BEST PILES TREATMENT IN INDIA

We understand that Piles ( Mulvyadh / Bavasir ) may not be a subject you feel comfortable talking about, but there is no need to suffer in silence. If you have Piles, you are not alone. It is estimated that Piles will affect at least 50% population at some point during their lives, that makes it one in two of us!

Do keep in mind that the earlier you seek advice and a thorough diagnosis, the better the chances are that the symptoms can be cured with minimal discomfort. Because of the pre-conceived notion that treatment and the consequences are extremely uncomfortable, many patients previously preferred to live with the problem rather than see a doctor. However,advances in medical science have made the current treatments extremely patient friendly, with minimal discomfort and an abridged healing time.

DR ASHWIN PORWAL : A PRODIGY OF PILES

Dr Ashwin Porwal addressing medical students on 'Proctology: An upcoming branch of medicine'

Dr Ashwin Porwal is the founder and lead surgeon of Healing Hands Clinic (HHC). He has dedicated his career to practice and research in Proctology – the branch of medicine dealing with the disorders of the rectum and anal canal. He has had the privilege of receiving training in Proctology from the world-renowned Colorectal surgeon, Dr Antonio Longo of Italy. Dr Longo invented the MIPH/PPH ( Stapler surgery ) for Piles and Dr Porwal has received hands-on training from the master himself.

Till date >20,000 patients have been satisfactorily treated for their Piles at Healing Hands Clinic. Dr Porwal has performed the maximum number of Stapler surgeries in Asia. He brought to India the Leonardo Laser for Piles and the country’s first Laser Hemorrhoidoplasty (LHP) was performed by him at HHC. Today, the clinic treats more patients with LHP than any other center in the world. With his indisputable expertise in this field, Dr Porwal has trained many fellow surgeons from the country and across the globe in the Stapler and Laser procedures.

The regular MIPH/PPH surgery, clearly the most popular technique worldwide, nevertheless has a recurrence rate of 8%. Dr Porwal with his immense experience has modified the procedure by adding Horizontal Mucopexy to it, which brings down the bleeding and recurrence rate to <1%. In November 2013, he presented a Research paper on this, 'Stapler hemorrhoidopexy alone vs Stapler hemorrhoidopexy plus Mucopexy for Grade 3 Internal Hemorrhoids' at the 3rd Biennial ECTA Conference, Singapore.

Dr Porwal was selected among international speakers at the World Congress of Coloproctology-2011, Rome, where he presented a Study Paper on 'Piles and Constipation in Indian Scenario'. He has also presented a Paper at ESCP Conference-2014, Barcelona, on 'Stapler Hemorrhoidopexy - Successful results from a case series of 3000 patients treated at a single center in India.

TREATMENT STRATEGY AT HEALING HANDS CLINIC

Hemorrhoids are treated depending on the grade that they are in. As a general rule, early grades are treated conservatively with medicines, exercise and diet modification. At later stages a surgical treatment is preferred in order to rule out the possibility of a recurrence.

(diagrammatic representation)

MCDPA

An innovation of Dr Porwal himself, this is a conservative approach intended to halt and reverse the early disease without any surgical intervention. It includes a combination of two or more of the following:

• Medication - Creams (Anoac) and stool softeners are used so that the motion is passed smoothly. Anoac reduces any itching or burning that may be present.
• Constac - A herbal preparation formulated under the guidance of Dr. Porwal by Ayurvedic doctors at Healing Hands & Herbs. This is given as a lot of patients suffer from constipation which aggravates piles.
• Diet - Counselling by qualified nutritionist to correct any imbalances in diet and chart a diet conducive to healthy bowel habits.
• Physiotherapy - Pelvic floor physiotherapy helps to strengthen muscles in the region.
• Ayurveda therapy - This includes about 6 sessions of enema with medicated herbal oils.

LASER HEMORRHOIDOPLASTY (LHP) - LASER TREATMENT FOR PILES

Laser Hemorrhoidoplasty is the preferred treatment for Grade 2 and early stages of Grade 3 Piles.This procedure is done under short general anesthesia and takes about 20 minutes. Through the natural anal opening, laser energy is applied using a special radially emitting fiber. The controlled emission of laser energy leads to vaporization causing the hemorrhoidal mass to shrink.

ADVANTAGES OF LHP

• No cuts, no open wounds
• Less post-operative pain as compared to other procedures
• Healing is excellent as there are no cuts or stitches
• No sense of urgency (need to rush to the toilet) after the procedure
• No risk of rectal stenosis
• Patient can return to normal activities within a shorter space of time

POTENTIAL DRAWBACKS OF LHP:

• Burning sensation – Some patients have a burning sensation in the area for a few days. This usually disappears with time.
• External skin tag thrombosis

MIPH (MINIMALLY INVASIVE PROCEDURE FOR HEMORRHOIDS) AKA PPH (PROCEDURE FOR PROLAPSE AND HEMORRHOIDS) AKA STAPLER HEMORRHOIDOPEXY

What is MIPH/PPH?

It is a procedure that was originally conceived in 1994 by Dr Antonio Longo, and since,has gained popularity as the treatment of choice for Grade 3 and Grade 4 prolapsed Piles.

( stapler image) Haemorrhoidal Stapler PPH03, a disposable device (Ethicon, Johnson & Johnson, USA)

The procedure is usually done under short general anesthesia and takes around 25-30 minutes. Using the circular stapler, the mucosa which is responsible for the the prolapse of Hemorrhoids is circumferentially excised and the prolapsed Hemorrhoids are pulled up back to their normal position.

ADVANTAGES OF MIPH/PPH:

The Stapler procedure has definite advantages over other treatments available for Piles (Mulvyadh).

• No external cuts/stitches
• Minimal blood loss
• Minimal pain easily managed by painkillers
• Sphincter function is not hampered hence voluntary control over motion is preserved
• Faster recovery - Patient can resume work from 5th day
• Lowest recurrence rate (8%) - This is further brought down to <1% byMucopexy technique introduced by Dr Porwal at HHC.
• Safe in diabetics, cardiac patients (those with heart problems) and senior citizens

POTENTIAL DRAWBACKS:

As with any surgical procedure there are possible drawbacks associated with MIPH:

• Inflammation or Infection - Can be prevented with anti-inflammatory agents and antibiotics
• Urgency (i.e. need to rush to the toilet) - May last for 4-8 weeks. This can be kept under control with Kegels exercises
• Bleeding following the procedure (6-8%)
• Staple line stricture (~5%) - In experienced hands it can be prevented with proper positioning of staple line
• Recurrence (8%) - With the addition of Mucopexy, this can be brought down to <1%