What is HelPexx (Hemorrhoidal Laser Procedure with Mucopexy)?

What is HeLPexx (Hemorrhoidal Laser Procedure with Mucopexy)?

HeLPexx is a minimally-invasive outpatient procedure that combines Doppler-guided laser dearterialization of hemorrhoidal arteries with suture mucopexy (tissue lifting) to treat symptomatic grade II-III hemorrhoids, particularly when significant mucosal prolapse is present. 1, 2

Mechanism and Technique

The procedure works through two complementary mechanisms:

Laser Dearterialization Component

• A Doppler probe identifies terminal branches of the superior rectal arteries approximately 2-3 cm above the dentate line 1, 3
• A diode laser platform delivers pulsed laser shots to close these arterial branches, reducing blood flow into the hemorrhoidal plexus 1, 3
• The Doppler probe operates at 20MHz frequency to locate arteries that would otherwise be missed due to their variable location and distribution 1
• Typically 8-12 arterial branches are treated during the procedure 4
• Absence of Doppler signal after treatment confirms successful arterial coagulation 3

Mucopexy Component

• Three to six running sutures are placed to lift prolapsed hemorrhoidal tissue back into the anal canal 1, 2
• This component addresses the mechanical prolapse that laser alone cannot correct 1
• The sutures secure long-term resolution of prolapse symptoms 1

Clinical Indications

HeLPexx is specifically indicated for grade III hemorrhoids with significant mucosal prolapse, while HeLP alone (without mucopexy) is used for grade II-III hemorrhoids with minimal or no prolapse. 1, 2, 5

• The addition of mucopexy becomes necessary when mucosal prolapse is symptomatic and cannot be adequately addressed by dearterialization alone 1
• Patients must have failed conservative treatment (fiber, fluids, lifestyle modifications) before considering this procedure 6

Clinical Outcomes and Efficacy

Symptom Resolution

• In a prospective study of 170 patients with grade III hemorrhoids, the Hemorrhoid Symptom Score improved from 15.83 ± 3.04 preoperatively to 1.3 ± 2.4 postoperatively (p ≤ 0.001) 2
• Resolution of symptoms occurred in 90% of patients treated with HeLP compared to only 53% with rubber band ligation at 6 months (p < 0.001) 3
• Recurrent symptoms requiring further treatment occurred in only 7% of patients at median 36-month follow-up 2

Pain Profile

• Mean postoperative pain VAS score was 1.8 ± 1.1 at 1 week, with no patients reporting pain by 3 weeks postoperatively 2
• This is significantly lower than rubber band ligation (median pain score 1.1 vs 2.9, p < 0.001) 3
• The laser beam is well tolerated, allowing the procedure to be performed without anesthesia in most cases 1
• At 1 week post-procedure, 82.3% of patients reported no pain, increasing to 95.2% at 1 month 4

Return to Activities

• Patients are typically discharged within approximately 90 minutes and allowed to resume normal activities quickly 4
• Only 7% of patients required pain medications for more than 1 week postoperatively 2

Complications and Safety Profile

The procedure demonstrates a favorable safety profile:

• Urinary retention: 4.1% of patients 2
• Bleeding not requiring transfusion: 0.6% 2
• Thrombosis of hemorrhoidal piles: 1.2% 2
• No cases of rectal tenesmus or altered defecation habits 5
• Patients with third-degree hemorrhoids had higher rates of intraoperative bleeding (11.3%) and thrombus formation (11.3%) compared to second-degree hemorrhoids 4

Predictors of Failure

Severe chronic constipation prior to surgery is a significant predictive factor for treatment failure (p = 0.04). 2

• These patients should be counseled about higher risk of recurrence and may require more aggressive bowel management postoperatively 2

Comparison to Traditional Treatments

Advantages Over Rubber Band Ligation

• Superior symptom resolution (90% vs 53% at 6 months) 3
• Less postoperative pain (median VAS 1.1 vs 2.9) 3
• Better hemorrhoid downgrading (80% vs 40% reduction by at least 1 grade) 3
• Significantly higher quality of life scores (p = 0.002) 3

Advantages Over Conventional Hemorrhoidectomy

• Avoids the major drawback of excisional hemorrhoidectomy: severe postoperative pain requiring narcotics and 2-4 weeks off work 7, 6
• Lower morbidity and quicker return to work compared to traditional surgical approaches 1
• Complications of conventional hemorrhoidectomy include urinary retention (2-36%), bleeding (0.03-6%), anal stenosis (0-6%), and incontinence (2-12%) 7

Important Caveats

• The procedure is not suitable for grade IV hemorrhoids or when large external hemorrhoid components require removal 1
• Follow-up data beyond 2 years remain limited, with median follow-up in most studies being 6-36 months 2, 3, 5
• The technique requires specialized equipment (Doppler probe, diode laser platform, dedicated proctoscope) and training 1, 3
• Cost is higher than rubber band ligation due to equipment requirements, though this may be offset by superior outcomes 3