Best piles treatment in india Dr Ashwin Porwal is the founder and lead surgeon of Healing Hands Clinic (HHC )

1. Best piles Treatment in india Dr Ashwin Porwalis the founder and lead surgeon of Healing Hands Clinic (HHC). He has dedicated his career to practice and research in Proctology – the branch of medicine dealing with the disorders of the rectum and anal canal. He has had the privilege of receiving training in Proctology from the world-renowned Colorectal surgeon, Dr Antonio Longo of Italy. Dr Longo invented the MIPH/PPH (Stapler surgery) for Piles and Dr Porwal has received hands-on training from the master himself. Till date >20,000 patients have been satisfactorily treated for their Piles at Healing Hands Clinic. Dr Porwal has performed the maximum number of Stapler surgeries in Asia. He brought to India the Leonardo Laser for Piles and the country’s first Laser Hemorrhoidoplasty (LHP) was performed by him at HHC. Today, the clinic treats more patients with LHP than any other center in the world. With his indisputable expertise in this field, Dr Porwal has trained many fellow surgeons from the country and across the globe in the Stapler and Laser procedures. http://www.healinghandsclinic.co.in Page 1

2. TREATMENT STRATEGY AT HEALING HANDS CLINIC Hemorrhoids are treated depending on the grade that they are in. As a general rule, early grades are treated conservatively with medicines, exercise and diet modification. At later stages a surgical treatment is preferred in order to rule out the possibility of a recurrence. MCDPA An innovation of Dr Porwal himself, this is a conservative approach intended to halt and reverse the early disease without any surgical intervention: Medication - Creams ( Anoac ) and stool softeners are used. Constac - A herbal preparation formulated under the guidance of Dr Porwal by Ayurvedic doctors at Healing Hands & Herbs. Diet - Counselling by qualified nutritionist to correct any imbalances in diet and chart a diet conducive to healthy bowel habits. Physiotherapy - Pelvic floor physiotherapy helps to strengthen muscles in the region. Ayurveda therapy - This includes about 6 sessions of enema with medicated herbal oils. LASER HEMORRHOIDOPLASTY (LHP) - LASER TREATMENT FOR PILES Laser Hemorrhoidoplasty is the preferred treatment for Grade 2 and early stages of Grade 3 Piles.This procedure is done under short general anesthesia and takes about 20 minutes. Through the natural anal opening, laser energy is applied using a special radially emitting fiber. The controlled emission of laser energy leads to vaporization causing the hemorrhoidal mass to shrink. ADVANTAGES OF LHP •No cuts, no open wounds • Less post-operative pain as compared to other procedures • Healing is excellent as there are no cuts or stitches http://www.healinghandsclinic.co.in Page 2

3. • No sense of urgency (need to rush to the toilet) after the procedure • No risk of rectal stenosis • Patient can return to normal activities within a shorter space of time POTENTIAL DRAWBACKS OF LHP: •Burning sensation – Some patients have a burning sensation in the area for a few days. This Usually disappears with time. • External skin tag thrombosis MIPH (MINIMALLY INVASIVE PROCEDURE FOR HEMORRHOIDS) AKA PPH (PROCEDURE FOR PROLAPSE AND HEMORRHOIDS) AKA STAPLER HEMORRHOIDOPEXY What is MIPH/PPH? It is a procedure that was originally conceived in 1994 by Dr Antonio Longo, and since,has gained popularity as the treatment of choice for Grade 3 and Grade 4 prolapsed Piles. ( stapler image) Haemorrhoidal Stapler PPH03, a disposable device (Ethicon, Johnson & Johnson, USA) The procedure is usually done under short general anesthesia and takes around 25- 30 minutes. Using the circular stapler, the mucosa which is responsible for the the prolapse of Hemorrhoids is circumferentially excised and the prolapsed Hemorrhoids are pulled up back to their normal position. http://www.healinghandsclinic.co.in Page 3

4. ADVANTAGES OF MIPH/PPH: The Stapler procedure has definite advantages over other treatments available for Piles (Mulvyadh). • No external cuts/stitches • Minimal blood loss • Minimal pain easily managed by painkillers • Sphincter function is not hampered hence voluntary control over motion is preserved • Faster recovery - Patient can resume work from 5th day • Lowest recurrence rate ( 8% ) - This is further brought down to < 1% byMucopexy technique introduced by Dr Porwal at HHC. • Safe in diabetics, cardiac patients ( those with heart problems ) and senior citizen POTENTIAL DRAWBACKS: As with any surgical procedure there are possible drawbacks associated with MIPH: • Inflammation or Infection - Can be prevented with anti-inflammatory agents and antibiotics • Urgency (i.e. need to rush to the toilet) - May last for 4-8 weeks. This can be kept under control with Kegels exercises • Bleeding following the procedure (6-8%) • Staple line stricture ( ~5% ) - In experienced hands it can be prevented with proper positioning of staple line • Recurrence ( 8% ) - With the addition of Mucopexy, this can be brought down to < 1% http://www.healinghandsclinic.co.in Page 4