- Gastroenterology Education and CPD for trainees and specialists - http://www.gastrotraining.com -

Haemorrhoidectomy

Discuss the various surgical treatments for haemorrhoids?

  • Rubber band ligation
  • Suction bands are used.
  • Up to 3 bands can be placed in a session for first or second degree haemorrhoids
  • Most effective method of clinic treatment with 80% of patients satisfied with short term outcomes
  • Bands should be applied above the dentate line to minimise pain
  • Most common complications are pain and bleeding. Anticoagulated patients should not be banded. Localised infection or abscess can occur at the site of banding
  • Ligation leads to thrombosis of the vein and causes local scarring to fix the mucosa on to the underlying muscle


Injection sclerotherapy

5% oily phenol is injected in the submucosa of the first or second degree haemorrhoid. It is less successful than banding.

Haemorrhoidectomy

  • Up to three haemorrhoidal columns are dissected out from the underlying anal sphincter complex. The defect is closed with continuous absorbable suture in closed haemorrhoidectomy.
  • Open haemorrhoidectomy is advocated by some surgeons to reduce the risk of infection. Here, the mucosal defect is left open and allowed to granulate by secondary intention.
  • Complications include- secondary haemorrhage, infection, urinary retention, faecal incontinence due to sphincter damage and anal stenosis.


Stapled haemorrhoidopexy

  • This is an alternative to surgical haemorrhoidectomy.
  • A transanal circular stapling gun is used to excise a circumferential ring of mucosa and submucosa approximately 2-3 cm above the dentate line. It thus reduces the prolapsed mucosa and interrupts the haemorrhoidal blood supply.
  • This technique can be offered to patients with second or third degree haemorrhoids that have not responded to outpatient treatment or even fourth degree haemorrhoids that are reducible under anaesthesia.
  • It is a less painful alternative to surgical haemorrhoidectomy but recurrence rates are higher.
  • Complications: bleeding, urinary retention, faecal incontinence, rectal perforation, rectovaginal fistulas, anastomotic leak, anal stricture, and infection

Article printed from Gastroenterology Education and CPD for trainees and specialists: http://www.gastrotraining.com