What is Hemwellectomy?

Hemwellectomy is the electrosurgical ligation of the hemorrhoid’s afferent circulation produced by intense vasospasm of the arterial smooth muscle media and thrombosis. In addition, an electro-biochemical reaction occurs within the serum of the hemorrhoid, aiding in its permanent ligation.

Hemwellectomy induces vasospasm and thrombosis in the hemorrhoid’s feeder arteries, cutting off its blood supply while the veins remain open, which causes the hemorrhoids to shrink. Because the Hemwellectomy uses such low electrical energy, it produces minimal tissue damage, making it very safe with minimal pain for our patients.

Hemwellectomy applies a precisely controlled low-energy direct current to the branches of the artery, inducing vasospasm and thrombosis, permanently closing the hemorrhoid’s feeder vessel. The current also produces a localized electrochemical effect, generating visible hydrogen bubbles and a mildly alkaline environment that accelerates tissue breakdown. Simultaneously, platelet activation promotes stable intravascular clot formation, sealing the vessels and preventing recurrence. This unique mechanism of action addresses the underlying vascular pathology rather than removing tissue, resulting in a safe, effective, and minimally invasive solution for all grades of hemorrhoids with rapid recovery and minimal patient discomfort.

The Hemwellectomy procedure is FDA-Cleared and has demonstrated excellent safety and efficacy in clinical trials. It’s non-invasive, minimizing risks such as pain, bleeding, and infection.

The before image shows light reflecting off a concave rectal bulge, reported as a grade III hemorrhoid. Immediately following the procedure, two points marked as 1 and 2 indicate the locations where the electrodes contacted the hemorrhoid. Most notable is the normal mucosa between these two points. Minimal mucosal blackening is seen at the highest electron flux, suggesting submucosal thrombosis or denaturing of the serum albumin at these sites. The relatively normal mucosa confirms the Hemwellectomy is Nonthermal. No necrotic tissue, no tissue coagulation, or ulceration is seen. With relatively little tissue damage, one expects minimal pain, infection, or complications, explaining why the Hemwellectomy is relatively painless and free from complications such as infection, incontinence, and excessive bleeding.

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Hemorrhoid Pathophysiology and Anatomical Considerations

Historically misinterpreted as simple varicosities, hemorrhoids are now understood as the pathological herniation of the anal cushion into the rectal lumen.

The normal hemorrhoid is a highly vascularized structure consisting of a cushion, a sinus-like structure supplied by terminal branches of the superior rectal artery and drained by the rectal veins via both the portal and systemic venous systems. In hemorrhoidal disease, these arterial branches become dilated with increased blood flow, contributing to the development and progression of the condition. Concomitant venous dilatation further worsens the symptoms, and the hemorrhoid may prolapse into the rectum.

Hemwellectomy vs. Doppler-Guided Hemorrhoid Surgery: A Comparative Overview

Medical Advisory Board
Chief Medical Officer

Introduction

This article compares the Hemwellectomy procedure—a low-energy electrosurgical approach—to the Doppler-guided transanal dearterialization with mucopexy (“surgery”). Although both techniques aim to reduce hemorrhoidal blood flow, they differ markedly in their mechanisms of action, post-procedural pain profiles, and overall complication rates.

Surgical Technique and Mechanism

Doppler-Guided Transanal Dearterialization with Mucopexy

Doppler-guided surgery utilizes a transanal Doppler probe to identify the arterial supply to hemorrhoids. The identified arteries are ligated, thereby reducing or eliminating the afferent blood flow. In a subsequent step, the prolapsed tissue is plicated (mucopexy), repositioning it back into the rectal submucosa. Although initially intended to decrease post-operative pain, several studies indicate that pain remains a significant concern following this procedure (1).

Hemwellectomy

Hemwellectomy employs a two-pronged, rounded probe (serving as the cathode) that is applied directly at the base of the hemorrhoid or onto the hemorrhoidal tissue. The procedure administers a continuous, low-energy direct current (16 mA), similar in magnitude to that used in temporary transvenous pacemakers. This low-energy current induces sustained smooth muscle contraction, resulting in profound vasospasm, closing off the hemorrhoid’s arterial supply. Unlike the Doppler-guided technique, Hemwellectomy’s non-thermal mode of action spares the overlying mucosa, thereby mitigating post-operative pain and other complications. Veins, without a smooth muscle media, are also spared, allowing blood to leave the hemorrhoid which shrinks to the submucosa. (Fig. 1)

