Landmarks in the History of Haemorrhoids

Transcription

1 Landmarks in the History of Haemorrhoids Charles V. Mann Date Comments c.2250 BC 1700 BC 1552 BC BC Old Testament, Samuel 5:9 Old Testament Samuel 5:12 25 BC-AD 50 AD Sometime between the fourth & sixth century AD 10 th century AD 10 th _5 th century AD Code of Hammurabi, King of Babylon. Description of anal symptoms (haemorrhoids). Edwin Smith papyrus. Use of astringent lotions for anal symptoms (haemorrhoids?) described. Eber papyrus. The most complete record of Egyptian medicine. Haemorrhoid remedies described. Writings of Hippocrates. Treatment of haemorrhoids by cautery and excision described. Philistines punished with "emerods". After the Ark moved to Ekron, perpetrators smitten by "emerods". Celsus describes ligature of piles with flax. Galen recommended conservative management of piles (laxatives, ointments, leeches) and regarded bleeding as therapeutic. Also described, however, use of a tight thread to induce sloughing of haemorrhoids. Susruta Samhita described use of treatment by clamp and cautery method. EI-Zahrawy described treatment by application of cautery irons. Treatment in Byzantine medical practise by twisting pile, application of ligature to its base, followed by amputation. A "modern" approach that lapsed for many centuries. 173

2 174 Surgical Treatment of Haemorrhoids Date Comments John of Arderne published his treatise on the treatment of fistula and haemorrhoids, and the use of clysters (enemas). Georg Ernst Stahl published a classic work on the treatment of haemorrhoids. Foundation of St. Marks Hospital, London by Frederick Salmon for the treatment of anal diseases, especially fistula in ano and haemorrhoids. J.G. Maisonneuve described treatment by forceful anal dilation. Subsequently, this treatment was revived by P.H. Lord. Development of the classical method of open dissection and ligature at St. Marks Hospital by E.T.C. Milligan and C. Naughton Morgan. Development of a closed method of haemorrhoidectomy by A.G. Parks, London. The closed surgical method of treatment established by J.A. Ferguson and colleagues at Grand Rapids, Missouri. Invention of the method of rubber band ligation of haemorrhoids as an office procedure by J. Barron (USA). Method widely adopted thereafter. New methods for physical destruction of haemorrhoids developed (cryotherapy infrared thermocoagulation, diathermy, laser). Some still used. Use of anal dilatation advocated by P.H. Lord. Was not widely adopted but of historical importance. Classical studies by W.H.F. Thomson into the nature of haemorrhoids, and their development from anal cushions, which are normal structures. Day-case surgery initiated in special centres.

3 Index A Abdominal examination Acute haemorrhoids 124 Age of patients 25,75, 109, 159 as contraindication to surgery 139 Ageing anatomical changes 11 changes in anal cushions 8 AIDS Alcohol abuse, as contraindication to surgery Ampullary pump 10 Anaemia 26-27,42 Anaesthesia 110 day case analgesia positioning preoperative selection and preparation technique Anal cushions changes with ageing 8 function of 7-8 role in anal sphincter control 17 Anal dilatation 51-56,115, complications 55 contraindications 53 indications 51 post-dilatation care results technique Anal fissure 31,35,68, ,158 postoperative 86, 137 Anal fistula 31,35, 137, 156 postoperative Anal hypertonia 10 Anal intercourse 25,142 Anal stenosis 87 Anal stricture Anal tags 136 Anal tone 13 Anal ulcer 137 Anatomy 5-7,8-9 Anopexy ("stapling") see Circular stapler anopexy Anoscopy Antibiotics, prophylactic Anxiety management 113 Autoimmune deficiency 76 B Banding see Rubber band ligation Barber surgeons 2 Bleeding see Haemorrhage Bowel habit 27 Bowel regulation postoperative 116 preoperative 112 Bulking agents 45 ( Carcinoma, as contraindication to surgery 143 Cardiovascular problems 109 Cathartic colon 45 Circular stapler anopexy complications indications postoperative course results technique 98-99, 100 Classification of haemorrhoids external 15 primary internal secondary internal 15 Closed haemorrhoidectomy complications 91 diathermy indications 89 position and anaesthesia 89 postoperative management 91 preoperative preparation 89 procedure results

