PakarBedahAnda or Your-General-Surgeon is my blog in which I highlight common surgical problems faced by Malaysians. In the last 20 years of my practice, many of my patients presented with advanced diseases in which treatments were more complicated, and if they were cancers then the prognosis were poor. This is also my personal 'fight' against late presentation of surgical diseases particularly cancers.
Monday, May 26, 2008
HEMORRHOIDECTOMY; Surgery for Hemorrhoids
Today I received an e-mail from someone who enquired about prolapsed hemorrhoids, and what to do to it. Hemorrhoids or piles is an interesting disease. It is an 'old' disease that surgeons thought the treatment is already established long time ago. However with the 'new' understanding on the pathogenesis (how it comes about) of the hemorrhoids, came new treatment modality. We believe that hemorrhoidal tissue is a part of a normal structure (endocushions) in the anal canal that helps in maintaining continence of the anal sphincter. You just imaging without this, if you fart or jump, you might get fecal soiling of your underpant. I prefer to use the word 'hemorrhoidal disease' to 'hemorrhoids' per se.
Some Malaysians go to Singseh or Tabib Buasir for their hemorrhoids. I am not against 'alternative medicines'. Unfortunately not all prolapsed anal lesions are hemorrhoids. I have seen many anal or rectal cancers 'treated' as hemorrhoids. Furthermore they are something called secondary hemorrhoids; these are hemorrhoids that formed as a result of (secondary to) other rectal disease, usually cancers. My advice is that if you notice some mucus on your feces or the blood from your 'hemorrhoids' mixed (not stain on the surface) of your feces; you should go to a surgeon instead of a singseh. You might be having life-threatening cancer.
This is a hemorrhoids, the more reddish inner part is the internal component,
while the darker outer part is the external component.
Prolapsed hemorrhoids is best treated surgically. The old surgical techniques are usually painful. Now, there is a new technique recently introduced by Prof. Antonio Longo from Italy called the Stapling Hemorrhoidectomy or the PPH (Procedure for Prolapse and Hemorrhoids). I personally believe that this method has revolutionised surgical treatment of hemorrhoids. The main advantage is painlessness of this surgery. This is how some of the staplers look like.
Basically it cuts out a segment of rectal mucosa and staples the two ends together with small titanium staples. As a result, the prolapsed tissues are pulled back into the anus and rectum back to their original position. Since the cutting and stapling are done well inside the rectum, you won't feel the pain. Some patients might complain of some degree of pain, this is from the stretching of the anal canal , and this is usually minimum. The only 'setback' of this instrument is its cost. You may need to pay about RM 1700 for this single-use gadget.
These pictures show the hemorrhoids after and before stapling (PPH)
Before procedure Immediately after completion of surgery
A nurse told me this morning that one of her relatives has a 'huge' prolapsed piles that made him unable to wear a trouser for many months. The same old story, repeatedly....LATE PRESENTATION !