Publication:

Pallam's painless hybrid laser sandwich procedure for grade III and IV hemorrhoids

Background Doppler-guided hemorrhoid artery ligation with recto-anal repair (DGHAL-RAR) addresses only primary branches of superior rectal artery and do not address secondary branches of superior rectal artery (cause of recurrence) which are situated in between primary terminal branches. Mucosal prolapse part of grade 3 and 4 hemorrhoids is addressed by mucopexy (RAR) which is integral part of DGHAL-RAR. Laser hemorrhoidopexy (LHP) addresses these secondary branches of superior rectal artery. So, in Pallam's painless hybrid laser sandwich procedure, we sandwiched LHP in between DGHAL and RAR and modified Doppler guided HAL to digit (finger) guided HAL. Aim of this procedure is to prevent recurrence and decrease postop pain and to address patient’s compliance.

Methods All patients with grade 3 and 4 hemorrhoids who were operated in our hospital were included in prospective cohort study. All patients underwent Pallam’s painless hybrid laser sandwich procedure. Post operative pain, bleeding, abscess, recurrence and anal incontinence were evaluated.

Results The 493 patients with grade 3 and 4 hemorrhoids operated between January 2020 to October 2024 were included in the study. Median follow-up time was 22 (Range 6-36) months.45 patients were excluded from analysis because of lost to follow up. No complications were observed in 442 (98.67%) patients. Bleeding was observed in 3 (0.67%) cases. Hematoma in 1 (0.22%) case and Abscess in 1 (0.22%) case incontinence for flatus in 1 (0.22%) case. No cases developed récurrence.

Conclusions Pallam’s painless hybrid laser sandwich procedure is a novel, effective and minimally invasive technique to decrease post operative pain and to prevent recurrence of hemorrhoids.