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Original Article

Longterm effects of compression method in the surgical
treatment of bleeding haemorrhoids

Alfazzaman M
1
, Goldin VA

2
, Anwary SA

3
, Rahman MM

4
, Islam MR

5

Abstract
Objective: Present study was undertaken to find out the long term effect of application of compression
probe after haemorrhoidectomy in the treatment of bleeding haemorrhoids.  Materials and methods: They
study was carried out in the Department of Clinical Surgery, Russian People's Friendship University,
Moscow, Russia, from January 1992 to December 2001, on 80 patients, equally divided into two groups,
case (haemorrhoidectomy plus application of compression probe) and control (haemorrhoidectomy only).
Results:  Long term follow up showed higher good outcome in case group (82.1%) compared to control
(53.8%) (P<0.05), satisfactory and unsatisfactory outcome was higher in control group (17.9% and 28.2%)
compared to case group (12.8% and 5.1%). Conclusion: Application of compression problem after haem-
orrhoidectomy in patients with bleeding haemorrhoids gives better long term results.

Key Words: Bleeding haemorrhoids, Compression probe

Introduction
The surgical illnesses of anorectum are frequently
observed disease among the persons of working age.
Haemorrhoids is one of the most common disease of
anorectum.  The frequency of it among the adult
population varies within the limits of 60 to 70 per-
cent1.  According to data, absolute increase of this
pathology only in Russia annually 600,000 patients
are admitted to hospitals.  A large number of patients
receiving outpatient treatment engaged a self treat-
ment plan is not included in the statistics2. Majority
of the patients are from the working age group 30 65
years.  Among these patients, 29 90% encounter
from 2 6 episodes per year, and for each episode loss
of working days range from 6 to 35 days.  Therefore,
haemorrhoids represent an important social prob-
lem3.  Patients with bleeding haemorrhoids have the
agonizing problems due to passage of blood per rec-
tum after defaecation which are worrisome and may
result in fatal outcome due to loss of excessive
blood.

Various methods of surgical treatment of bleeding
haemorrhoids have been described in the literature
but none of these are considered to be radical
because of their side effects, complication and even
fatal outcome4 6. Compressive probe was used effec-
tively in bleeding haemorrhoids as part of conserva-
tive treatment in patients in whom general or spinal
anaesthesia was contraindicated7. Surgical treatment
of haemorrhoids, especially, the bleeding haemor-
rhoids is a concern of colorectal surgeons, and this
article shows the effectiveness of compressive probe
with the combined surgical treatment of bleeding
haemorrhoids.

Materials And Methods 
Subjects
This study was carried out in the Department of
Clinical Surgery, Russian Peoples' Friendship
University, Moscow, Russia (Hospital No. 17), dur-
ing January 1992 and December 2001, and included
80 patients with bleeding haemorrhoids.  The

Corresponds to: Dr. Victor Alexieavich Goldin, Professor, Department of Clinical Surgery, Russian Peoples'
Friendship University, Moscow, Russia

1. Dr. Md. Alfazzaman, Assistant Professor, Department of Surgery, Z.H. Sikder Women's Medical College
and Hospital, Dhaka

2. Dr. Victor Alexieavich Goldin, Professor, Department of Clinical Surgery, Russian Peoples' Friendship
University, Moscow, Russia

3. Dr. Shaheen Ara Anwary, Assistant Professor, Department of Obstetrics and Gynaecology, BSMMU,
Dhaka

4. Dr. Md. Mujibur Rahman, Associate Professor and Head, Department of Urology, Z.H. Sikder Women's
Medical College and Hospital, Dhaka

5. Prof. Md. Rezaul Islam, Professor and Head, Department of Anaesthesiology, Z.H. Sikder Women's
Medical College and Hospital, Dhaka

Bangladesh Journal of Medical Science Vol. 12 No. 02 April’13

129



patients were subdivided into case (n=40) and con-
trol (n=40).  Patients with bleeding haemorrhoids
concomitant with rectal polyp, chronic anal fissure,
partial prolapsed rectal mucosa and patients with
condyloma of anus were included in the case group.
Histologically confirmed cases with rectal carcino-
ma were excluded from the study.  Informed con-
sents were obtained from study patients and hospital
authorities. Ethical approval was taken from the hos-
pital authorities before study.

Methods
All 80 patients underwent Milligan Morgan haemor-
rhoidectomy.  After operation, in 40 case group
patients, after operation, compressive probe was
applied at the internal and external haemorrhoidal
sites of the anorectum with inflated balloon (50
mmHg in each balloon) for 24 hours (Fig. 1).  In con-
trol group, after operation proper haemostasis was
ensured and antibacterial ointment soaked tampon
was introduced into the anorectum.  The patients
were discharge from hospital only after full recovery.

