title: Hemorrhoid laser procedure for second- and third-degree hemorrhoids: results from a multicenter prospective study.
abstract: BACKGROUND
  The aim of our study was to assess the outcome of hemorrhoidal dearterialization, achieved by a dedicated laser energy device.
  
  
  METHODS
  From November 2012 to December 2014, 51 patients with second- or third-degree hemorrhoids were studied. The primary end point was a reduction in the bleeding rate; secondary end points were: postoperative complications, reduction in pain and prolapse, resolution of symptoms, and degree of patient's perception of improvement. The procedure was carried out as 1-day surgery. A diode laser device was employed to seal the terminal branches of the hemorrhoidal arteries, detected by a Doppler-equipped proctoscope. Follow-up was scheduled at 1 and 4 weeks, 3, 12, and 24 months. The rate and degree of symptoms was assessed with a four-point verbal rating scale. The rate of subjective symptomatic improvement was also evaluated with the Patient Global Improvement (PGI) Scale.
  
  
  RESULTS
  Mean bleeding and pain scores at baseline were 2 and 0.57. All the patients were discharged on the day of surgery. Postoperative complications were bleeding (n = 4) and external hemorrhoidal thrombosis (n = 4). Mean bleeding and pain scores at 3, 12, and 24 months were significatively reduced. After 24 months, complete resolution of bleeding was observed in 28/29 patients (96.7 %), resolution of pain in all patients, and resolution of the mucosal prolapse in 15/18 patients (76.9 %). At 12-month follow-up, 86.3 % of patients reported improvement with the PGI Scale.
  
  
  CONCLUSIONS
  The hemorrhoid laser procedure was effective in improving bleeding and pain symptoms in patients with grade II and III hemorrhoids.
authors.affiliation: Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: De Nardi
authors.affiliation: Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132, Milan, Italy. tamburini.andreamarco@hsr.it.
authors.forename: A M
authors.initials: AM
authors.lastname: Tamburini
authors.affiliation: Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132, Milan, Italy.
authors.forename: P G
authors.initials: PG
authors.lastname: Gazzetta
authors.affiliation: Gastrointestinal Surgery, San Raffaele Scientific Institute, 20132, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lemma
authors.affiliation: Department of Surgery and Orthopaedics, General Surgery Unit, Pieve di Coriano, Carlo Poma Hospital, Mantua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pascariello
authors.affiliation: Department of Surgery and Orthopaedics, General Surgery Unit, Asola, Carlo Poma Hospital, Mantua, Italy.
authors.forename: C R
authors.initials: CR
authors.lastname: Asteria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011351:Proctoscopy; D011391:Prolapse; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Dearterialization; Doppler-guided artery ligation; HeLP; Hemorrhoids; Patient Global Improvement Scale