350 ambulatory hemorrhoidectomies using a scanner coupled to a CO2 laser.

OBJECTIVE: The purpose of this study was to investigate how a scanner device would improve the outcome of laser hemorrhoidectomy regarding pain, healing, secretion, and hemostasis.

BACKGROUND DATA: The technology of the laser has been applied since the 1960s in several clinical and surgical specialties. The inherent advantages, due to the biological characteristics of this instrument are: (1) it does not affect the neighborning tissues, (2) it is hemostatic, (3) it favors healing, (4) it is bactericidal, and (5) it presents less postoperative pain. Several authors have questioned these supposed advantages. After scanners were introduced, better results were accomplished, including in proctological surgery.

METHODS: A total of 350 patients, consecutively, went through a laser hemorrhoidectomy using a CO2 laser coupled to a scanner device in a 3-year period. Patients were monitored for pain, healing, bleeding, and local secretion for up to 36 months.

RESULTS: Almost 13% of the patients required bondage of arteries during the operation; 96% used analgesics for up to 3 days; and 5 patients (1.42%) complained of strong pain for several days. Only 2 patients (0.6%) reported intense pain for more than 7 days. All patients presented complete healing between the 30th and the 40th POD. In the 90th POD tissue regeneration appeared healthy. The immediate complications included 2 cases of nipple hemorrhage that demanded a review. Stenosis occurred in 4 patients. Residual "plicoma" was often present with the laser technique (20%). Return to work, regardless of its nature, was an average, on the 3rd postoperative day.

CONCLUSIONS: Our evaluation of the results led to the conclusion that the scanner coupled to the CO2 laser was fundamental for better postoperative outcome in our patients, at least compared to other laser techniques.