Symptoms govern treatment

doi:10.1136/bmj.39500.442384.1F

BMJ 2008;336:461 (1 March), doi:10.1136/bmj.39500.442384.1F

Letters

Management of haemorrhoids

Symptoms govern treatment

The first 150 words of the full text of this article appear below.

Acheson and Scholefield reviewed the management of haemorrhoids.¹At our centre, we have adopted an approach whereby symptomsgovern the therapeutic decision.

For many patients, bleeding is the principal symptom, and wehave used Doppler guided haemorrhoidal artery ligation (DGHAL)since 2004 in those whose condition has not improved after injectionof oily phenol in the outpatient clinic. Over this time we havetreated more than 400 patients. In 113 with long term follow-up,the rate of symptoms recurring was 19% at 30 months and therate of complications low.

Although this technique has proved effective in the controlof bleeding, it is not effective in the treatment of prolapsedhaemorrhoids, with recurrence of prolapse occurring in 64% at30 months. Many patients experience prolapse of their piles,which can lead to discharge of mucus, pruritus, and occasionallyseepage of stool. Contrary to the cover of the BMJ, Acheson. . . [Full text of this article]

Simon B Middleton, consultant colorectal surgeon, Richard E Lovegrove, specialist registrar in general surgery, Howard Reece-Smith, consultant general surgeon

¹ Royal Berkshire Hospital, Reading RG1 5AN

simon.middleton@royalberkshire.nhs.uk