PROSPECTIVE STUDY ON DIFFERENT MODALITIES OF TREATMENT FOR SYMPTOMATIC HEMORRHOIDS

AIM: Prospective observational study of symptomatic pile masses reveals that all masses in a patient may not be of the same size or degree. Since long the only treatment for different degrees of piles had been hemorrhoidectomy. Acceptance for non-surgical modalities have come up in recent past and they are being utilized because they minimize the morbidity and save working hours. Present study has successfully utilized both surgical and non - surgical methods together in a patient in the same sitting. METHODS: 102 patients with symptomatic first to third degree hemorrhoids were studied. Depending upon the degree, treatment modality was selected. Depending on the treatment given patients were divided into four groups. Sclerotherapy alone (n=25), Sclerotherapy & Band ligation (n=17), Sclerotherapy and Hemorrhoidectomy (n=24), sclerotherapy, Band Ligation & Hemorrhoidectomy (n=36). All 102 patients were subjected to four finger Lord's Dilatation before the definitive procedures. All of them were followed for six months. Symptomatic relief, early side effects and need for re-treatment were evaluated. RESULTS: Satisfactory response was seen in 83 patients (I-20, II-13, III-20, lV-30). Sclerotherapy was more effective for 1st degree than for 2nd degree (p=0.04). Hemorrhoidectomy & band ligation were equally effective for uncomplicated 2nd degree piles. Use of hemorrhoidectomy had a definite edge in 3rd degree cases with or without associated external hemorrhoids and in 2nd degree masses with external pile mass. Local pain (no=32) and bleeding (n=6) were the most common complications. Single session was used in all the groups. None of the patients required additional treatment during follow up. Dietary modifications and life style changes were incorporated in the discharge advice for each patient. CONCLUSIONS: Conservative (non-surgical) methods can be effectively used with good results even for 2nd & 3rd degree piles. Sclerotherapy & band ligation have got different roles to play for different degrees of piles. Both were not used together for the same mass as it does not give any additional advantage. Use of surgery in 3rd degree masses with or without external mass has a definite edge over band ligation.