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The HemZem Anal Pile Driver Medical Device is a nonabsorbable medical minipad made from 16 ply layered facial tissue paper. The minipad is novel in that it is employed as an anal pessary using the body’s own distinct anatomy, physiology, and chemistry to remain in place, and prevent the prolapse of anatomical hemorrhoids. When inserted into the anal canal, the HemZem Anal Pile Driver prevents medical complications such as itching, burning, or pain associated with, or secondary to prolapsing hemorrhoids. The HemZem Anal Pile Driver also serves as an absorbent minipad for anal mucus, and prevents soiling of clothing from such mucus, or topical ointments, creams, and gels commonly used to treat hemorrhoids. The US Food and Drug Administration classified the HemZem Anal Pile Driver as a Class I medical device on Aug. 23, 2012.
However, several patients affected by symptomatic III or IV grade hemorrhoids, with a single or double prolapsed pile, could benefit from a limited excision under LA performed in the ambulatory setting without the need for anal dilation. For this selected group of patients, traditional hemorrhoidectomy could result in an overtreatment even if the recurrence of hemorrhoidal prolapse in other quadrant may occur several years later ().
This retrospective single-center study aimed is to evaluate the safety and long-term effectiveness of outpatient MMH performed without anal dilation under LA in patients with single or double pile hemorrhoids.
Hemorrhoids in commonly seen locations in the anal canal as viewed through the anoscope. The indicates the planned site for injection of the left lateral pile, in an insensitive area of the anal canal.
In my opinion, pain is much more likely to be a source of concern if multiple bandings are attempted. Although this statement is not supported by controlled studies, it seems reasonable to conclude that the simultaneous ligation of three or more pile sites will inevitably lead to an exponential risk of discomfort. Pain that seems to worsen a few days following treatment merits reevaluation of the patient, especially if fever supervenes or if a problem with micturition develops. Anal and perineal sepsis can lead to gangrene and result in death (see Sepsis).
