Patients with severe hemorrhoids (grade II-IV) are better off with hemorrhoidectomy (traditional excisional hemorrhoidopexy). Professor Dr Watson AJM and colleagues of University of Aberdeen, UK, have recently reported the findings of phase-3 eTHoS trial and concluded that surgical innovations – stapled hemorrhoidopexy – that promise pain-free hemorrhoid treatment are not superior to traditional excisional surgery at all.
Hemorrhoids, or piles, are swollen veins in the lowest part of your large intestines – rectum and anus. Sometimes the veins get so much swollen that with straining during defecating when you have constipation, the walls “thin out” and bulge into the anal canal. A slight irritation as you pass out feces can irritate them and result in bleeding, itching and pain. Hemorrhoids are the number one cause of rectal bleeding and affect as many as 44% of the UK population.
Hemorrhoids are more common in pregnant women and people aged 45-65 years. Homosexuals and people who sit for prolonged hours are at increased risk as well. Sometimes hemorrhoids can bulge out of the anus (prolapse), cause pain and require surgery.
Hemorrhoids are usually benign but they can lead to colorectal cancer – a concern which has sparked anxiety among patients leading them to consider various surgical techniques. Two of them include stapled hemorrhoidpexy and traditional open hemorrhoidectomy.
However, uncertainties existed for two common surgeries performed on hemorrhoidal patients which prompted Watson AJM and co to ascertain which surgical technique is safer and superior in patients. Eventually, the two procedures were compared with each other.
Open hemorrhoidectomy, also known as excisional hemorrhoidopexy, is the whole or partial excision of the hemorrhoid which is only performed in severe cases. It commonly preferred treatment method although patients hesitate to undergo the procedure due to its post-surgical morbidity, the pain that comes after the surgery and required 2-4 weeks of recovery time.
Stapled hemorrhoidopexy, on the other hand, involves the removal of the enlarged hemorrhoidal tissue, followed by a repositioning of the remaining prolapsed tissue back to its original position. It is less painful and healing occurs at a faster rate compared to complete removal of hemorrhoids.
However, the chance of hemorrhoids returning is greater with this procedure than with excisional hemorrhoidectomy so it is typically recommended for grade II and III hemorrhoids.
The eTHoS trials, was a large, open-label, multicenter, parallel-group, pragmatic randomized controlled trial which was carried out between the beginning of 2011 to the mid of 2014. 777 patients were selected for the trials who were aged 18 or above and were hospitalized for grade II-IV hemorrhoids, which is termed as a severe condition.
The patients were randomly assigned to receive either stapled hemorrhoidopexy or traditional hemorrhoidopexy. After taking note of their hemorrhoidal grade, sex and center having an automated system which would perform either of the surgery, the outcome was plotted under the quality of life curve (AUC) measured with the EuroQol 5 dimensions 3 level score (EQ-5D-3L), a descriptive system over a period of 24 months assessed according to the randomized groups.
The results of the eTHoS trial, carried out in different places in the UK, indicated that traditional excisional hemorrhoidopexy should be considered over stapled hemorrhoidopexy due to its numerous advantages.
It was found out that although the EQ-5D-3L was higher for stapled hemorrhoidopexy in the first 6 weeks post-surgery, patients who had been operated on according to the traditional hemorrhoidopexy technique had a considerably better quality life score than the patients operated on with the former surgery technique.
Does Hemorrhoids Lead To Colon Or Rectal Cancer?
The symptoms of hemorrhoids and colon cancer are nearly the same as both cause rectal itching and bleeding. Hemorrhoids tend to come and go, so bleeding is more irregular and circumstantial. But if the bleeding is constant and the pain is increasing, it may be more than hemorrhoids. Therefore, there is a slight chance that the itching and bleeding is not due to hemorrhoids but due to colon cancer.
Cancerous tumors can sometimes appear in the colon and the resultant pain can be due to an intestinal hindrance or due to a colon polyps blocking fecal matter. Such cancerous tissues which are aggravated again and again bleed more than normal tissue.
There is a 90% chance that people who develop colon cancer are above 50 years of age. The symptoms of colorectal cancer are constipation, blood in the feces, abdominal pain and bleeding, excessive gas, fatigue and exhaustion.
NHS recommends waiting for a few days after hemorrhoidal symptoms appear as they can disappear without the need of treatment. However, in such cases they necessitate making lifestyle changes to reduce inflammation of the blood vessels in the bowel areas by drinking plenty of fluids, avoiding medication that causes constipation, exercising regularly and increasing the amount of fiber in your diet, sources of which include wholegrain rice and bread, whole-wheat pasta, fruits, vegetables and seeds.
These measures ensure the reduction of hemorrhoids and even prevent it from appearing in the first place.