Anal Pathology Research Articles

Validation and adaptation to Spanish of the quality-of-life questionnaire in patients with hemorrhoidal disease and anal fissure (HEMO-FISS-CdV).

Haemorrhoidal disease and anal fissure are the two most frequent entities within benign anal pathology, both of which have a negative impact on patients' quality of life. To date, there is no specific questionnaire in Spanish to assess the impact on quality of life in patients suffering from these conditions. The aim of our study is to validate in Spanish a questionnaire for this purpose, adapting it to our daily clinical practice. The HEMO-FISS-CdV is the Spanish version of the original HEMO-FISS-QoL by Abramowitz. The questionnaire consists of 23 items organised in 4 dimensions (physical, psychological, defecation and sexuality). The reliability of the new tool was assessed by determining internal consistency using Cronbach's alpha and Guttman's coefficient. It was also correlated with the quality of life questionnaire SF12 version 2. The Cronbach's alpha obtained for our questionnaire (HEMO-FISS-CdV) was 0.951 (ICC 95% +-0.016), with a range between 0.935 and 0.967. The Guttman two-half coefficient had a value of 0.910. Patients with internal haemorrhoids, anal fissure or both had higher values on the HEMO-FISS-CdV questionnaire than patients without internal haemorrhoids and these differences were significant (p<0.05). Both diseases have a negative impact on patients' quality of life. The HEMO-FISS-CdV questionnaire provides a tool in Spanish that easily and specifically assesses the impact of haemorrhoidal disease and anal fissure on quality of life.

Commonly Drawn Immunologic and Inflammatory Markers as Risk Predictors for Anal Cancer in Veterans Living With HIV.

This study aimed to determine if immune inflammatory markers (neutrophil lymphocyte ratio [NLR], platelet lymphocyte ratio [PLR], and prognostic nutritional index [PNI]) correlate with anal cancer risk in people living with HIV and to compare these markers with the CD4/CD8 ratio. This is a regional retrospective cohort study of veterans living with HIV who were screened for or diagnosed with anal neoplasia or cancer from 2001 to 2019. The NLR, PLR, PNI, and CD4/CD8 ratio within 1 year of anal pathology results were computed. Patients with anal cancer were compared to patients without anal cancer. Regression modeling was used to estimate the odds of developing anal cancer. Three hundred thirty-four patients were included (37 with anal cancer, 297 without anal cancer). In patients with anal cancer, NLR and PLR were higher (2.17 vs 1.69, p = .04; 140 vs 110, p = .02, respectively), while PNI and CD4/CD8 ratio were lower (44.65 vs 50.01, p < .001; 0.35 vs 0.80, p < .001, respectively). On multivariate logistic regression modeling, only PNI (odds ratio, 0.90; p = .001) and CD4/CD8 ratio (odds ratio, 0.05; p < .001) were associated with increased anal cancer risk. Although NLR and PLR independently correlate with anal cancer risk, when controlling for other risk predictors, only PNI and CD4/CD8 ratio were statistically significant biomarkers for anal cancer. The CD4/CD8 ratio is the strongest immune inflammatory marker that predicts risk of anal cancer among veterans living with HIV.

Current update on the role of endoanal ultrasound: a primer for radiologists.

Endoanal ultrasound (EAUS) is a valuable imaging modality for the evaluation of anal and perianal pathologies. It provides detailed information about the anatomy and physiology of the anorectal region and has been used in pre-and post-operative settings of anorectal pathologies. EAUS is not only useful in the evaluation of benign pathologies but also in loco-regional staging of anal and rectal tumors. EAUS has several advantages over MRI, including reduced cost, better patient tolerance, and improved scope of application in patients with contraindications to MRI. Despite its benefits, EAUS is not widely performed in many centers across the globe. This article aims to educate radiologists, trainees, and surgeons about the indications, contraindications, patient preparation, imaging technique, and findings of EAUS. We will also highlight the technical difficulties, diagnostic challenges, and procedural complications encountered during EAUS, along with a comparative analysis of EAUS with other imaging approaches.