Electrophysiological and Biochemical Effects

 Both techniques aim to de-arterialize hemorrhoidal tissue, but they differ in their underlying mechanisms:
Vasospasm: Hemwellectomy’s continuous direct current produces sustained contraction of the smooth muscle in the arterial wall, leading to immediate and effective vasospasm. In contrast, Doppler-guided ligation mechanically occludes the arteries. (Fig. 2)
Electro-biochemical Reactions: The Hemwellectomy procedure harnesses a series of electro-biochemical events. As the low-voltage current is applied, electrolysis occurs in the electrolyte-rich serum, splitting water into H⁺ and OH⁻ ions. The generation of hydrogen gas at the cathode results in visible, soapy, hydrogen-filled bubbles that are a byproduct of saponification. This process not only confirms the local electro-biochemical reaction but also contributes to the de-arterialization by altering the local pH and promoting thrombosis in the arterial vessels. (Fig. 3)

Platelet Activation and Thrombosis: The continuous current also directly affects endothelial cell membranes and activates platelets, contributing to the permanent ligation by thrombosis of the hemorrhoidal arterial supply. (Fig. 2)

Clinical Efficacy and Safety

Doppler-Guided Surgery

Clinical studies report that Doppler-guided de-arterialization with mucopexy offers similar efficacy to conventional hemorrhoidectomy in terms of symptom relief. However, post-operative pain remains a significant limitation, potentially offsetting its less invasive intent.

Hemwellectomy

In contrast, Hemwellectomy has demonstrated a success rate exceeding 90% with a single treatment. The procedure’s targeted mechanism results in effective de-arterialization with minimal collateral tissue damage. Importantly, Hemwellectomy is associated with negligible post-operative pain, and serious complications have not been reported in over 100,000 procedures since FDA clearing.

Conclusion

While both Doppler-guided surgery and Hemwellectomy aim to reduce the arterial blood supply to hemorrhoids, the latter offers distinct advantages. Hemwellectomy achieves its effect through a unique electrosurgical mechanism that induces sustained vasospasm, targeted thrombosis, and electro-biochemical reactions without thermal injury. This results in highly effective treatment with a superior safety and tolerability profile, making it the procedure of choice for the full spectrum of hemorrhoidal disease.

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Hemwellectomy: A Novel Electrosurgical Approach that Replaces Banding Treatment For Hemorrhoidal Disease

Medical Advisory Board
Chief Medical Officer

Introduction

Hemwellectomy first performed in 2022, represents an innovative, FDA‐approved electrosurgical treatment for hemorrhoidal disease spanning grades I through IV. Unlike office-based therapies that are limited to lower grades, this procedure offers a comprehensive option for managing the full spectrum of hemorrhoidal pathology encountered in gastroenterology, and surgical practices. This review outlines the epidemiology and pathophysiology of hemorrhoidal disease, examines conventional treatment modalities and their associated complications, and then details the scientific principles, procedural technique, and clinical efficacy of Hemwellectomy.

Comparative Efficacy and Safety Profile

Clinical data indicate that Hemwellectomy is highly effective, with complete arterial ligation achieved in over 90% of cases following a single treatment under optimal conditions. Reported adverse effects are minimal—post-procedure discomfort is typically mild and transient, resolving within hours, and pain is observed in less than 1% of patients. In contrast, traditional modalities such as rubber band ligation and surgical hemorrhoidectomy are associated with higher rates of pain and complications. Notably, Hemwellectomy is the sole FDA-approved treatment for all grades of hemorrhoidal disease, providing a significant advantage over existing office-based procedures and surgical techniques.

Epidemiology and Clinical Presentation

Hemorrhoidal disease is the fourth most frequent gastrointestinal diagnosis in outpatient settings, accounting for approximately 3.3 million ambulatory care visits annually in the United States. An estimated 10 million individuals self-report hemorrhoids each year, with peak prevalence noted between 45 and 65 years of age. Demographic data indicates a higher incidence in Caucasian populations and among individuals of higher socioeconomic status. Although not associated with high mortality, the symptom burden—including rectal bleeding, prolapse, pain, and pruritus—can significantly impair quality of life.

Pathophysiology and Anatomical Considerations

Historically misinterpreted as simple varicosities, hemorrhoids are now understood as the pathological herniation of the anal cushion into the rectal lumen. The normal anal cushion is a highly vascularized, sinus-like structure supplied by terminal branches of the superior rectal artery, with drainage occurring via both the portal and systemic venous systems. In the setting of hemorrhoidal disease, these arterial branches exhibit increased diameter and flow, contributing to the development and progression of the condition. Concomitant venous dilatation further exacerbates symptomatology. Drainage occurs from rectal veins via both the portal and systemic venous systems.

