Ligation and cryosurgery of all hemorrhoids. An office procedure.

Over 21,000 patients with symptomatic hemorrhoids were treated either at the Rudd Clinic in Toronto, or at Proctology International in the Cayman Islands, with the ligation or the ligation and cryosurgical technique. The procedures as described are simple, very effective and should be done in the office and not in the hospital. It is better for both patient and doctor and the cost saving is in the tens of millions of dollars in our series alone. Other problems such as anusitis and para-anal lesions should be differentiated from hemorrhoids and treated as described to improve your success rate. All surgeons are encouraged to adopt new techniques which will improve the treatment of their patients and their own reputation. It is a changing world--especially in medicine and we must keep up and be willing to adapt. I recommend the ligation and cryosurgical technique to all surgeons for the treatment of all symptomatic patients with hemorrhoids.

Office treatment of hemorrhoids.

The author holds that the weight of evidence from experience with 20,000 patients indicates overwhelmingly that the office treatment of hemorrhoids by means of ligation and the cryosurgical technique described is the treatment of choice. He gives 10 reasons, most of which are to the benefit of the patient, but some of which also benefit the doctor. The cost saving amounts to millions of dollars, a factor that should be of interest to government and insurers. The author suggests that operative hospital hemorrhoidectomy should no longer be performed.

The kock pouch: a continent ileostomy with no appliance.

In this new operation, a pouch or reservoir is fashioned out of terminal ileum with a valve mechanism at its exit to the skin surface. This allows storage of the liquid bowel contents in an expandable container with no leakage of stool or gas and therefore no skin problems. There is no need for appliances or bags, no embarrassment from the involuntary noise and smell of flatus through the ileostomy. The stoma is created flush and within the bikini line. The patient catheterizes the pouch on an average of three times a day.Not only does this procedure solve many of the complications of a conventional ileostomy, but it helps decrease the amount of emotional trauma suffered by the young ileostomist, greatly improving the quality of life.

Lateral subcutaneous internal sphincterotomy for chronic anal fissure, an outpatient procedure.

We have adapted the lateral internal sphincterotomy technique for the repair of chronic anal fissure to a strictly office or outpatient procedure. The early cure rate in this review of our first 200 patients was very good - well in excess of 98 per cent. Complications were exceedingly minor, the considerable cost to the patient of hospitalization and time off from work has been saved, and patient acceptance has been excellent.

Please doctor - no colostomy.

Many cancers of the rectum are discovered which are too low for the standard abdominal resection and anastomosis; therefore an abdominal perineal resection and colostomy are performed. Three new techniques are described which will allow a number of these patients to have their low rectal tumors resected with primary anastomosis, so that a colostomy is avoided. These are very grateful patients.

Ligation of hemorrhoids as an office procedure.

Hemorrhoidectomy has been done on all our patients in whom operation was indicated, using the ligation method in the office. The patient does not require hospitalization or general anesthesia and rarely has pain or loss of time from work. Many thousands of hospital bed-days have been saved for more serious problems. The results of the treatment of our first 1000 patients have been very satisfactory.

Office Surgery for Chronic Fissure-in-Ano.

We have modified a new technique of surgical repair for chronic fissure-in-ano at the Rudd Clinic. The patient is treated by preference in the office under local rather than general anesthetic; he may then drive home and is back to work within two days. Healing is quicker, the cure rate is higher, complications fewer and only minor. This method has been enthusiastically received by both patient and doctor.

Fiberoptic colonoscopy: a dramatic advance in colon surgery.

A new instrument is now available which will allow direct viewing of the lumen of the entire colon from rectum to cecum. Biopsies as well as excision of some lesions are also possible through the instrument. The advantages to the patient are many and obvious.

Office proctology-how I do it.

Several new concepts and some excellent new office procedures are brought out in the discussion of six of the commonest anorectal diseases seen in the family physician's office.