Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser.

<b>Indroduction:</b> Hemorrhoids often cause pain, and achieving painless outcomes through surgery is challenging. Hemorrhoidal Laser Ablation, a method for treating severe hemorrhoids, has limited documentation in clinical trials.</br> <br><b>Aim:</b> This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation in symptomatic grade II, III, and IV internal hemorrhoids and evaluate the efficacy and safety of this relatively recent technique.</br> <br><b>Material and methods:</b> The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation at three different medical centers in 2017-2022. Patients were treated with a 1470 nm diode laser. Data were collected on clinical and perioperative characteristics and outcomes.</br> <br><b>Results:</b> No evidence of intraoperative complications occurred. There was no rectal tenesmus or alteration of defecation habits. Early mild postoperative symptoms were observed for an average of one week after the operation. The plateau of symptom resolution and downgrading of hemorrhoid size reached approximately six months post-procedure. The short- -term recurrence rate was 0.8% within roughly a month after the laser surgery, while the long-term recurrence rate was 5% over up to five years of follow-up. The overall satisfaction rate was 95% with symptomatic relief.</br> <br><b>Conclusions:</b> Hemorrhoidal Laser Ablation is a painless outpatient technique that does not require general anesthesia. It is an easy-to-perform, convenient, safe, and efficient modality in reducing symptoms and complications of grades II, III, and IV internal hemorrhoids. Hemorrhoidal Laser Ablation limits postoperative discomfort and allows the patient to return to daily routines quickly.</br>.

Effect of LVAD outlet graft anastomosis angle on the aortic valve, wall, and flow.

Left ventricular assist devices (LVADs), which pump blood from the left ventricle to the aorta are an important therapy option for patients with end-stage cardiovascular diseases. Recent publications show that even with optimized LVADs fatal complications can occur because of the blood deformations around the inflow cannula or through the LVAD outlet graft-aorta anastomosis. This study investigates the effects of the anastomosis geometry on the flow through the aorta, on the pressure and wall shear stress (WSS) distributions on the aortic wall and on the total entropy generation in the anastomosis region. Anastomosis geometry is defined with two angles, one on the coronal plane and the other on the transversal plane. Turbulent flow simulations are performed for each geometry. Results indicate that 3% to 5% of the work given by the LVAD is dissipated because of the viscous losses in the anastomosis region. The entropy generation, as well as the maximum WSS, increases as the inclination angle decreases. Some portion of the blood streaming out of the LVAD conduit flows toward the aortic valve; therefore the reverse-flow region extends up to the aortic valve in some cases, which may be one of the causes of aortic-valve dysfunction. Results of this study provide insight on the importance of the anastomosis geometry on the hemodynamics in the aorta and downstream the aortic valve, stresses on the aortic wall, and viscous losses.