Suha Hamid Khan ( Surgical Unit 1, Civil Hospital and Dow Medical College, Karachi. )
Raja G. Asghar ( Surgical Unit 1, Civil Hospital and Dow Medical College, Karachi. )
In order to decrease health care cost and evolve a strategy for the management of common problems in Pakistan, it is important to assess, common surgical practices.
In the present retrospective study clinical features and the management of haemorrhoids in a general surgical unit is being presented.
MATERIAL, METhODS AND RESULTS
Case records of 89 patients presenting with haemorrhoids during January 1982 to December 1985 in Surgical Unit I of Civil Hospital Karachi were analysed retrospectively. Parameters studied included the male to female ratio, duration of stay, clinical features, catchrnent area of the patients, operation versus injection sclerotherapy and the type of anaesthesia used.
The male to female ratio was 6:1. Maximum (52%) cases belonged to 40-50 years age group (Range 20-50 years). Catchment area of the patients in descending order of frequency was
District South (27 %), Central (18%), West (17%), East (16%), Sind/Punjab (11%). The place of residence in 11% remained unknown.
The clinical features were bleeding per rectum (81%), something coming out of anus (66%), constipation (16%), pain during defecation (12%), itching (4%), weakness (3%) and other general complaints (6%). Presentation of haemorrhoids at primary” sites of 3,7 and 11 o’clock position was seen in 57% cases. 16% had haermor. rhoids at primary and secondary sites both and 3% at secondary sites only. In 24% the site was not specified. 68% had second degree haemorrhoids, 28% had third degree haemorrhoids and only 3 % had first degree haemorrhoids. All the patients presenting with second degree haemorrhoids except 3 were treated by Mulligan Morgan Haemorrhoidectomy. Seven patients (8%) received injection sclerotherapy. The ratio between operated cases to those who had injection scierotherapy was 10 : 1. Fifty four cases (61 % all males) were o.perated under spinal- anaesthesia, 16 (18% underwent operation under general anaesthesia, of these 8 were female. 7 patients (8%) left against medical advice, LAMA and 5 (6%) received conservative treatment and were discharged or transferred to another unit. The average pre-operative stay was 7.4 days and the post-operative stay was 9.5 days. Mean duration of stay was 16.9 days as shown in Figure.
Only 6% patients developed post-operative complications.
Haemorrhoids is one of the commonest diseases of the anorectal region1. The male to female ratio of 6:1 as determined in this study does not correlate with that given in text books2. In the present study 1235% patients presented with pain during defecation. The frequency of pain was much less than that reported in the West3-4 The mean pre.operative stay was 7.4 days. In order to reduce the cost of hospital stay and for a rapid and smooth rotation of the patients it is suggested that a filter clinic and waiting list system for patients with common diseases e.g., haemorrhoids,inguinal hernias, cholelithiasis, fistula in ano etc. may be maintained as suggested earlier5. The mean post-operative stay was 9.5 days which could further be reduced by an early post-operative follow up and then discharge of the patient, who is called for regular follow ups thereafter. Short term results of Infra Red Coagulation show it is equal in efficacy to injection, scierotherapy or Rubber Band Ligation6. In patients with third degree haemorrhoids that required digital repositioning, Murie et a!7 reported complete cure of the prolapse by haemorrhoi. dectomy in 28 out of 29 patients in contrast to only 19 out of 27 patients by rubber band ligation. In the present experience Mulligan Morgan Haemorrhoidectomy was found to be the best method for third degree haemorrhoids.
1. Siddiqui, B. Pattern of non-malignant anorectal diseases. Med. Spectrum, 1988; 9~6.
2. Goligher, J.C. Surgery of anus, rectum and colon. 5th ed. London, Balliere Tmdall, 1984; p. 98.
3. Bennett, R. C., Freidman, M.H.W. and Goligher, J.C. The late results of haemorrhoidectomy by ligature and excision. Br. Med. 1., 1963; 2:216.
4. Murie, J. A., Sim, AJ.W. and Mackenzie, I. The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haeinorrhoidectomy or rubber band ligation. Br. J. Surg., 1981; 68:247.
5. Qureshi~ A. and Desa, H. Management of patients with inguinal hernia. JPMA., 1986; 36:29.
6. Goligher, J.C.. Surgery of anus rectum and colon. 5th ed. London, BalliereTindall, 1984, p. 123.
7. Murie, J.A., Mackenzie, I. and Sim, A. J.W. Comparison of rubber band ligation and haemorrhoidectomy for 2nd and 3rd degree haemorrhoids; a prospective clinical trial. Br. J. Surg., 1980; 67:786.