Sclerotherapy of hemorrhoids

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The sclerotherapy of hemorrhoids , also haemorrhoids called, is a method for the treatment of symptomatic hemorrhoids first or second degree.

description

Schematic representation of 1st degree hemorrhoids. On the left in the picture the hemorrhoidal nodule reaching far into the anal canal.

The sclerotherapy of hemorrhoids is a minimally invasive procedure, which is usually on an outpatient basis is made. No anesthesia is necessary. The tissue to be sclerosed is largely insensitive to pain. Sclerotherapy is the treatment of choice for first-degree hemorrhoids. Two sclerotherapy procedures are established.

Sclerotherapy according to Blond and Hoff

The intrahämorrhoidale sclerosis in 1936 described by Kasper Blond and Herbert Hoff first time. Through a proctoscope therethrough injected , the attending physician in a syringe , the sclerosant in the submucosa (submucosal). A bluish-glassy discoloration of the mucous membrane indicates the correct injection visually through the proctoscope. The injection into the tela submucosa is painless, as the tissue above the dentate line has no free nerve endings and is therefore much less sensitive than below the dentate line . The sclerotherapy is repeated in three to five treatment sessions over a period of approximately four to six weeks. The inflammatory reaction in the hemorrhoidal cushions causes scarring of the tissue , which leads to a reduction in the arterial blood supply. In addition, the loosened mucous membrane is fixed.

In its original variant, a 20% quinine solution is used. In the meantime, sclerosants with a significantly lower allergenic potency, such as polidocanol or zinc chloride solution, are used.

In principle, the procedure is suitable for 1st and 2nd degree hemorrhoidal disorders. For 2nd degree hemorrhoids, however, Barron's rubber band ligation is the method of choice. The complication rate for intraemorrhoidal sclerotherapy is less than 1%. However, the recurrence rate is very high at 68% after three years. There are no randomized controlled studies on the procedure. In Germany, sclerotherapy according to Blond and Hoff is the most common method for sclerosing hemorrhoids.

Blanchard sclerotherapy

The suprahämorrhoidale sclerosis was described in 1928 by Charles Elton Blanchard. However, as early as 1871, Mitchell in Clinto ( Illinois ) used a similar method for sclerosing hemorrhoids. In this form of sclerotherapy, phenol , usually 5% dissolved in almond or peanut oil , is applied extravasally as a sclerosant in the area of ​​the arteries supplying the hemorrhoidal cushions. Again, a postinflammatory reaction leads to a fixation of the piles above the dentate line .

The use of phenol in humans is legally problematic in Germany. The application is therefore the responsibility of the doctor ( freedom of therapy ). The method is mainly used in Anglo-American countries for symptomatic 1st to 3rd degree hemorrhoids. However, there are no positive study results for the treatment of 3rd degree hemorrhoids.

This method also has a low complication rate of less than 1%. The recurrence rate after three years is around 80%. From an international perspective, Blanchard's sclerotherapy is the most widely used method of sclerosing hemorrhoids.

further reading

  • E. Laurisin: Sclerotherapy of hemorrhoids. In: American journal of proctology. Volume 22, Number 4, August 1971, pp. 241-244, ISSN  0002-9521 . PMID 5160997 .
  • P. Benin, C. D'Amico: Foam sclerotherapy with Fibrovein (STD) for the treatment of hemorrhoids, using a flexible endoscope. In: Minerva chirurgica. Volume 62, Number 4, August 2007, pp. 235-240, ISSN  0026-4733 . PMID 17641583 .
  • Chand M., Nash GF, Dabbas N.: The management of haemorrhoids. In: British journal of hospital medicine (London, England: 2005). Volume 69, Number 1, January 2008, pp. 35-40, ISSN  1750-8460 . PMID 18293730 . (Review).
  • AG Acheson, JH Scholefield: Management of haemorrhoids. In: BMJ (Clinical research ed.). Volume 336, Number 7640, February 2008, pp. 380-383, ISSN  1756-1833 . doi : 10.1136 / bmj.39465.674745.80 . PMID 18276714 . PMC 2244760 (free full text). (Review).

Individual evidence

  1. ↑ A. Herold: Current therapy options for hemorrhoids. In: Medical Journal Travel & Medicine. 3, 2011, pp. 44-45.
  2. ↑ K. Blond, H. Hoff: Das Haemorrhoidalleiden. Deuticke Verlag , 1936.
  3. ↑ a b c d A. Herold, C. Breitkopf et al: Haemorrhoidalleiden. ( Memento of the original from April 25, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 749 kB) Guidelines of the German Society for Coloproctology, AWMF , as of July 2008 @1@ 2Template: Webachiv / IABot / www.awmf.org
  4. ↑ I. Kanellos, I. Goulimaris include: Long-term evaluation of sclerotherapy for haemorrhoids. A prospective study. In: International journal of surgical investigation. Volume 2, Number 4, 2000, pp. 295-298, ISSN  1028-5229 . PMID 12678531 .
  5. ↑ a b G. Pühse, F. Raulf: Das Hämorrhoidalleiden. In: Urologe A. Volume 46, Number 3, March 2007, pp. W303-W314, ISSN  0340-2592 . doi : 10.1007 / s00120-006-1281-6 . PMID 17294153 . (Review).
  6. ^ CE Blanchard: Textbook of ambulant proctology. Youngstone, Med.Success Press, Number 134, 1928, p. 7.
  7. ↑ SB Kleiner: The Development of the Injection Treatment of Hemorrhoids. In: The Yale journal of biology and medicine. Volume 3, Number 1, October 1930, pp. 49-57, ISSN  0044-0086 . PMID 21433473 . PMC 2606344 (free full text).
  8. ↑ HG Anderson: The treatment of haemorrhoids by submucous injections of chemicals. In: British Medical Journal . Volume 2, Number 3316, July 1924, pp. 100-102, ISSN  0007-1447 . PMID 20771669 . PMC 2304726 (free full text).
  9. ^ A. Furtwängler: Haemorrhoidalleiden. ( Memento of the original from September 23, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Professional Association of German Surgeons, from September 1, 2011 @1@ 2Template: Webachiv / IABot / www.bdc.de
  10. ^ P. Cataldo, CN Ellis et al. a .: Practice parameters for the management of hemorrhoids (revised). In: Diseases of the Colon and Rectum . Volume 48, Number 2, February 2005, pp. 189-194, ISSN  0012-3706 . doi : 10.1007 / s10350-004-0921-4 . PMID 15711856 .