Year 2013 Vol. 21 No 1

REVIEWS

M.YU. GAIN

LASER TECHNOLOGIES IN COMPLEX TREATMENT OF HEMORRHOIDS

SEE “Belarusian Medical Academy
of Postgraduate Education”.
The Republic of Belarus

Objectives. Using modern digital search systems to carry out the analysis of the national and foreign literature, concerning applications of mini-invasive laser technologies in surgical treatment of hemorrhoids, and by means of it to define the perspective directions to increase efficiency in the complex treatment of this disease and its complications.
Methods. With the use of the text database of medical and biological publications PubMed (on the basis of “Biotechnology” section of U.S. National Library of Medicine through the access NCBI-Entrez by principle application of “Medical Subject Headings” (MeSH), and also by means of the information received in funds of the State Establishment “Republican Scientific Medical Library” and library of the State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”, the analysis of more than 700 medical sources of the special literature and full-text articles devoted to the high-intensity laser systems use in treatment of chronic hemorrhoids and its complications has been carried out.
Results. According to literary data, the destruction of hemorrhoidal nodes by means of the W-laser (classification of R.A. Weiss and Í. Valley) is considered to be a mini-invasive method of hemorrhoid treatment, based on the interstitial thermal therapy of nodes with its subsequently wrinkling, sclerosing and disappearance, and also occlusion influence on a vascular component. The performance of this method under local infiltrative anesthesia in ambulatory conditions should be considered as a positive aspect and advantage as well as absence of clinically significant rehabilitation period, fast restoration and returning of a patient to a normal life and work. All listed sets the conditions for improvement of patients’ life quality that provides considerable social and economic effects and allows speaking about prospects of new techniques use in ambulatory and mini-invasive proctology and surgery.
Conclusions. Priority of active surgical tactics, a reliable hemostasis and biological properties of the W-laser radiation, absence of necessity for long-term hospitalization appears to be the factors permitting to receive good results of acute and chronic hemorrhoids treatment.

