LASERS IN TREATMENT OF HAEMORRHOIDS
Sanjay B Kulkarni
Laser Surgeon, PR Patil Memorial Hospital, Sangli (Maharashtra). 416 416
A variety of treatment modalities are available for haemorrhoids. Laser is one of the latest surgical tools available to a colorectal surgeon and is being used extensively in the management of haemorrhoids.
WHAT IS A 'LASER'?
Laser (light amplication by stimulated emission of Radiation) is a beam of light with some special properties. The intense beam of light interacts with tissue and can be used to 'Cut, coagulate or ablate the tissue. The laser-tissue interaction depends on the type of laser. The laser-tissue interaction depends on the type of laser i.e. the wavelength of laser). Power of laser and type of delivery system.
WHAT ARE TYPES OF LASER?
Different media used in various machines generate different wavelengths of laser light.
Commonly used surgical lasers are-
Nd : YAG laser.
Holmium : YAG laser etc.
The nature of laser-tissue interaction depends on the wave-length i.e. type of laser.
All these lasers are widely used in the treatment of various colorectal pathologies.
HOW ARE LASERS USED?
Depending on the grade of haemorrhoids and type of laser various modes are in use.
A)In situ coagulation of piles : - Small to medium sized pile masses can be coagulated in situ by using 'Diode' or Nd : YAG or defocussed CO2 laser. The coagulation can be done by submucous or trans mucous mode.
B)Ablation of piles : Total or submucosal ablation of small pile masses can be done by a high powered diode laser or a CO2 in focussed mode or Nd : YAG laser with ablating delivery system.
C)Excision of piles : Commonly used method is 'Modified Milligan-Morgan' procedure. 'Laser' is used as dissecting tool to incise the mucosa/skin and excision of pile masses is done submucosally. Most of the medium to large sized haemorrhoids are managed by laser excision.
In a particular patient any one of these or various combinations of the above mentioned methods can be employed to treat primary as well as secondary pile masses.
WHAT ARE ADVANTAGES OF LASERS?
'Lasers' offer a lot of advantages when used in the treatment of haemorrhoids.
1.Average operative time is less than conventional surgical procedures.
2.Intraoperative as well as postoperative bleeding is significantly less.
3.Postoperative pain is considerably less.
4.Good and rapid healing of operated area with minimal inflammation.
5.Quicker recovery and early return to normal lifestyle.
6.Many procedures can be done under local or regional anaesthetia.
7.Complication rate is much less.
Other colorectal pathologies like, fistula-in-ano, polyps, condylomatosis, haemangiomas, recurrent or advanced carcinomas can be very effectively treated by lasers simultaneously or separately.
COMPLICATIONS AND PRECAUTIONS
Like any other advanced modality of treatment, lasers also need to be used very cautiously and judiciously in surgery. Thorough knowledge of laser physics, accessories, delivery systems, and laser-tissue interactions is extremely important for the surgeon.
All the operation theatre personnel should be well versed with 'Laser Safety Norms'.
When used properly, laser is a very safe and effective modality of treatment in surgery.
A) Laser Safety : All the persons; including the patient present in operation theatre should wear appropriate goggles for protection of eyes from laser rays.
All the Doors and windows of operation theatre should be properlycovered and interlockable.
All the inflammable objects should be adequately protected from direct or reflected laser rays.
Proper laser delivery systems should be used during surgery and their integrity should be checked from time to time.
B) Complications : Possible complications that can be encountered during laser surgery for haemorrhoids are:
Perianal itching and burning sensation, which is always self-limiting. Secondary haemorrhage and localised perforation due to excessive lasing.
In personal experience of more than 200 cases of haemorrhoids treated by laser, the complication rate was about 1 percent and none were serious complications.
Over last 5 years, lasers are being used extensively in the management of haemorrhoids and other colorectal pathologies. Though the treatment is slightly costly. It offers tremendous advantages to the patients with minimal complications. In coming days it may be the gold standard for treatment of haemorrhoids.