Do Surgeries for piles really fail and require to be repeated?
• Often surgeries done for other anal disorders are loosely called as “piles operation”.
A usual example is a case of a Perianal Abscess. After the initial operation to drain the abscess, often patient is found
to have a Fistula-in-Ano for which a second surgery is required. The general impression is that a piles surgery has failed ?
Another example is when some cases of Fistula-in-Ano turned out to be complex nature and requires staged surgery and is operated in stages. Again the perception is that a piles operation is required again.
• Many times the 1st operation has indeed been for hemorrhoids.
Using conventional methods the operation would consist of Ligation & Excision of the hemorrhoids which are of larger size (grade3 /4). There are atleast 3 locations where hemorrhoids manifest and all the 3 pile masses need not grow symmetrically. It is common to find low grade hemorrhoids along with the larger ones. It is not advisable to cut off small internal piles as this may result in narrowing of the passage. New noninvasive techniques like the INFRA RED COAGULATOR(IRC) can arrest the subsequent progress of such smaller hemorrhoids to a stage where they become large enough to prolapse. Since this equipment is relatively new, patients operated earlier could manifest with recurrence of untackled hemorrhoids.
When such a patient sees another surgeon and is advised operation , his natural response will be “ But I am already operated for piles?”
It is important to note that at the locations where pile masses have been excised there will be usually no recurrence. It is at locations where low grade piles are noted but could not be tackled [e.g. by IRC] that may cause a recurrence.
Corollary: If IRC equipment is available & combined with the surgery, there is lesser chance of recurrence of piles
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Created to clear confusion