Anal Pathologies during Pregnancy and Postpartum: Diagnosis and Treatment at the Kalaban Coro Referral Health Center

Pregnancy and childbirth are generally considered to be happy episodes in women's lives, these events can be marred by anal affections. The exact epidemiology of anal pathologies is difficult to define, due to the reluctance of patients to discuss their symptoms and to be examined. In most cases, their diagnosis is delayed and their management is inadequate or inappropriate. Aim: To study anal pathologies during gravido-puerperality at the CS Ref of Kalaban Coro. Methods: This was a single-center descriptive and analytical prospective study with prospective data survey at the CS Ref of Kalaban Coro. The study was conducted over a 9-month period from January 1 to September 30, 2019. Results: During the study period, we identified 151 pregnant women. Of these pregnants, 88 or 58.27% had anal pathology. The different anal pathologies encountered were, hemorrhoidal disease (30.68%), anal fissure (30.68%) and anal incontinence (27.27%). The offending factors were dominated by constipation, a newborn weight &gt; 3500g, a foetal expulsion time &gt; 20 minutes. The clinic was conducted by interrogation and proctological examination. Clinical signs were anal pain, rectorrhagia, and pruritus. Treatment primarily includes the regulation of intestinal transit and topical topicals, analgesics, and those that improve blood circulation (Veinobiase, Daflon).

Anal Pathologies: What Management at the Reference Health Center of Bamako’s Commune V?

Anal Pathologies: What Management at the Reference Health Center of Bamako’s Commune V?

Colon and Rectal Surgery Fellowship Applicant and Matching Trends in the United States: An Analysis of National Resident Matching Program Data.

Colon and Rectal Surgery fellowships are training programs that aim to train surgeons in the management of small bowel, colon, rectal, and anal pathologies. We investigated trends in Colon and Rectal Surgery fellowship match to help applicants anticipate future fellowship application cycles. This was a retrospective cohort study of applicants in the Colon and Rectal Surgery match from 2009 to 2023. Proportion of positions filled, match rates, and rank-order lists were collected. The impact of US-MD, non-US-MD, and DO status on match rate was assessed. We used the Mann Kendall trend test to obtain tau statistic and P-value for temporal trends over time, while associations between categorical variables were investigated by a chi-square test. Fellowship programs increased from 43 to 67, positions increased from 78 to 110, and number of applicants rose from 113 to 135. Nearly all positions were filled from 2009 to 2023 (range: 96.3%-100%). The overall match rate fluctuated between 67.3% and 80.7%. The match rate over the past 5years was 72.0%. The match rate for US-MDs was 80.0%, while non-US-MDs had a 56.2% match rate. The percentage matching at each rank were first choice 28.0%, second choice 10.4%, third choice 6.9%, and fourth choice or lower 23.5%. Despite an increase in Colon and Rectal Surgery fellowship positions, the overall match rate has not changed significantly over the years, mainly as a result of increased applicants.

Indications and Results of Endoanal Ultrasonography in Anal Pathology

Anal disease encompasses a diverse array of disorders, including conditions such as sphincter defects, anorectal fistulas and abscesses, unexplained chronic anal pain. The objective of this study is to assess the diagnostic value of endoscopic ultrasound (EUS) in the context of anal diseases. A total of 58 patients who benefited from an EUS, over a period between January 2018 and april 2023. Mean age was 43,4 years with a sex ratio (M: F) of 0.4. The main indication for EUS is dominated by fecal incontinence (FI) in 53% of patients, followed by the anoperineal manifestations of Crohn's disease in 22%. Among patients with perineal Crohn's disease (CD), fistulas were observed in 47% of CD cases. anovaginal or rectovaginal fistulas (ARVFs) were visualized in 9% of all cases. In patients presenting with fecal incontinence (FI), EUS identified defects in the internal and external anal sphincters. EUS is a highly sensitive technique for assessing anal anatomy and diagnosing of anal diseases.

EFFECTIVENESS OF PERINEAL PELVIS REHABILITATION COMBINED WITH BIOFEEDBACK AND RADIOFREQUENCY DIATHERMY (RDF) IN ANORECTAL FUNCTIONAL PAIN SYNDROMES ASSOCIATED WITH PARADOXICAL CONTRACTION OF THE LEVATOR ANI MUSCLES. A PROSPECTIVE STUDY.

