A study on plication of piles

Abstract

Background: Haemorrhoids are specialized, highly vascularized ‘cushions’ forming discrete masses of thick sub-mucosa containing blood vessels, smooth muscles and elastic and connective tissues limited to the anal canal and perianal area. The cause of haemorrhoids remains unknown. Numerous factors contribute to haemorrhoidal diseases such as constipation, prolonged squatting, pregnancy, aging, hereditary, portal hypertension, abdominal tumor and defecation habits. Methods: This prospective study was carried out in the department of surgery, GMCH, Udaipur, Rajasthan, India from June 2014 to December 2015 after taking the permission from institutional ethics committee. Patients from both sexes of various age groups having haemorrhoids and associated anorectal pathology such as fissure were included. Patients with prolapsed piles, thrombosed piles and piles secondary to anorectal tumor were excluded from the study. Preoperative Bisacodyl 2 tablets at night before operation and Sodium picosulphate enema was given early morning on the day of surgery to ensure a clear visualization of anal canal. Operative technique: With the patient in lithotomy position after appropriate anesthesia anal stretching was done and thereafter tissue forceps was applied to the skin tags corresponding to the three major piles. A Babcock forceps was then applied to the pile mass above the level of pectinate line. Then the held pile mass was transfixed and ligated with silk 1-0 atraumatic needle suture at the proximal end of the internal haemorrhoids in order to occlude the superior haemorrhoidal vessel as they enter the internal haemorrhoids. If there were any small secondary pile the same procedure would be done. A small piece of gauge soaked with 2% xylocaine jelly would be left in anus as dressing. Results: Total 50 patients of piles were examined and most of the patients were between 31-50 years of age (60%) with males preponderance. All the patients in this study had bleeding per rectum as the main symptom. Among all patients 60% received some form of conservative treatment and partially relieved. Out of 50 patients, 38% had 1st degree piles, 58% had 2nd degree piles and rest had 3 rd degree piles. In this study of plication of piles 94% of cases had no pain, 6% of cases who had pain were also suffering from fissure. The results of plication of piles are satisfactory and only 2% of the patients had pain for which long term analgesics were given. Conclusions: The treatment of haemorrhoids has been widely discussed and various methods are being employed by majority of surgeons throughout the world. In the plication of piles one should appreciate the fulfilment of above mentioned requirements.