4 176 Index Co-morbidity anal abnormalities inflammatory bowel disease old age 159 perianal/perineal sepsis 156 sexual habits 159 systemic Coagulopathy 156 Colitis 24, 25 Complications of haemorrhoidectomy anal fistula 137 anal stricture anal tags 136 constipation ectropion 136 epidermal cyst 137 faecal incontinence fissure/ulcer 137 haemorrhage 135 infection mucosal prolapse 136 pain pruritus ani 137 pseudopolyps 137 rectal stricture 137 recurrence 138 retroperitoneal air 138 urinary retention 134 urinary tract infection 134 Complications of haemorrhoids anal fissure recurrent haemorrhoids 152 thrombosis internal haemorrhoids Condylomata 35 Conservative management of haemorrhoids 4 Constipation 43,47, postoperative Continence disorders 20 Contraindications to haemorrhoidectomy age 139 anal intercourse 142 carcinoma 143 chronic illness deformed anal canal drug and alcohol abuse gastrointestinal disease 141 immune deficiency disorders 142 lymphogranuloma venereum 143 mucosal inflammation 143 pregnancy and parturition 141 tuberculosis 143 venereal disease 143 weak anal sphincter 142 Crohn's disease 24,25,30,36, Cryotherapy immediate after effects 129 long-term effects 130 D Day case haemorrhoidectomy anaesthesia consent 164 payment 163 postoperative care preoperative preparation 164 selection of patients social considerations 163 technical aspects Deep-vein thrombosis prevention 113 Defaecatory position 10 Deformed anal canal Dermatitis 30 Diabetes mellitus 110 Diagnosis concomitant conditions 24 haemorrhoid size 23 history age 25 childbirth 25 family history 25 gender 25 marital status 25 previous treatment principal complaints 26 secondary complaints social/occupational background 27 Diathermy haemorrhoidectomy acute haemorrhoids 124 circumferential prolapsed piles closed open 120 results Diet 10,43-44 Digital examination 32 Drug abuse, as contraindication to surgery E Ectropion 136 Egyptians, references to haemorrhoids Enemas Epidermal cyst 137 Examination abdominal anoscopy digital 32

5 Index 177 flexible recto-colonoscopy 34 general appraisal 27 position preparation 28 proctoscopy rectoscopy sigmoidoscopy visual inspection External haemorrhoids 15,19 thrombosis of F Faecal incontinence 40-41,55,87, Faecal retention 86 Family history 25 Far East, references to haemorrhoids 2 Fissure see Anal fissure Fissure-in-ano see Anal fissure Fisting 142 Fistula see Anal fistula Fistula-in-ano see Anal fistula Flexible recto-colonoscopy 34 Funnel anus ,152 (i Gastrointestinal disease, as contraindication to surgery 140 Gay bowel syndrome 159 Greeks, references to haemorrhoids Gutter deformity 143 H Haemorrhage 26, 38-39, 68 postoperative 135 risk of 114 Haemorrhoidectomy closed see Closed haemorrhoidectomy complications see Complications of haemorrhoidectomy contraindications see Contraindications to haemorrhoidectomy day case diathermy laser open see Open haemorrhoidectomy submucosal see Submucosal haemorrhoidectomy total see Total haemorrhoidectomy Historical aspects 1-4, barber surgeons 2 Egypt 1 Far East 2 Greece 1 Master Surgeons 2 nineteenth century 3 Renaissance 2-3 Rome 2 twentieth century 3-4 HIV 157 Immune deficiency disorder 142 Immunosuppression Indications for intervention anaemia 42 bleeding faecal soiling and incontinence mucus seepage and pruritus 40 pain thrombosis prolapse Infection 10, 68 perineal 156 postoperative urinary tract 110,134 Infrared thermocoagulation technique tissue effects 72 Internal haemorrhoids 13-15,19 thrombosis of L Landmarks (historical) Laser haemorrhoidectomy Laxatives 45 Lymphogranuloma venereum, as contraindication to surgery 143 M McGiveny ligator 65, 66 Master Surgeons 2 Metronidazole 165,169 Mucosal inflammation 143 Mucosal prolapse 136 Mucus discharge 26, 40, 42 N Non-invasive therapy bulking agents 45 diet enemas laxatives 45 purgatives suppositories Non-steroidal anti-inflammatory drugs 169