•Anorectal functional pain syndrome is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. •The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient. Background - Anorectal functional pain syndrome, also called chronic proctalgia, represents a neglected clinical entity and often confused with other syndromes such as vulvodynia or acute proctalgia. It is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. To improve symptoms in functional anorectal pain syndromes, various rehabilitation techniques are used with the aim of promoting relaxation of the pelvic floor; however, to improve defecatory dynamics in patients with levator ani syndrome, only biofeedback has shown efficacy in a randomized study. The aim of this work is to evaluate whether a rehabilitation protocol with manometric biofeedback and radiofrequency diathermy (mt100 Fremslife emotion Tecar) reduces pain and paradoxical contraction of the levator ani and improves the quality of life in patients with anorectal pain syndromes. functional. Methods - This was a prospective study on 30 patients (20 women and 10 men) with anorectal functional pain syndrome and paradoxical contraction of the pelvic floor enrolled at the UOC of General, Minimally Invasive, Oncological and Obesity Surgery of the AOU "Luigi Vanvitelli" of Naples, Italy, from September 2021 to May 2022. All patients were evaluated with a coloproctological specialist visit followed by anorectal manometry and evaluation of altered clinical physiatric parameters (Brusciano Score). The protocol consisted of 10 rehabilitation sessions of the pelvic floor once a week and lasting approximately 45 minutes. During the sessions the patients were subjected to diathermy / radiofrequency treatment (10 minutes) with a static resistive electrode on the diaphragm, during which they were required to breathe diaphragmatically and to become aware of the perineal muscles, under the supervision of a physiotherapist; followed by application of diathermy with static capacitive (5 minutes) and resistive (10 minutes) electrode at the lumbar level. This was followed by the use of manometric biofeedback (15 minutes of tonic / phasic exercises) in order to instruct the patient on the reflex mechanism to obtain a voluntary relaxation of the external anal sphincter. The variables evaluated were Pain (VAS 0-10) and the questionnaire on the impact of colorectal and anal pathologies on the quality of life (CRAIQ-7) at the beginning, after 3 months and at the end of the treatment. Results - After 10 weeks, the rehabilitation treatment combined with diathermy and manometric biofeedback proved effective in the short term with a reduction in the scores of the Vas scale and CRAIQ-7 questionnaire and an increase in the percentage of release of the anal muscles on anorectal manometry. Conclusion - The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient.

Identification and Reporting of Anal Pathology during Routine Colonoscopies

AbstractThe gold-standard procedure for anal canal examination is anoscopy. Nonetheless, patients are referred for a colonoscopy for many reasons, and a routine exam might provide an opportunity to diagnose anal pathologies, such as hemorrhoids, anal fissures, anal polyps, condylomas, and anal squamous cell carcinoma. It is important to know the main features of these conditions and relevant information to report in order to help guide patient treatment and follow-up.

Combined operations in outpatient laser treatment of chronic hemorrhoids of stage 2–3

Introduction. When performing laser coagulation of hemorrhoids, there is a demand for the elimination of simultaneous diseases, but their laser treatment is under study and implementation in the practice of coloproctologists.Aim. To study the features of transmucous laser thermal ablation of chronic hemorrhoids of stage 2–3 with simultaneous elimination of other anal canal diseases in outpatient settings.Materials and methods. Transmucous ablation of hemorrhoids of 2–3 degrees was performed in 104 (27.5%) people in combination with laser removal of chronic anal fissures in 82 (75%) patients, intra-sphincter fistulas in 10 (9.6%) and other anal canal pathology in 18 (17.4%) patients. The median age of patients was 43 years, 48 men (46.2%), 56 women (53.8%).Results. Surgical tactics of laser treatment of simultaneous and underlying pathology allowed one-step elimination of both diseases in all 100% of patients. The duration of combined operations was 20.0 min. (15; 20) the pain intensity was 2.5 points (2; 3). Intraoperative blood loss was minimal. Pain in the postoperative period persisted for 5 days. After surgery, bleeding occurred in 2 (1.9%) patients. During the year, a recurrence of hemorrhoids occurred in 2 (1.9%), anal fissure in 10 (12.2%), condyloma in 2 out of 3 operated.Discussion. The obtained characteristics of combined operations showed that all their signs corresponded to minimally invasive interventions, both operations, the main and combined, were low-traumatic, performed under local anesthesia and had one access and a common operating field.Conclusion. Combined pathology of the anorectal region is observed in a quarter of patients with chronic hemorrhoids. In 100%, it was eliminated by simultaneous operations that were minimally invasive, which allowed them to be performed on an outpatient basis under local anesthesia.

