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Hemorrhoid laser dearterialization: systematic review and meta-analysis.
Paola De Nardi1, Giulia Maggi2, Michele Pagnanelli3
1Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. denardi.paola@hsr.it.
Lasers in Medical Science
|January 25, 2023
Summary
The hemorrhoidal laser procedure (HeLP) effectively treats hemorrhoids with high symptom resolution rates. While promising for minimally invasive hemorrhoid treatment, more high-quality research is needed to confirm its long-term benefits and safety.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Gastroenterology
Background:
- Hemorrhoidal disease is a prevalent condition often managed with excisional hemorrhoidectomy, which carries risks of pain and morbidity.
- Minimally invasive techniques are sought to mitigate the drawbacks of traditional surgery.
- The hemorrhoidal laser procedure (HeLP) emerged in 2009 as a doppler-guided laser dearterialization technique for symptomatic hemorrhoids.
Purpose of the Study:
- To systematically review the benefits and disadvantages of the hemorrhoidal laser procedure (HeLP) for symptomatic hemorrhoids.
- To analyze HeLP's efficacy in symptom resolution, postoperative pain, complications, and recurrence rates.
- To compare HeLP with other interventional techniques.
Main Methods:
- Systematic review of Medline/PubMed, Embase, and Cochrane Library databases (January 2010 - March 2022).
- Inclusion of randomized and non-randomized studies (prospective and retrospective cohorts).
- Risk of bias assessment using ROBINS-I and RoB2 tools; GRADE approach for evidence certainty.
Main Results:
- HeLP improved or resolved symptoms in 83.6% to 100% of patients.
- In one randomized study, HeLP achieved 90% symptom resolution compared to 53.3% with rubber band ligation.
- Published data suggest HeLP is effective and safe with limited recurrence in the short to medium term, but evidence quality is low.
Conclusions:
- The hemorrhoidal laser procedure (HeLP) demonstrates effectiveness and relative safety for symptomatic hemorrhoids.
- There is a significant lack of high-quality studies, particularly randomized trials, evaluating HeLP.
- Further robust research with adequate power, proper design, and long-term follow-up is essential to validate HeLP's advantages over other minimally invasive treatments.
