Degree Hemorrhoids Research Articles

Global treatment of haemorrhoids-A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons.

There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I-IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids - with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed.

A Comparative Study Between Open Hemorrhoidectomy and Rubber Band Ligation for Second Degree Hemorrhoids: A Prospective Randomized Control Study

Background: The symptoms of hemorrhoids has a wide spectrum that ranges from bleeding per rectum, itching, prolapse of the hemorrhoidal cushions, thrombosis leading to pain and discomfort, incontinence especially of fluids and mucous discharge. But for surgical management, hemorrhoidectomy is more sustainable in symptom control and has been considered as gold standard. Rubber band ligation has been the most popular amongst non-surgical interventions because of its effectiveness, minimal complication rate and shorter recover period compared to operative procedures. The present study aimed at determining the efficacy and safety of rubber banding ligation procedure versus the standard hemorrhoidectomy for second degree hemorrhoids. Methods: A prospective randomised comparative study was conducted at Department of Surgery, Indira Gandhi Medical College Hospital, Puducherry for 18 months after getting institutional ethical committee clearance. A total no. of 74 cases of 2nd degree hemorrhoids were divided into two groups A (open hemorrhoidectomy) and B (banding) by simple randomization technique of 37 each. A detailed history & examination including per rectal and Proctoscopy examination was done of each patient and the data entered in the pro forma. The description of data was expressed in the form of mean±SD for quantitative data, while frequency and proportion for qualitative data. Results: Totally male patients represented 57% compared to female with 43% 78% of the patients who underwent banding did not have any immediate post-operative complications while only 4 persons reported pain and bleeding post-operatively compared to 12 patients reporting bleeding and 11 patients reporting pain after hemorrhoidectomy. The duration of hospital stay post procedures was found to be lesser in banding group compared to hemorrhoidectomy group with p value being statistically highly significant (p<0.001). Conclusion: Rubber band ligation is very simple, safe, effective outpatient procedure that can be performed for grade II hemorrhoids. It generally requires fewer expertise and instruments. It is found to improve the symptoms of the patients and making them sustain a good quality of life since it has minimal complications.

Laser Hemorrhoidoplasty vs Conventional Milligan-Morgan Hemorrhoidectomy for Treatment of Third and Fourth Degree Hemorrhoids: A Prospective Comparative Study

Abstract Background Hemorrhoids are the most common disease of anal canal affecting a large number of people at least once during their lifetime and can interfere with their daily functioning. Surgical treatment is the best available option for symptomatic hemorrhoid cases, which are refractory to medical treatment. In spite of many modifications made to the hemorrhoid surgical techniques, postoperative pain and discomfort remain the major concern for patients, which is why they often refuse to undergo surgical treatment. Laser ablation has opened new possibilities for the minimally invasive treatment of hemorrhoids. Objective To compare the outcomes between laser hemorrhoidoplasty and the conventional Milligan-Morgan hemorrhoidectomy for treatment of third and fourth degree haemorrhoids especially postoperative pain, bleeding, and recurrence. Patients and Methods Recent studies have proven that laser ablation was much better regarding postoperative pain and hemorrhage in the various degrees of hemorrhoids. Our study also confirmed that laser ablation technique has shorter operative time, less severe postoperative pain, bleeding and comparable regression of hemorrhoid columns. Studies with longer follow-up period (around 2 years) have also reported effectiveness of laser for the treatment of hemorrhoids which was confirmed in our study over 6 months. Results Although some studies showed that wound inflammation or hemorrhoid thrombosis could be a problem however our study showed no postoperative local infection in the group treated with laser ablation and only two patients were presented with thrombosis of external hemorrhoid 7–10 days after the surgery, which was resolved with medical treatment. Conclusion Laser hemorroidoplasty has better outcomes than the traditional surgical resection of hemorrhoid disease for the control of grade III and IV symptomatic refractory hemorrhoids specially regarding post-operative pain and bleeding which are the main concerns for most patients.

Hemorrhoids are associated with an increased risk of depression in Germany: A retrospective cohort study in primary care outpatients

