A�hemorrhoid�can be described as masses or clumps of tissue within the anal canal. These masses of tissue contain blood vessels and their surrounding, supporting tissue made up of muscle and elastic�fibers. Hemorrhoids (piles) arise from congestion of internal and/or external venous plexuses around the anal canal.

Internal hemorrhoids�involve the veins inside the rectum that usually do not hurt but they may bleed painlessly. Sometimes, an internal hemorrhoid may stretch down until it bulges outside the anus and that is known as a prolapsed hemorrhoid. A prolapsed hemorrhoid will go back inside the rectum on its own. If it does not happen, it can gently be pushed back inside else one should consult with a physician about surgical treatment options.

External hemorrhoids�involve the veins outside the anus that can be itchy or painful and can crack and bleed. If a blood clot forms, a tender lump can be felt on the edge of your anus.

The differentiation between internal and external hemorrhoids is based on whether the hemorrhoid originates above or below the dentate line. One main cause for hemorrhoids is straining when person is trying to have a bowel movement as in the case of constipation or diarrhea. Increase in Fresh fruits, leafy vegetables and whole-grain breads and cereals are good sources of fiber that might help content in the diet prevents constipation. Adequate water intake also is required.

Traditional methods
Most forms of hemorrhoidal disease can be treated by dietary modifications, topical medications and soaking in warm water, which temporarily reduce symptoms of pain and swelling. Surgical intervention is required in certain cases for a long term relief and a variety of operative techniques are employed to address the problem.

Milligan-Morgan Technique
This technique is developed and pioneered in the United Kingdom in which three major hemorrhoidal vessels are excised. Three pear-shaped incisions are left open, separated by bridges of skin and mucosa to avoid stenosis. This is the most popular method and is considered the gold standard by which most other surgical hemorrhoidectomy techniques are compared.

Ferguson�Technique
This technique, developed in the United States is a modification of the Milligan-Morgan technique, whereby the incisions are totally or partially closed with absorbable running suture. A retractor is used to expose the hemorrhoidal tissue, which is surgically removed. The remaining tissue is either sutured or is sealed through the coagulation effects of a surgical device.

Causes

It is not known why hemorrhoids enlarge. There are several theories about the cause, including inadequate intake of fiber, prolonged sitting on the toilet, and chronic straining to have a bowel movement (constipation). None of these theories has strong experimental support. Pregnancy is a clear cause of enlarged hemorrhoids though, again, the reason is not clear. Tumors in the pelvis also cause enlargement of hemorrhoids by pressing on veins draining upwards from the anal canal.

One theory proposes that it is the shearing (pulling) force of stool, particularly hard stool, passing through the anal canal that drags the hemorrhoidal cushions downward. Another theory suggests that with age or an aggravating condition, the supporting tissue that is responsible for anchoring the hemorrhoids to the underlying muscle of the anal canal deteriorates. With time, the�hemorrhoidal tissue�loses its mooring and slides down into the anal canal.

Symptoms

All of us have hemorrhoidal veins in the anal area, both inside and outside of the anus. In hemorrhoids, these veins are irritated and swollen, causing hemorrhoids symptoms such as pain, itching, bleeding and burning sensation and general discomfort.

PPH�is a technique that reduces the prolapse of hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling device. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining hemorrhoidal tissue is stapled. This restores the hemorrhoidal tissue back to its original anatomical position.

The introduction of the Circular Anal Dilator causes the reduction of the prolapse of the anal skin and parts of the anal mucous membrane. The�Purse-String Suture Anoscope�is then introduced through the dilator.

This anoscope will push the mucous prolapse back against the rectal wall along a 270� circumference, while the mucous membrane that protrudes through the anoscope window can be easily contained in a suture that includes only the mucous membrane. By rotating the anoscope, it will be possible to complete a purse-string suture around the entire anal circumference. The�Hemorrhoidal Circular Stapler�is opened to its maximum position. Its head is introduced and positioned proximal to the purse-string, which is then tied with a closing knot.

Patients undergoing Stapled Hemorrhoidopexy experience less pain and a quicker return to normal activities as compared to conventional techniques.

Possible complications include:

• Severe postoperative pain
• Postoperative bleeding
• Swelling of the skin bridges
• Major short-term incontinence
• Difficult urination
• Anal stenosis
• Recurrence
• Anal fissure
• Minor incontinence

The other Gastro procedures are:

• Colonic Gastric Polypectomy
• Laparoscopic Appendectomy
• Treatment for Liver Cysts�� etc

Few Major Hospitals for Stapler Surgery for Hemorrhoids are:

• Wockhardt Hospitals
• HealingHands Clinic
• Apollo Hospitals
• Max Healthcare
• Piyavate Hospital
• Florence Nightingale Hospital
  

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