Common Anorectal Disorders Research Articles

Natural Products with Potential Effects on Hemorrhoids: A Review.

Hemorrhoid disease is a common anorectal disorder affecting populations worldwide, with high prevalence, treatment difficulties, and considerable treatment costs. Compared to other treatment options, medical therapy for hemorrhoids offers minimal harm, more dignity to patients, and is more economical. Unfortunately, there are few chemical hemorrhoid medications available clinically, which makes the search for efficacious, cost-effective, and environmentally friendly new medication classes a focal point of research. In this context, searching for available natural products to improve hemorrhoids exhibits tremendous potential. These products are derived from nature, predominantly from plants, with a minor portion coming from animals, fungi, and algae. They have excellent coagulation pathway regulation, anti-inflammatory, antibacterial, and tissue regeneration activities. Therefore, we take the view that they are a class of potential hemorrhoid drugs, prevention products, and medication add-on ingredients. This article first reviews the factors contributing to the development of hemorrhoids, types, primary symptoms, and the mechanisms of natural products for hemorrhoids. Building on this foundation, we screened natural products with potential hemorrhoid improvement activity, including polyphenols and flavonoids, terpenes, polysaccharides, and other types.

Anal Fistula in Children: A Case Report from The Donka Chu National Hospital in Conakry

Introduction: anal fistula (AF) is a common anorectal disorder, with an estimated incidence of 0.5% to 4.3% in daily practice in infants. Most cases occur in children under one year of age, with a strong male predominance. Anal fistula during these periods is probably congenital in origin. The aim of our study was to discuss a case of crypto-glandular anal fistula in children. Case Report: 4-year-old patient admitted with a purulent perianal discharge of congenital origin. He had no previous history of the condition and was the second oldest of three siblings. General examination showed a lucid patient with a good physical appearance and good colouration of the integuments and conjunctivae. Pulse = 90/min; FR=26/ min; the abdomen was symmetrical and supple with no hepatosplenomegaly. Examination of the perineum showed a cutaneous orifice in the form of a granuloma of left lateral topography. The cryptic orifice was visible with the finger prick (Good Sall). Biological tests were unremarkable. We performed a fistulectomy (Figures 2 and 3); the specimen sent to the pathology department showed a fleshy bud on the fistulous pathway. Conclusion: Crypto-glandular anal fistula in children is a common condition. It is diagnosed clinically, and surgical treatment remains appropriate in our context despite the lack of consensus.

Causal association between adiposity and hemorrhoids: a Mendelian randomization study.

Hemorrhoids are a very common anorectal disorder affecting a large number of individuals throughout the world. This study aimed to evaluate the causal effects of four adiposity traits including body mass index (BMI), body fat percentage, waist circumference, and waist-to-hip ratio on hemorrhoids by Mendelian randomization (MR). We used summary statistics of BMI (N = 461,460), body fat percentage (N = 454,633), waist circumference (N = 462,166), waist-to-hip ratio (N = 212,244), and hemorrhoids (N = 337,199) from large-scale genome wide association studies of European ancestry. Univariable and multivariable MR were carried out to infer causality. The MR Steiger directionality test was used to test the causal direction. The primary MR analysis using the inverse variance weighted (IVW) method showed that there were positive effects of genetically determined BMI [odds ratio (OR) = 1.005, 95% confidence interval (CI): 1.003-1.008, per standard deviation (SD), p = 7.801 × 10-5], body fat percentage (OR = 1.005, 95% CI: 1.001-1.008, per SD, p = 0.008), waist circumference (OR = 1.008, 95% CI: 1.005-1.011, per SD, p = 1.051 × 10-6), and waist-to-hip ratio (OR = 1.010, 95% CI: 1.003-1.017, per SD, p = 0.003) on hemorrhoids. These findings were robust in multivariable MR adjusting for physical activity. The Steiger directionality test showed evidence against reverse causation. Our MR study supports a causal role of adiposity in the development of hemorrhoids. Adiposity prevention may be an important strategy for reducing hemorrhoids risk.

The role of colonoscopy in young patients with rectal bleeding: a systematic review and meta-analysis.

