Combined operations in outpatient laser treatment of chronic hemorrhoids of stage 2–3

Abstract

Introduction. When performing laser coagulation of hemorrhoids, there is a demand for the elimination of simultaneous diseases, but their laser treatment is under study and implementation in the practice of coloproctologists.Aim. To study the features of transmucous laser thermal ablation of chronic hemorrhoids of stage 2–3 with simultaneous elimination of other anal canal diseases in outpatient settings.Materials and methods. Transmucous ablation of hemorrhoids of 2–3 degrees was performed in 104 (27.5%) people in combination with laser removal of chronic anal fissures in 82 (75%) patients, intra-sphincter fistulas in 10 (9.6%) and other anal canal pathology in 18 (17.4%) patients. The median age of patients was 43 years, 48 men (46.2%), 56 women (53.8%).Results. Surgical tactics of laser treatment of simultaneous and underlying pathology allowed one-step elimination of both diseases in all 100% of patients. The duration of combined operations was 20.0 min. (15; 20) the pain intensity was 2.5 points (2; 3). Intraoperative blood loss was minimal. Pain in the postoperative period persisted for 5 days. After surgery, bleeding occurred in 2 (1.9%) patients. During the year, a recurrence of hemorrhoids occurred in 2 (1.9%), anal fissure in 10 (12.2%), condyloma in 2 out of 3 operated.Discussion. The obtained characteristics of combined operations showed that all their signs corresponded to minimally invasive interventions, both operations, the main and combined, were low-traumatic, performed under local anesthesia and had one access and a common operating field.Conclusion. Combined pathology of the anorectal region is observed in a quarter of patients with chronic hemorrhoids. In 100%, it was eliminated by simultaneous operations that were minimally invasive, which allowed them to be performed on an outpatient basis under local anesthesia.