Successful non-surgical management of all degree hemorrhoids

Abstract

Background: To evaluate the patients with primary hemorrhoids after employing mainly the non-surgical treatment in all degree hemorrhoids.Methods: A prospective and descriptive study over three hundred and fifty (350) patients in four-year period. Concomitant anal fissure, anal fistula, secondary hemorrhoids, and recurrent hemorrhoids were excluded from the study.Results: Total 350 patients (age range-18-80 years). Female340 (97.14%) and male10 (2.58%) admitted in surgical OPD of three different hospitals during the period of Feb 2013- Jan 2017. All patients were thoroughly examined abdominally and per rectally and proctoscopied as well to rule out concomitant pelvic and perineal pathologies. All proctoscopic findings and treatment were done by single surgeon. Treatment of hemorrhoids was categorized into three types. Type I, conservative (fiber +oral lubricants + in jeer + micronized purified flavonoid fraction + sitz bath), type II, injection sclerotherapy & type III, surgery (open Hemorrhoidectomy). All degree hemorrhoids were first kept on conservative treatment and followed weekly for bleeding and hemorrhoid swelling. Only 38.57% required Injection sclerotherapy in cases where conservative treatment was failed, large hemorrhoid swelling (> 2cm size) seen on first proctoscopy and in cases where frequent fresh bleeding episodes found either on every 2nd-3rd day or every passage of stool. Strangulated bleeding hemorrhoids dealt with anal strapping, conservative treatment and later with injection sclerotherapy, which was given after resolution of bleeding and strangulation. Open hemorrhoidectomy was done in non-compliant and in patients with exclusive external hemorrhoids.Conclusions: Although conservative oral therapy has been given appreciating results but in adjunct with injection sclerotherapy the optimal results were promising.

Role of Internal Sphincterotomy as an Adjunct to Open Haemorrhoidectomy for Management of Third- and Fourth Degree Haemorrhoids

“…3 Although variable success rates of nonsurgical management has been reported but surgical treatment is usually preferred for the third and fourth degree haemorrhoids. 4 Different surgical options include stapled haemorrhoidectomy, trans-anal hemorrhoidal dearterialization, open (Milligan-Morgan) or closed (Ferguson) haemorrhoidectomy and haemorrhoidectomy using ligature or harmonic scalpel. 5 Hemorrhoid surgery is often associated with complications which include post-operative pain, bleeding, urinary retention, wound infection, fecal incontinence, constipation or anal stenosis.…”