6 178 o Obesity 29,34,110,140 Obstetric history 25 Occupation of patient 27 Open haemorrhoidectomy (St Marks Milligan-Morgan technique) aftercare restoration of defaecation 85 to anal wounds case selection complications acute urinary retention 86 anal stenosis 87 faecal retention 86 fissue-in-ano 86 fistula-in-ano incontinence 87 postoperative haemorrhage 86 recurrent haemorrhoids 87 secondary haemorrhage 86 diathermy 120 difficult haemostasis 84 position 77 preoperative preparation prolapsing skin bridges 83 residual circumferential haemorrhoids residual skin tags results 87 technique p Pain 26,40-41,68, Parks method see Submucosal haemorrhoidectomy Pathophysiology of haemorrhoids Pecten band 51,53 Pelvic sepsis 68 Perianal abscess 156 Perineal infection 156 Perineal problems Perioperative precautions Porphyria 110 Portal hypertension 9,156 Postoperative haemorrhage 86 Postoperative management closed haemorrhoidectomy 91 submucosal haemorrhoidectomy 95 total haemorrhoidectomy Pregnancy 24,76, as contraindication to surgery 140 Preoperative preparation antibiotics anxiety management 113 assessment bowel regulation 112 closed haemorrhoidectomy 89 haemorrhage risks 114 open haemorrhoidectomy perineavanal skin problems prevention of deep-vein thrombosis 113 regulation of food and drink 113 submucosal haemorrhoidectomy 93 total haemorrhoidectomy 106 Prevalence of haemorrhoids 9 Proctalgia Proctoscopy Prolapse 13,26,39-40,55 circular stapler anopexy for diathermy for Prostate enlargement 110 Pruritus ani 26,40,47, 137 Pseudopolyps 137 Pulmonary disease Purgatives R Rectal stricture 137 Rectocele 158 Rectoscopy Recurrent haemorrhoids 138, 152 Renaissance, references to haemorrhoids 2-3 Renal disease 110 Retroperitoneal air 138 Romans, references to haemorrhoids 2 Rubber band ligation complications 68 equipment injection of local anaesthetic 69 operative technique patient positioning and preparation 66 principle 65 results 67 single versus multiple band application S St Marks Milligan-Morgan technique see Open haemorrhoidectomy Sclerotherapy 26,57-64 aftercare 63 case selection 58 complications bleeding at injection site intravenous injection 62 pain 62 prostatic injection results 63 technique injection position 58 preparation 58 Index

7 Index 179 Sigmoidoscopy Sinuses 31 Size of haemorrhoids 23 Skin abnormalities Skin tags 19,31,83-84 fibrotic 36 Stapling see Circular stapler anopexy Stool consistency 10 Strangulated piles see also Prolapse Submucosal haemorrhoidectomy (Parks method) follow-up regimen 95 indications 93 postoperative management 95 preoperative preparation 93 results technique Suppositories Surgery see Haemorrhoidectomy Syphilis 30 T Therapy see Cryotherapy; Haemorrhoidectomy; Noninvasive therapy Thrombosis of haemorrhoids 40-41,68, external aetiology 145 complications 147 presentation 145 treatment internal aetiology 149 presentation 149 treatment Total haemorrhoidectomy complications 108 indications 106 postoperative care preoperative preparation 106 technique Thberculosis, as contraindication to surgery 143 U Ulcerative colitis 155 Urinary retention 62, 86, 134 Urinary tract infection 110,134 V Varicose veins 9 Venereal disease, as contraindication to surgery 143 Visual inspection W Weak anal sphincter 142 Whitehead deformity 20 Whitehead operation see Total haemorrhoidectomy