Advancements in Minimally Invasive Surgery for Hemorrhoid Treatment

In a recent session of the National Academy of Surgery, experts underscored the significant strides made in minimally invasive surgical techniques for the treatment of hemorrhoidal disease. Dr. Béatrice Vinson-Bonnet, a visceral and digestive surgeon at Poissy-Saint-Germain-en-Laye Community Hospital, emphasized the shift from traditional hemorrhoidectomy to innovative, less invasive procedures that prioritize patient comfort and quick recovery. "Thanks to technological advancements, all surgical approaches now aim to be as minimally invasive as possible," stated Dr. Vinson-Bonnet. She elucidated that surgical intervention is considered only after conventional medical treatments, such as addressing intestinal transit disorders and educating patients on bowel habits, have failed.

Historically, hemorrhoidectomy was the standard surgical approach until the 2000s. Since the advent of less painful alternatives, including nerve blocks and stapling techniques, there has been a pronounced decrease in postoperative pain and recovery times. One such method, the pudendal nerve block, effectively anesthetizes the pudendal nerve to provide 12 to 24 hours of postoperative pain relief. Despite these advancements, patients may still experience discomfort when passing stool in the days immediately following surgery, and full recovery can take up to six weeks.

Dr. Antonio Longo, a colorectal surgeon and director of the European Centre for Coloproctology and Pelvic Diseases in Vienna, pioneered the stapled hemorrhoidopexy technique in 1998. This method utilizes a circular stapler to excise a circumferential ring of rectal mucosa above the hemorrhoids, repositioning them to their normal position. However, Dr. Vinson-Bonnet cautioned that this innovative technique is associated with significant complications and is often supplanted by simpler methods that involve ligating small rectal arteries using an anoscope. It is important to note that these techniques are primarily effective for internal hemorrhoids and are not suitable for larger external hemorrhoids, particularly those caused by thrombosis.

As new techniques emerge, thermofusion, which employs microwave energy to eliminate internal bleeding, is gaining traction. Although this method is still being evaluated, it is already implemented in clinical practice. Concurrently, other methods such as radiofrequency and, less frequently, laser treatments are also being utilized.

In a related area, Professor Émilie Duchalais, MD, PhD, a digestive surgeon at Nantes University Hospital, reported on advancements in treating fecal incontinence using minimally invasive techniques. Her research at the Institute of Digestive System Diseases includes clinical studies on sacral neuromodulation and Botox injections, which are used as second- or third-line treatments when conventional therapies fail. Sacral neuromodulation involves stimulating nerve roots near the sacrum to improve sphincter control and rectal sensitivity, showing long-term improvement in 50% to 70% of patients five to ten years post-implantation.

Botox, commonly used to treat overactive bladder, has a comparable effect on the rectum by blocking muscle contractions to enhance control in patients suffering from fecal incontinence. While Botox provides temporary relief, studies indicate that patients may require fewer injections over time.

Emerging research into fat injections for urge incontinence is also underway, with early findings from a clinical trial at Rennes University Hospital presenting promising results. This technique aims to restore sphincter tone by utilizing stem cells found in adipose tissue, although it remains experimental.

The continued evolution of minimally invasive surgical techniques in proctological surgery not only illustrates the medical community's commitment to enhancing patient outcomes but also highlights the importance of ongoing research and development in this critical area of healthcare. As these methods become more refined, they promise to reduce recovery times and improve quality of life for patients suffering from hemorrhoidal disease and fecal incontinence, paving the way for a future where surgical interventions are safer and more effective.