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Combined treatment for rectal disorders?

Post by 
Dr. Mohamed Salama
August 30, 2023

hat treatment combinations are possible for hemorrhoids and anal fistulas?

Dr. Salama: Treatment for hemorrhoids may include a combination of approaches such as lifestyle modification, dietary adjustments, minimally invasive procedures such as laser-based hemorrhoidoplasty and, in certain cases, surgery. This combination is tailored to the severity of the condition and the patient's overall health. Similarly, anal fistulas may use a combination of surgical techniques as well as laser treatment, wound care and occasionally medications to effectively improve the condition.

What does the decision to use treatment combinations depend on? 

Dr. Salama: The decision to combine treatment methods is often based on factors such as the patient's specific condition, severity, overall health, and on the expertise and judgment of the healthcare professional. Combining treatment meth- ods can lead to better outcomes and therefore improved patient satisfaction. Combining two medical procedures, such as laser hemorrhoidoplasty (LHP) with Ferguson hemorrhoidectomy, may have benefits, according to a study published in 2020. 

What are the potential benefits of combining multiple procedures?

Dr. Salama: One potential benefit could be increased efficacy - meaning improved treatment outcomes compared with using a single procedure. Different procedures can address different aspects of the disease, leading to more comprehensive treatment. Some procedures may have synergistic effects when combined. Their combined effect may be more effective than the sum of their individual effects. If the combination of procedures addresses a broader range of symptoms or their underlying problems, more comprehensive symptom relief would also be possible. Combinations of procedures allow for a tailored approach to each patient's individual medical condition. The treatment plan can be tailored to individual needs. Sometimes, combined procedures can also reduce the need for invasive options, potentially lowering the overall risk compared to multiple single complex procedures. However, combining complementary procedures can also result in an overall shorter recovery time compared to performing multiple separate procedures. Only one anesthesia session reduces stress to the body and potential additional anesthesia-related risks. I see other benefits in cost efficiency and patient comfort. Fewer hospital visits and treatments mean less disruption to daily life and therefore work life. 

What is the laser hemorrhoidopexy you mentioned?

Dr. Salama: Laser hemorrhoidoplasty and mucopexy is a combined method that has a revolutionary approach to hemorrhoid treatment, according to a 2017 study. It does not alter the anatomy of the anal canal and improves symptoms without affecting the physiological functions of the hemorrhoidal plexus in the anus. Furthermore, LHP causes less postoperative pain than other conventional methods. Several prospective randomized studies comparing the LHP procedure with other techniques found that postoperative pain was less in the LHP group than in all other procedures. Postoperative comfort is an important factor for patients when choosing a surgical method. Before medical procedures are performed, it is critical that patients have a thorough discussion with their healthcare provider to understand potential benefits, risks and expected outcomes.

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