CLINICAL EVALUATION OF HYBRID TECHNIQUE FOR THE MANAGEMENT OF SECOND-DEGREE INTERNAL HAEMORRHOIDS W.S.R ABHYANTARA ARSHAS: A CASE REPORT

According to Acharya Sushruta, Arshas is one among the Ashtamahagada. Arshas are the variety of Mamsankuras occurring in the Gudamarga. Internal haemorrhoids are a common anorectal condition that substantially reduce patient’s quality of life. In the Sushruta Samhita, Kshara Karma is described as an effective parasurgical technique for treating specifically the Mridu, Prasruta, Avagada, and Ucchrita varieties. Kshara Karma in Arshas is a simple and safe procedure renowned for its high success rate with minimal chances of recurrence. In recent years Laser Ablation has gained popularity in the management of Haemorrhoids owing to its shorter operative time, low post-operative pain, lesser intra & post-operative bleeding compared to other techniques. Despite the fact that, Laser Ablation and Kshara Karma have shown to be successful in treating Haemorrhoids, each method has drawbacks of its own. Hence the need for a Hybrid Technique arises, wherein, Kshara Karma and Laser Ablation are used in unison, which act complementary to their respective limitations. This Hybrid Technique (Laser ablation followed by Saptacchada Madhyama Pratisaraneeya Kshara Karma) is a novel approach & a revolutionary strategy in the management of Internal Haemorrhoids aiding good prognosis, minimal post-operative pain and low possibility of recurrence. It is an attempt towards advancement in new age Ayurveda with the integration of Novel Technology for a better outcome and improved patient compliance. A 45year old Male presented to our OPD with the complaints of Pain, Discomfort and Bleeding during defecation. On and off, Since 4 months. The intervention resulted in marked improvement in both subjective and objective parameters, demonstrating the effective intervention in enhancing better patient outcomes with improved quality of life. The present hybrid intervention integrated the therapeutic benefits of laser ablation and Kshara Karma, with the objective of achieving effective shrinkage and obliteration of the haemorrhoidal mass while minimizing intraoperative bleeding, tissue trauma, and the risk of recurrence. No major intra-operative complications such as excessive bleeding, anal canal injury, mucosal burns or hemodynamic instability were observed suggesting that the hybrid technique was a well-tolerated procedure.