title: A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work?
abstract: OBJECTIVE
  This study aimed to describe the clinical results of intrahemorrhoidal application of a diode laser.
  
  
  BACKGROUND
  Hemorrhoids are a common source of pain, and no surgical technique achieves a painless outcome. Endovascular laser therapy for varicose veins as described in an experimental study is a method that could be used in the treatment of hemorrhoids, but there are few clinical trials described in the literature.
  
  
  METHODS
  Fifteen patients with second and third degree hemorrhoids underwent intrahemorrhoidal laser therapy. After the piles were identified, a fiber was introduced into each and it was irradiated with laser energy (810 nm, 5 W, frequency of 5 Hz, energy density of 19 J/cm(2), total energy of 4-10 J).
  
  
  RESULTS
  The piles were immediately partially reduced, and clinical examination 7, 14, 21, and 28 d after surgery showed complete healing in nine patients (60.4%) and partial resolution in five patients (33%). In one patient (6.6%) the treatment failed. Mean pain intensity throughout the study period, measured by a visual analog scale (0-10), was 0.84 +/- 1.13 (mean +/- SD). Major complications were burn lesions (n = 4) and residual plicoma (skin tag) (n = 5). Ten control patients underwent an open "cold scalpel" hemorrhoidectomy. Their pain intensity was 1.78 +/- 0.68 (mean +/- SD). There was a significant statistical difference (p = 0.018) between groups.
  
  
  CONCLUSIONS
  The diode laser energy delivered into small to median hemorrhoidal piles caused little pain and led to a partial to complete resolution within a short time compared to open hemorrhoidectomy. Some adjustments must be made to prevent burning lesions and residual plicoma. Although it is not a good method for big piles, this technique opens new possibilities for surgical treatment of hemorrhoidal disease.
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. helio@plapler.com.br
authors.forename: Hélio
authors.initials: H
authors.lastname: Plapler
authors.forename: Raduan
authors.initials: R
authors.lastname: Hage
authors.forename: Janaina
authors.initials: J
authors.lastname: Duarte
authors.forename: Nilza
authors.initials: N
authors.lastname: Lopes
authors.forename: Igor
authors.initials: I
authors.lastname: Masson
authors.forename: Cláudio
authors.initials: C
authors.lastname: Cazarini
authors.forename: Thiago
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D054023:Lasers, Semiconductor; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*