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Haemorrhoidal Photocoagulation

Photocoagulation by infrared rays

Haemorrhoids are normal anatomical structures of the anal canal present from birth. When there are symptoms associated with haemorrhoids it is called haemorrhoidal disease. Three types of events are possible: the thrombosis which causes pain and swelling, bleeding, prolapse or externalization of haemorrhoids without pain.

Infrared photocoagulation is one of the three main instrumental hemorrhagic haemorrhoidal disease treatment techniques with elastic ligation according to Barron and haemorrhoidal Scleroses to aetoxy alcohol.

Infrared photocoagulation is performed using a device (photo) for turning on the heat radiation emitted by a tungsten lamp focused on a quartz rod to the point of application.

This treatment performed at the Clinic Montbrillant, only lasts a few minutes and requires no preparation or anesthesia.

The device, pistol-shaped, is provided with a rod covered with a Teflon tip (photograph No. 2) Permitting the rod to not "stick" to the mucosa once the coagulation is realized.

In gynecological or decubitus lateral position, most often through an anoscope, the end of the device is applied to the top of the haemorrhoidal cushions. The device is powered which delivers radiation for 0.5 to 2 seconds and causes a small burn when applied (Photo No. 3 and 4).

Several impacts are made on the anal circumference. Scarring occurs after three weeks. It causes local scarring and coagulation of small vessels. Generally, 2 to 3 sessions in an interval of 2 to 4 weeks apart are performed.

To this day, no serious complications have been registered after the effects of infrared photocoagulation. The treatment is painless and rarely is the result of very moderate transient discomfort (20% of the area) that extends up to 48 hours (5% of cases). No time off of work is required. 5 to 25% of cases occur to be light bleeding for 7 to 10 days. Also it is important to mention that the Teflon tip is changed between each patient and sterilized, providing no risk of any transmission of infection.

The treatment should not be performed if there is any anal pain. The patient should not take drugs affecting coagulation such as anticoagulants or antiplatelet agents (aspirin).

In the case of pain, paracetamol treatment can be safely administered.

In the short term and after 6 to 12 weeks, there are no differences in the efficacy between the three instrumental haemorrhoid treatments. On the bleeding and prolapse symptoms, the infrared photocoagulation is effective in 70-90% of cases if we judge by the various works that have been published.

In the longer term the efficacy of this treatment decreases: after 1 year, 50% of patients that have been treated with infrared can be subject to symptoms again, and it seems that this treatment is less effective in the long term than rubber band ligation. However, infrared photocoagulation sessions can be repeated on demand without any risk whereas elastic ligations are sometimes subject of being painful also hemorrhage and infection complications can occur.

The indication of choice for infrared photocoagulation is in the haemorrhoidal disease which is manifested by bleeding with little or no prolapse (in this case rubber band ligation, is more likely to be more effective when surgery is a last resort).

This treatment has not been proven for its efficiency for the prevention of haemorrhoidal thrombosis episodes.

Is Infrared therapy going to remove all the haemorrhoids?

No, only surgery can remove the haemorrhoidal network. However, less than one in ten haemorrhoid consultants requires surgery. Infrared photocoagulation is a simple procedure that is done during the consultation, usually is painless and is effective for controlling haemorrhoidal bleeding when the prolapse is not too important.

The effectiveness of one year of infrared photocoagulation is about 50% over the bleeding. However, the treatment can be repeated easily when haemorrhoidal disease is not too advanced.

References

  1. http://www.proktos.com
  2. Recommandations SNFCP for haemorrhoidal disease http://www.snfcp.org/
  3. Xavier Delgadillo. News SNM 2003

Dr Xavier Delgadillo
EBSQ coloproctology