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Practice Guideline
. 2024 Nov 23;29(1):2.
doi: 10.1007/s10151-024-03022-1.

Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations

LHP Recommendation Development Group
Collaborators
Practice Guideline

Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations

LHP Recommendation Development Group. Tech Coloproctol. .

Abstract

Background: Laser hemorrhoidoplasty (LHP) has emerged as a novel, minimally invasive technique for managing symptomatic hemorrhoids, gaining popularity among clinicians. Despite its increasing adoption, significant variations exist in the application of LHP across different practices.

Purpose: The aim of these recommendations was to spell out some basic principles and recommendations for performing a standard LHP procedure.

Methods: The Recommendation Development Group (RDG) consisting of surgeons with experience in LHP were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above.

Results: The RDG developed 21 recommendations that were voted upon by 49 panelists. Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus.

Conclusion: The RDP offers a comprehensive suite of guidelines to enhance the safety and efficacy of standard LHP procedures. Out of 21 detailed recommendations, 16 reached strong consensus, collectively addressing the full spectrum of LHP procedures-from laser settings and preoperative preparations to perioperative strategies and postoperative care. This coherent framework is anticipated not only to standardize but also to refine the LHP technique across the board, thereby elevating the management of symptomatic hemorrhoidal disease.

Keywords: Hemorrhoidal surgery; Hemorrhoids; Laser hemorrhoidoplasty; Laser proctology; Laser surgery; Minimally invasives surgery.

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Conflict of interest statement

Declarations. Conflict of interest: PCA, GW, CB, IHR, AAA, IBP, KW, SA, RS, SK, MMA, MM and DM received travel grants and honorarium for lectures from Biolitec. Ethical approval: Not applicable. Informed consent: Not applicable.

Figures

Fig. 1
Fig. 1
Results of the Delphi process for the 21 Qs and Rs
Fig. 2
Fig. 2
Introduction of the LHP probe into the submucosa plane with digital guidance via a palpating finger
Fig. 3
Fig. 3
Visual control of laser probe position
Fig. 4
Fig. 4
Note the different positions (A-C) of the laser probe for a standard LHP procedure
Fig. 5
Fig. 5
Note the indicator light above the dentate line
Fig. 6
Fig. 6
Note the final position below the dentate line
See this image and copyright information in PMC

References

    1. Azadgoli B, Baker RY (2016) Laser applications in surgery. Ann Transl Med 4(23):452 - PMC - PubMed
    1. Danys D, Pacevicius J, Makunaite G et al (2020) Tissue coagulation in laser hemorrhoidoplasty–an experimental study. Open Med 15(1):185–189 - PMC - PubMed
    1. Karahaliloğlu AF (2010) Die Laserhämorrhoidoplastie (LHP). Coloproctology 32(2):116–123
    1. Tümer H, Ağca MH (2023) Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II–III hemorrhoidal disease: a retrospective analysis. ANZ J Surg 93(7–8):1885–1889 - PubMed
    1. Khadr MA, El Shazly WG, Zakria MM, Moaz AM (2024) Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV hemorrhoids: a non-randomized prospective trial. Surg Open Digestive Adv 13:100129

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