High Resolution Anoscopy and Laser Ablation
What is HRA and Laser Ablation Under General Anaesthesia?
High-Resolution Anoscopy (HRA) is a procedure used to examine your bottom. Specifically, it looks at the anus, anal canal, and lower rectum for abnormalities such as pre-cancerous or cancerous lesions. Laser ablation, a minimally invasive procedure using a laser to remove abnormal tissue, is often performed during HRA to treat any abnormal growths.
You will be asleep under general anaesthesia (GA), this allows for a more comfortable experience and ensures you remain still while the procedure is performed.
Before the Procedure
Follow any preoperative instructions provided by the pre-operative clinic, including sometimes changing your medication
• Ensure you have not eaten or drunk anything that day as written in your instructions
• Arrive at the hospital on time as instructed.
During the Procedure
• You will be given general anaesthesia by an anaesthetist to ensure you are asleep and pain-free throughout the procedure.
• Once you are asleep, the HRA and laser ablation procedure will be performed.
• The anoscope will be gently inserted into the anus to visualize the area, and any abnormal tissue will be treated using the laser.
• We will biopsy any new lesions, which means taking away small pieces of skin for testing.
• If you are a woman, we will also examine the cervix, vagina and vulva for any lesions. These will also be treated if previously biopsied. Otherwise, we will take new biopsies.
• The procedure typically takes around 30 to 60 minutes to complete, depending on the findings and extent of treatment needed.
After the Procedure
• You will be monitored in a recovery area until you are fully awake and ready to go home.
• You may experience some grogginess, sore throat (if a breathing tube was used), or mild discomfort in the anogenital area.
• You may have mild bleeding for up to one week after the procedure.
• Arrange for someone to drive you home after the procedure.
We routinely follow you up at 10-12 weeks with HRA in clinic to assess response to treatment and plan further management.
Post-operative Care
You will be sent home with:
• Laxatives (medicines which make it easier to have a bowel movement).
• Paracetamol and Codeine for pain relief.
• Dermol 500 lotion which can be used as a wash, to wash with.
• Hydromol cream to be applied to keep moisture in the treated area.
• 5% lidocaine ointment to be applied to the treated area for pain relief.
• Flamazine cream to be to be applied to reduce inflammation.
• You may also wish to buy itz salt bath kit and petroleum jelly and integrate these in your post-operative care.
Possible Risks and Complications
While HRA and laser ablation under general anaesthesia are generally safe procedures, there are some risks and complications, including:
• Reaction to anaesthesia
• Bleeding
• Infection
• Pain or discomfort
• Scarring
• Recurrence of abnormal tissue
Laser ablation of external lesions is generally more painful post-operatively than internal lesions.
Healing will take 8-12 weeks. Most patients will need 3-4 laser ablation sessions to control and treat their disease.
Benefits of HRA and Laser Ablation Under General Anaesthesia
• Complete comfort and pain relief during the procedure.
• Ability to perform a thorough examination and treatment without discomfort or movement from the patient.
• Minimally invasive procedures with relatively low risk.
Contact Us
If you have any questions or concerns about the procedure, don't hesitate to ask us.
Contact Information: chelwest.anogenitaldysplasiaservice@nhs.net
References:
1) Beavis, A.; Najjar, O.; Murdock, T.; Abing, A.; Fader, A.; Wethington, S.; Stone, R.; Ferriss, J.S.; Tanner, E.J.; Levinson, K. Treatment of vulvar and vaginal dysplasia: plasma energy ablation versus carbon dioxide laser ablation. International Journal of Gynecologic Cancer 2021, 31
2) Fuertes, I.; Chivite, I.; Cranston, R.D.; Sánchez, E.; Cordón, E.; Rodríguez-Carunchio, L.; Blanco, J.L. Short-term eVectiveness and
tolerability of carbon dioxide laser for anal high-grade squamous intraepithelial lesions in individuals living with HIV. International journal of STD & AIDS 2022, 09564624221100069.
3) De-Masi, A.; Davis, E.; Cuming, T.; Chindawi, N.; Pesola, F.; Cappello, C.; Chambers, S.; Bowring, J.; Rosenthal, A.N.; Sasieni, P. The
acceptability of high resolution anoscopy examination in patients attending a tertiary referral centre. BMC cancer 2018, 18, 1-6.
4) Jay, Naomi. "High-resolution anoscopy: Procedure and findings." Seminars in Colon and Rectal Surgery. Vol. 28. No. 2. WB Saunders, 2017.
5) Brogden, Danielle RL, et al. "Evaluating the eVicacy of treatment options for anal intraepithelial neoplasia: a systematic review." International Journal of Colorectal Disease 36 (2021): 213-226.