Thrombosed external hemorrhoids are common in anorectal diseases. From 2002 to 2005, we used a combination of traditional Chinese medicine and Western medicine, employing surgical thrombus closed stripping plus Chinese herbal fumigation and washing for outpatient treatment of 629 patients with thrombosed external hemorrhoids, achieving satisfactory results. The report is as follows:
1 Materials and Methods
1.1 General Information: In this group, there were 432 male cases and 197 female cases; ages ranged from 8 to 78 years old, with an average age of 36.2 years. There were 287 first-time occurrences and 342 recurrences; the course of the disease lasted from 1 to 16 days, averaging 3.4 days. Among them, 411 cases had a single hemorrhoidal nodule, while 218 cases had two or more nodules. Regarding the diameter of the largest single nodule, 272 cases were less than 1cm, 298 cases were between 1-2cm, and 59 cases were over 2cm.
1.2 Surgical Treatment: Patients were placed in the lateral position, routine disinfection was performed, and 1% lidocaine hydrochloride was used for local anesthesia around the anus. A 1~1.5 cm incision was made radially from the midpoint of the hemorrhoid towards the anal margin to the subcutaneous layer. Blunt dissection was used to remove the blood clot, venous sinus, and varicose veins under the skin. The bilateral skin flaps were trimmed to ensure smooth coaptation of the skin, and the wound surface was mattress sutured 2~3 times without leaving any dead space. For patients with two or more hemorrhoidal nodules, the same method was applied separately to each nodule. Sutures were removed 48~72 hours post-operation.
1.3 Traditional Chinese Medicine Treatment: On the second day after surgery, Huang Lian Shang Qing tablets were given to clear heat, moisten the intestines, and promote defecation, controlling the first bowel movement within 24~48 hours post-surgery. After defecation, a sitz bath using San Huang Tang was administered, followed by the external application of Ma Ying Long Musk Hemorrhoid Ointment. This process was continued daily for 3~4 days post-defecation.
2 Results
Of the 629 cases in this group, 621 cases achieved primary healing after suture removal 2~3 days post-surgery; 3 cases experienced infection at the suture site, which healed after suture removal and drainage; 5 patients developed dry stools after suture removal, causing the wound to split open and resulting in secondary healing. Primary healing accounted for 98.5%.
3 Discussion
Thrombosed external hemorrhoids are a common and frequently occurring disease in anorectal surgery and are also the most common type of external hemorrhoids. They often occur due to constipation, defecation, coughing, excessive force, or prolonged strenuous exercise, leading to rupture of the anal margin veins and formation of round or oval blood clots under the anal skin. Symptoms typically include severe local pain, often following episodes of constipation. Recurrent thrombosis is usually caused by prolonged sitting on the toilet and straining during defecation. It is recommended to correct the habit of prolonged sitting on the toilet, adjust to seated defecation, and treat constipation symptoms promptly. Symptoms generally begin to alleviate 2-3 days after onset, after which conservative treatment can be considered. Cases presenting with local ulcers, ruptured hemorrhoidal nodules, severe pain, or lesions within two days should be advised to undergo surgical excision to prevent local infection and the formation of abscesses or fistulas.
The traditional surgical method is the open stripping technique, which has the advantage of thorough lesion removal but also suffers from longer postoperative healing time, severe pain, easy bleeding of the wound, and residual anal tags in some cases. The purpose of the closed thrombosed external hemorrhoid stripping surgery is to remove the hemorrhoidal tissue while suturing and closing the anal margin wound to achieve primary healing. Due to the good blood supply around the anus and the contraction function of the anal sphincter muscle, rapid closure of the wound is promoted, providing assurance for early suture removal. If the suture line is not removed in time after 72 hours, it easily embeds into the subcutaneous tissue, increasing the risk of infection and difficulty in suture removal, and also causing unnecessary pain to the patient.
In San Huang Tang, Huang Bai clears damp-heat in the lower energizer; Huang Qin clears heat, dries dampness, cools blood, and stops bleeding, with antibacterial and antiviral effects; Da Huang clears heat, dries dampness, resolves stasis, and alleviates pain, and modern pharmacological studies have shown it has good anti-infection and hemostatic effects. Combined, these three herbs provide pain relief, hemostasis, anti-infection, and promote wound healing. Musk Hemorrhoid Ointment can stop bleeding, relieve pain, and promote wound healing. The combination of Chinese herbal fumigation and external application ensures primary healing after this contaminated area surgery.
In this group of cases, 3 cases of postoperative infection were considered to be caused by the presence of dead space during suturing. Therefore, avoiding dead space during suturing is an important means to prevent postoperative infection. It is still necessary to maintain smooth bowel movements after suture removal; if recent bowel movements are dry and constipated, it is easy to cause the wound to split open. In this group, 5 patients did not adjust their constipation symptoms in time, resulting in the incision splitting open again and causing secondary healing. Through clinical observation, treating thrombosed external hemorrhoids using this combination of traditional Chinese and Western medicine methods is simpler to operate, causes less trauma and pain, has fewer complications, and achieves satisfactory results compared to the traditional open stripping technique.