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Background Perianal fistulizing Crohn’s disease (PFCD) is the main risk factor for anal cancer in patients with inflammatory bowel disease. It is not known whether this occurs due to a higher frequency of human papillomavirus (HPV) in this population or due to the chronic inflammatory condition resulting from perianal fistulas. We aimed to evaluate whether there is a higher prevalence of HPV and high-risk HPV in patients with PFCD compared to the control group, estimate the prevalence of HPV and the subtypes most frequently associated with PFCD. Methods We performed a bicentric cross sectional study in which participants were matched by age and sex. A total of 108 patients with surgical indication for perianal fistula, were recruited, 54 patients in PFCD group and 54 patients with anorectal fistula without Crohn’s disease, from December 2018 through November 2020. These patients were subject to histological material collection during exam under anesthesia with biopsy of the fistulous pathway. The sample was sent for HPV detection and genotyping by INNO-LiPA HPV Genotyping Extra II. Results The PFCD group showed a statistically higher frequency of HPV in the fistulous path compared to control group (33.3% vs 16.7%, p = 0.046). The isolated analysis of the high-risk subtypes numerically demonstrated double the frequency in PFCD group, however, not statistically significant (18.5% vs 9.3%, p = 0.164). After multiple logistic regressions, patients with PFCD had a chance of HPV 3.42 times higher than patients without Crohn’s disease (OR = 3.42, 95% CI, 1.25–9.40), regardless of other variables. The subtypes most frequently identified in PFCD group were HPV11 (12.72%) and HPV16 (9.09%). Conclusion Perianal fistulizing Crohn’s disease is associated with a higher prevalence of HPV compared to patients with anorectal fistula without Crohn’s disease.

Introduction: Hemorrhoidal disease is associated with the theory of arterial blood hyperflow causing swellings in hemorrhoids and, consequently, hyperplasia and venous congestion. The technique helps to promote the obliteration of the terminals of the superior rectal artery branches without the need for anesthesia by electrofulguration with diode fiber LASER. The objective of this study is to describe the results of 55 patients with hemorrhoidal disease treated by the Hemorrhoidal LASER Procedure technique. Method: Without the need of anesthesia, terminal arterioles of the upper rectal artery are identified by a Doppler transducer (20 MHz probe 3 mm) placed on a specially designed proctoscope. After identification, it promotes arteriolar electrofulguration at 980 nm fiber laser diode, causing interruption of hemorrhoidal flow. This procedure is repeated circumferentially, following the clockwise positions. Results: Between 2011 and 2014, 55 patients underwent the Hemorrhoidal LASER Procedure technique for hemorrhoidal disease grades I, II and III. There was no need for anesthesia and only two patients required sedation for the procedure. The overall satisfaction rate was 89%, with symptom resolution in 84% and a decrease of at least one grade in hemorrhoidal disease in 80% of cases. Conclusion: Hemorrhoidal LASER Procedure is a painless outpatient technique that does not require anesthesia, in addition to being safe and easy to perform. It is effective in reducing symptoms and complications of the hemorrhoidal disease grades I and II, with high satisfaction rates. Resumo: Introdução: A doença hemorroidária está associada a teoria vascular de hiperfluxo arterial causando dilatações nos plexos hemorroidários e, consequentemente, hiperplasia e congestão venosa. A técnica HeLP promove a obliteração dos ramos terminais da artéria retal superior, sem a necessidade de anestesia, através da eletrofulguração com fibra de diiodo LASER.O objetivo deste trabalho é descrever os resultados de 55 pacientes com doença hemorroidária tratados pela técnica HeLP. Método: Sem a necessidade de anestesia, as arteríolas terminais da artéria retal superior são identificadas através de um transdutor doppler (20mhz probe de 3 mm) locado em um proctoscópio especialmente desenhado. Após a identificação, promove-se a eletrofulguração arteriolar através de uma fibra de 980 nm de diiodo LASER, ocasionando interrupção do hiperfluxo hemorroidário. Este procedimento é repetido circunferencialmente, seguindo-se as posições das horas de um relógio. Resultados: Entre 2011 e 2014, 55 pacientes foram submetidos a técnica HeLP para doença hemorroidária de graus I, II e III. Nenhum paciente utilizou anestesia e apenas dois necessitaram sedação para a realização do procedimento. O índice de satisfação global atingiu 89%, houve resolução dos sintomas em 84% e diminuição de ao menos um grau, na doença hemorroidária, em 80% dos casos. Conclusão: HeLP é uma técnica ambulatorial e indolor, que não utiliza qualquer anestesia, é segura e fácil de ser realizada. Eficiente para reduzir sintomas e complicações da doença hemorroidária graus I e II, com índice de satisfação elevada. Keywords: Hemorrhoids, Hemorrhoidal LASER Procedure, Hemorrhoidal dearterialization, Palavras-chave: Hemorroidas, Hemorrhoidal LASER Procedure, Desarterialização hemorroidária