Anal bleeding is a frequent complaint in the coloproctological practice. Although usually associated with common anorectal disorders, it may represent a sign of an occult colorectal carcinoma. Our purpose was to evaluate the accuracy of the colonoscopy for detection of neoplastic lesions in patients under 50years of age with rectal bleeding. This systematic review and meta-analysis searched publications in PubMed, Web of Science, and Cochrane Library databases up to August, 2023. Cross-sectional and case-control studies including patients under 50years with rectal bleeding evaluated by colonoscopy were included. Primary outcome was prevalence of neoplastic lesions (adenomas and adenocarcinomas). Secondary outcomes were prevalence of those lesions according to age and anatomic location. The study was registered on PROSPERO (CRD42021257859) on July 5, 2021. Nine studies comprising 4162 patients were analyzed. A total of 398 patients with adenomas and 40 patients with adenocarcinoma were identified. Prevalence of neoplastic lesions (adenomas and carcinomas) was 10%. In patients under 40years, the prevalence of neoplastic lesions was 7% (6% of adenomas, 1% of carcinomas). Among patients aged 40-50years the prevalence was 15%, 14%, and 1%, respectively. Most lesions (71%) were located distally to splenic flexure. About 10% of patients under 50years with anal bleeding will have a neoplastic lesion detected through colonoscopy. The greatest benefit of the procedure is observed between 40 and 50years. Almost 30% of the neoplastic lesions were found in the proximal colon and could not be detected without the performance of a complete colonoscopy.

A Prospective Study of Post-operative Complications Following Stapled Haemorrhoidectomy

Introduction: Haemorrhoids is one of the most common anorectal disorders. Stapled haemorrhoidectomy (SH) is newly developed method for the surgical management of Haemorrhoids. Objective: To evalute postoperative complications followed by Stapled haemorrhoidectomy. Methods: A prospective observational study was conducted among the patients with haemorroid those who got admitted in different surgery units in the department of surgery in Shaheed Suhrawardy Medical College Hospital, Dhaka from 01 December 2015 to 31 May 2016. A total of 60 patients were selected following convenient sampling technique. Data were collected by face to face interview using a structured questionnaire and check list. All completed questionnaires were validated manually and data were analyzed by using descriptive and inferential statistics with SPSS 19.0. Results: In this study, immediate complications (first week) were: bleeding (8.3%), urinary retention (5.0%), moderate pain (5.0%), pruritus (5.0%) and submucosal abscess (1.7%). The most common complication after 1 week was mild pain (8.3%), stenosis (5%), flatus incontinence, recurrence of hemorrhoids in 3.3% and bleeding was (3.3%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. It was revealed from study that among the patients treated with SH 21.6% had immediate complications followed by 24.3% had late complications. Conclusion: Prevention is the best treatment of haemorrhoids. Stapled haemorrhoidectomy is safe with many short-term benefits like less post-operative pain, early return from hospital and early return to their normal activities. Like other modalities it is also associated with a long-term risk of hemorrhoid recurrence and the symptom of prolapse. However, this method is well accepted and comfortable for the patients. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 57-60

A Gentle Cure with Homoeopathy Through Individualisation, Anal Fissure: A Review & An Acute Case Report

In this modern era, life style diseases are commonly encountered in daily clinical practice. Sedentary life styles, lack of proper exercise, low intake of dietary fibre and water, stress and emotional factors, all these causes make a person prone to different varieties of gastrointestinal disorders. Constipation, haemorrhoids, Fissures, bleeding per rectum are most common lower GIT disorders that are seen in our daily OPDS. This article reviews the most common anorectal disorder, anal fissure. Even though anal fissure is not a major life-threatening disease, the unbearable pain in anus, because of which patient presents himself to the doctor for consultation, advice and treatment. Homoeopathy offers the safe, rigour, effective and permanent treatment, for such cases, and prevents recurrence. The patient explains different types of pain sensations which are to be given high importance in homoeopathy for selection of similimum. Keywords: Homoeopathy, Anal Fissure, Lac Defloratum, Peculiar sensation, Individualisation

The evolution of hemorrhoids publications during 1980-2021: a global and medical view with bibliometric analysis

