Suggest Treatment For Hemorrhoids

Posted on Wed, 30 Aug 2017

Question: Hi Dr XXXXXXX This follows my previous correspondence with you. I have large internal hemeroids probably grade 1 or 2. I went to a HET doctor and they will put me to sleep before doing the HET. Is this consistent with your understanding of HET. Also there is a CRH O'Regan system for banding considered much better than normal banding. How do you think O'Regan system compares with HET and laser? Thanks.

Answered by Dr. Ramesh Kumar (1 hour later)

Brief Answer:
Go for HET.

Detailed Answer:
Hi,
Thanks for query.
Hope you are doing good.

Have gone through all details.

In HET-Low grade heat energy is applied next to the hemorrhoids to minimize blood flow to the area and reduce the inflamed hemorrhoids.As per the standard protocol you will be placed under a light anesthesia.Without anesthesia the heat applied through laser would cause irritation and burning pain.
So don't worry anesthesia would make procedure painless and hastlefree.

CRH o XXXXXXX is a modified version of rubber band ligation.Principle is same just the ligator used is based on CRH technology and o XXXXXXX is name of dr who founded it.
Advantage is that by o XXXXXXX process it takes 1minute to ligate the hemorrhoid while conventional banding takes almost 5-8 minutes and pain killers are not required post op in O regans method.

As per my experience-
hemorrhoid laser procedure technique is more effective than rubber band ligation(by any method)in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II hemorrhoids.

However final descion would be taken by primary gastro only.But if i were your primary i would have suggested you to go for HET.

Warm regards!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ramesh Kumar (6 hours later)

Thanks alot Dr XXXXXXX for your thoughtful and detailed assesment and guidance.
I have also seen another specialist in this area. He did Anoscopy. His report recommends either rubber band or PPH and says neither infrared coagulation or scierotherapy would be adequate given the size of the hemeroids. Please advise your thoughts.
The O'Regan method banding doctor's website claims a success rate of 99.1 percent which sounds prettu good.
In HET, I got the impression that they burn some of the blood vessels feeding the Hemeroids. I wonder if this burning of blood vessels can cause cancer in the long run. There may not be any information on this but I will value your own thoughts and judgment on it. Thanks again.
Rama Marda in USA

Answered by Dr. Ramesh Kumar (10 hours later)

Brief Answer:
Follow up.

Detailed Answer:
Hello again.
In HET, I got the impression that they burn some of the blood vessels feeding the Hemeroids-This is called cauterization and this is used in almost every surgery to minimize bleeding.
High enerrgy waves are used to photo coagulate the main artery supplying your hemorrhoid.Hemorrhoid is also a mass of cells and has its own blood supply.As the blood vessel is coagulated hemorrhoid disappears and withers off.
Cancer, shock etc are extremely rare complication and i don't think you should consider them.

As a rule of thumb for large masses usually banding is more successful then laser coagulation.
You can go through it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

Final decision can be taken only by your primary surgeon because procedure choice depends on size of hemorrhoid.

Regards

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Above answer was peer-reviewed by : Dr. Kampana