Outcomes of Diode Laser in Treatment of Common Anal Surgical Lesions (Haemorrhoids, Chronic Fissure and Fistula): A Prospective Study

Abstract

Introduction: Management of anorectal disorders has been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to the conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay. Patients and Methods: This prospective study was carried out on 76 patients with common anal surgical lesions categorized into 3 groups. Group 1 included 26 patients with hemorrhoids and underwent laser hemorrhoidoplasty, group 2 included 24 patients with chronic anal fissure and underwent closed laser lateral internal sphincterotomy whereas group 3 included 26 patients with perianal fistula and underwent either fitula laser closure (FILAC) or laser fistulotomy in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (12 months, from February 2021 to February 2022 on 76 patients). Results: Regarding group1, laser hemorrhoidoplasty (LHP) was associated with minimal postoperative pain using VAS score, minimal bleeding with no serious bleeding requiring intervention, short hospital stay and only one case of recurrence. There was significant relation between postoperative edema and grade 4 hemorrhoids. Regarding group 2, closed laser lateral internal sphincterotomy was associated with no complications except for postoperative itching in five cases and was treated by local soothing agents. As for group 3, success rate was 73.9% among cases who underwent fistula laser closure (FILAC) and overall success rate was 76.9%. There was significant relation between recurrence and posterior position of the fistulous track of the intersphincteric type and significance between wide caliber of the track (more than 7mm) and recurrence. Conclusion: Diode laser is a safe minimally invasive procedure for treatment of hemorrhoids, chronic anal fissure and perianal fistula.