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New Indian Journal of Surgery

Volume  11, Issue 2, April-June 2020, Pages 182-197
 

Original Article

Clinical Study of Various Treatment Modalities in Haemorrhoids

Vijaykumar S Kappikeri1, Manjunath Meti B2

1Professor, 2Postgraduate, Department of General Surgery, MR Medical College, Gulbarga, Kalaburagi, Karnataka 585105, India.

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DOI: https://dx.doi.org/10.21088/nijs.0976.4747.11220.17

Abstract

 

Background: Haemorrhoids are tormenting human race since ancient times. It affects all people irrespective of gender, age, race, socioeconomic status and cultural differences. The exact prevalence
can’t be estimated accurately. Many patients don’t seek medical guidance. This causes severe discomfort for patients and cause complications. There are many treatment modalities available for this condition. This study is aimed at evaluating those various modalities
available. Objectives: 1. To study the various modalities of treatment options available for the treatment of haemorrhoids at our hospital (Open Haemorrhoidectomy, Closed Haemorrhoidectomy, Rubber Band Ligation and conservative management). 2. To evaluate advantages and disadvantages of one modality over the other. Methods: Clinically diagnosed case of haemorrhoids in a Tertiary care hospital, Kalaburagi. 50 patients clinically diagnosed case of haemorrhoid presenting
between December 2017 to June 2019 (18 months) at our hospital. The presenting complaints were noted, detailed examination, diagnosis was made and treated accordingly. The relevant data was collected.
Post-operative complications were noted and postoperative Follow-up was done on day 7, 1 month and 3 month. Results: The mean age of presentation was in the fourth decade (41.36 ± 13.26 years). The disease was more in males. The major presenting complaint was Bleeding per rectum + Mass per rectum (28%) followed by Bleeding per rectum (26%). On detailed examination 11 (22%) cases were diagnosed as External Haemorrhoids, 39 (78%) cases as internal haemorrhoids, further internal haemorrhoids were graded as 9 (18%) Grade-1 cases, 10 (20%) Grade-2 cases, 10 (20%) Grade-3 cases and 10 (20%)
Grade-4 cases. As treatment modality, 9 (18%) cases were managed conservatively, in 15 (30%) cases Closed Haemorrhoidectomy, in 16 (32%) Open haemorrhoidectomy and in 10 (20%) cases Rubber
Band ligation was done. Post-operative pain was more in Open haemorrhoidectomy 10 (62.5%) cases, Closed haemorrhoidectomy 6 (40.0%) cases and 2 (20.0%) of cases had post-operative pain in
whom RBL was done. Post-operatively bleeding was seen in 7 (43.75%) cases who underwent Open haemorrhoidectomy, 4 (26.6%) cases under Closed haemorrhoidectomy, 2 (20%). One case each under
Open haemorrhoidectomy and RBL had postoperatively discharge per rectum and developed recurrence. Comparison was done between
different treatment modalities; statistical Analyzis was done. Surgery was beneficial compared to conservative approach. RBL was better than other modalities with lesser rate of complication, early resumption of work and short hospital stay. Closed haemorrhoidectomy had lesser post-operative pain, bleeding and complications, when compared to
Open haemorrhoidectomy. Conclusion: Surgical intervention is better than conservative approach. In the surgical techniques RBL was better followed by Closed haemorrhoidectomy and Open haemorrhoidectomy in respect of postoperative complications, hospital stay and better
wound healing.

Keywords: Rubber Band Ligation (RBL) Open Haemorrhoidectomy, Closed Haemorrhoidectomy, Bleeding per rectum, Mass per rectum.


Corresponding Author : Manjunath Meti B