대한대장항문학회

Hemorrhoids are the most common problem in anorectal disease, presenting bleeding<br>and prolapse. The definitive treatmant for severe hemorrhoids is surgery, but for milder<br>cases, it is difficult to recommend a hemonhoidectomy. Some patients, especially<br>relatively young and active males, don't want to be admitted, and they ask for<br>ambulatory surgery. For that reason, we have developed a modified bipolar probe which<br>can be simply and conveniently applied and which produces as good a result as that<br>produced by a radical hemouhoidectomy. We restrospectively analyzed the cases of 341<br>patients who had received a BHC(bipolar homo-coagulation) between July 1994 and<br>December 1995 and who had been followed up for at least six months. The results are<br>as follows:<br>1) 309 cases(90.6%) were Grade II, and 32 cases(9.4%) were Grade III hemorrhoids.<br>The chief complaint was bleeding in 179 cases(52.5%) and prolapse in 148 cases(43.4%).<br>2) Evaluation of the BHC procedure was based on patient satisfaction. About<br>threefourths of the patients were very satisfied, and 59 patients(17.3%) were somewhat<br>satisfied. Grade III patients were relatively more satisfied than others, regardless of the<br>number of piles managed by BHC, and patients whose symptom was bleeding were<br>significantly more satisfied, in general, than those with prolapse. Only 26 patients(7.6%)<br>were dissatisfied.<br>3) No postoperative discomfort was observed in 153 cases(44.9%). However,<br>post-operalive pain and bleeding were present in 92 and 50 cases, respectively.<br>4) Complications were observed in a total of 26 cases(7.6%). Skin tags were the most<br>frequently observed complication(13 cases), followed by secondary bleeding which was<br>managed by sutures(6 cases).<br>5) Three patients experienced recurrent hemorrhoids. Two were treated by using a<br>radical hemorrhoidectomy, and one by using a second BHC.<br>Based on these five results, we consider BHC to be a very useful technique for<br>treating Grade II and early Grade III hemorrhoids by outpatient surgery and to be a<br>time-saving procedure for treating accessory piles after main pile extirpation.<br>Furthermore, early detection of hemorrhoids along with their early management by BHC<br>will reduce the need for more radical surgery at some later time.<br>