Hemorrhoids - Piles


Hemorrhoids (Piles) is a very common problem encountered by all practitioners in field of Gastroenterology. Only a miniscule percentage of such cases need to actually undergo surgical treatment. Bright red blood in stool is very scary for the patient but rarely if ever life threatening. Treatment ranges from simple home remedies to medical treatment, sometimes non surgical procedures and rarely surgery; open or stapled hemorrhoidectomy. We provide the entire gamut of the therapeutic options for hemorrhoids. We pioneered IRC (Infrared coagulation) in the region by introducing it in 1998, Now we have also introduced endoscopic hemorrhoid band ligation about 4 yrs ago. Though we also have facility of sclerotherapy (Injections) and cryotherapy (freezing) these are no longer frequently used being obsolete technology with established complications. We have our own operation theater to perform open or stapled hemorrhoidectomy.



Endoscopic  Treatment  of  Piles (Internal  Hemorrhoids);

This  method  first  reported  in  world  literature  around  2004  is  now  brought  to  this  region  after  initial  trials  at  out  center. Treatment  involves  Endoscopic  suction  band  ligation  of  internal  hemorrhoids in   straight  or  retroflexed  position. The  technology  was  originally  developed  in  late 1990s  for  esophageal  varices  and  was  found  to  be  exceeding  useful  and  today  is  treatment  of  choice  for  esophageal  varices. Banding  using  rigid  proctoscope  has  been  practiced  as  treatment  for  hemorrhoids  since  many  decades  but  problems  associated  were  many  including tearing  of  the  hemorrhoid  when  pulled  into  the  band, lack  of  documentation, lack  of  maneuverability. The  Endoscopic  suction  band  ligation  obviates  most  of  the  problems  and  is  expected  to  become  the  standard  of  care  for  Gr  2  &  Gr  3  Internal  hemorrhoids  in  coming  years.

How  many  sessions  are  needed  for  complete  treatment ?

About  60%  of  patients  do  not  require  more  than  1  session to  eradicate  the  symptoms  of  the  disease.

What  grade  of  hemorrhoids  are  suitable  for  this  method  of  treatment?

This  method  is  suitable  for  Gr  2 &  Gr 3  internal  hemorrhoids.

How  to  prepare  for the  procedure ?

Patient  comes  after  clearing  the  lower  intestines  either  by  taking  “Colopeg”  powder  or  after  enema. This  is  a  walk  in  walk  out  procedure  for  which  no  hospitalization  is  needed.  Usually  no  preprocedure  investigations  are  needed  but  a  previous  colonoscopy  is  advised  to  rule  out any  other  cause  of  bleeding high  up.

Can  diabetics  and  Heart  disease  patients  undergo  this  procedure?

This  procedure  is  specially  suitable  for  patients  with  diabetes  and  IHD  as  also  for  elderly  patients  otherwise  not  fit  for  surgery.

Is  the  procedure  100 %  successful?

Rarely  the  procedure  may  fail  to  cure  the  disease  and  then  surgical  hemorrhoidectomy  may  still  be  needed  but  our  results  so  far  are  exceedingly  good  with  no  surgery  having  been  performed  in  the  last  128  patients  treated  by  this  method  over  here  over  the  last  1  year (upto  Mar  2011). However  since  our  center  provides  all  surgical  facilities  even  surgical  hemorrhoidectomy  if  needed  patient  does  not  need  to  be  referred  to  any  other  place.

What  are  the  complications?

Reported  complications  in  world  literature  are  ;  Pain  controlled  with  analgesics  in  25%, Failure (Continued  bleeding)  in  less  than  5  %, Thrombosed  external  hemorrhoid (single  case  reported  in  world  literature),  perianal  abscess (single  case  reported in  world  literature). Surgery  treated  the  cases  of  failure,  perianal  abscess  and  thrombosed  external  hemorrhoid.

What  is  the  cost  of  treatment?

  First  session  of  ESBL;  Rs  8000/-, repeat  sessions if  needed Rs  5000/-, 

IRC ;  Rs  4500  for  upto  3  sessions. Consultation fee  remains  payable  on  each  visit.