Laser hemorrhoid surgery
Hemorrhoids laser
LHP: Laser - Hemorrhoidoplasty
Laser treatment of dilated vascular structures has long been proven in the treatment of varicose veins (varices). In proctology, haemorrhoid treatment with an 810 nm laser was first reported in 2009 by Hèlio Plapler at the University Hospital of Sao Paulo. The development of a fine, cone-shaped radiating glass fibre probe and the use of a waveform-optimised 1470 nm laser improved the effectiveness of the laser application.
Haemorrhoidoplasty (LHP) can be considered a mature therapy procedure today. In this procedure, the haemorrhoidal nodes are reduced in size and fixed from the inside with dosed laser energy. The Hemorrhoid Laser Procedure (HeLP), which only scleroses the afferent vessels at the base of the haemorrhoid, is even more restrained.
The ligation method according to MORINAGA
HAL-RAR: Hemorrhoid ligation under ultrasound control
The principle of the surgical technique developed in Japan(patient information of the manufacturer A.M.I. ) is based on two approaches:
- Hemorrhoid artery ligation (HAL): The arterial tributaries to the hemorrhoids that run under the mucosa are visited with a special ultrasound probe and blocked with sutures. This takes the pressure out of the system and the hemorrhoids shrink. Bleeding is effectively reduced.
- Recto-Anal Reconstruction (RAR): In the case of a pronounced prolapse, this effect is not enough for the hemorrhoids to retract completely into the anus.
Thus, the hemorrhoids are not removed, only the normal anatomy of the hemorrhoid cushions is restored.
If there is a prolapse of the hemorrhoids at the same time, it can be gathered and fixed by a spiral continuation of the suture. The threads dissolve completely, leaving no foreign material behind.
Basically, haemorrhoids of stages I to III can be treated with this technique, serious risks are not to be expected. Due to the very good safety of the procedure, it has developed into the standard treatment of advanced haemorrhoidal disease in our proctological practice. Postoperative pain can be well treated by administering painkillers. In addition, treatment with LLLT and magnetic field treatment can accelerate the healing process and optimize the treatment result.
In cases of very voluminous haemorrhoids or a pronounced bleeding tendency, the additional sclerotherapy by laser probes inserted into the haemorrhoid nodes (laser haemorrhoidoplasty) has proven to be an excellent addition to the HAL-RAR procedure. Particularly in the early stages of haemorrhoidal suffering, this technique comes very close to the ideal of painless haemorrhoid surgery and can prevent the disease from progressing.
Only in the case of a very pronounced incident, which can only be postponed with difficulty, does one have to be aware of the limits of the HAL-RAR procedure. Despite the inevitable wound, laser hemorrhoidectomy is often the best choice in this situation.
Whichever method we choose together with you, we are experts in this field and bring with us many years of experience and expertise. Only about 10 to 20 percent of patients treated with HAL-RAR and/or laser haemorrhoidoplasty develop haemorrhoids again. In this case, conservative methods such as classical sclerotherapy are often sufficient, but HAL-RAR and laser haemorrhoidoplasty can also be used repeatedly.
HAL-RAR Bibliography
Xu, L., Chen, H., & Gu, Y. (2019). Stapled Hemorrhoidectomy Versus Transanal Hemorrhoidal Dearterialization in the Treatment of Hemorrhoids: An Updated Meta-Analysis. Surgical Laparoscopy Endoscopy and Percutaneous Techniques, 29(2), 75-81.
Double holds better
Laser and ligation (HAL-LHP)
We usually combine both procedures ("belt plus suspenders"). The HAL-RAR provides mechanical stability, the LHP shrinks the hemorrhoidal nodes and reduces the tendency to bleed.
What do I get out of it as a patient?
Laser treatment of haemorrhoids: Major advantages
- The procedure is performed on an outpatient basis, after 2 hours of monitoring in the recovery room you can be picked up again
- LHP can also be used in stage 3 and - with restrictions - stage 4 haemorrhoidal disease.
- Larger wounds as with conventional haemorrhoid removal are avoided
- The downtime in work and sports is minimal compared to conventional surgery, most patients are fit for work again after 5 - 7 days.
- Studies showed better efficacy and quality of life after laser haemorrhoidoplasty compared to the commonly used rubber band ligation
- The haemorrhoidal cushion, which is important for elasticity, sensitivity and sealing against gas and fluid of the anus, is preserved and reduced to the normal level.
- The sphincter muscle is optimally protected
Treatment costs
Hemorrhoids laser surgery - Does the health insurance pay?
Private health insurance
The costs for the operation and anesthesia as well as material costs are covered by most private health insurances. The medical necessity of laser surgery is rarely doubted. In the case of very extensive findings, the time required for the procedure cannot be covered within the above-mentioned framework. In these cases, we will have to arrange an individual fee agreement with you with higher increase rates. As a rule, the insurance company will pay a share of up to 3.5 times the increase rate.
Statutory health insurance
HAL-RAR and LHP are not part of standard care in statutory health insurance. The adjacent list shows you which statutory health insurers have already concluded contracts for the laser treatment of hemorrhoids and anal fistulas. If your insurance company is not included, we can generally submit an application on a case-by-case basis. However, experience in recent years has shown that those health insurance companies that have not yet concluded a contract for laser surgery also regularly reject individual applications. Legally, this is not objectionable, since the decision on the approval of treatment procedures within the framework of the statutory health insurance is not made by the health insurer itself, but by the Joint Federal Committee(GBA).
Because of a single operation, you will usually not change your health insurance if you are otherwise satisfied with your insurance.
People with statutory health insurance can also be treated as self-payers. For these cases, we were able to negotiate comparatively favorable conditions, which we will be happy to inform you about upon request.
Self-payer
Patients without domestic health insurance will receive a cost invoice to be paid in advance in cash, by credit card or bank transfer according to the official fee schedule GOÄ. We will be happy to provide a cost estimate consisting of the fees for examination and consultation, the surgical operation service, material costs (laser probe) and the fee for anesthesia and use of the OR.