Diseases of the

COLON r RECTUM

Vol. 16 May-June, 1973 No. 3

Symposium

Diverse Methods of Managing Hemorrhoids *

Moderator: ROBERT TERRELL, M.D.

Richmond, Virginia

Panelists: JAX.IES A. 17ERGUSON, M.D., MAR'rIY I. LEWIS, M.D.,

JAMES BARRON, ~I .D. , PETER H. LORD, ~[ .D.

The discussion was begun by Dr. McAdams.

DR. MCADAMS

THIS IS THE FINAL SESSION Of o u r scientific presentation this year. I am pleased to see that so many of you have survived the battle fatigue and are still in here trying. Every year we devote a good bit of our program to the consideration of hemor- rhoidal disease, and in the 75 years or 73 years since the Society was founded, the answer has not yet been found or, if it has, it has not been presented. But that's not surprising because it hadn ' t been found in the 2,000 ),ears preceding the founding of the Society, either. However, every exchange of ideas brings something of usefulness to each of us, and today this final session will be again devoted to the treatment of hemor-

* Symposium presented at the annual meeting of the American Proctologic Society, New York, New York, June 11 to 14, 1972.

For reprints of the symposium, please write to authors of individual presentations.

171 Di~. Col. & R~ct. ~ay-~'une 1973

rhoidal disease. This is in the form of a symposium on different methods off man- aging hemorrhoids, and the moderator of the panel is a man of vast experience in this area. I will turn the program over to Dr. Robert Terrell .

DR. TEgaEI_L

Man is the victim of a capricious creator. There is no doubt that man was intended to walk on all fours, and having perhaps frustrated his creator's plans by walking on two, he has created several problems. Some of these are our sinuses, which drain uphill, and the weakness of the i n , f i n a l ring and consequent hernias, backstrains, flat feet and hemorrhoids. T h e assumption of the erect posture was a prodigious accomplish- ment, and man pays for his arrogance by the pain and humili ty that go with hemor- rhoids. Hemorrhoids have a tremendously high incidence in the general populat ion-- at least 50 per cent. There are many methods of treating them, as our title would suggest,

Volume 16 Number 3

172 FERGUSON, ET AL. Dis. Col. & Rect. May-June 1973

and we will try to show you some of these methods. The main objective of the treat- ment of" hemorrhoids is the lasting relief of symptoms, and many of us surgeons are more or less accustomed to thinking along the lines of complete removal of the hemor- rhoids. This is certainly a rather sure and good way to do it, but there may be other ways just as good, and you will hear some of them today. Certainly, it behooves the proctologist to be thoroughly familiar with all forms of t reatment so that he can thereby select the most appropr ia te for a case at hand. Some treatments have been long used and subsequently discarded. I t would be of interest to us all to have a show of hands of those who use the various methods. I would like to see the hands of those of you who are using the dosed technic for hemorrhoidectomy. This seems to be pretty popular. How many still use the open method of hemorrhoidectomy? This still has a loyal following. How many of you have had experience with ca-yotherapy? This is a new thing, and I suspect that, in years to come, you pioneers will be joined by a N-ea t many others.

How many of you have had experience with the rubber-band ligation technic? This is not quite so new, and has achieved a rather impressive following already.

How many of you are still loyal to the clamp-and-cautery method of hemorrhoidec- tomy? I see a lot of them.

How many of you use sclerotherapy-- the injection method of t reatment of hemor- rhoids? This is a good form of treatment but appears to be waning in popularity.

Some forms of t reatment will have peculiar advantages for certain cases and, at tile same time, there may be limitations in others.

Now I am going to introduce the first of our panelists. We would like for you to be attentive and think of questions that you might like to put to the panelists after they have made their presentations. I f you have a part icular member of the panel to whom you would direct y o u r question, please put the panelist 's name at the beginning of your question.

Our first panelist is James Ferguson, who will talk on the surgical t reatment of hemorrhoids.

American Proctologic Society Slide Library

The American Proctologic Society is pleased to announce the avail- ability of its Slide Library. This excellent collection of slides on diseases of the colon, rectum and anus is available for lectures and teaching purposes. In addition to the basic set of slides, sets are available on specific subjects, i.e., ulcerative colitis, fissure-in-ano, etc.

The slides are available for loan upon request and inquiries should be directed to:

Dr. Bernard J. Kaplan 21 Woodland Street Hartford, Conn. 06105

There is a $5.00 charge to defray handling and shipping costs, plus a deposit on the slides borrowed.