Physician to Physician: Nonsurgical Hemorrhoid System Optimizes Patient Care on East Tennessee Medical News

Physician to Physician: Nonsurgical Hemorrhoid System Optimizes Patient Care

By: BY HOPE SHERIE, MD

I am very interested in helping my patients achieve their optimal health. This often involves tackling those nagging, lifestyle limiting problems which are not emergent but significantly impact people in their day-to-day lives. One of these common conditions is enlarged hemorrhoids which can cause bleeding, itching, pain, and difficulty with hygiene.

While surgical hemorrhoidectomy is very effective, it usually involves a long and painful recovery period, is expensive, and can carry significant complications. Notably, urinary retention due to edema in the tissues or spasms in the pelvic muscle has been reported to occur in about 20% of patients. Moderate to intense post-procedure pain is a major complaint. A 2000 study found that patients treated with hemorrhoidectomy reported an average pain score of 6.5 on a scale of 1 to 10.

Additionally, a 2005 study found late complications of urgency (12%), continence problems (10%) or tenesmus (3%). The rare but fatal complication of Fournier’s gangrene has been reported in five or more cases, and a 2004 study found that reoperation due to adverse events was required in 7.6 % of hemorrhoidectomies.

I have frequently used rubber band ligation, a simple procedure which involves placing a very small band around the tissue where the hemorrhoidal column begins in the anal canal, to definitively treat hemorrhoids. This cuts off the blood flow to the hemorrhoid which falls off within a few days leaving a small internal scar.

However, the metal instruments which I used during training were introduced in the 1950s and 1960s, before the advent of virulent, blood borne pathogens such as HIV and hepatitis B and C. Today they pose reprocessing challenges and concerns about cross-patient infection. They also require a large anoscope and awkward maneuvers in order to directly visualize and grasp the hemorrhoid tissue, making use in the office setting inconvenient.

My continued reading and research on this issue recently led to my discovery of the CRH O’Regan banding system. It is the first entirely disposable, single-use device for hemorrhoid removal. Cleared by the FDA in 1997, the CRH O’Regan System is 99.1% effective and can treat approximately 95% of all hemorrhoid patients.

The procedure is done in the office, requires no sedation , activity restriction, or downtime from work. Most importantly, it is painless and well tolerated. I have performed 50 of these procedures in the office so far and have had no complications and high patient satisfaction rates. I typically treat one hemorrhoidal column at a time; and 2-3 procedure visits, spaced 2 weeks apart, provide lasting results for the majority of patients.

The treatment is also very affordable, even for our self-pay patients.

A large 2005 prospective study (5,424 procedures) utilizing the CRH O’Regan System™ reported an extraordinarily low complication rate of 0.3%. Post-band bleed occurred in 8 patients (0.15%), post-band pain in 3 patients (0.2%) and post-band thrombosis in 5 patients (0.3%.). No other complications were observed.

Compared to conventional rubber band ligation, these figures demonstrate a ten-fold reduction in complications. Beyond this significant advance, the results showed the CRH O’Regan System™ to have lower recurrence (4.8% at 2 years) than previous banding techniques (12%) or even hemorrhoidectomy (5-8%).

I am very excited to offer this service as we are currently the only practice between Knoxville, Tenn., and Forest, Va., which offer this hemorrhoid treatment system. It should be noted that patient education and compliance with dietary changes and recommended bowel habits may have marked influence on recurrence rates. We recommend the routine use of fiber supplementation in order to minimize the risk of recurrence in our patients.

Hope Sherie, MD, is a general surgeon with Smyth Regional Surgical Group in Marion, Virginia. She received her BS in Biology and English from Randolph-Macon College in Ashland, Virginia, and her MD from Eastern Virginia Medical School in Norfolk.

She completed her surgical residency at Travis Air Force Base in Northern California, and practiced at air force bases in South Korea, Italy, Germany, Kyrgyzstan, and D.C. before returning to practice where she was born-at Smyth County Community Hospital. She is board certified with the American Board of Surgery and is a Fellow of the American College of Surgeons.

Smyth Regional Surgical Group

1020 Terrace Drive, Suite 202, Marion VA 24354 • 276-781-7848

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