Merits and Demerits of Scleotherapy in the Management of Grade I and II Hemorrhoids: A Study of 100 Cases

Abdul Majid, Jaffar Sathiq (2013) Merits and Demerits of Scleotherapy in the Management of Grade I and II Hemorrhoids: A Study of 100 Cases. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: A lthough few people have died of hemorrhoidal disease, many patients wish they had, particularly after therapy, and this fact led to the beatification of St. Fiachre, the patron saint of gardeners and hemorrhoidal sufferers. Hemorrhoids means blood flowing (Greek: Haema=blood and Rhoos=flowing). The latin word ‘pila’ from which the word ‘pile’ is derived, actually means a ball. Since ancient times haemorrhoids have been the most disturbing diseases. Vascular structures in anal canal which help in stool control are called haemorrhoids. They are composed of arterio-venous channels and connective tissue, acting like a cushion in their physiological state. In clinical practice of general surgery, it is the most frequent problem which the surgeons have been treating for centuries. These swollen inflamed veins cause bleeding, discomfort, and itching in the anus or lower rectum. If the symptoms are minimal, patients do not always need any treatment. The first recommendation usually is making simple lifestyle changes through diet (increase in fibre intake, to drink plenty of water and to avoid too much caffeine) and exercises. Symptomatic hemorrhoids can be treated both non operatively and operatively. Non operatively, hemorrhoids can be treated by regulating the bowel motility by various proprietary creams inserted into the rectum from a collapsible tube fitted with a nozzle with a hip bath or by using hydrophilic colloids (isogel, dulcolax, lactulose etc.). Operative management includes injection sclerotherapy, cryosurgery, elastic rubber band ligation to the base of each haemorrhoid, laser therapy, infra red photo coagulation and various formal surgeries. Though various modalities have been described in managing them effectively, it recurs unless the causative factor have been eliminated. But the cause of hemorrhoids remains unknown.1 Factors which increase intra abdominal pressure, particularly constipation, play an important role in their development. The operative technique for hemorrhoidectomies described by Milligan Morgan and Ferguson and their modified ones are the most effective and widely used haemorrhoid treatment modalities.2 These techniques are dealt with many complications like post operative pain, bleeding, sphincter dysfunction etc. thereby increasing the postoperative morbidity and delay in returning to their work. Moreover these techniques are less applicable for elderly malnourished, patients with severe anaemia and for those having additional co-morbid factors like ischemic heart diseases. AIM OF THE STUDY: 1. To compare the preoperative and postoperative symptomatology of patients presenting with grade I and II hemorrhoids after treating them with injection sclerotherapy. 2. To reduce the postoperative morbidity of patients presenting with hemorrhoids rendering them early return to work, less postoperative complications and avoiding period of stay in the hospital. 3. A conservative approach to ischemic heart disease, severely malnourished and anemic patients presenting with hemorrhoids using injection sclerotherapy. MATERIALS AND METHODS: All patients who presented with grade I and II hemorrhoids to the Government Stanley Medical College Hospital were included in the study. The other causes of bleeding PR like fistula and fissure in ano, inflammatory bowel disease and rectal malignancy were excluded from the study. These patients were treated on outpatient basis fixing up a day called the sclerotherapy day, every week. All the patients were free of comorbid disease like diabetes, hypertension, tuberculosis and cirrhosis. A small set of additional patients with pre-existing comorbid factors were also subjected to sclerotherapy. A total of 100 patients were studied excluding the small set of patients. The purpose of sclerotherapy is ultimately to scar the submucosa, resulting in atrophy of the tissue injected and scarification with fixation of the hemorrhoidal complex within its normal location in the anal canal. A variety of solutions have been advocated, although it appears that sodium morrhuate and sodium tetradecyl sulfate predominate currently. This modality is most effective in situations with minimal enlargement of hemorrhoidal complexes where the primary complaint is bright red rectal bleeding. OBSERVATION AND RESULTS: After injection sclerotherapy dilated hemorrhoidal vein collapses and shrinks within a week. The inflammatory reaction initiated by sclerosants causes ischemic necrosis of the dilated vein making it to disappear in a week time. The collapsed vein following fibrosis is naturally absorbed by the body and eventually disappears over a period of time. It takes only ten minutes to perform this non-invasive procedure and is more appropriate for grade I and II hemorrhoids. It is curative for grade I and few grade II hemorrhoids, but treatment results for grade II masses is not promising and tend to recur within a year. For pile masses of grade III and IV, the size of mass is found to decrease following this procedure which is not consistent. These higher grades, does not completely disappear and most often require repeated injections for better control of symptoms. CONCLUSION: The management of symptomatic hemorrhoidal disease should be directed at the symptom complex of the individual patient. Most of these patients can be successfully treated by improving bowel function, correcting constipation, and using any of a variety of anal ointments. For persistent symptoms, either injection or banding of the internal hemorrhoids is predictably successful. Only a few patients should require excisional hemorrhoidectomy by any of the described techniques. Cir-cular stapled hemorrhoidectomy may prove to be an effective, less painful technique to manage grade III hemorrhoids. Thus, sclerotherapy is a curative option for Grade I and II hemorrhoids, also serves as a tool for temporary symptomatic control for patients with Grade III haemorrhoids.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Scleotherapy ; Merits ; Demerits ; Management of Grade I and II Hemorrhoids ; 100 Cases.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 03 Apr 2018 02:44
Last Modified: 03 Apr 2018 02:52

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