BackgroundThe aim of the present study was to analyze the cumulative incidence of depression diagnosis in patients with hemorrhoids and to evaluate the association between hemorrhoids and subsequent depression diagnosis. MethodsThis retrospective cohort study was based on electronic medical records from the Disease Analyzer database (IQVIA) and included 87,264 individuals with hemorrhoids (mean age: 54.2 years; 42% women) and 87,264 propensity score-matched individuals without hemorrhoids in 1284 general practices in Germany between January 2005 and December 2021. Univariable Cox regression analysis was conducted to assess the association between hemorrhoids and depression. ResultsAfter up to 10 years of follow-up, 21.4% of patients with hemorrhoids versus 16.3% of the matched cohort (p < 0.001) were diagnosed with depression. There was a significant association between hemorrhoids and a subsequent diagnosis of depression (HR: 1.32; 95% CI: 1.28–1.37), which was confirmed in age- and sex-stratified analyses. The association was stronger with increasing degree of hemorrhoids, from HR: 1.29 (95% CI: 1.15–1.45) for Grade 1 to HR: 1.73 (95% CI: 1.11–2.69) for Grade 4 compared to no hemorrhoids. ConclusionsThe present study provides compelling evidence of an association between hemorrhoids and subsequent depression. Addressing the mental health of individuals with hemorrhoids may not only improve their overall well-being but could also lead to better treatment outcomes for the primary condition.

A Case Study on Effective Management of Arsha (II Degree Haemorrhoids) by Teekshna Kshar Pratisarana

Arsha, commonly known as haemorrhoids, is a prevalent medical condition characterized by dilated blood vessels in ano rectal region and they can cause bleeding, pain, mucous discharge, discomfort etc. The primary causes of Arsha include increased pressure on the rectal veins, commonly attributed to chronic constipation, prolonged sitting, and straining during bowel movements. Genetic predisposition and certain lifestyle factors, such as a sedentary lifestyle and low fiber diet, can also contribute to the development of haemorrhoids. Arsha requires a surgical technique in modern treatment, such as haemorrhoidectomy, rubber band ligation, and so on, but after sometime of excision there is great possibility of reappearance of the disease. But in Ayurveda, fourfold management of Arsha has been indicated viz., Bheshaja, Kshar karma, Agni karma and Shastra karma according to chronicity and presentation of the disease. In this case study, a 40 years old female patient presented with complaints of some mass coming out during defecation, bleeding, pain and mucous discharge while passing stool to the Shalya OPD, Rishikul Campus, Uttarakhand Ayurved University Haridwar. The patient was treated successfully with Kshar karma application. The pile mass, per rectal haemorrhage and mucous discharge was gone in 7 days and the patient was free of all symptoms within 15 days. The findings revealed that there are maximum advantages which are shared in this case study.

Treatment of grade four hemorrhoids in a patient with acute myeloid leukemia with severe thrombocytopenia by laser hemorrhoidopexy: A case report

Here, we present the case of a 66-year-old female patient with acute myeloid leukemia and severe thrombocytopenia who came with the complaints of painful per anal mass and bleeding per rectum for 1 year. The patient is a known case of obesity, hypertension, and diabetes mellitus and has received three cycles of chemotherapy with decitabine. On examination, she was found to have fourth- degree hemorrhoids at 3, 7, and 11 oclock positions with acute edematous changes. We successfully treated this patient with laser hemorrhoidopexy, whereby laser energy was delivered to each hemorrhoidal cushion. While lasers for the successful treatment of grade 2 and 3 hemorrhoids are well documented in the literature, we successfully treated this patient with prolapsing fourth-degree hemorrhoids with just laser energy delivery. With these results, we would also like to consider laser hemorrhoidopexy as an effective treatment option for four-degree hemorrhoids for which open Milligan–Morgan hemorrhoidectomy and stapler hemorrhoidectomy are currently considered treatment options.

PPH and Biological Glue and Phytonadione infusion in patients with Cirrhosis and Anticoagulation therapy with high risk of bleeding during and after Stapled Hemorrhoidopexy

Background: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue and the intravenous administration of Phytonadione. Some studies in the literature demonstrate the risks of periprocedural bleeding and post-surgical procedures, generally lasting &gt; 45 minutes and in chemically or pathologically anticoagulated patients as being at high risk of bleeding and death. Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue. Methods: Between 2005 and 2024 172 patients were analyzed, in a retrospective cohort study. Results: From 86 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue in the local of stapled line, only one (1.16%) presented bleeding in the surgical postoperative (Group 1). Eighty-six patients submitted to PPH procedure and biological glue use, also received 3 days before surgery and 3 days after surgery one dose of 5 mg of Phytonadione (Vitamin K1) per day (Group 2). In this group, no patients presenting rectal bleeding after surgery with the follow up of 3 months. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operative time was 55 min and the median (IQR) length of hospital stay after surgery was 3 days. Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue (Group 1) presented very low rates of bleeding in the postoperative period. The adjuvant administration of vitamin K1 (Group2) at a recommended dose is proven to better prevent bleeding.

