Interview with Dr. Ionel Roman (Clinique CIC Valais; Saxon, Switzerland) about haemorrhoids
- Dr Roman, what are patients’ biggest concerns and fears when they come to you as a proctologist and what can you say to them?
First of all, you have to consider that, according to statistical studies, the average period from the start of the condition until the initial visit to the doctor is around 5 years. It therefore takes time for the patient to have the courage to visit the doctor. Most cases that concern the patient are to do with bleeding during bowel movements – red blood. Of course, the initial fear is colon cancer.
It is true that most anal bleeding is due to haemorrhoids in 90% and other more aggressive things in only 10% of cases. As such, it is reassuring for the patient to know that 90% of cases are haemorrhoids. I reassure them by telling them that it is a very common condition, that we have solutions which are really minimally invasive and cause very little pain, and that recovery 2 or 3 days after the operation is more than 60 to 70% with this technique.
- Which treatment options can you recommend and why?
For a number of years, I have mainly performed minimally invasive, outpatient surgery. Consequently, laser being the least aggressive and the least invasive, it is now my first choice compared with other, more “traditional” techniques such as Ferguson or THD. Effectively, patients are no longer hospitalised, they go home on the evening of the operation and they will be able to have a bowel movement even on the day of the procedure. They do not have dietary restrictions and they sleep at home. The more experience I gain in treating haemorrhoids with the Leonardo diode laser, the more patient satisfaction also increases. I would also like to clarify that it is quite difficult for the proctologist surgeon to review a patient one week after a haemorrhoid operation, especially when the patient has suffered a traditional, painful technique; the patient has suffered a great deal and regards us as responsible for the pain, despite all the empathy that I show. With the Leonardo diode laser and its gentle technique, I no longer have this worry. I see satisfied patients, who are themselves surprised at the speed of recovery and at how little pain they have suffered – and who have recovered more than 60% after a few days.
- Can you describe the exact procedure for laser treatment of haemorrhoids?
First of all, I tell patients that this method is not destructive like other, more traditional methods.
To insert the laser fibre behind the haemorrhoid, we need only a small incision of around 1 to 2 mm (minimally invasive). This allows a strong reduction of pain.
Then, the laser “targets” the water molecules contained in the blood of the haemorrhoid sac. The thermal effect reduces the haemorrhoid sac whilst ensuring good haemostasis. These are varicose veins inside the anal canal. The effect of the laser reduces the enlarged varicose veins; this is a less aggressive, less painful process.
Furthermore, we do not use stitches. These are the main cause of postoperative pain.
- What are the specific advantages of the laser therapy?
Firstly, there is far less pain; secondly, faster recovery after only a few days.
The possibility of sleeping at home on the evening of the operation and eating with no restrictions.
The lack of aggression of the treatment, using a more physiological mechanism to reduce the haemorrhoid masses and the lack of scars also allow better recovery.
- What experience have you had with long-term results after laser treatment?
Regarding experience, I have more and more happy patients, who are pleased to have undergone this procedure. I have used the laser method even for 4th degree haemorrhoids and for haemorrhoid tags.
So far, I have had only extremely positive results, good patient acceptance and no negative consequences.
Among the more “traditional” practitioners, if there are fears of burning the anal sphincter, I can guarantee that the sphincter is not touched; everything happens in the submucous.
The local infiltration protects the underlying tissue from the action of the laser. The laser beams can really be directed well towards the haemorrhoid bundle.