Aims: Hemorrhoids is a common anorectal disorder and significantly affects quality of life. Although the number of global studies on hemorrhoids has increased in recent years, there is still no bibliometric study in the literature. In this study, it aimed that analyzing the scientific articles published on hemorrhoids holistically. 
 Methods: The articles published between 1980 and 2021 were analyzed using bibliometric and statistical methods on hemorrhoids. Network visualization maps were used to identify trending topics and international collaborations. Spearman’s correlation coefficient was used for correlation studies. The Exponential Triple Smoothing estimator was used to estimate the number of articles expected to be published in the coming years. 
 Results: A total of 3203 publications were found. 1863 (58.1%) of these publications were articles. The most active author is Gupta PJ. (n=26). The first 2 journals that published the most articles were Diseases of the Colon & Rectum (n=228) and Colorectal Disease (n=82). Singapore General Hospital (n=35) and University of Rome La Sapienza (n=19) were the 2 most active institutions. According to the average number of citations per article, the top 2 most influential journals were British Journal of Surgery and American Journal of Gastroenterology. 
 Conclusion: In this comprehensive study on hemorrhoids, a statistical analysis of 1863 articles was shared. It was determined that the trend topics in hemorrhoid researches were THD, mucopexy, transanal hemorrhoidal dearterialization, colorectal surgery, embolization, constipation, risk factors, Milligan-Morgan, classification, recurrence and randomized controlled trial. This article can be a useful resource for scientists and clinicians in terms of the global output of hemorrhoids yesterday, today and tomorrow.

Efficacy of Palashgudavarti and Diclofenac Sodium Suppository in the management of Acute fissure in ano

Introduction: Parikartika is most common ano-rectal disorder. The text of parikartika is mentioned in Samhitas. In this disease there are symptoms such as bleeding per rectum, hard stools, burning sensation around anal region. In this trial, group A (n=30) included Palashadigudavarti, whereas group B included Diclofenac sodium suppository for administration over Parikartika (acute anal fissures). Gandharva haritaki choorna acts as laxative and helps to relieve constipation and sitz bath was given to both group as conservative management.. Materials and method: Literary aspect of the study was collected from classical Ayurvedic and contemporary text and updated with recent medical journals, previous research work done on same topic. Observation and results: Assessment was done by the parameters such as pain, bleeding and itching as Subjective and healing as Objective Parameter. Results were obtained by statistical analysis. Discussion: In this research work Palash, Goghrita and Beewax as suppository base was used in the form of varti application (advanced anal Suppository) for managing Anal fissure. There is need of ayurvedic suppository easily available in market which will relieves anorectal symptoms instantly, because repeated use of diclofenac sodium have side effect to the body. In the present case series, it proved to be significant in managing Fissure in ano, it reduced pain, itching, bleeding and promoted healing. Conclusion: In the treatment of Parikartika, Palashadigudavarti was more effective than Diclofenac sodium suppository
 Keywords: Parikartika, fissure in ano, Palashadigudavarti, Diclofenac Sodium Suppository.

Three Acupuncture Methods for Postoperative Pain in Mixed Hemorrhoids: A Systematic Review and Network Meta-Analysis.

Background Mixed hemorrhoids are a common anorectal disorder, surgery is the most effective means of eradicating hemorrhoids, and pain is the most common postoperative complication of mixed hemorrhoids. Objective To compare the clinical efficacy of auricular plaster, acupoint application, and acupoint catgut embedding for treating postoperative pain in mixed hemorrhoids. Method PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM databases were searched for randomized controlled trials (RCTs) of three acupuncture-related therapies for postoperative pain in mixed hemorrhoids from the time of database creation to October 2021. After screening the literature, extracting information, and evaluating the risk of bias of included studies, statistical analysis was performed using RevMan 5.3 and Stata 15.0. Result Forty-seven RCTs with a total of 5121 patients were included. Network meta-analysis (NMA) showed that auricular plaster (OR = 5.90, 95% CI = (2.02, 17.21)) and acupoint catgut embedding therapy (OR = 5.55, 95% CI = (1.01, 30.40)) were more effective than analgesics in the treatment of postoperative pain in mixed hemorrhoids. The cumulative ranking probability (SUCRA) showed that acupoint application (73.6%) had the best overall efficacy and the rest were auricular plaster (68.7%), acupoint catgut embedding therapy (64.6%), auricular plaster combined with acupoint application (63.4%), and pain medication (8.9%) in that order. Secondly, auricular plaster (OR = −0.93, 95% CI = (−1.66, −0.20)), acupoint catgut embedding (OR = −0.8, 95% CI = (−1.50, −0.10)), and acupoint application (OR = −1.4, 95% CI = (−2.50, −0.31)) all led to a significant decrease in pain scores and were all more effective than analgesics. As ranked by SUCRA, the results showed that the efficacy of acupoint application (73.5%) was optimal and the rest were auricular plaster (56.1%), acupoint catgut embedding (50.2%), and pain medication (15.3%) in that order. In terms of pain degree, acupoint application (OR = 3.83, 95% CI = (1.25, 11.74)) was significantly better than pain medication. Conclusion Acupoint application can improve the overall efficiency, reduce pain scores, and relieve the degree of postoperative pain in mixed hemorrhoids.

