Comparative morphological characteristics of thermal tissue damage caused by the use of various types of surgical energy in the treatment of hemorrhoidal disease

Introduction. The invasiveness of surgical intervention in the treatment of hemorrhoidal disease (HD) remains one of the key challenges in coloproctology. The intensity of postoperative pain, healing rate, and risk of complications are directly dependent on the depth and nature of thermal tissue damage caused by different types of surgical energy.

Objective. To conduct a comparative analysis of the depth, morphological, and histochemical characteristics of thermal damage to hemorrhoidal tissue using a monopolar coagulator, diode (1,5 μm), 2-μm, and CO₂ lasers, as well as to evaluate the protective role of infiltration anesthesia.

Materials and Methods. The study included 90 hemorrhoidal specimens removed intraoperatively using different types of surgical energy. The material was divided into three groups: Group 1 (n=40) – CO₂ laser; Group 2 (n=22) – monopolar coagulator; Group 3 (n=28) – diode and 2-μm lasers. Histological examination was performed to assess general morphological characteristics, vascular status, stromal changes, inflammatory infiltration, and to measure the depth of coagulation necrosis. Additionally, a literature review was conducted on the physical principles of energy-tissue interaction and the molecular mechanisms of repair.

Results. Histological examination revealed signs of dermal edema (moderate – 87 %, severe – 13 %), vascular changes (venous thrombosis – 31 %, erythrocyte stasis – 40 %), foci of fibroblast proliferation (18 %), and lymphocytic infiltration (87 %) in all groups. Analysis of coagulation zones showed significant intergroup differences. In Group 2 (monopolar coagulator), the depth of damage ranged from 0,27 to 0,82 mm, reaching 1,50–2,20 mm in 14 % of cases, with the formation of total necrosis and foci of carbonization. In Group 3 (diode and 2-μm lasers), the depth of impact ranged from 0,11 to 0,75 mm (abnormal values of 1,30–1,68 mm in 7 %), with partial fiber homogenization and preservation of some vascular structures. The best results were observed in Group 1 (CO₂ laser): the depth of thermal effect ranged from 0,07 to 0,38 mm, reaching 0,40–0,48 mm in only 5 % of cases; histologically, it was characterized by the smallest damage zone and a complete absence of carbonization. The role of tumescent infiltration anesthesia as an additional tissue protective factor (photohydropreparation) was demonstrated.

Conclusion. A direct correlation was established between the type of surgical energy and the extent of thermal necrosis. Monopolar electrocoagulation causes the most extensive and deep damage with tissue carbonization. Diode and 2-μm lasers provide an intermediate coagulation depth, sufficient for reliable hemostasis while preserving regenerative potential. The CO₂ laser in pulsed mode demonstrates a minimal necrosis zone (up to 0,38 mm) without carbonization, creating optimal conditions for rapid repair. A differentiated approach to the choice of energy source and the use of photohydropreparation can minimize surgical trauma, reduce the risk of anal stenosis, and improve patients' quality of life.

1. Sandler R.S., Peery A.F. Rethinking What We Know About Hemorrhoids. Clin Gastroenterol Hepatol., 2019, no 17(1), рр. 8–15. https:// doi.org/10.1016/j.cgh.2018.03.020

2. Cherepenin M.Yu., Lutkov I.V., Gorsky V.A. Comparative analysis of hemorrhoid treatment by electrocoagulation, bipolar electrosection and combined laser destruction. Moscow Surgical Journal, 2023, no 1, pp. 27–33. (In Russ.) https://doi.org/10.17238/2072-3180-2023-1-27-33

3. Longchamp G., Liot E., Meyer J., Toso C., Buchs N.C., Ris F. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci., 2021, no 36(3), рр. 485–496. https://doi.org/10.1007/s10103-020-03142-8

4. Surya D., Gharde P. Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management. Cureus, 2024, no 16(5), рр. e60011. https://doi.org/10.7759/cureus.60011

5. Gupta K. Lasers in Proctology. Lasers in surgery: from past to present. Springer, 2022, pp. 1–12.

6. Sowula A. The role of laser CO2 in proctology. Wiadomosci Lekarskie, 2010, no 63(1), рр. 27–32.

7. Awazli L.G. Hemorrhoidectomy using (10600 nm) CO2 laser. Iraqi J Laser, 2019, no 13(B), рр. 33–39. https://doi.org/10.31900/ijl.v13iB.67

8. Bachtsetzis G. et al. ELITE: a diode laser minimal invasive technique for hemorrhoids during the surgical treatment for anal fissure. J Surg Case Reports, 2019, рр. rjy363. https://doi.org/10.1093/jscr/rjy363

9. Jahanshahi A., Mashhadizadeh E., Sarmast M.H. Diode laser for treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Polski przeglad chirurgiczny, 2012, no 84(7), рр. 329–332.

10. Medrado A.R., Pugliese L.S., Reis S.R., Andrade Z.A. Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med., 2003, no 32(3), рр. 239–244. https://doi.org/10.1002/lsm.10126

11. Lasers in surgery. Edited by O.K. Skobelkin. M. : Medicine, 1998. 256 p. (In Russ.)

12. Sazonov A.A., Maistrenko N.A., Romashchenko P.N., Makarov I.A. Comprehensive assessment of the results of hemorrhoidectomy with lateral ultrasound dissection in the "cutting" mode. Bulletin of the Russian Military Medical Academy, 2021, vol. 23, no 3, pp. 17–22. (In Russ.) https://doi.org/10.17816/brmma72344

13. Keshk Z.S., Salah M.M., Samy N.A. Fractional carbon dioxide laser treatment of hypertrophic scar clinical and histopathological evaluation. Lasers Med Sci., 2025, no 40(1), рр. 137. https://doi.org/10.1007/s10103-025-04371-5

14. Won T., Ma Q., Chen Z., Gao Z., Wu X., Zhang R. The efficacy and safety of low-energy carbon dioxide fractional laser use in the treatment of early-stage pediatric hypertrophic scars: A prospective, randomized, split-scar study. Lasers Surg Med., 2022, no 54(2), рр. 230–236. https://doi.org/10.1002/lsm.23459

15. Ji Q., Luo L., Ni J., Pu X., Qiu H., Wu D. Fractional CO2 Laser to Treat Surgical Scars: A System Review and Meta-Analysis on Optimal Timing. J Cosmet Dermatol., 2025, no 24(1), рр. e16708. https://doi.org/10.1111/jocd.16708