Conventional Treatments and Their Limitations

Initial management of hemorrhoidal disease typically involves conservative measures such as dietary modifications, topical therapies, and laxatives. When these fail, office-based procedures, most notably rubber band ligation, sclerotherapy, and infrared coagulation—are considered. These office-based procedures, although widely used, are approved only for grades I, II and some grade III hemorrhoids and are associated with complications including pain, bleeding, vaso-vagal reactions, allergic reactions, and, in rare instances, serious outcomes such as urinary retention, sepsis, and even death. Surgical hemorrhoidectomy remains the definitive treatment for refractory grade III and IV disease; however, it invariably produces severe postoperative pain, prolonged recovery (with return to work typically delayed three or more weeks), and other complications such as bleeding, infection, fecal incontinence, and rarely death.

The Hemwellectomy Procedure: Technique and Mechanism

Hemwellectomy employs a novel electrosurgical unit that delivers a controlled, low-power direct current (<0.1 Watts) 16 mA at 5 volts. The procedure is performed with the patient sedated, in the left lateral decubitus position. A two-pronged, round tipped electrode is introduced into the rectum and positioned at the base or directly on the hemorrhoidal tissue. This electrode serves as the cathode, while the anode, a metal plate and saline-soaked sponge (to reduce skin resistance) is placed beneath the patient’s left hip completes the circuit.

Electrophysiological and Biochemical Effects

The non-thermal low-energy direct current initiates several key physiological responses:

Vasospasm: The current induces rapid, sustained contraction of smooth muscle in the terminal branches of the superior rectal artery (arterioles), leading to immediate ligation of blood flow, de-arterializing the hemorrhoid. (Fig. 1)

Thrombosis: Sustained contact of low-energy current, ie, 16 mA, damages the endothelial cell membrane, precipitating thrombosis. The combination of vasospasm and thrombosis permanently ligates the hemorrhoid, causing ischemic necrosis and hemorrhoid shrinkage.

Electrolysis and Saponification: As electrons flow, they cause electrolysis of the electrolyte-rich serum, generating hydrogen gas at the cathode (Fig. 2) and resulting in the local formation of a basic environment. When the pH exceeds 10, saponification occurs through the reaction of serum triglycerides with sodium hydroxide, forming hydrogen-filled soap bubbles that are observed on the hemorrhoid’s surface. This alkaline environment aids thrombogenesis. (Fig. 3)

Conclusion

Hemwellectomy offers a paradigm shift in the treatment of hemorrhoidal disease by integrating a non-thermal, low-energy electrosurgical technology with a precise, minimally invasive approach. Its unique mechanism—characterized by targeted vasospasm, controlled electro-biochemical reactions affecting thrombosis—results in rapid hemorrhoidal dearterialization by ligating the afferent circulation and immediate regression of hemorrhoidal tissue to the submucosa with minimal morbidity. Given its superior safety profile and high clinical efficacy, Hemwellectomy stands as the procedure of choice over older therapies for the broad spectrum of hemorrhoidal disease.

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A Physician’s Story

Gastroenterologist’s Personal Experience with Hemwellectomy​

My Dear Colleagues,

I am usually private about personal health matters, but I felt I should share my experience to provide some insight and inspiration.

I have had right-sided hemorrhoids that have bothered me off and on since college. I have experienced a few episodes of (very painful) thrombosis over the years, nagging symptoms of prolapse, pain, burning, and bleeding. A true grade 3/4 with the whole spectrum of symptoms that has only gotten worse with age. A colorectal surgical colleague had done banding on two separate occasions. Each resulted in two weeks of post-procedural misery for minimal short-lived partial improvement.

Dr. P was to perform my colonoscopy as he had done in the past. I asked him to address the hemorrhoids by treating both the right anterior and right posterior columns by Hemwellectomy.

I am pleased to report the results after one month: my hemorrhoids have clinically DISAPPEARED!

Post-procedure, I experienced a slight low-grade ache in the right anal area x 48 hrs. No analgesics were needed, it did not interfere with any of life’s daily activities, and defecation was not painful. The next day, my schedule at our GI center was full, and I performed my duties as if nothing had been done the previous day. Now, a month later, there are no masses or prolapse, pain, bleeding, pruritus, or burning. I have become completely asymptomatic, and I have not felt this well in over 30 years! Clearly, this is a short-term follow-up and the experience of one patient; however, I think the results are MIRACULOUS!

As a clinician and a patient, I think Hemwellectomy is an amazing technology to treat one of the most common afflictions that we see in GI practice. I hope this feedback provides some insight and inspiration. For those GIs who have not started using Hemwellectomy, please reach out to me or any of your partners to learn the technique. It is easy and satisfying. For those of us actively performing the Hemwellectomy, I encourage you to incorporate a hemorrhoidal review of symptoms for each new and follow-up patient visit to uncover symptoms that might not be shared voluntarily by patients. Most patients are unaware that we can treat their hemorrhoids, so we must field the questions.

Introducing and using new technology for patient care is what keeps our practice, endoscopy centers, and gastroenterologists cutting-edge and ahead of the competition. Please reach out with any questions or comments.

Regards,

Dr. D.A.

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