Schubach G., Practice parameters for hemorrhoid treatment out of date.
Dis Colon Rectum. 2004 Nov;47(11):1990; author reply 1990-1.

Suffering from internal thromboid hemorrhoids that had progressed to the third degree, I sought medical advice for this condition in 1997 and 2002. In both cases, a hemorrhoidectomy was recommended. Reluctant to undergo the pain, cost, and disruption of a hemorrhoidectomy, I did some research on my own into alternative therapies. This led me to the UCLA Gastroenterology Clinic and Dr. Dennis Jensen. Dr. Jensen had been part of a team that had conducted a number of studies evaluating the safety and efficacy of Direct Current (DC) Probe Treatment of chronic anal fissures associated with internal hemorrhoids and to analyze the effectiveness of this procedure versus traditional hemorrhoidectomy.1,2 Dr. Jensen referred me to the office of Dr. Daniel Norman of South Lake Tahoe, California.

Dr. Norman’s treatment involving direct current electrotherapy (Hemorrhoidolysis) produced complete relief of my condition in a series of painless office visits. This experience leads me to wonder how many hemorrhoidectomies are performed every year in this country and how many of these are really necessary. “The Practice Parameters for the Treatment of Hemorrhoids” as prepared by The American Society of Colon and Rectal Surgeons is dated April 1993. Its discussion of electrotherapy techniques under the heading “Bipolar Diathermy Coagulation” is perfunctory and gives no substantive information about the technique. Its statement that “significant clinical data are not yet available” is no longer true. Good clinical research has now been completed on both the direct current and bipolar electrocoagulation treatment methods.3,4,5,6 It would be valuable to the public as well as to colorectal surgeons for these studies to be recognized and disseminated by the American Society of Colon and Rectal Surgeons through its Journal.

1 Randall GM, Jensen DM, Machicado GA, et al. Prospective randomized comparative study of bipolar versus direct current electrocoagulation for treatment of bleeding internal hemorrhoids. Gastrointest Endosc 1994;40:403-10.
2 Machicado GA, Cheng S, Jensen DM. Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe. Gastrointest Endosc 1997:45:157-62.
3 Blakeslee, S. Removing hemorrhoids in painless office visit. New York Times:Health Section:2: April 25, 1991;.
4 Zinberg SS, Stern DH, Furman DS, Wittles JM. A personal experience in comparing three nonoperative techniques for treating internal hemorrhoids. Am J Gastroenteral 1989; 84:488-92.
5 Norman DA, Newton R, Nicholas GV. Direct current electrotherapy of internal hemorrhoids: an effective, safe, and painless outpatient approach. Am J Gastroenteral 1989; 84:482-87.
6 Elliot D. Dr. Norman’s new device. Tahoe Daily Tribune. April 28, 1987:1.


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