Tamponade dressing versus no dressing after haemorrhoidectomy: multicentre, randomized clinical trial.

BackgroundSymptomatic haemorrhoids are a common anorectal disorder. The aim of the study was to investigate whether the omission of tamponade dressings after haemorrhoidectomy reduces postoperative pain without increasing the risk of severe bleeding.MethodThis was an open-label, randomized clinical trial conducted at 14 German hospitals. All patients with third- or fourth-degree haemorrhoids undergoing haemorrhoidectomy were considered eligible for selection in the intervention (no dressing) or control group (tamponade applied). Two co-primary outcomes were analysed by testing hierarchically ordered hypotheses. First, maximum pain intensity within 48 h after surgery was compared between the groups (superiority). This was followed by an analysis of severe bleeding complications, defined as any bleeding requiring surgical re-intervention within 7 days (non-inferiority). Secondary outcomes included health-related quality of life, patient satisfaction, haemoglobin levels, and adverse events.ResultsOut of 950 patients screened, 754 were randomized and 725 received intervention (366 patients in the intervention and 359 patients in the control group). In the group with tamponade dressings, median pain intensity on the 0 to 10 scale was 6 (interquartile range (i.q.r.) 4–7). Patients without tamponade dressings reported significantly less pain (median 5 (i.q.r. 3–7), P < 0.001). In each group, five patients (1.4 per cent) experienced severe bleeding. The absolute difference for the severe bleeding rate was −0.03 per cent with the 90 per cent confidence interval ranging from −1.47 per cent to +1.41 per cent, in line with the non-inferiority aim. No significant between-group difference was found for secondary outcomes.ConclusionsThe practice of inserting tamponade dressings after haemorrhoidectomy correlates with increased postoperative pain and does not provide benefits in terms of reduced postoperative bleeding.Registration numberDRKS00011590

Hemorrhoidal disease: What nurses need to know.

Hemorrhoidal disease (HD) is a common anorectal disorder that affects at least 10 million people in the US, with a peak incidence in individuals between the ages of 45 and 65. This article discusses the signs, symptoms, risk factors, classification, treatment, and nursing interventions for patients with HD.

An initial experience with laser haemorrhoidoplasty in addition to mucopexy for symptomatic haemorrhoids

Dear Editor, Symptomatic haemorrhoids is the most common anorectal disorder, where up to 75% of people experience symptoms sometime in their lives.1 The current gold standard for the surgical management of haemorrhoids is the Milligan-Morgan haemorrhoidectomy,2 with unrivalled long-term results.3 However, the technique is associated with significant postoperative pain,4,5 leading to delayed return to normal

Benign anorectal disease in children: What do we know?

Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant problem for the child and his or her family. Hemorrhoids, fissures, rectal prolapse, and perianal abscess and fistulas are the most common anorectal disorders in pediatric population and their appearance may be age-specific. Although they generally follow a benign course, a careful examination must be performed in order to exclude other serious and complicated underlying pathology. Their diagnosis is based on the patient's medical history, physical examination, endoscopy, and imaging. Moreover, the management of these disorders includes medical and surgical treatment options, and if they are treated promptly and properly may be limited and short lived. This review presents the currently available data in the literature on the diverse aspects of these disorders, including the definition, epidemiology, clinical presentation, pathogenesis, diagnosis, indications for surgery, and long-term outcomes.

Disorders of anorectal motility: Functional defecation disorders and fecal incontinence.

Functional defecation disorders (FDDs) and fecal incontinence (FI) are common anorectal disorders often distressing and significantly add to the healthcare burden. They present with multiple, overlapping symptoms that can often obscure the underlying pathophysiology and can pose significant management dilemmas. A detailed history, stool diaries and visual scales of stool form, a careful digital rectal examination are needed to guide anorectal physiology tests. With high-resolution (3-D) anorectal manometry, anal ultrasonography, (magnetic resonance) defecography and imaging, and neurophysiological tests, it is possible to define and characterize the underlying structural and functional abnormalities more accurately. In this review, we present a succinct update on the latest knowledge with regards to the pathophysiology, diagnosis and management of FDDS, fecal incontinence and abnormalities of rectal capacity (i.e., megarectum, microrectum).

