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Piles Treatment

Laser HemorrhoidoPlasty Laser Hemorrhoidectomy

Pathogenesis

Haemorrhoids:

  • Everybody has haemorrhoids
  • Fine tuning of the rectal closure
  • 30-50% of the people over 50 have enlarged haemorrhoids
  • 75% of the hemorrhoids progress in size if they are no treated

Causes for Haemorrhoids:

  • Wrong diet – too less fibers and liquids
  • Diarrhea
  • Misuse of laxative
  • Too much pressure, long toilet time
  • High sphincter tonus
  • Pregnancy

Hemorrhoid Laser Procedure

Usual  treatment options :

  • Change of diet and lifestyle (Grade I)
  • Lotions, medicaments, ointments (Grade I)
  • Rubber band, sclerotherapy, infrared coagulation (Grade I + II)
  • Closed surgery: Stapler Hemorrhoidopexy (Grade III)
  • Open surgery: Milligan-Morgan, Parks (Grade III + IV)‏

Conventional Hemorrhoidoplasty

Facts on Hemorrhoidoplasty:

  • Couple of days until a week in hospital
  • Pain for 7-10 days
  • Postoperative bleeding
  • Infections
  • Abces
  • Problems with sitting
  • Open wounds need 4-6 weeks to heel
  • Necessity of taking baths

Three treatment principles with laser:

  • Reduction of the hemorrhoidal tissue, not total destruction/excision
  • Reconstruction of the natural anatomy
  • Non touch of the anoderm

Laser Hemorrhoidoplasty (LHP)‏

LHP Plattform

  • Diode Laser 980/1470nm
  • LHP Fiber : Delivery of energy in conical shape

Characteristics of lasers fibres

Standard is bare fibre


Working mechanism: High temperatures on fibre tip lead to hot neadle effect. Temperature gradient to surrounding tissue structures.


Homogeneous radiation on certain tissue region. No hot
spots. No carbonisation.

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The influence of the laser wavelength

Better controlls on tissue depth

Laser Hemorrhoidoplasty (LHP)

Advantages:

  • Painless procedure
  • Outpatient or short hospital stay (overnight)
  • Short down times
  • No stenosis
  • No incontinence
  • No mucosa damaging
  • No foreign body insertion (no clamp complications)‏
  • No application of medicaments
  • Less complications
  • Several repetitions possible

Pilonidal cyst/ sinus

Symptoms

Usually present with abcess formation

Traditional Excision

Less symptomatic disease

  • Soiling
  • Perineal mass
  • itching

Pilonidal cyst

Therapeutic Goal

To treat as less invasive as possible 

Laser Operative Technique

Laser Operative Technique

Operative Technique

Advantages

  • Safe procedure
  • Smaller wounds
  • Less pain
  • Low complication rate
  • Early „Return to work“
  • High patient satisfaction
  • Daycare or outpatient surgery possible