Transanal doppler guided dearterialization with mucoplexy is a relatively new surgical procedure (for the purpose of this discussion it will be referred to simply as surgery). A transanal doppler identifies the hemorrhoid’s arteries which are then ligated, decreasing or completely elimination the hemorrhoid’s afferent circulation. The prolapsed hemorrhoid is then plicated and reduced to the rectal submucosa, eliminating all redundant tissue, ie mucoplexy. It was hoped this surgery would reduce postoperative pain. This hope has not been realized in some studies (1), although its effectiveness is equal to traditional hemorrhoidectomy. Hemwellectomy’s affects on a hemorrhoid is equivalent to surgery without the pain or other post op surgical complications. With Hemwellectomy, a two pronged probe (the cathode) is placed at the hemorrhoid’s base or on the hemorrhoid proper. The current is extremely low, maximumly 16mA. On the order of magnitude of a temporary transvenous pacemaker. No heat is produced. The overlying mucosa is undamaged (see image below).

Like a pacemaker, Hemwell’s current produces muscle contraction, but unlike a pacemaker’s pulsating current, Hemwell’s current is continuous, producing sustained smooth muscle contraction vasospasm, in the smooth muscle rich media of the hemorrhoid’s arterial circulation. The veins and cushion have very little smooth muscle and are relatively unaffected. The vasospasm immediately and effectively, ligates, dearterializing the hemorrhoid. Because of the profound sustained vasospasm (2), direct effect of electrons on endothelial cell membranes, cell function and platelets (3,4), thrombosis occurs in these vasospastic arteries affecting permanent dearterialization (5, 6 and 7).

Because serum is electrolyte rich water, proteins, lipoproteins, and lipids electrolysis occurs. Electrolysis of water, H2O, is the production of H2 gas at the cathode and O2 gas at the anode when low energy DC current is introduced. H2O first splits into H+ and OH-. The cathode, resting at the hemorrhoid’s base is close to the serum. H+ migrates toward the negative charged cathode, which gives electrons to the H+ ion forming H2 gas. Hydrogen is an invisible, colorless and odorless gas that because of its very small size easily passes through the body’s tissues to enter the atmosphere.

Very shortly following the initial hydrogen gas production white soapy, hydrogen filled, bubbles are seen emerging from the hemorrhoid. These bubbles are created by the saponification of the serum triglycerides as the serum’s ph rises. Hydrogen gas production leaves an excess of OH- ion. OH- ion is unable to reach the anode to relinquish its electron and its concentration increases in the serum. Na+, already present in the serum and OH- form a strong base, NaOH, increasing the serum’s ph. When the serum’s ph reaches 10, saponification begins and soap is produced from the reaction between the serum’s triglycerides with NaOH. Hydrogen gas filled soap bubbles are then seen leaving the hemorrhoid’s surface.

The combination of the serum’s electro-biochemical reactions and unobstructed venous drainage reduces the hemorrhoid to the submucosa (Figure 1) ie. a mucoplexy equivalence.

With 1 treatment the success rates with Hemwellectomy has been reported to be, greater than 90%, by some gastroenterologists. Dr Norman and others (8,9), have reported 100% success rate with all four hemorrhoid grades, but 20 – 30% of patients needed more than 1 treatment. No serious complications or significant pain, from our electrosurgical procedure, have ever been reported to our company. Since FDA approval, over 100,000 patients have been treated.

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Bibliography

1) De Nardi, P., Capretti, G., Corsaro, A., & Staudacher, C. (2014). A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Diseases of the Colon and Rectum, 57(3), 348-353.

2) LaPelusa, A., & Dave, H. D. (2023, May 1). Physiology, Hemostasis. StatPearls. Treasure Island, FL: StatPearls Publishing.

3) Chen, W. (2005). Electroconformational denaturation of membrane proteins. Annals of the New York Academy of Sciences, 1066, 92-105.

4) Hardy, E., Sakurai, Y., Sanjaya, N., Wolberg, A. S., & Lam, W. (2012). Effect of locally applied electricity on clot formation and hemostasis. Blood, 120(21), 2220.

5) Sedlarik, K et al, “Electro-thrombosis and alternative to embolization using particles” Rofo 1981 June Pub Med (German).

6) Sedlarik, K et al, “Electrothrombosis as a treatment” Z Exp Chir 1981 Pub Med (German).

7) Yada, Y et al ” Submucosal  Electrocoagulation of prolapses Hemorrhoids: A new operative approach “. Acts Med Okayama 2010 vol 64 No 6 pp 359-365 Pub Med.

8) D. Norman. “Direct Current Electrotherapy of Internal Hemorrhoids: An Effective, Safe and Painless Outpatient Approach.” The American Journal of Gastroenterology, December 1988.

9) Olatoke, S., Adeoti, M., Agodirin, O., Ajape, A., & Agbola, J. (2014). Direct current electrotherapy for internal hemorrhoids: experience in a tertiary health institution. The Pan African medical journal, 18, 145.