Abstract
Non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD). However, so far, their efficiency is based on low-level evidence. Therefore, we aimed to systematically review the efficiency of non-excisional laser therapies for HD. MEDLINE/Pubmed, Web of science, Embase, and Cochrane were searched from database implementation until the April 17th, 2020. We included studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies, encompassing laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP). Fourteen studies describing LH and HeLP were included, representing 1570 patients. The main intraoperative complication was bleeding (0–1.9% of pooled patients for LH, 5.5–16.7% of pooled patients for HeLP). Postoperative complications occurred in up to 64% of patients after LH and 23.3% after HeLP. Resolution of symptoms ranged between 70 and 100% after LH and between 83.6 and 90% after HeLP. Moreover, four randomized controlled trials included in our review reported similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation. Recurrence rate was reported to range between 0 and 11.3% after LH and between 5 and 9.4% after HeLP. When compared with hemorrhoidectomy, LH showed conflicting results with one randomized controlled trial reporting similar recurrence rate, but another reporting decreased recurrences associated with hemorrhoidectomy. Laser therapies showed lower postoperative pain than hemorrhoidectomy or rubber band ligation. LH and HeLP are safe and effective techniques for the treatment of grades II and III HD.
Highlights
Hemorrhoidal disease (HD) is frequent, with an estimated prevalence of 4.4% among the US population [1]
– Improvement, defined as postoperative decrease of HD symptoms or grade adapted from the Goligher classification [3]; The initial search identified 1031 studies
Of the 1540 patients included in these studies, majority were classified as suffering from grades II and III HD (35.8% and 33.6%, respectively), while grades I and IV HD patients were less frequent (5.1% and 0.4%, respectively, grade unavailable for 25.1% of cases)
Summary
Hemorrhoidal disease (HD) is frequent, with an estimated prevalence of 4.4% among the US population [1]. HD is the consequence of an increased inflow into the superior rectal artery, which causes dilatation of the hemorrhoidal plexus. Degradation of the supportive tissue results in sliding down of hemorrhoids [2]. After failure of conservative management, HD is treated with interventional therapies [4]. Open hemorrhoidectomy (HC) was first described in 1937 by Milligan-Morgan [5] and is still considered as the gold standard interventional therapy for advanced stages of HD. Significant postoperative pain and complications were associated with excision of hemorrhoidal tissue. Various non-excisional therapies have been developed, such as rubber band ligation (RBL), mucopexy (MP), and more recently laser therapies [4, 6]
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