Excision hemorrhoidectomy versus laser hemorrhoidoplasty in second and third degree hemorrhoids: a prospective cohort study

Background Hemorrhoids are considered the commonest benign anorectal diseases globally, being the most annoying anorectal problem. They commonly present with discomfort, prolapse, and bleeding. Aim The aim of this study is to compare between surgical excision of hemorrhoids and laser hemorrhoidoplasty (LHP) in the treatment of second and third-degree hemorrhoids. Patients and methods The study was conducted on 80 patients. The patients were divided into two equal groups. First group underwent surgical excision of hemorrhoids while the second group underwent LHP. We compared the outcomes of surgical excision of hemorrhoids with LHP in the of duration of surgery, intraoperative bleeding, postoperative pain, postoperative hospital stay, and the time needed for work return and short and long-term postoperative complications. Results LHP had a significantly lower time of surgery, intraoperative blood loss and pain postoperative with no effect on defecation. There were no significant difference in the complications postoperative. Conclusion LHP is a safe and effective modality in treatment of second and third degree hemorrhoids and being more superior than traditional surgical excision of hemorrhoids.

Sclerotherapy vs Band Ligation: A comparative study of efficacy and compliance in second degree Haemorrhoids

Sclerotherapy vs Band Ligation: A comparative study of efficacy and compliance in second degree Haemorrhoids

Does routine partial lateral sphincterotomy with open hemorrhoidectomy improve postoperative pain?

ObjectiveIn this study we aimed to detect the difference regarding the postoperative pain and continence in patients with third and fourth degree hemorrhoidal disease who underwent either hemorrhoidectomy alone or combined hemorrhoidectomy with partial internal sphincterotomy for the treatment of hemorrhoidal disease.Patients and methodsThis prospective comparative randomized clinical trial was conducted at hospitals of Tanta University during the period from March 2021 to August 2022 on 100 patients with third or fourth degree hemorrhoids who were randomly assigned either to group A, patients who only underwent hemorrhoidal excision by the classical technique of Milligan–Morgan or group B, with added partial lateral sphincterotomy to the classic technique. All patients in both groups underwent anorectal manometry both preoperatively and postoperatively. Pain following surgery was analyzed by using visual analog scale system at 24 h, 48 h, and on 10th postoperative day, other complications including incontinence, infection, hematoma, bleeding, and anal stricture were evaluated at 24 h, 48 h, 10th postoperative day, 1 month, and after 3 months.ResultsTotal 100 patients were divided among both groups. The mean age of the patients was 37.7±11.3 and 36.3±11.3 years in group A and group B, respectively. Thirty-two males and 18 females were in group A in comparison to 33 males and 17 females in group B. During follow-up periods, patients in group B had less postoperative pain than those in group A with statistically significant difference. None of the patients developed fecal incontinence for solid or liquid stools in both groups, except for nine patients developed only mild degree of incontinence for flatus in the first week that improved gradually till completely resolved before the end of the 3 months follow up.ConclusionThe addition of partial internal sphincterotomy to the classical haemorrhoidectomy technique significantly improves postoperative pain without increasing overall related morbidity.

Local anesthesia versus saddle block for open hemorrhoidectomy: cost-analysis from a randomized, double blind controlled trial

BackgroundDespite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids.MethodsThis trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0.ResultsFindings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p < 0.05). The mean operating time was 15.52 ± 5.34(SD) minutes versus 33.72 ± 11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42 ± 8.90 US$ compared to 63.38 ± 12.77US$ in SB group.ConclusionThe use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals.Trial registrationPan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.

Study of Efficacy and Early Post-Procedure Complications of Rubber Band Ligation for Controlling Bleeding in Second Degree Hemorrhoid at National Referral Hospital

Study of Efficacy and Early Post-Procedure Complications of Rubber Band Ligation for Controlling Bleeding in Second Degree Hemorrhoid at National Referral Hospital

Combined mucopexy & Milligan-Morgan's technique in circumferential 4th degree haemorrhoids: Prospective observational cohort study

