Treatment of hemorrhoids by infrared thermocoagulation

Abstract

The ideal therapy for hemorrhoids in early stages has always been debated. Some methods are effective but are associated with more pain, while some are less painful but also less effective. Thermocoagulation methods have been used for a long time, including direct current probe, bipolar diathermy, cryoablation, and infrared coagulation, with variable success rates. Infrared coagulation was introduced in the 1970s by Nath. This method returns the anal cushions to their normal size and position, offering a more anatomical cure, which is preferable to the destruction of tissue that other thermal methods produce. The infrared coagulating system works by infrared radiation and not by any electrical current. Mechanical pressure and radiation have to be applied simultaneously. Pulses of infrared radiation are applied to the hemorrhoidal packages using a handheld applicator, causing shrinkage of the hemorrhoids and causing the mucosa to become fixed to the underlying tissue. Most of the instruments consist of a power unit and a manual applicator that has interchangeable light conductors and a trigger to activate the device. A standard projector bulb focused on a quartz light guide by a gold-plated reflector generates the infrared energy. A 10-mm quartz light conductor is generally used for the treatment of hemorrhoids. Infrared coagulation operates at a temperature just above 100° C. Tissue coagulation with radiation is based on the denaturalization of proteins. After 1 second of exposure a hissing noise can be heard, which indicates that intracellular fluid has reached the boiling point. The superficial cellular fluid is at a temperature of more than 100° C. Longer exposure times lead to desiccation and subsequent carbonization, which is useful to arrest acute bleeding hemorrhoids [1]. This technique can be controlled and reproduced simply by measuring the time of exposure, obtaining the same depth of necrosis, and avoiding the area of the surrounding tissue. This allows high power density to be generated at a single point. In order to prevent adhesion, the tip of the light conductor is coated with a fluorocarbon copolymer that is transparent to the infrared light. Hemostasis is achieved with a minimum energy dose and coagulation intervals are shorter. The reliability of this technique lies in the simplicity of operation and that the exact depth of necrosis can be preset using a timer adjustment. This is in contrast with electrocoagulation, which is dependent on the electrolyte concentration of the cells, and the depth of necrosis cannot be reproduced in a standardized way. © Springer-Verlag London Limited 2009.