Conceptual view on Arsha and its Management through Ayurveda Prospective

Arsha is a Tridoshaj disease caused by the production of Mandagni and Ama. It affects people from all socioeconomic backgrounds. According to Ayurvedic theory, the aetiology of Arsha is mostly linked to the patient's Mandagni. Sedentary behaviour, irregular bowel habits, low-fiber diet, and continuous straining are only a few of the major culprits. Virudhdha-adhyashana, Utkatashana, and Samudirna vega vinigrahata are some of the variables that contribute to Mandagni, according to Ayurveda. While the illness is beyond therapy, it does have its own issues, such as excessive bleeding, oedema, and thrombosis, which cause severe discomfort and make it impossible for the patient to complete his daily tasks. Patients with chronic constipation or diarrhoea strain during faeces, causing pathological varicosity of the haemorrhoidal veins as a result of the increased pressure on veins. Impaired dietary habits, changing lifestyles, genes, and pregnancies are all common causes of pile. It is one of the most common ano-rectal disorders, affecting up to 50% of the population between the ages of 40 and 50. The therapy of Arsha (Piles) in Ayurveda is based on the chronicity and presentation of the condition. There are four therapeutic techniques for Arsha management, with Bheshaj Chikitsa and Kshara Karma Chikitsa showing excellent outcomes

Knowledge, the extent of awareness, and attitudes toward hemorrhoids in Makkah population, Saudi Arabia

Background: Hemorrhoids are disorders characterized by symptomatic enlargement and distal displacement of the anal canal. It is a worldwide common anorectal disorder that increases with age. The present study aims to determine the knowledge, the extent of awareness, and attitudes toward hemorrhoids in the Makkah population, Saudi Arabia. Methods: A descriptive, cross-sectional study was conducted among the general population who resides in Makkah region, aged 18 years or older. The data were collected using an online questionnaire designed by Google forms distributed electronically via Social media. The questionnaire covered demographical data and history of having hemorrhoid disease, general information about the knowledge, awareness, and attitude toward hemorrhoids. Results: Among 417 of the participants surveyed, (64%) had a poor level of awareness regarding hemorrhoids. More than 60% of the participants were considered to have a good level of awareness. A significant relationship was found between income and history of hemorrhoids when linked with the level of awareness. Fifty percent of the participants considered tradition a barrier when they have hemorrhoids and want to see a doctor. Conclusion: The present study found a lack of knowledge and awareness among the general population of Makkah city about hemorrhoid causes, preventive measures, and complications of hemorrhoids. This warrants the need for raising the level of awareness of Makkah residents through awareness programs and campaigns.

Harmonic Scalpel Hemorrhoidectomy Versus Bipolar Diathermy Hemorrhoidectomy – A Prospective Evaluation

Background Hemorrhoidal disease is a very common anorectal disorder occurring more frequently in individuals who are older than 40 years. Although early-stage diseases can be managed conservatively, late-stage diseases usually need surgical treatment. Aims and Objectives The aim of the study was to compare harmonic scalpel hemorrhoidectomy with bipolar diathermy hemorrhoidectomy in terms of operative time, intraoperative bleeding, hospital stay, pain expectation score, time to start normal activity, and complications if any. Materials and Methods The study entitled, "Harmonic scalpel hemorrhoidectomy versus bipolar diathermy hemorrhoidectomy-A prospective evaluation" was conducted in the Department of General and Minimal invasive Surgery SKIMS and SKIMS Medical College Srinagar from July 2017 to June 2019. The study was performed on all patients with Grade 3 and Grade 4 hemorrhoids. The total number of patients studied was 64, who were randomly subjected either to the harmonic scalpel hemorrhoidectomy or to bipolar diathermy hemorrhoidectomy. Results Thirty-one patients were subjected to harmonic scalpel hemorrhoidectomy and 33 patients were subjected to bipolar diathermy hemorrhoidectomy. Mean operative time and intraoperative bleeding were significantly less in harmonic scalpel hemorrhoidectomy as compared to that of bipolar hemorrhoidectomy. The patients who underwent harmonic scalpel hemorrhoidectomy experienced significantly less pain and had significantly shorter hospital stay and early return to routine work in contrast to bipolar diathermy hemorrhoidectomy. Conclusion Harmonic scalpel hemorrhoidectomy is recommended in patients with symptomatic Grade 3 internal hemorrhoids in association with large external components and those with Grade 4 hemorrhoids.

