surgery for hemorrhoids and other techniques for the management

SURGERY AND OTHER MANAGEMENT OPTIONS FOR HEMORRHOIDS

If medical management fails, then what are the surgical options for hemorrhoids ? There are several ways of handling the problem, ranging from a more conservative approach to an aggressive plan, depending on the clinical situation.

RUBBER BAND LIGATION

The principal behind rubber band ligation is the placement of a contricting band around the hemmoirhoidal tissue. This procedure is done in the office using an anoscope, a tube that is placed into the anus to expose the redundant tissue. The grasper is then used to hold the tissue, while the rubber band is placed at the base of the bunched up area, acting as a noose. The blood supply to the constricted area is cut off, and the tissue then dies and is passed out in the feces. The placement of the rubber band and subsequent necrosis of the tissue is not very painful; the insertion of the anoscope is the thing that is not too comfortable!

Figure illustrating rubber band ligation of hemorrhoids, courtesy of the Mayo Clinic.

SCLEROTHERAPY OF HEMORRHOIDS

Alternatively, the hemorroidal tissue can be injected with sclerosing solution, much like spider and varicose veins. The injection leads to clotting and scarring of the varicose veins that form the hemorrhoid.

INFRARED TREATMENT OF HEMORRHOIDS

With this technique, infrared energy is applied for a brief second to the tissue, causing it to coagulate. This type of treatment requires several visits and different treatments, but is generally well tolerated.

STAPLING OF HEMORRHOIDS

Hemorrhoids can also be removed using a stapling device. Staplers are very commonly used in the surgical arena to put bowel back together, and have allowed surgeons further access to difficult points in the body where sewing would not be possible. With stapling, the tissue is grasped and cut off with a ring of staples.

SURGERY FOR MANAGEMENT OF HEMORRHOIDS

Surgery is the traditional management technique for hemorrhoids. The procedure is done under anesthesia, and involves excision of the redundant tissue. It is more painful than rubber band ligation and other techniques, but the recurrence rate of new hemorrhoids is less. For an in-depth forum on colorectal disease, please click on this link to the American Society of Colorectal surgeons