The first experience of simultaneous submucous laser destruction of hemorrhoids during laparoscopic sleeve gastrectomy and cholecystectomy in an obese patient

Introduction. Simultaneous procedures in bariatric operations account for 3.4-28.1% of cases. The main advantages of the approach is to achieve the maximum positive impact on the quality of life of patients. Most often, bariatric procedures are combined with simultaneous cholecystectomy, hernioplasty, and elimination of hiatal hernia. There are single descriptions of simultaneous interventions in combining obesity with other nosologies. The implementation of simultaneous surgical correction of chronic hemorrhoids during bariatric intervention has not been previously described in the available literature.Clinical case. Presented the first experience of laparoscopic sleeve gastrectomy and submucous laser hemorrhoidoplasty in a 45-year-old woman with alimentary-constitutional obesity and grade 3 chronic hemorrhoids. The total time to complete the procedures did not exceed the total time of individual interventions. The severity of pain syndrome during the early postoperative period was comparable to the standard after bariatric interventions.Discussion. Based on the first experience, the simultaneous submucous laser destruction of hemorrhoids, according to indications, simultaneously with the bariatric procedure for chronic hemorrhoids in patients with morbid obesity is a justified and fairly safe combination.Conclusion. The simultaneous elimination of two diseases at once has a positive effect on the further quality of life and reduces the risk of further proctological problems.