Keywords: hemorrhoids, complications, mini-invasive technologies, intrahemorrhoidal laser influence
p. 94 – 104 of the original issue
References
  1. Vorob'ev GI, Blagodarnyi LA, Shelygin IuA. Gemorroi: ruk dlia prakt vrachei [Hemorrhoids: a practical guide for physicians]. 2-e izd, pererab, dop. Moscow, RF: Litterra; 2010. 200 p.
  2. Datsenko BM, Datsenko AB. Gemorroi [The hemorrhoids]. Kharkov, Ukraine: Novoe slovo; 2011. 144 p.
  3. Rivkin VL, Kapuller LL, Belousova EA. Koloproktologiia: ruk dlia vrachei [Coloproctology: a guide for physicians]. Moscow, RF: GEOTAR-Media; 2011. 368 p.
  4. Adamian AA, Magomadov RKh, Kutin AA, Naumov SS. Osobennosti khirurgicheskogo lecheniia v tsentre ambulatornoi khirurgii [Features of surgical treatment in Center for ambulatory surgery]. Annaly Plast, Rekonstrukt i Estet Khirurgii. 2007;(1):80–83.
  5. Mukhin AG, Volkov AV, Komarova MIu. Lechenie gemorroia v ambulatornykh usloviiakh [Treatment of hemorrhoid in an outpatient conditions]. Koloproktologiia. 2010;(1):18–20.
  6. Genri MM, Svosha M, red, Morozova NV, Rivkina VL, per s angl. Koloproktologiia i tazovoe dno. Patofiziologiia i lechenie [Coloproctology and the pelvic floor. Pathophysiology and treatment]. Moscow, RF: Meditsina; 1988. 464 p.
  7. Shakhrai SV, Denisenko VL, Gain MIu. Maloinvazivnaia khirurgiia khronicheskogo gemorroia: ucheb-metod posobie [Minimally invasive surgery of chronic hemorrhoids: a training handbook]. Minsk, RB; 2011. 36 p.
  8. Greenberg R, Karin E, Avital S, Skornick Y, Werbin N. First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum. 2006 Apr;49(4):485–89.
  9. Gearhart SL. Symptomatic hemorrhoids. Adv Surg. 2004;38:167–82.
  10. Perekhodov SN, Vologdin AA. Khirurgicheskaia anatomiia priamoi kishki i anal'nogo kanala: ucheb posobie [Surgical anatomy of the rectum and anal canal: a study guide]. Moscow, RF: GIUV MO RF; 2010. 58 p.
  11. Iaitskii HA, Vasil'ev SV, Sednev AV. Ispol'zovanie poluprovodnikovogo lazera v khirurgicheskom lechenii khronicheskogo gemorroia [The use of a semiconductor laser in the surgical treatment of chronic hemorrhoids]. Regionar Krovoobrashchenie i Mikrotsirkuliatsiia. 2002;(2):17–21.
  12. Skobelkin OK. Lazery v khirurgii [Lasers in surgery]. Moscow, RF: Meditsina; 1989. 256 p.
  13. Statsenko VT, Iupatov SI, Gertsen AV. Primenenie lazerov v khirurgii anorektal'noi oblasti [The use of lasers in surgery of the anorectal area]. Zdravookhranenie Belorussii. 1990;(3):38–40.
  14. Liandresa IG, red. Lazery v klinicheskoi khirurgii [Lasers in clinical surgery]. Minsk, RB; 1997. 228 p.
  15. Walfisch S, Ohana N, Charuzi E. Nd: YAG laser for anorectal surgery: initial experience in Israel. Harefuah. 1994 Jan 2;126(2):1–4, 56.
  16. Geinits AV, Elisova TG. Lazery v khirurgicheskom lechenii gemorroia [Lasers in the surgical treatment of hemorrhoids]. Lazernaia Meditsina. 2009;(1):31–35.
  17. Kuz'minov AM, Borisov IF. Gemorroidektomiia s primeneniem vysokikh energii (obzor literatury) [Hemorrhoidectomy with high-energy using (literature review)]. Koloproktologiia. 2009;(3):46–51.
  18. Vasil'ev SV, Sobolev SN, Itkin IM. Otkrytaia gemorroidektomiia s ispol'zovaniem apparatno kontroliruemoi bipoliarnoi elektrokoaguliatsii [Open hemorrhoidectomy with using of automatically controlled bipolar electrocoagulation]. Vestnik Khirurgii. 2004;(4):75–78.
  19. Filingeri V, Rosati R, Gravante G, Pietrasanta D, Fiorito R, Casciani CU. Milligan-Morgan hemorrhoidectomy with a radiofrequency scalpel. Minerva Chir. 2003 Jun;58(3):355–59.
  20. Fleshman J. Advanced technology in the management of hemorrhoids: stapling, laser, harmonic scalpel, and ligasure. J Gastrointest Surg. 2002 May-Jun;6(3):299–301.
  21. Iwagaki H, Higuchi Y, Fuchimoto S, Orita K. The laser treatment of hemorrhoids: results of a study on 1816 patients. Jpn J Surg. 1989 Nov;19(6):658–61.
  22. Damianov N, Poleganova Iu. Laser hemorrhoidectomy. Khirurgiia (Sofiia). 1993;46(4):22–4.
  23. Chia YW, Darzi A, Speakman CT, Hill AD, Jameson JS, Henry MM. CO2 laser haemorrhoidectomy–does it alter anorectal function or decrease pain compared to conventional haemorrhoidectomy? Int J Colorectal Dis. 1995;10(1):22–4.
  24. Smith LE. Hemorrhoidectomy with lasers and other contemporary modalities. Surg Clin North Am. 1992 Jun;72(3):665–79.
  25. Wang JY, Chang-Chien CR, Chen JS, Lai CR, Tang RP. The role of lasers in hemorrhoidectomy. Dis Colon Rectum. 1991 Jan;34(1):78–82.
  26. Zahir KS, Edwards RE, Vecchia A, Dudrick SJ, Tripodi G. Use of the Nd-YAG laser improves quality of life and economic factors in the treatment of hemorrhoids. Conn Med. 2000 Apr;64(4):199–203.
  27. Leff E. Hemorrhoidectomy – laser vs. nonlaser: outpatient surgical experience. Dis Colon Rectum. 1992 Aug;35(8):743–36.
  28. Barr LL, Jantz TA. Effects of various laser wavelengths and energy levels on pig rectal submucosal tissue. J Laparoendosc Adv Surg Tech A. 1998 Apr;8(2):83–7.
  29. Pandini LC, Nahas SC, Nahas CS, Marques CF, Sobrado CW, Kiss DR. Surgical treatment of haemorrhoidal disease with CO? laser and Milligan-Morgan cold scalpel technique. Colorectal Dis. 2006 Sep;8(7):592–95.