All 80 patients were followed up on outdoor basis
for a period ranging from 6 months to 9 years.  Long
term follow up results could be obtained from 78
patients, as one patient from each group died due to
other disease not related to haemorrhoidectomy.

Out of 78 patients, 21 patients were followed up at
the outpatient department, and data from the rest 57
patients were obtained with the help of data collec-
tion form provided to them as they were unable to
Ethical approval: This protocol was approved by
institutional Ethics Committee.

Long term assessment
Long term follow up results were evaluated as (1)
Good:  when a patient has no complaint related to
the operation on anorectum, as there are no exacer-
bation or relapse of haemorrhoids, i.e. there is no
nodulation, bleeding or prolapse of haemorrhoids;
(2) Satisfactory:  when there is no nodulation or pro-
lapse of haemorrhoids, but only periodic bleeding or
difficulties at defaecation (with or without pain) or
disturbance in micturition; (3) Unsatisfactory:  when
there are relapse of haemorrhoids which demanded
repeated operative measure.

Statistical methods
Data were expressed a number (percentage) and
mean (±SD).  Statistical analyses were done by
unpaired Student's 't' test and Chi square test.

Results
Table I shows patient data.  Mean (±SD) are showed
no significant difference between case (42.70±7.88
years) and control (43.55±6.72 years) groups.  Sex
also showed to significant variation between groups.
In case and control groups, respectively, there were
28 (70%) and 26 (65%) males, and 12 (30%) and 14
(35%) female.  Associated diseases in case and con-
trol group, respectively, were polyp of anal canal
(10% and 20%), anal fissure (2.5% each), anal
stenosis (7.5% and 2.5%), condyloma of anus (2.5%
each), prolapse of anal mucosa (10% and 0%), and
none (67.5% and 72.5%).  Distribution of associated
diseases between groups showed statistically no sig-
nificant variation.

None of the case group of patients required blood
transfusion, however, 9 (22.5%) control group of
patients required blood transfusion (P<0.01).
Mean (±SD) hospital stay was significantly high
(P<0.001) for control group of patients compared to
case (12.3±1.54 vs 6.83±0.98 days).

Preoperative and postoperative mean (±SD) haemo-
globin level in case and control groups showed sig-
nificant difference between groups.  Preoperative
haemoglobin level was 13.04±0.56 and 12.57±0.89
g/dl (P<0.01), and postoperative was 12.84±0.56
and 11.23±1.00 g/l (P<0.001).  Mean change in
haemoglobin level at postoperative period from pre-
operative level was  0.20 ( 1.54%) in case and  1.34
( 10.73%) in control group.

Table II  shows long term follow up results.  In case
group, out of 39 patients, 32 (82.1%) were evaluated
as good.  In these patients, there was no complaint
related to the performed operation.  Satisfactory
results was obtained in case of 5 (12.8%) patients
though they did not show any sign of relapse.  Two
patients (5.1%) of case group showed unsatisfactory
results.  In one case, there was only internal nodula-
tion, but there was no bleeding per rectum or haem-
orrhoidal relapse,  In second case, periodic bleeding
per rectum was present without any sign of haemor-
rhoids.

Out of 39 control patients, outcome results in 21
(53.8%) were evaluated as good based on their
health and absence of any complaints connected to
anorectum operation.  In case of 7 (17.9%) patients
follow up outcome was satisfactory, as they devel-
oped constipation and period bleeding but had no
signs of haemorrhoidal nodules.  Four patients

Longterm effects of compression method in the surgical treatment of bleeding haemorrhoids

130



developed increased frequency of micturition and
two patients lost their capacity to work.  In control
group, 11 (28.2%) patients follow up results were
unsatisfactory as they showed signs of relapse of
haemorrhoids requiring repeated operative treat-
ment.

Comparing the long term outcome of treatment of
haemorrhoids and benign tumours of anorectum, it
was noted that good outcome was higher in case
group (82.1%) in comparison to control group
(53.8%), satisfactory outcome was higher in control

group (17.9%) in comparison on case group
(12.8%), and also unsatisfactory outcome was high-
er in control group (28.2%) in comparison to case
group (5.1%).  Higher satisfactory and unsatisfacto-
ry result obtained in control group may be attributed
to non application of compressive probe after haem-
orrhoidectomy.  Statistically, good result was signif-
icantly high (P<0.05) in case group in comparison to
control.

