Hemorrhoids are a very common condition presenting with bleeding on passing stool, prolapse, itching and burning sensation. Pain is not usually present unless the hemorrhoids are thrombosed. The introduction of new techniques, such as laser, ultrasound Doppler- guided ligation and stapling, has offered an alternative to traditional excision with the aim of reducing postoperative pain and reducing the complications of anal incontinence or stenosis.
However, the incorrect use of these techniques has also caused severe complications that were not seen with traditional treatment. I am referring in particular to chronic pain, severe urgency, perforation and rectal stricture (stapling devices )that are nowadays extremely rare and should not happen with adequate training. There is a tendency in a competitive environment like Dubai to treat any stages of hemorrhoids even those ones with minimal symptoms with definitely more problems to the patients than benefits. There are two main issues I see.
All general surgeons treat hemorrhoids, but very few of them have gone through strict colorectal training especially before using the new techniques. Secondly, there is also commonly an over treatment of hemorrhoids that in the early stages should be most of the times conservative with changes in diet, proper toilet behaviors, fiber supplements and laxatives.
It is not rare to find patients that have been treated with full stapled resection of the rectum for simple hemorrhoids. Rubber band ligation, a technique that is effective in the early stages of hemorrhoids and that does not require any form of anesthesia, seems to have been forgotten in the UAE since is not well paid by insurances.
1) Conservative treatment of hemorrhoids should be tried first, especially in the early stages.
2) A fellowship- trained colorectal surgeon is the best surgeon to provide the best indication and results of this common condition.
