Three Years of Experience Using a Diode Laser in the Management of Common Anal Benign Pathologies: A Retrospective Study

TL;DR

This study shows that diode laser surgery is a safe and effective treatment for common anal conditions like hemorrhoids and fistulas, with minimal pain and recovery time.

Contribution

The paper presents a three-year retrospective analysis of diode laser use in treating anorectal conditions, providing real-world clinical outcomes.

Findings

Laser hemorrhoidoplasty resulted in minimal pain, negligible bleeding, and low recurrence rates.

Fistula laser closure had a 73.9% success rate, with recurrence linked to posterior and wide fistulas.

Laser treatment for chronic anal fissures had no major complications and resolved itching with topical treatment.

Abstract

Background

The management of anorectal conditions continues to evolve with newer techniques for colorectal surgeons. Recently, diode laser technology has gained attention in proctology as a less invasive alternative to traditional surgery. The mechanism involves tissue shrinkage and degeneration and depends on the power of the laser and the duration of exposure. This method is associated with reductions in postoperative pain, bleeding, discharge, and hospital stays.

Patients and methods

This retrospective study involved 456 patients with hemorrhoids, chronic anal fissure, and perianal fistula. They were divided into three groups. Group 1 (156 patients) had hemorrhoids treated with laser hemorrhoidoplasty (LHP). Group 2 (144 patients) had chronic anal fissures and underwent closed laser lateral internal sphincterotomy. Group 3 (156 patients) had perianal fistulas managed either by fistula laser closure (FILAC) or laser fistulotomy. All of the procedures were performed at the Gastrointestinal Surgery Unit in the General Surgery Department at Tanta University Hospitals in Egypt over a three-year period (February 2021 to February 2024).

Results

In Group 1, LHP resulted in minimal postoperative pain (as measured by the visual analogue score), negligible bleeding (with no cases requiring intervention), brief hospital stays, and a low recurrence rate (one case). Postoperative edema was significantly associated with grade 4 hemorrhoids. Group 2 experienced no major complications, though 30 patients reported postoperative itching, which resolved with topical treatment. In Group 3, the success rate for FILAC was 73.9%, and the overall success rate was 76.9%. Recurrence correlated significantly with posteriorly located intersphincteric fistulas and fistulous tracts wider than 7 mm.

Conclusion

Diode laser treatment is a safe and minimally invasive option for managing hemorrhoids, chronic anal fissures, and perianal fistulas that results in favorable outcomes and minimal complications.