A whole new world for haemorrhoid surgery

Escrito por: Mr Arif U Khan
Publicado:
Editado por: Cal Murphy

Haemorrhoids or piles are an irritating and often painful condition affecting many people. These little lumps around the anus are in fact swollen blood vessels, which can become inflamed, leading to itching, soreness, bleeding and swelling. If the symptoms become significant enough to affect the patient’s life and other treatments aren’t working, a haemorrhoid may need to be surgically removed. Top surgeon Mr Arif Khan explains the different approaches to haemorrhoid surgery:

What does modern haemorrhoid surgery look like?

Symptomatic haemorrhoids or piles can be Grade I (with minimum bleeding and no prolapse) to Grade IV (with recurrent bleeding and marked haemorrhoidal prolapse). Surgery for symptomatic piles is indicated for Grade II – IV haemorrhoids.

Surgery for haemorrhoids has revolutionised over the last 10 years. Before a few decades ago, open haemorrhoidectomy or Milligan-Morgan haemorrhoidectomy was the treatment of choice for Grade III and IV haemorrhoids. This procedure required general anaesthetic and left the patients with a large wound around the back passage. Patients would experience recurrent bleeding and pain after the procedure up to six weeks. The wounds required a long time to heal, resulting in a prolonged recovery time.

Following open haemorrhoidectomy, stapled haemorrhoidectomy used to be a procedure that was relatively less invasive; however the procedure lost popularity due to problems of sepsis, urgency of stools and incontinence experienced by the patients.

Now modern haemorrhoid surgery is being performed by trained surgeons in a few centres. The procedure is called Doppler-guided haemorrhoidal artery ligation (also known as the THD procedure or HALO procedure). The latest technology has made it possible to reduce the blood supply to the haemorrhoids without cutting or resection. The procedure has a high success rate of around 85-90% and a low recurrence rate. As no cutting is required, the procedure is relatively painless, and the incidence of sepsis and incontinence are negligible. The majority of patients can return to work after 48 hours.

 

What new types of haemorrhoid surgery are being investigated?

The new procedure for treatment of symptomatic (Grade II – IV), is called Doppler-guided haemorrhoidal artery ligation (THD or HALO procedure). This new procedure was developed with the extended use of modern ultrasound technology to locate the precise position of the arterial blood supply to the haemorrhoids. The procedure localises the blood supply to the haemorrhoids and the inflow to the haemorrhoids is minimised by ligating (tying with a stitch) the blood vessels, thus shrinking the piles. Further developments are currently being made with the equipment and our patients will benefit from them in near future.

 

If there’s a promising form of surgery on the horizon, when might patients start to benefit from the procedure?

Further developments are also being made in the use of laser and infra-red radiation in the treatment of haemorrhoids. These modalities have already been tried, and can be performed in an outpatient setting, but have a higher recurrence rate.

 

What are the non-surgical options for haemorrhoids treatment?

Non-surgical treatment for haemorrhoids is cost and time saving. Techniques usually performed in patients suffering from early haemorrhoids (Grade I-II) include haemorrhoidal ointments, rubber band ligation of haemorrhoids and infrared coagulation.

Mr Arif U Khan

Por Mr Arif U Khan
Cirugía general

Arif Khan es consultor general senior, cirujano laparoscópico y colorrectal que trabaja en clínicas en Greater Manchester y Cheshire . Se especializa en cirugía general y colorrectal, y ofrece una variedad de procedimientos quirúrgicos para tratar las hernias , la enfermedad de la vesícula biliar , las hemorroides , la fisura anal , la fístula anal , las verrugas anales , la enfermedad de Crohn y el SII .

Después de obtener su MBBS en 1985, Khan realizó una formación especializada en London Deanery y University College Hospital y recibió una beca de la Junta Interuniversitaria del Royal College of Surgeons en 2005. El Sr. Khan fue nombrado consultor general y cirujano colorrectal en Mid Cheshire Hospitals NHS Foundation Confianza, donde fue jefe del programa Enhance Recovery in Surgery (ERAS).

Como Supervisor Educativo en el hospital Leighton, el Sr. Khan está comprometido con la enseñanza y entrenamiento de aprendices quirúrgicos. También participa activamente en la formación de otros cirujanos consultores en técnicas quirúrgicas mínimamente invasivas, en su calidad de Entrenador Nacional para LAPCO (Cirugía Colorrectal Laparoscópica) y THD (Desarterialización Hemorroidal Transanal). Los intereses de investigación actuales de Khan incluyen cáncer de colon y cirugía colorrectal, y su investigación se cita con frecuencia en revistas revisadas por pares.


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