1. Open Cohort Study
on 50 Patients
with grade III/IV and IV/IV
using
Closed Bloodless Hemorrhoidectomy
Technique (CBH)
by Sarkis Yeretsian, M.D. FRCSC
3. Closed Bloodless Hemorrhoidectomy
CBH
A New Technique in Proctology
• There is a history an incident leading to the
discovery of CBH .
• Frustration pushes the human being towards
creativity and innovation to circumvent obstacles
and difficulties.
• Since then the procedure has been successfully
performed on 2000 patients in the clinic under
strictly local anaesthesia.
4. Closed Bloodless Hemorrhoidectomy
CBH
advantages of this suturing/excision technique over the
existing hemorrhoidectomy procedures:
1. Office procedure.
2. Done strictly under local or loco-regional anesthesia
with xylocaine 2% with or without epinephrine.
3. It is a bloodless operation in comparison with other
hemorrhoidectomy procedures.
5. Closed Bloodless Hemorrhoidectomy
CBH
4. Electrocautery is not necessary.
5. The amount of tissue to be excised is controlled and
consequently an eventual anal stenosis or fissure is
avoided.
6. No I-V sedation is needed; the patient leaves the office
on his feet.
7. The anatomy of the anus is respected meticulously
without any kind of distortion.
6. Closed Bloodless Hemorrhoidectomy
CBH
8. No tear of the internal sphincter is produced because
the convexity of the modified crile is applied on the
circular internal sphincteric muscle.
9. No retractor is necessary which could be cumbersome
for the surgeon.
10. An accurate apposition of the wound is realized.
7. Closed Bloodless Hemorrhoidectomy
CBH
11. The procedure could be performed in all kinds of
hemorrhoids grade III and grade IV as well as in rectal
mucous membrane prolaps and even in acute
hemorrhoidal disease.
12. It could be practiced even on patients suffering from
benign hyperplasia of the prostate.
13. It is easy to learn and practice; a general practitioner
could perform the intervention in remote areas.
8. Closed Bloodless Hemorrhoidectomy
CBH
14. It is very practical and economical.
15. No long-term complications are observed after six
weeks of recovery. There is no persistent
postdefecatory anal pain, fecal urgency, or inclusion of
rectal muscle in the procedure as described following
stapled hemorrhoidectomy (PPH)
9. Closed Bloodless Hemorrhoidectomy
CBH
16. No life-threatening complications, such as severe
pelvic and retroperitoneal sepsis, rectal perforation,
retropneumoperitoneum, and pneumomediastinum are
observed even after surgical treatment of acute
hemorrhoidal disease. In the latter cases, recovery is
prolonged without experiencing severe tenesmus or
persistent pain. In most of the cases, the pain is
resolved within ten days of the surgery.
17. Almost, no Acute Urinary Retention.
10. Closed Bloodless Hemorrhoidectomy
CBH
18. Even, it is possible to perform Hemorrhoidopexy.
19. It is extremely safe operation.
20. Rarely, recurrence because of high and low ligation
of the cushions
21. Very minor post op. complications, such as :
- Skin tags
- Fissure
- Post op. delayed hemorrhage in extreme cases
- Acute Constipation due to narcotics
- Diarrhea
- Thrombosed Hemorrhoids
- Rarely Infection
29. Patent
• Closed Bloodless Hemorrhoidectomy is Pantented in US
since February 2004 (US patent #6,688,312).
• The instrument PBHP is now in National phase and PCT
is applied in six countries (PCT # CA2007/000204, 12
February 2007.)