Quality of life in patients with hemorrhoidal disease

BackgroundOperation for hemorrhoidal disease is one of the most common operations performed globally. However, we know little about the impact of the disease on health-related quality of life (HRQoL), or the importance of the observed clinical and anatomical changes. MethodThis was a single-center cross-sectional and cohort study. HRQoL was assessed using the Short Form 12 and 36 (SF12 and SF36), EuroQoL 5-dimensions 5-levels (EQ-5D), and a disease specific questionnaire; Short Health Scale for Hemorrhoidal Disease (SHSHD). SF12 and EQ-5D scores in 257 patients with symptomatic hemorrhoids referred to our proctologic outpatient clinic were compared to a Danish background population adjusting for age, gender, body mass index and educational status.Symptoms were assessed using the Hemorrhoidal Disease Symptom Score. The anatomical pathology was graded using Goligher's classification. The associations between clinical characteristics and HRQoL were tested. The impact of surgical treatment was assessed in 111 patients followed one year postoperatively. ResultsPatients reporting a high symptom load had lower SF12 physical health scores compared with the background population. The EQ-5D indexes indicated impaired HRQoL in men, women <50 years and patients with higher education. Improvements in all three HRQoL measures were seen after surgery.Symptom burden had a negative association with HRQoL measures, whereas the surgeon's grading of anatomical pathology had no association. ConclusionHemorrhoidal disease has a negative impact on HRQoL related to the degree of symptoms. Surgical treatment improve the QoL. The surgeon's grading of anal pathology had no association with QoL.

Epidemiological and Therapeutic Aspects of Proctological Pathologies in Pregnant and Postpartum Women at the Reference Health Center of Commune IV of Bamako District

Introduction: Painful proctological conditions that are far less pleasant can mar pregnancy and childbirth. In Mali, few studies have been carried out on proctological pathologies in pregnant women and in the postpartum period. Objective: To determine the frequency and identify the risk factors of anal pathologies during pregnancy and in the postpartum period in the obstetric gynecology department of the Centre de Santé de Référence de la comme IV du District de Bamako. Mali. Methods and Materials: Our observational study, a cross-sectional cohort survey over a period of nine (09) months from January 1, 2020 to September 30, 2020, was conducted in the obstetrics and gynecology department of the Health Center of Reference of Type IV of the District of Bamako. Results: The frequency of anal pathologies during pregnancy and in the post partum period was 24% (36/150). The different anal pathologies found were anal fissures, hemorrhoidal disease, anal incontinence and multiple anal pathologies with respectively 10%; 6.67%; 5.33%; 2%. Chronic constipation (p = 0.003), a newborn weight > 3500 g (p = 0.000) to the occurrence of hemorrhoidal disease. For anal fissures, risk factors were noted such as (weight of the newborn > 3500 g (p = 0.002) and duration of fetal expulsion > 20 minutes (p = 0.000). Finally, a newborn weight > 3500 g (p = 0.000) and a maternal age of up to 30 years (p = 0.001) were associated with the occurrence of anal incontinence. Conclusion: Our study shows that anal pathologies affecting women's intimacy are frequent during pregnancy and in the postpartum period and are part of the many taboos difficult to address in our society.

Indications and Results of Lower Gastrointestinal Endoscopy in a Regional Hospital Center in Senegal

Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital center in Senegal. Patients and Methods: We conducted a descriptive retrospective study from September 1st, 2017, to September 30, 2018 at the gastrointestinal endoscopy unit of the regional hospital center of Thiès. All patients received for lower gastrointestinal endoscopy and whose reports were usable, were included. In the reports, we collected and analyzed sociodemographic data, indication and results of the endoscopic examination. Results: We included 250 patients. There were 140 men (sex ratio 1.27). The average age was 42 years [range 1 - 92 years]. There were 37 colonoscopies (14.8%), 51 rectosigmoidoscopies (20.4%) and 162 anorectoscopies (64.8%). The patients were from the region of Thiès in 82% of cases. In most cases, they were most often referred by general practitioners (22.8%) and surgeons (20.8%). The main indications were rectal bleeding (36.8%), hemorrhoidal disease (23.2%) and proctalgia (11.6%). Hemorrhoidal disease (63.6%), anal fistula (14%) and tumors (8.8%) were the most common pathologies. Conclusion: Admitted patients at the gastrointestinal endoscopy unit of the regional hospital center of Thiès have many indications as well as pathologies. Anal pathology is dominated by hemorrhoidal disease.

