Haemorrhoids

From Ganfyd

Symptoms

• Itch
• Pain
• Bleeding
• Sensation of lump
• Prolapse
• Thrombosis (thrombosed pile to be distinguished from perianal haematoma)

Classification

Goligher Classification

First Degree 

Internal only. No prolapse.

Second Degree 

Prolapses, but reduces spontaneously.

Third Degree 

Prolapse and require manual reduction.

Fourth Degree 

Permanent prolapse, not reducible.

Treatment

Depends on degree and distribution. Internal vs external vs both. Circumferential vs isolated.

Generally: first and second degree: banding/sclerotherapy.

Operative management (reviewed ^[1]; mainly for 3rd/4th degree)

Sclerotherapy

5% phenol in almond oil or similar sclerosant injected submucosally to cause shrinkage of haemorrhoids. May required more than one injection.

Band Ligation

Tight rubber bands can be applied with special equipment. The rubber bands cause ischaemia and shrinkage of the haemorrhoids.

Haemorrhoidal Artery Ligation Operation

Doppler ultrasound used to locate and ligate the arteries supplying the haemorrhoidal tissue.^[2][3]

Haemorrhoidectomy

• Milligan-Morgan Technique (no sutures to close wounds)
• Ferguson Technique (sutures to close wound)

Stapled Haemorrhoidopexy

• Also known as Procedure for Prolapse and Haemorrhoids (PPH), Circumferential Mucosectomy or a Stapled Hemorrhoidectomy (slight misnomer).
• Rationale: removes sleeve of mucosa, hitching up circumferential haemorrhoids as well as reducing blood supply. Less painful and less likely to cause stenosis associated with standard haemorrhoidectomy of circumferential haemorrhoids.
• Evidence reviewed ^[4]

^[5]

References