New Horizon in Piles Treatment |
Treatment of piles without operation and pain
Prof Dr A K M Fazlul Haque
By dint of modern and sophisticates technology the developed countries of the world have achieved tremendous success in medical treatment. With the help of such a modern technology now-a-days 80-90 per cent of the piles patients are treated with the help of a modern instrument requiring no surgical intervention and getting no pain.
The instrument is first discovered by Dr Blaisdell by which he showed how to treat piles as out patient basis and without operation. Earlier, injection treatment for piles was available since 1869. The injection sclerotherapy (treatment of a varicose vein by injecting a sclerosing agent, an irritating liquid injected into tissue to harden it, into the vein, and so encouraging the blood in the vein to clot) does not give long term satisfactory success.
Injection gives good result only in first degree or preliminary stage of piles. A study in this connection showed that the people who underwent such treatment, 80 per cent of them showed recurrence of piles symptoms after one year. The medical scientists have also proved that repeated injection after failure does not give better result. Rather it gives rise to some complications. Under these circumstances, the invention of ring ligation system in the treatment of piles has opened up a new horizon.
Another dimention was added to the advancement made by Dr Blaisdell when Dr J Baron made an improvement in the design of the instrument and in two research paper he claimed that this new approach of treatment was giving wonderful result. World renowned piles specialist of USA Dr Marvin L Corman and Dr DM Steinberg have done extensive clinical trial with this instrument on piles patients and concluded that 80-90 per cent of piles patients can be successfully treated by this instrument without having the need to undergo operation.
Who are the appropriate candidates?
With few exceptions, all the piles patients can be treated by this method. Exceptional patients can be categorised as follows – patients with external piles, hypertrophied anal papilla, associated anal fissure or fistula, Grade IV piles which always hang outside, thrombosis, infection, gangrene etc.
Details of the Procedure
This procedure is done on out patient basis i.e. at the chamber of a surgeon. There is no need of any sort of anesthesia. We identify the piles with the help of proctoscope (surgical instrument consisting of a long tube with a light in the end, used to examine the rectum) and then apply the instrument in proper place. The patient is not supposed to get any pain. The patient should be informed about the procedure beforehand so as to get his cooperation.
It should be mentioned here that bleeding through anus may be due to cancer of rectum or colon. It is sometimes hard to differentiate between piles and cancer by listening to the history of the patient. So it is very pertinent to do a colonoscopy (examination of the inside of the colon, using an instrument passed through the rectum) before the procedure specially when the patient's age is about 40 or has family history of colonic cancer.
This procedure needs to be done about three times successively at a particular interval because we have three main piles in our body. The piles cuts off after a few days. It looks like an operation without cutting by a knife.
Advice after the procedure
There is no need to take any leave from your office. One can go back home on rickshaw or car comfortably. Patient is asked to rest for six hours. Bowel management should be done in such a way that the patient does not need to force to pass motion. It is better to avoid beef and mutton for a week. Vegetable and fruits are beneficial.
There may be a little bit discomfort after the procedure. Very few may feel slight pain which is easily treated. In very rare instances, there can be some other problem which can be solved.
With the invention and application of this instrument, we can now treat 80-90 per cent of piles patients without operation and without pain. Satisfactory result is obtained with this single technique. It is internationally accepted that this technique is a reasonable alternative to operative procedure. This is very economic; it saves time, risk and money. This is less complicated and having less side effect. Because of its long term success and availability it is easily acceptable to patients and so very commonly used and internationally popular.
For last 9 years we have done research on 29,635 patients all having problem of rectum and anal canal. We have treated 2400 piles patients with the method called ring ligation in a span of 9 years. About 92 per cent of them were cured without operation. So, I can confidently say now that vast majority of piles patients can be permanently cured without any operation.
Prof Dr A K M Fazlul Haque MBBS, FCPS, FICS is Head of Colorectal Surgery Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.