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Medica 2011
Laser Hemorrhoidoplasty (LHP)
Arne Wilhelm1, Volker Nutz1, Guido Weyand², Andreas Keerl³
1Enddarm- und Beckenbodenzentrum Köln
² Kreisklinikum Siegen
³ Kantonsspital Baden, Schweiz
Symtoms
• Bleeding
• Itching
• Soiling
• Burning
• Incontinence
Medica 2011
Medica 2011
Therapeutic Goal
Do not get rid of the hemorrhoids ... Get rid of the symptoms !
3° Hemorrhoids
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Medica 2011
3° hemorrhoids
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• Resection
– Open (Milligan Morgan)
– Cosed (Parks, Ferguson)
– Stapled hemorrhoidopexie (Koblandin, Pescatori, Longo)
• Non resection
– Hemorrhoidal-Artery-Ligation (HAL) with or without Recto-Anal-
Repair (RAR),
– Transanal Hemorrhoidal Dearterilisation (THD)
– Laserhemorrhoidoplastie (LHP)
Operative Techniques
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Laser Hemorrhoidoplasty - LHP
•Ceralas E diode laser
•1470 nm wave length
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LHP probe
• Sharp tip for improved
tissue penetration
• Radial laser energy
• Advantages:
– Homogeneous
applicationof energy
– Controlled tissue
infiltration
– No „hot spots“
– No carbonisation
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Treatment considerations
– Shrinking of hemorrhoidal segments
– Preserving of anal canal anoderm
– Restoring of normal anatomy
Energy: 8 W, pulse mode (3 sec)
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LHP –Video 1
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LHP – Video 2
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LHP – Data
Pat.
N=496
Age Segmental Circular Additional
ORs
Mucopexie/
HAL
Karahalioglu1
01/06 – 10/09
332 46 227 76 25 115
Wilhelm
12/10 – 8/11
10 46 5 5 - 10
Nutz
4/10 – 8/11
55 45 45 14 36 12 (HAL)
Weyand
11/10 – 7/11
64 55 35 29 22 29
Keerl
11/10 – 3/11
35 k. A. 16 29 k. A. -
1 Karahalioglu, Coloproctolgy 2010
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LHP – Complikationen
Bleedin
g
Thrombosis Nekrosis Fibroma Fistula Urinary
retention
Karahalioglu
n = 332
0,6 % 1,5 % 0,3 % 7,8 % 0,6 % 2,1 %
Wilhelm
n = 10
- - - 10 % - -
Nutz
n = 55
3,6 % - 3,6 % 9 % - -
Weyand
n = 64
1,5 % 4,6 % - - - 1,5 %
Keerl
N =35
5,7 % 2,8 % - - 2,8 % -
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AU / die Benefit Recommen
dation
Re-OR Ligatures Recurr
ence
Karahalioglu
n = 332
5,8 k. A. k. A. 1,8 % k. A. 5,8 %
Wilhelm
n = 10
16 90 % 90 % - - -
Nutz
n = 55
9 94 % k. A. - 6,2 % -
Weyand
n = 64
k. A. 92 % 95 % 3,6 % 5,4 % -
Keerl
N =35
4,2 94 % 94 % - k. A. -
LHP - Data
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LHP – Pain (VAS)
Day 1 Day 3 Day 7 No Pain
Karahaliloglu
n = 332
4,5
(1,5)
3,0
(0,5)
1,4
(0,1)
k. A.
Wilhelm
n = 10
4,5 5 2,1 10 days
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Conclusion
• Individual and stage adopted therapy of hemorrhiodal
disease
• Main therapeutic effect: Modulation of blood supply
• LHP :
Saving of hemorrhoidal tissue and anoderm
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Advantages
• Safe procedure
• Mild to moderate pain
• Low complication rate
• Early „Return to work“ (ca. 1-2 weeks)
• No incontinence
• High patient satisfaction
• Daycare or outpatient surgery possible
Medica 2011
Enddarm- und Beckenbodenzentrum Köln
www.ebzkoeln.de