Discussion
Haemorrhoidctomy is the method of choice in the

M Alfazzaman, VA Goldin, SA Anwary, MM Rahman, MR Islam

131

Table I:   Patient data 

Variables Case Control P value 
(n=40) (n=40) 

Age (years) 
Mean±SD 42.70±7.88 43.55±6.71 0.605ns 

No. (%) No. (%) P value 
 

Sex     0.633ns 
Male 28 (70.0) 26 (65.0) 
Female 12 (30.0) 14 (35.0) 

Associate diseases     0.269ns 
Polyp of anal canal 4 (10.0) 8 (20.0) 
Anal fissure 1 (2.5) 1 (2.5) 
Anal stenosis 3 (7.5) 1 (2.5) 
Condyloma of anus 1 (2.5) 1 (2.5) 
Prolapse of anal 4 (10.0) 0 
mucosa 
None 27 (67.5) 29 (72.5) 

Blood transfusion     0.001** 
Required 0  9 (22.5) 
Not required 40 (100.0) 31 (77.5) 

 
Hospital stay (days) 
Mean±SD 6.83±0.98 12.30±1.54 0.0001***  

Variables Case Control P value 
(n=40) (n=40) 

 
Haemoglobin (g/dl) 
Preoperative 
Mean±SD 13.04±0.56 12.57±0.80 0.003** 

Postoperative 
Mean±SD 12.84±0.56 11.23±1.00 0.0001*** 
Mean change -0.20 -1.34 
Percent change -1.54 -10.73 

Unpaired Student's 't' test/Chi-square test 
ns = Not significant, ** = Significant (P<0.01), *** = Significant (P<0.001) 
 Table II:  Outcome of treatment 

Outcome Case Control P value 
(n=39)  (n=39) 

No. (%) No. (%) 

Good 32 (82.1) 21 (53.8) 
Satisfactory 5 (12.8) 7 (17.9) 0.012* 
Unsatisfactory 2 (5.1) 11 (28.2) 

 
Chi-square test 
* = Significant (P<0.05) 



treatment of bleeding haemorrhoids.  The compres-
sive probe applied after haemorrhoidectomy
revealed better results in comparison to haemor-
rhoidectomy alone.  Long term compression in
haemorrhoidal zones of anorectum results in the
reduction of influx of blood on arteriolovenular
anastomoses of cavernous bodies and simultaneous
elimination of stagnation of blood in the haemor-
rhoids.  Therefore, the pressure in the lumen of cav-
ernous bodies is reduced; they are drained and the
lumens of the cavernous bodies collapse.  In addition
to this, at pressure on haemorrhoids, the nerve recep-
tors are irritated, simulates the contraction of mus-
cles of anal sphincters, which even more signifies
compression on haemorrhoids and accelerates the
process of collapse of walls of ecstatic vessels.
There is an oxygen deficiency in tissues of haemor-
rhoids, the physicochemical properties of walls of
pathologically changed vessels and their surround-
ing tissues are changed; stimulation of development
of young connective tissues and the process of cica-

trization is magnified7.

The walls of pathologically changed vessels of
haemorrhoids in connection with a long time com-
pression and local hypoxia are squeezed, gradually
scleroses, emptying of haemorrhoids and bleeding
ceases8.

From our data, we found that the application of com-
pressive probe in the conservative method of treat-
ment of bleeding haemorrhoids intended for stop-
page of haemorrhoidal bleeding, lowering of activi-
ty of arteriolovenular anastomoses, normalization of
microcirculation in cavernous bodies, and thus it
was effective as conservative treatment of bleeding
haemorrhoids.  The duration was for 4 hours per day,
and the process was repeated for 4 5 times at an
interval of 1 4 days7.

The application of compressive probe after surgical
treatment of bleeding haemorrhoids was directed to
stop the residual bleeding, restoration of bloodflow
and normalization remaining cavernous bodies,
adaptation of edges of sutures mucosa and to reduce
perianal oedema.  The time of application of com-
pressive probe was for 24 hours after operation.

Conclusion
The application of compressive probe at the end
stage of haemorrhoidectomy in patients of bleeding
haemorrhoids provided the elimination of stagnation
of blood in the cavernous derivations, resulting in all
and aseptic pasting together of their walls, sclerosis
and shrinkage of haemorrhoidal clusters.  Thus, it
prevented relapse of haemorrhoids in the long term.

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132

Compressive probe for the treatment of Haemorrhoids.


