Innovated several painless techniques
The other name for Hemorrhoids is Piles. Hemorrhoids are clumps of tissues present within the anal canal, that contain blood vessels, muscle and some elastic tissues. This tissue normally serves as a cushion that acts as a seal that does not allow stools to come out when you don’t want to pass it out. The problem arises when this cushion of tissue swells up. This usually happens when the pressure within the rectum increases due to Long term constipation or diarrhea, heavy weight lifting, pregnancy, and straining while passing stools.
Various hemorrhoidectomy procedures are currently available. The aim is to prevent further bleeding and prolapse of the hemorrhoidal tissue. This can be achieved by either cutting the prolapsed hemorrhoidal tissue or by cutting off the blood supply to the tissue by tying the artery supplying it. Because the rectum is closely associated with rich blood supply and nerves, these procedures may be associated with increased infection, bleeding, urine retention and considerable pain post operatively. However, Stapled Hemorrhoidectomy is a newer technique, reserved for much larger hemorrhoids and involves stapling in the part of the rectal canal above which there are no pain nerves. Hence, this procedure is virtually pain free.
How is Stapled Hemorrhoidectomy Performed
A circular stapler device is inserted and the anal canal is dilated.
The tissues supporting the hemorrhoids is first sutured with purse string sutures. A Purse string suture is a surgical suture applied around the edges of a circular wound, applied in such a way that when the edge of the suture is drawn close, the wound is closed like a purse. The sutures are applied at an adequately higher level in the rectal canal, where pain nerves are absent.
With the hemorrhoids put inside, the sutured part is stapled. Stapling lifts the protruding hemorrhoid tissues away from the anal outlet and cuts off blood flow to these hemorrhoids.
This leads to its gradual decrease in size and ultimately death. These dead tissues shed off normally while passing stools.
Care After HEMORRHOIDECTOMY
Severe pain, persistant bleeding or pus discharge after surgery should be brought to the notice of the surgeon.
Patients will be advised to take diet rich in fiber and lots of fluids.
Prolapsed hemorrhoidal tissues cause a lot of pain and discomfort while passing stools. So once the hemorrhoids are noted to bulge out and does not go back in by itself, the best option is to remove these tissues by Hemorrhoidectomy.
Rest assured that there have been no tablets that can cure or heal piles. And a number of people make money of an unsuspecting public by selling proprietary medicines for piles. Severe exacerbations of piles can probably be reduced to a little bit. But permanent cure is definitely not possible.
No, not if they are not giving any symptoms or discomfort. If there is no itching, bleeding or discomfort around the anus, one could advice these patients to wait and watch for sometime. However if any of the above symptoms come on, then these patients are better off with treatment for it. This treatment does not always involve an operation.
There are many options like:
• Injecting the piles with a sclerosant, or a solution that will cause the piles to harden up and solidify.
• Infra red coagulation, in which infrared rays are applied to the piles in order to make them congeal or solidify.
• Rubber bands could be applied to the piles in order to constrict the veins and decrease the size of the hemorrhoids.
These are some of the non-surgical ways in which we treat hemorrhoids.
Either an open hemorrhoidectomy, in which the piles are removed using an electrical dythame pencil, or a Minimally Invasive Procedure for Haemorrhoid(MIPH) called stapler haemorrhoidopexy, in which a circular stapler gun is inserted into the anus to remove the masses, can be done. There is not a major difference in the long time, between these two groups, but the short-term pain and discomfort is certainly far less in patients undergoing stapler haemorrhoidectomy.
It is a little bit more expansive then the regular operation, mainly because of the cost of the disposable stapler gun. However, the lack of pain and discomfort in the post operative period more then makes up for this !
Many of our patients at LIMA go back the same evening. Some prefer to go the next morning. Overall a 24 hour period is more then enough for a patient undergoing stapler haemorrhoidectomy. You are also back on your feet with an active normal life within three or four days, making it a very popular technique for large hemorrhoids.
Patients with alarming symptoms like loss of weight, appetite, or alteration of bowel habit are probably with much better off having a colonoscopy in order to rule out a tumor before they undergo treatment for hemorrhoids.
Dr. J. S. Rajkumar
M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)
Dr. S. Akbar
Consultant General and Laparoscopic Surgeon
M.B.B.S., M.S (GENERAL SURGERY), D.MAS, F.MAS.
Dr. Anirudh Rajkumar
Bariatric and Laparoscopic Surgeon
M.B.B.S., Dip.N.B. (GENERAL SURGERY).