A Clinical Study of Bipolar Diathermy (BICAP) in Hemorrhoids

Choi, Dong Ha

Abstract

Many nonsurgical techniques are currently employed for outpatient treatment of hemor rhoids. Sclerotherapy, rubber band ligation, cryotherapy, laser therapy, infrared photocoagula tion and direct current therapy have been utilized in the management of hemorrhoids in the outpatient setting, but bipolar diathermy(BICAP) has not been introduced in korea yet. This study is a clinical analysis of 472 patients of hemorrhoids treated with BICAP bipolar diathermy at outpatient department from July 1996 to June 1997. Among them, 396 patients had been followed up for 3 to 15 months. Male to female ratio was 2.2:1 and mean age of male and female was 42.8 and 39.7 years, respectively. Duration of symptoms in 216 patients(57.6%) was below 5 years. The most frequent degree of internal hemorrhoids was second degree(62.7%), followed by third degree(23.9%), first degree (7.8%) and fourth degree(5.5%). Major presenting symptoms were prolapse combined with bleeding(45.8%), prolapse(21.2%) and bleeding(19.7%). In 62.9% of patients 3 piles were treated. Associated anorectal diseases with hemorrhoids, such as skin tags, thrombi and anal polyps were present in 179 patients. Among them, 126 patients were operated as outpatient operation procedure with BICAP therapy. Previous medical managements of hemorrhoids, such as use of rectal suppositories(32%), injection of sclerosing agents(8.6%) and hemorrhoidectomy(7.8%) were done in 240 patients(51%). Number of treatments was one session(88.7%), two sessions(10%), three sessions(1.1%) and four sessions(0.2%) in order of frequency. Mild to moderate anal discomfort was experienced during BICAP therapy by 215 patients(46%), mild sensation of local heat by 95 patients(20%) and mild bleeding by 10 patients(2%). No postdiathermy discomfort was observed in 337 patients(85.1%). However, postdiathermy bleeding and pain were present in 41 patients (10.4%) and 18 patients(4.5%), respectively. Results of followed up patients for 3 to 15 months were asymptomatic in 270 patients(68.2%), improved in 88 patients (22.2%), and no changed in 38 patients(9.6%). Among 18 patients with fourth degree hemorrhoids, only 2 patients(11%) became asymptomatic, 5 patients(28%) improved and 11 patients(61.9%) were not changed in their symptoms. Six patients experienced recurrent hemorrhoids requiring hemorrhoidectomy. In conclusion, bipolar diathermy(BICAP) for hemorrhoids is safe, easy to apply, painless, needs no anesthesia and bowel preparation with short time and repeated treatments and can be applied to first, second, third and some patients of fourth degree hemorrhoids. The effect of treatment was satisfactory in about 90%. Side effects were minimal compared to other nonoperative treatments. Therefore, the auther believes that bipolar diathermy(BICAP) is a desirable nonoperative treatment for internal hemorrhoids.