulation area approximately 4 mm, and further coagulation should be initiated approximately 5 mm from the first one.

Crohn's Disease in Children

Once considered rare in children, Crohn's disease (CD) is being recognized with increasing frequency.1-3 This is due not only to physical awareness but to an alarming increase in the incidence of the disease in young people. Although early descriptions of CD localized the site of involvement to the terminal ileum, it is now recognized that all organs of the alimentary tract may be affected, and in some unfortunate patients involvement extends proximally as far as the stomach, esophagus, or oropharynx and distally, to involve even perianal tissue. Unlike ulcerative colitis which is rather clear-cut in its presentation, CD is often insidious with solitary symptoms of anorexia, weight loss, short stature, or fever of unknown origin being its only manifestation. The presenting symptoms and longterm course vary with the site of disease, and although each patient must be evaluated and treated individually, some overall predictions may be offered as to the victim's future quality of life.4-6 Significant advances have been made during the last decade in understanding the pathophysiology of the disease and in methods of its treatment, although as yet the etiology remains to be defined. Although CD has many features in common with ulcerative colitis and the two are often combined in the terminology, "inflammatory bowel disease," the pathologic findings, course, and complications are distinctive enough that they should be considered as two distinct diseases.