  30. Blagodarnyi LA, Shelygin IuA, Khmylov LM, Sottaeva VKh. Besshovnaia gemorroidektomiia [Seamless hemorrhoidectomy]. Koloproktologiia. 2006;(3):8–12.
  31. Lawes DA, Palazzo FF, Clifton MA. The use of Ligasure haemorrhoidectomy in patients taking oral anticoagulation therapy. Colorectal Dis. 2004 Mar;6(2):111–12.
  32. Kuz'minov AM, Borisov IF. Gemorroidektomiia plazmennym skal'pelem [Hemorrhoidectomy by plasma scalpel]. Koloproktologiia. 2009;(2):3–7.
  33. Franklin EJ, Seetharam S, Lowney J, Horgan PG. Randomized, clinical trial of Ligasure vs conventional diathermy in hemorrhoidectomy. Dis Colon Rectum. 2003 Oct;46(10):1380–83.
  34. Chung YC, Wu HJ. Clinical experience of sutureless closed hemorrhoidectomy with LigaSure. Dis Colon Rectum. 2003 Jan;46(1):87–92.
  35. Sokolov AL, Liadov KV, Lutsenko MM, Lavrenko SV, Liubimova AA, Verbitskaia GO, Minaev VP. Primenenie lazernogo izlucheniia 1,56 mkm dlia endovazal'noi obliteratsii ven v lechenii varikoznoi bolezni [The use of laser radiation (1.56 micron) for endovasal obliteration of veins in the treatment of varicose disease]. Angiologiia i Cosud. khirurgiia. 2009;15(1):69–75.
  36. Proebstle TM, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg. 2005 Dec;31(12):1678–83.
  37. Wang D, Zhong KL, Chen JL, Wang XX, Pan K, Xia LG, Chen XC, Yang XD. Effect of diode laser coagulation treatment on grade III internal hemorrhoids. Zhonghua Wei Chang Wai Ke Za Zhi. 2005 Jul;8(4):325–27.
  38. Plapler H. A new method for hemorrhoid surgery: experimental model of diode laser application in monkeys. Photomed Laser Surg. 2008 Apr;26(2):143–46.
  39. Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, Fukuda T. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg. 2009 Oct;27(5):819–23.
  40. Shakhrai SV, Gain MIu. Sravnitel'naia otsenka rezul'tatov lecheniia ostrogo gemorroidal'nogo tromboza v ambulatornoi praktike [Comparative evaluation of the treatment results of acute hemorrhoidal thrombosis in outpatients]. Voen Meditsina. 2011;(1):84–88.
  41. Zagriadskii EA. Transanal'naia dezarterizatsiia vnutrennikh gemorroidal'nykh uzlov pod doppler-kontrolem s mukopeksiei i liftingom slizistoi v lechenii gemorroia III-IV stadii [Transanal desarterization of internal hemorrhoids under Doppler control with mucopexy and mucosa lifting in the treatment of hemorrhoids (III-IV stage)]. Khirurgiia. Zhurn. im NI Pirogova. 2009;(2):52–58.
  42. Shakhrai SV, Sokolov AIu, Gain MIu. Otsenka ekonomicheskoi effektivnosti raboty Minskogo gorodskogo tsentra ambulatornoi i maloinvazivnoi khirurgii [Evaluation of the economic efficiency of the Minsk city center of ambulatory and minimally invasive surgery]. Novosti Khirurgii. 2011;19(6):76–81.
  43. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pittaluga M, Tibaldi L, Torre G, Valente M. Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc. 2011 May;25(5):1369–75.
  44. Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M. The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum. 2011 Jun;54(6):693–98.
  45. Jongen J, Kahlke V. Randomized trial of the hemorrhoid laser procedure vs rubber band ligation: 6-month follow-up. Dis Colon Rectum. 2012 Apr;55(4):e45.
  46. Jahanshahi A, Mashhadizadeh E, Sarmast MH. Diode laser for treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012 Jul;84(7):329–32.
  47. Plapler H, de Faria Netto AJ, da Silva Pedro MS. 350 ambulatory hemorrhoidectomies using a scanner coupled to a CO? laser. J Clin Laser Med Surg. 2000 Oct;18(5):259–62.
  48. Lopatin VN, Priezzhev AV, Aponasenko AD, Shepelevich NV, Pozhilenkova PV, Prostakova IV. Metody svetorasseianiia v analize dispersnykh biologicheskikh sred [Light scattering techniques in the analysis of dispersed biological media]. Moscow, RF: Fizmatlit; 2004. 384 p.
  49. Roggan A, Friebel M, Do Rschel K, Hahn A, Mu Ller G. Optical Properties of Circulating Human Blood in the Wavelength Range 400-2500 nm. J Biomed Opt. 1999 Jan;4(1):36–46.
  50. Shakhno E.A. Fizicheskie osnovy primeneniia lazerov v meditsine [Physical basis of therapeutic uses of lasers]. Saint– Petersburg, RF: NIU ITMO; 2012. 129 p.
  51. Mordon SR, Wassmer B, Zemmouri J, Schmedt CG, åd. Letter to the editor re: Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insufficiency in an ex-vivo model. Eur J Vasc Endovasc Surg. 2007 May;33(5):642.
  52. Mun NV, Kalugin VV. Experience in using helium laser therapy for acute anorectal thrombosis and thrombophlebitis. Vestn Khir Im I I Grek. 1978 Oct;121(10):88–9.
Address for correspondence:
210013, Respublika Belarus', g. Minsk,ul. P. Brovki, d. 3, kor. 3, GUO «Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra neotlozhnoi khirurgii,
e-mail: gain@tut.by,
Gain Mikhail Iur'evich
Information about the authors:
Gain M.Yu. A post-graduate student of the emergency surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
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