Cryosurgical treatment of hemorrhoids in Japan.

Hemorrhoid treatment in Japan consists mainly of conservative therapy and conventional surgery. Cryosurgical hemorrhoidectomy, though still not widely used, has attained a reputation for low profile surgery and relatively painless recovery compared to conventional surgery, in spite of some inevitable problems. Our series includes external hemorrhoids and prolapse, which have been ruled out from the indications for cryosurgery, yet obtained satisfactory results. A threatening drawback is lower digestive tract hemorrhage, which occurred in 19 of 372 prolapse patients (5.1%) after cryosurgery. As for its pathogenesis, an autoimmune reaction at the site of the terminal ileum is postulated. Characteristics of the hemorrhage are: onset around the 14th postoperative day at night or early in the morning, and seen particularly in nervous patients. Prophylactic administration orally of covering materials may reduce incidence. Cryosurgery is certainly an effective measure for the treatment of hemorrhoids, including prolapse.