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Chris Macklin
Colorectal Surgeon

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Colorectal Website Review: Haemorrhoids

This section provides a monthly review of websites both from the specialist colorectal surgeon, colorectal nurse specialist and the patient’s perspectives.

A different topic will be addressed every issue. If you have any topic or website suggestions then please send them to: website.review@colorectalsurgeon.org.uk

Hemorrhoids – a common complaint but where to go on the web for updates in surgical management and technique and where should you direct your patients for more information?

For the surgeon:

Surgical Management
These two articles give a review of the aetiology, classification, diagnosis, investigation and treatment options for hemorrhoids including the level of evidence and grade of recommendation. Treatment options covered include conservative measures, office procedures (injection sclerotherapy, banding, photocoagulation, cryotherapy and bipolar diathermy) and surgical options (open and closed haemorrhoidectomy including use of lasers and the harmonic scalpel, doppler guided haemorrhoid artery ligation and stapled haemorrhoidopexy).
	This professional resource link gives the Practice Parameters for the Management of Hemorrhoids which was written by the Standards Practice Task Force and the American Society of Colon and Rectal Surgeons, published in this journal in February 2005.
	A full text online review article in Digestive Surgery written by a group from St. Mark’s Hospital, U.K.

Multimedia Presentations
A picture speaks 1000 words and multimedia presentations of new procedures are one of the easiest ways of visualising the technique:
Bloodless Hemorrhoidectomy - Harmonic Scalpel and Ligasure
	A video on performing hemorrhoidectomy with the harmonic scalpel is available on the Johnson and Johnson website. The video is of good quality and impresses the bloodless field achievable using the harmonic scalpel but this technique does not obviate the need for a perianal wound.
	A video again demonstrating a bloodless haemorrhoidectomy but using the Ligasure system.
Hemorrhoidal Artery Ligation Operation
	The principle of this procedure is to ligate the artery feeding the haemorrhoidal plexus efficiently using a doppler probe. The videos are small and short and not the most informative but the principle is easily understood.
Stapled hemorrhoidopexy
	This page is actually on the Indian Johnson and Johnson site and includes lots of information on stapled hemorrhoidopexy (PPH). This is not available on the United States website. There are 3 videos demonstrating operative cases and additional presentations detailing the steps in performing stapled hemorrhoidopexy.

For the patient:
	This is an excellent interactive tutorial in very plain and simple language with clear diagrams and pictures that instructs patients on hemorrhoids and hemorrhoid surgery. There are 64 slides that describe the anatomy, symptoms, diagnosis, treatment and risks of surgery.
	This U.K. site has brought together a multitude of quality links to information sites about hemorrhoids for patients. Included are sites that overview the symptoms, diagnosis and treatment of hemorrhoids from a patient perspective. The links are mainly to sites in the U.K. and U.S. including ASCRS and NHSDirect and include links for dietary advice and downloadable / printable leaflets on hemorrhoids
	This site is incredibly detailed and even gives historical information about hemorrhoid surgery including famous people who have suffered with hemorrhoids! There is a patient message board that enables people to post questions or just to see the questions others have asked – the only issue here would be that there are no details on who runs the site though the advice is sensible it would be nice to know by what authority the advice is given.
	This industry sponsored site gives information about the Procedure for Prolapse and Hemorrhoids (PPH) also known as Stapled Hemorrhoidopexy. It gives a rundown on what hemorrhoids are, how they are classified and what are the treatment options. It gives a balanced appraisal of the risks and complications of PPH.

Next month: Colonoscopy