Saturday, September 18, 2010

A Breakthrough in Hemorrhoid Surgery

I remember the pain and discomfort when I suffered from hemorrhoids after the normal delivery of my 4 kids. The extreme pushing during labor resulted in my hemorrhoids acting up for days. I could not sit normally and every bowel movement was excruciating. Thankfully, the situation would clear up after a couple of weeks.

But that got me thinking about the many other men and women who suffered daily from hemorrhoids. Some suffer the milder form - internal hemorrhoids. These are usually not painful although they may bleed. But others who are less fortunate suffer extreme pain from hemorrhoids where the veins are already outside the anus. These can be itchy or painful and sometimes crack and bleed.

Current Hemorrhoid Treatments

Often, lifestyle changes, topical medications and good hygiene are all that is needed to reduce the symptoms of hemorrhoids. In my case, after my normal deliveries, the pain just cleared up after a couple of weeks on its own. However, in a certain percentage of sufferers, surgery may be required. To-date, here are some invasive treatments done:

1. Rubber band ligation - this is performed on persons whose internal hemorrhoids have fallen outside the anus. It involves pulling the hemorrhoidal tissue into a double-sleeved cylinder to allow the placement of latex/rubber bands around the tissue. Over time, the tissue below the bands die off and is eliminated during bowel movement. This can be performed in the doctor's office and requires little preparion.

2. Traditional hemorrhoidectomy - Excess tissue causing bleeding or protrusion is cut away under anesthesia. This requires hospitalization and absence from work for an average of 6 weeks. After-recovery is difficult due to discomfort and pain experienced by the patient. Employees usually lose about 20 days of work.

3. Cryotherapy (freezing the hemorrhoidal tissue) - This is a very painful procedure.

4. Bipolar Diathermy Coagulation (BICAP) and direct current - These techniques shrink the hemorrhoids and cause the tissue to die.

PPH: A Faster and Less Painful Option

Recently, Medical City announced the availability of a surgical option, developed by Dr. Antonio Longo of the St. Elizabeth Hospital in Vienna, which is modern, faster and less painful. It is called Procedure for Prolapse and Hemorrhoids or PPH.

Dr. Longo makes use of a stapling device that looks almost like some kind of weapon. This is inserted during surgery into the anus of the patient and "lifts up" and repositions the mucosa (or anal canal tissue) thereby reducing blood flow to the internal hemorrhoids. Within 4-6 weeks after the procedure, these hemorrhoids shrink. This procedure is less painful because it is performed ABOVE the "pain" line inside the anal canal, where there are few nerve endings. Traditional procedures are done BELOW the pain line where there are many sensitive nerve endings.

The result? The patient only spends 3-4 days of recuperation in the hospital and suffers less pain. He will also need less medication for the pain.

Not all hemorrhoidal patients will need PPH. But if surgery is required, and the patient is concerned about pain and losing inordinate amounts of work days, PPH is a prime advantage.

Here are some other info I gathered:

- The clips (or staples) used are made of titanium. Patients can still have MRI done with these staples inside them. These clips also will not trigger metal detectors.

- 70% of these clips are eventually excreted through regular bowel movement.

- While there are the usual risks in any surgical procedure, the doctors of Medical City say that these are considered low -- about 1-5% only and usually involve post-operation bleeding or difficulty urinating.

- The chances of recurrence of hemorrhoids is about 4% within a 5-year period. In the conventional hemorrhoidal surgery, recurrence is about 15%.

- For those with HMOs, check with your HMO if PPH is already covered. HMOs usually cover surgery if physician determines it is necessary.

- While price was not really discussed in the presentation to us, I think that a patient considering PPH should be ready to pay something in the range of 100,000 pesos. The stapling device alone, which is good for one-time use only, runs into around 250 euros or about P15,000.

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