Haemorrhoid treatment (2)

Traditional surgery – Hemorrhoidectomy

The principle of the surgery is to decrease the blood flow to anorectal ring, which is followed by the removal of redundant hemorrhoidal tissue.
 

Indications

• Grade II, III and IV hemorrhoids
• Failure of non-operative treatment of 2nd degree pile
• Thrombosed hemorrhoid
• Interoexternal pile when the external pile is well defined

 
Types

• Excision of hemorrhoids with (closed hemorrhoidectomy) or without (open hemorrhoidectomy) suturing
• Excision by using different energies
• Diathermy
• Harmonic scalpel
• Bipolar scissors

Stapled hemorrhoidopexy / Procedure for prolapsed and hemorrhoids (PPH)
Based on the concept of interruption of the superior and middle hemorrhoidal vessels, and the upward lifting of the prolapsed anorectal mucosa, followed by repositioning of the vascular cushions back into the anal canal, causing atrophy of hemorrhoidal tissue

• For Grade 3 and 4 hemorrhoids
• No incisions are made in the somatically innervated, highly sensitive anoderm, which cause significantly less postoperative pain
• Side effects include rectal perforation, sphincter dysfunction and sepsis
• Advantages:
  1. Simple and quick procedure
  2. Less postoperative pain, shorter hospital stay and earlier return to normal activity
  3. Similar complication rate as conventional procedure

	Staple hemorrhoidopexy	Traditional hemorrhoidectomy
Operative time	Quick, around 30 minutes	40-60 minutes
Postoperative pain	Much less	Painful wound, subsided days to weeks later
Recovery time	Fast, can resume normal activity on next day, avoid strenuous exercise	Slow, requires days to week to resume normal duty
Wound care	Not needed if not infected	Daily wound dressing, for one to two weeks

Hemorrhoidal artery ligation (HAL) and Transanal hemorrhoid dearterialization (TAH)
Video Demonstration


These are for treatment of bleeding and Grade 2 to 3 prolapsed hemorrhoids. Dearterialization is to apply Doppler-USG for identification and selective ligation of the branches of rectal artery, thereby correcting the arterial hyperinflux, which is the main cause of bleeding and swelling of the haemorrhoidal plexus. Mucopexy or rectoanal repair is the reposition of the cushions in their anatomical site by folding the muco-hemorrhoidal prolapsed
 

Benefits

• Minimally invasive and atraumatic
• Marginal post-operative pain
• No grave complications

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. 

Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.