439. Anal Dysplasia Screening Cascade within a Single-Center Outpatient HIV Clinic

Abstract Background HIV-positive men who have sex with men (MSM) are recommended to have anal Pap tests annually to screen for high-grade anal squamous intraepithelial lesions (HSIL). In this population, removal of HSIL reduces the risk of progression to anal cancer. This study aims to assess the effectiveness of the anal dysplasia screening cascade in a single-center outpatient clinic. Methods We conducted a single-center retrospective cohort study at Johns Hopkins. All adult HIV-positive MSM patients who had in-person encounters in the Bartlett Clinic between October 1, 2019-April 30, 2021 were included. Clinical information and dates of anal pap smears and HRAs were provided via an Epic data extraction. Manual chart review was conducted for anal pap and HRA pathology results. Descriptive analysis was performed. The primary outcome was successful navigation of the institutional anal dysplasia screening cascade, defined as annual anal Pap testing and completion of HRA if pap results were abnormal. This study was IRB exempt. Results 779 HIV-positive MSM patients were seen for in-person visits during the study period. 24% (190/779) of patients underwent at least one screening anal Pap, with 29 having multiple anal pap smears leading to a total of 219 anal pap smears done. 40% (87/219) were abnormal. Among those with an abnormal pap, 72% (63/87) had a referral for HRA placed but only 26% (23/87) underwent HRA. 39% (9/23) of HRAs identified HSIL in patients with lower-grade lesions on Pap test and one patient with HSIL on Pap had anal cancer detected on HRA. In total, 120 patients navigated the anal cancer screening cascade appropriately. This compromised 15% (120/779) of eligible MSM patients seen for at least one in-person clinic visit and 63% (120/190) of patients who underwent an anal Pap. Conclusion Completion of a screening cascade for anal dysplasia among HIV-positive MSM at our clinic was low. The largest gaps were seen in initiating annual anal Pap screening and scheduling referrals for HRA in surgical subspecialty clinics. Increased attention and clinic resources should be directed toward narrowing these gaps to ensure HSIL and anal cancers are detected early within this high-risk population. Disclosures All Authors: No reported disclosures.

The Role of White Blood Cell Count in Perianal Pathologies: A Retrospective Analysis of Hematologic Malignancies.

Background and ObjectiveInfections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period.MethodsPatients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study.ResultsA total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology.In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.

Comparative Study between Stapled and Excision Haemorrhoidectomy for the Treatment of Haemorrhoids

Introduction: There are different techniques for the treatment of hemorrhoidal diseases. Stapled haemrrhoidectomy is one of the modern technique which has shown little postoperative pain, less hospital stay and early go back to work. This study has been done to compare stapled haemorrhoidectomy with conventional excision hemorrhoidectomy. Methodology: The study was done in the Department of Surgery, Women’s Medical College Hospital and different private clinics in Sylhet District, from July 2016 to December 2017.A total of 42 patients were selected fulfilling the inclusion criteria to the stapled (n=21) and openexcision (n=21) group .Those patients having any other associated anal pathology like fistula, fissure, abscess and neoplasm were excluded from the study. Lithotomy position and spinal anesthesia were chosen for all the patients. Both the procedures were evaluated on the basis of total operative time, pain scores, complications, hospital stay and go back to work. Results: The mean age of patients was similar in both groups , that is 45.02 years (SD 12.30) in the stapled group and 47.54 years (SD13.50) in the open excision group.Male patients were more affected in both the groups ( 80.9%% in the stapled and 85.7% in the open group). Operative time was significantly less in the stapled group than in the open group (P .oo1). The blood loss, pain scores and requirement of analgesics was significantly less in the stapled group (P o.oo1). Average hospital stay was 2.20 days (SD 0.62) ) in the stapled group and 3.25 days (SD 1.01 ) days in the open group( P 0.01). Patients of the stapled group returned to work earlier (8.18days [SD2.24] as compared with 18.87 days [SD5.34] in the open group [P 0.001 ]). Maximum follow-up period was 6 months. Conclusions: Hemorrhoidectomy by stapled procedure is a safe and effective procedure for the treatment of grade II and grade III hemorrhoidaldieases. Early discharge and return to work are possible by this procedure. Furthermore, complications are as like as that of the open technique.

Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results

IntroductionAnal abscess is the most frequent urgent proctological problem. The recurrence rate and reported incidence of fistula after drainage and debridement of an anal abscess is widely variable. The objective of this study is to analyse the long-term recurrence rate and the incidence of fistula after drainage and urgent debridement of an anal abscess. MethodsRetrospective observational study of a prospective cohort with anal abscess of cryptoglandular origin. All patients (n = 303) were evaluated two months and one year after the intervention. At the 5th year, all the medical records were reviewed and a telephone call or appointment was made for an assessment if necessary. Specific antecedents of anal pathology, abscess characteristics, time and type of recurrence, presence of symptoms in the first revision and presence of clinical and/or ultrasound fistula were recorded. ResultsMean follow-up 119.7 months. Recurrence rate 48.2% (82.2% in the first year). Two hundred twenty-two ultrasounds performed. Incidence of ultrasound fistula: 70% symptomatic vs. 2.4% asymptomatic (p < 0.001). Global incidence of fistula 40.3%. The history of anal pathology and the presence of symptoms in the postoperative review significantly increase the possibility of recurrence (p < 0.001). The fistula is statistically more frequent if the abscess recurs (p < 0.001). ConclusionAfter drainage and debridement of an anal abscess, half of the patients relapse and 40% develop fistula especially in the first year, so longer follow-ups are not necessary. Endoanal ultrasound for the evaluation of the presence of fistula is highly questionable in the absence of signs or symptoms.

The Effect of Lateral Internal Sphinctorotomy on Post-operative Pain Following Open Hemorrhoidectomy

Hemorrhoid, is one of the most common anal pathologies. It is considered as a big issue in our society, surgical treatment is one of the valid ways to treat hemorrhoids. Pain after surgery is the most important complication beside other complications. Piles are removed with overlying skin removed with hemorrhoidectomy. Pain intensity varies, depending on the patient's pain threshold. This research attempts to see if open hemorrhoidectomy by itself or hemorrhoidectomy and internal sphinctorotomy were effective in treating post-operative pain.

Response factors associated with electrocautery treatment of intra-anal high-grade squamous intraepithelial lesions in a population of HIV-positive men who have sex with men.

Ablative treatment of anal high-grade squamous intraepithelial lesions (HSIL) reduces the risk of progression to anal squamous cell carcinoma. To identify factors that influence the response to treatment of anal HSIL by electrocautery ablation (ECA) in a population of HIV-positive men who have sex with men (MSM). Retrospective study of ECA treatment response in a prospectively followed anal dysplasia cohort. HIV-positive MSM diagnosed with anal HSIL were included. Demographic and HIV data were recorded. Response to treatment was assessed by biopsy after at least 18 months of follow-up. One hundred and twenty-eight HSILs in 91 men were included in this study. The overall response rate at 18 months was 70.3%. The number of electrocautery sessions required (2 ECA sessions vs 1: adjusted odds ratio [aOR] = 0.36 (95%CI 0.13-1.01); >=3 sessions vs 1: aOR = 0.10 (95%CI 0.04-0.29); p < 0.001]) and the history of previous HPV-related anal pathology (previous anal lesions vs no previous lesions AOR = 2.83 (95%CI 1.14-7.02), p = 0.024) were independently associated with response at 18 months. No serious adverse events were reported. Consideration should be given to alternative therapies in patients with unresolved HSIL after 1 ECA treatment.

Modern methods of surgical treatment of anal canal and rectum combined pathology

Objective. To evaluate the effectiveness of surgical treatment of anal canal and rectum combined pathology, through combined surgical interventions using modern electro- and radiosurgical technologies.&#x0D; Materials and methods. A comparative evaluation of the results of surgical treatment of 681 patients with combined pathology of the anal canal and rectum, who underwent combined single-stage operations using high-frequency electrosurgery and radio-wave surgery.&#x0D; Results. In case of application the device for radio-wave surgery "Surgitron", and also devices of high-frequency electrosurgery "ERBE ICC 200", "EFA", "KLS Martin" duration of operation is reduced to (15 - 25 ± 3) minutes, volume of blood loss decreases to (15 ± 6) ml, the need for narcotic analgesics decreases up to (2 ± 1) ml, the duration of inpatient treatment was reduced up to (4 ± 1) days.&#x0D; Conclusions. The use of modern radio- and electrosurgical technologies for the treatment of combined anorectal pathology prevents the occurrence of anal canal strictures and scarring of the perianal areas, causing the cosmeticity of combined operations.