A REVIEW OF HAEMORRHOIDS ACCORDING TO UNANI AND MODERN SYSTEM OF MEDICINE

Haemorrhoids are variceal Dilatation of anal and perianal venous plexus. Classically situated in the 3,7,11, o'clock position (left lateral, right posterior &amp; right anterior respectively). Superior haemorrhoidal (vein) gives 2 branches on right side and 1 branch on left side. Hence, Piles are 2 on the right side and 1 on the left side. It was probably Buqrat (Hippocrates) (460 BC) who was the first to apply the name to the flow of blood from the veins of the anus. There is a detailed description of Bawaseer in classical books authored by ancient Unani physicians. Haemorrhoids are one of the most common anorectal disorders with a reported prevalence of 4.4% up to 36.4% of the general population. The peak prevalence occurs between 45 and 65 years of age. Anatomical classification of haemorrhoids includes internal and external haemorrhoids based on whether they are above or below the dentate line. Goligher's classification is the clinical staging of the prolapsing degree of internal haemorrhoids. Risk factors for hemorrhoidal disease are conditions associated with increased intra-abdominal pressures such as pregnancy, obesity, constipation and straining during defecation and sitting for a long time on the toilet seat, and chronic cough. Principal complaints of haemorrhoids include bleeding on defecation and prolapse of tissue. Haemorrhoid diagnosis involves taking a detailed history and conducting anorectal examinations (visual inspection, manipulation, digital examination, and anoscope. Report of first recorded treatment for haemorrhoids comes from the Egyptian papyrus dated 1700 BC: “… Thou shouldest give a recipe, an ointment of great protection; Acacia leaves, ground, titurated and cooked together. Conservative treatment is used in “Everyday Lifestyle Guidance. Drug therapy for haemorrhoids is typically utilized for bleeding, pain, and swelling. Operative hemorrhoidectomies are reserved mainly for third- and fourth-degree haemorrhoids.

Comparative study between conventional fistulectomy and SLOFT in cases of low fistula in ano

Introduction: Fistula in ano is a common anorectal disorder requiring surgical intervention. It is associated with high recurrence rate and post-operative complications. In this study we have analysed and compare results of a newer technique for low anal fistula SLOFT with conventional Fistulectomy. Aims and Objective: To compare Submucosal Ligation of Fistula Tract (SLOFT) with conventional fistulectomy in patients of low anal fistula by analysing various intra-operative factors and post-operative outcome. Materials and Methods: An interventional study carried out at Santosh Medical College and Hospitals, Ghaziabad from January 2017 to October 2018. This study included 60 Patients of low anal fistula which were divided into two groups of 30 patients each. Group I was offered Conventional Fistulectomy & Group II underwent SLOFT. Result and Observations: Fistula in ano is commonly seen in middle aged males. There is no significant difference in duration of surgery between SLOFT and Fistulectomy. However post-operative complications, pain (measured by VAS scoring system), wound healing and early return to work was significantly better in patients who underwent SLOFT. Conclusion: SLOFT has significant advantage over convention fistulectomy in terms of post-operative pain, wound healing, early return to work and cosmetic outcome. Keywords: Fistula in ano, Low anal fistula, SLOFT (Submucosal ligation of fistula tract), LIFT (Ligation of intersphincteric fistula tract), Fistulectomy.

Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience.

Hemorrhoidal disease represents one of the most common anorectal disorders in the general population. Energy devices, such as LigaSureTM scalpel, have reshaped the concept of hemorrhoid surgery and in turn, have improved patient outcomes and simplified the work of surgeon. The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work. In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed. Complications were classified in early, late, and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively. 90.2% of patients were treated in day surgery regimen and the mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st postoperative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3%-of patients experienced postoperative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing, and anal fissure were detected in 3.6%, 1.2%, and 1% of patients, respectively. The long term complications rate was 5.3%: anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively. LH is a safe and fast procedure with a proven minimal complication rate.