Effective Piles Treatment in Delhi

Indications

Surgery is typically indicated for:

• Severe hemorrhoids (Grade III or IV).
• Hemorrhoids that do not respond to conservative treatments.
• Significant pain, bleeding, or discomfort.
• Thrombosed hemorrhoids (clots within hemorrhoids causing severe pain).
• Prolapsed hemorrhoids that cannot be manually reduced.

Types of Hemorrhoid Surgery

1. Hemorrhoidectomy
   • Procedure: Complete removal of hemorrhoidal tissue.
   • Types:
     • Closed Hemorrhoidectomy: The incision is closed with sutures.
     • Open Hemorrhoidectomy: The incision is left open to heal naturally.
   • Indications: Severe or prolapsed hemorrhoids.
   • Advantages: Effective for severe cases with a low recurrence rate.
   • Disadvantages: Longer recovery time and more postoperative pain.
2. Stapled Hemorrhoidopexy (PPH)
   • Procedure: Uses a circular stapling device to reposition prolapsed hemorrhoidal tissue and cut off its blood supply, causing it to shrink.
   • Indications: Prolapsed hemorrhoids.
   • Advantages: Less postoperative pain and quicker recovery compared to hemorrhoidectomy.
   • Disadvantages: Higher recurrence rate compared to traditional hemorrhoidectomy.
3. Hemorrhoid Artery Ligation (HAL) / Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL)
   • Procedure: Uses a Doppler probe to locate hemorrhoidal arteries, which are then tied off to reduce blood flow and cause hemorrhoids to shrink.
   • Indications: Internal hemorrhoids.
   • Advantages: Minimally invasive with less postoperative pain.
   • Disadvantages: May not be suitable for very large or prolapsed hemorrhoids.
4. Sclerotherapy
   • Procedure: Injection of a sclerosing agent into the hemorrhoid, causing it to shrink.
   • Indications: Small internal hemorrhoids.
   • Advantages: Minimally invasive with a quick recovery.
   • Disadvantages: May require multiple treatments.
5. Rubber Band Ligation (RBL)
   • Procedure: Rubber bands are placed around the base of the hemorrhoid, cutting off its blood supply and causing it to fall off.
   • Indications: Internal hemorrhoids.
   • Advantages: Minimally invasive and effective for smaller hemorrhoids.
   • Disadvantages: Can cause discomfort and may require multiple sessions.

Procedure Steps for Hemorrhoidectomy

1. Preoperative Preparation
   • Medical evaluation and history.
   • Instructions on fasting and bowel preparation if necessary.
   • Discussion of anesthesia options (typically regional or general anesthesia).
2. Anesthesia
   • Local, regional, or general anesthesia, depending on the extent of the surgery and patient preference.
3. Surgical Procedure
   • Positioning: Patient is positioned in the lithotomy or prone jackknife position.
   • Incision: Incisions are made around the hemorrhoid tissue.
   • Removal: Hemorrhoidal tissue is removed, and blood vessels are tied off to prevent bleeding.
   • Closure: The incisions are either left open (open hemorrhoidectomy) or closed with sutures (closed hemorrhoidectomy).
4. Postoperative Care
   • Pain Management: Pain relief medications as prescribed.
   • Wound Care: Keeping the surgical area clean and dry. Warm sitz baths can help reduce pain and promote healing.
   • Dietary Changes: High-fiber diet and adequate fluid intake to prevent constipation and straining.
   • Activity Restrictions: Avoid heavy lifting and strenuous activities for a few weeks.
   • Follow-Up: Regular follow-up visits to monitor healing and address any complications.

Risks and Complications

• Infection: Risk of infection at the surgical site.
• Bleeding: Some bleeding is normal, but significant or persistent bleeding should be reported.
• Pain: Postoperative pain is common, especially with hemorrhoidectomy.
• Urinary Retention: Difficulty urinating after surgery.
• Recurrence: Hemorrhoids can recur, especially if underlying risk factors are not addressed.

Conclusion

Surgical treatment for hemorrhoids is effective for severe cases that do not respond to conservative measures. The choice of surgical technique depends on the severity and type of hemorrhoids, patient preference, and the surgeon’s expertise. Proper preoperative preparation, skilled surgical technique, and diligent postoperative care are essential for achieving the best outcomes and improving the patient’s quality of life. Regular follow-up and adherence to postoperative care instructions are crucial for a successful recovery and minimizing the risk of recurrence.