I am 70 years old and I have had a haemorrhoidal disease for many years, but recently the bleeding became chronic, and I was offered radical surgery under spinal anesthesia. Are there any other methods?
Hemorrhoidal disease is frequent and can be disabling in 4% of cases, about half of the population, at least once in their life suffers or has suffered from disorders related to the presence of hemorrhoids, anal fissure and non-neoplastic proctological pathologies. Corman believes that about half of people over 50 in the United States have symptomatic hemorrhoids, and the peak prevalence is between 45 and 65 years.
The first descriptions of the treatment of haemorrhoidal disease were found on Egyptian papyri and date back to about 4000 years ago; “Hemorrhoid” has a Greek etymology [Haimorrois: from Haim (a) = blood, and rhèò = to flow], and was in fact coined more than 2400 years ago by Hippocrates in reference to a venous type of anal bleeding. The etiology of hemorrhoidal disease is not yet well defined. Probably, as in many other pathologies, there is a co-responsibility of several factors: constipation, prolonged standing, pregnancy, heredity, advanced age as well as socio-economic factors linked to poverty and a low-fiber diet.
There are different degrees of haemorrhoidal disease, as stated by Prof. Agus from Milan, precisely 4, and the first two, “that is, when the pathology is mild and only rarely symptomatic, dietary and behavioral measures are sufficient (diet rich in waste, avoid alcohol , chocolate, tea and spicy foods), drink plenty of water and exercise regularly; while in case of occasional exacerbations it is good to take over-the-counter supplements such as bioflavoloids based on diosmin and hesperidin, useful for protecting the venous wall, which is often inflamed “. Then there are more severe forms, where the symptom pain, often associated with a sense of localized weight (tenesmus), itching, burning and bleeding that deserve a more targeted and aggressive treatment, especially when the first remedies are not sufficient.
The history of hemorrhoidal disease therapy has very ancient roots. The first known mention of the pathology linked to hemorrhoids dates back to an Egyptian papyrus, which advises: “… You had to give a very protective ointment, the acacia leaves, ground, crushed and cooked together. Spread on a strip of linen. and placed in the anus, so that he can recover immediately. “[In 460 BC, the famous Greek physician Hippocrates discusses a similar treatment, adding, however, with absolute modernity the first cd ligature: “Hemorrhoids and in a similar way can be treated by piercing them with a needle and tying them with woolen thread …. then a dressing with hellebore flowers is put on …”
However, we will have to wait until 1937, when the two English surgeons Milligan and Morgan described a ligation technique at the origin of the haemorrhoidal gavocciolo, laying the foundations for an operation that takes their name and which, probably, is still the most common surgical technique today. used and validated worldwide for the radical cure of hemorrhoids.
Over the years, however, other more or less invasive techniques were born, used and then forgotten, which always had the purpose of “obliterating” or “removing” the origin or the hemorrhoidal bead itself. The elastic ligation, a resumption of the first Hippocratic method, but more modernly performed with particular pliers, preceded the advent of the laser or radiofrequency, “heat delivery” systems, dedicated to the coagulation of the hemorrhoid, which in reality never have fully satisfied and completely replaced the surgery of the 40s. Other surgeons have proposed a completely innovative method, not to remove the hemorrhoids, but to create the conditions for them to return to their seat, acting as a “pessi”, trivially like a “plastic of the anal calale”.
It is Prof Longo who coined and disseminated his method in the early 90s, however to this day it is not always a harbinger of lasting results and is always linked to the operating room, epidural anesthesia and hospitalization. Other specialists in Turkey and Italy and then in many other countries have proposed an outpatient method: selective cryotherapy, that is, using cold instead of heat, this has finally transformed the intervention from hospital to outpatient, sometimes combining the elastic ligation and binding the procedure to a machine that produces cold.
For some years an innovative and effective, non-invasive technique has been developed: the endosclerosis of the haemorrhoidal tract, this technique is inspired by the treatment of varicose veins, through the sclerosing foam technique, consists of the injection into the haemorrhoidal plexus of a small volume (2-4) of sclerosing active ingredient in the form of foam. This substance, in contact with the wall of the hemorrhoidal plexus, causes an immediate retraction with subsequent ascent of the plexus, and consequently progressive sclerosis up to its fibrosis. The injection is performed at the base of the plexus in an absolutely painless manner and on an outpatient basis. The procedure lasts about 15 minutes and the patient can immediately return to his home. The treatment can be repeated in subsequent periods to obtain a lasting result.
There are many Italian and foreign centers that are adopting this method, as the Portuguese proctologists Fernandes and Fonseca recently published: “The treatment of internal hemorrhoids with polydocanol foam injected at high doses is very effective and safe for the control of blood loss. and prolapse, even for patients on anticoagulant / antiplatelet treatment. “
Reporting a series of over 2000 patients treated with 98% efficacy. In the USA in September of last year, a clinical trial involving 65 colorectal centers was concluded, demonstrating the effectiveness of the method in 100% of cases with bleeding, and in any case where no associated pathologies exist. Certainly a promising new method that will not replace radical or conservative surgery, however in expert hands it will be able to solve a large number of cases.