BackgroundIt is well known that a large excisional haemorrhoidectomy could be certain cause of post-operative severe complications like incontinence, ectropion or anal stenosis. ObjectiveOur aim is to reduce post-operative complications avoiding a large haemorrhoidectomy in patients suffering of a circumferential 3-4th degree prolapsed haemorrhoids. DesignThis was a prospective, single institution study with propensity score matching performing a classic stapled mucopexy followed by the excision of the internal mucosae prolapse combining at the same operative time a concomitant classic Milligan and Morgan's technique of the remnant external piles. PatientsThe study population were 54 eligible patients, study included 32, to demonstrate feasibility and safety of our proposals. 20 males, 12 females, mean age 51.9 years (range 21–84) underwent combined mucopexy and haemorrhoidectomy in one single surgical procedure between January 2017 and December 2019. ResultsA total of thirty-two patients were included prospectively and consecutively; 18 patients (33.4% of the universe) presented anatomical variations on the CMHP and variations on the IHED (10), associated anal fissures (2), modified piles with HPV condylomata (2), non-stoppable anticoagulation treatment (2), immunity treated disease (1), no evidence of a haemorrhoidal mucosal prolapse and minor pile's components (1) and they were definitely excluded of the study. There were no significant differences in the postoperative complication rates. The length of the operation was (48, 05 min +/- 5, 30 min). Some special bleeding had required at the end of the procedure a supplementary haemostasis with absorbable single suture in six patients (18, 8%), men (12, 5%) women (6, 3%). The stapled haemorrhoidal mucopexy allowed a faster functional recovery with shorter time off work (weighted mean difference 9.45 days; p < 0.00001), earlier return to normal activities (weighted mean difference, 15.85 days; P = 0.03), and better wound healing (odds ratio, 0.1; P = 0.0006). No stenosis, neither ectropion. LimitationsBecause of a single limited study including a single operative group. ConclusionsOur results confirm the strategy, demonstrating that the combined technique drastically reduces the risk of anal stenosis, ectropion, incontinence or recurrence of the prolapse. By the restoration of the anal canal anatomy under visual control and preservation of the required mucosal and cutaneous bridges results are reproducible and sure.

Comparison of Pedicle Coagulation Haemorrhoidectomy with Ligasure vs Conventional Milligan Morgan Haemorrhoidectomy in Reducing Post-Operative Pain among Patients of 3rd and 4th Degree Haemorrhoids: a Randomised Controlled Trial

Background: Hemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan Morgan open hemorrhoidectomy with pedicle ligation with LigaSure in terms of postoperative pain on day 1 and day 7. Materials and methods: It was a randomised controlled trial conducted in Department of surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aging from 15 to 60 years who presented with the symptomatic third, and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Data was entered and analyzed using SPSS v. 23.0. Chi-square tests were applied. P-value &lt;0.05 was taken statistically significant. Results: Out of 100 patients, 68 (68%) were males while 32 (32%) were females. Mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in Milligan Morgan group while that in LigaSure group was 8.44±0.64 (p less than0.0001). Postoperative pain at day 7 was 5.00±0.85 in Milligan Morgan group while it was 3.04±1.08 in LigaSure group (p&lt;0.0001). Conclusion: Postoperative pain is much lower in the LigaSure group as compared to Milligan Morgan open hemorrhoidectomy.

314 Comparison of hemorrhoidectomy by LigaSure and conventional Milligan Morgan's Technique

Abstract Aim To compare outcomes of hemorrhoidectomy by LigaSure and conventional Milligan Morgan’s hemorrhoidectomy. Methods In this randomized controlled trial, we enrolled a total of seventy adult patients of either gender between age 17-80 years. All the enrolled patients presented with 3rd or 4th degree haemorrhoids and were planned for hemorrhoidectomy. The patients were assigned to two treatment groups. Group A (Milligan Morgan’s) patients were enrolled from one hospital and Group B (LigaSure) patients were enrolled form second hospital. Post-operative pain was assessed in both groups using VAS at 6, 12 and 24 hours along with amount of blood loss during the surgery. Duration of surgery (min) was estimated and compared in both the groups. Results There were 62.9% males and 37.1% females in group A and 80.0% males and 20.0% females in group B (P=0.112). Mean age in group A and group B patients was 43.3 years ± 11.3 SD and 46.4 years ± 8.2 SD respectively. In group A, there were 68.96% patients having grade III and 31.4% patients having grade IV haemorrhoids and in group B, 57.1% patients had grade III and 42.9% patients had grade IV haemorrhoids (P=0.322). Mean VAS at 6 hours, 12 hours 24 hours, mean amount of blood loss during the surgery and mean duration of surgery was significantly shorter (P=0.001) in patients of group A as compared to patients of group B. Conclusions The LigaSure method had significantly lower degree of post operative pain, lesser amount of blood loss during the surgery and shorter duration of surgery as compared to Milligan-morgan method.

Early Outcomes of Stapled Haemorrhoidopexy for 3RD Degree Haemorrhoids in Diabetic Patient

Background: Stapled haemorrhoidopexy is a newer modality representing a paradigm change in the treatment of haemorrhoids with better short-term outcomes, shorter operating times and less post-operative pain. Though short- term effects of stapled haemorrhoidopexy are well documented in general haemorrhoid patients, but till date, no study focused the outcome of diabetic patients. Aim of the Study: The aim of the study was to determine the short-term outcome of stapled haemorrhoidopexy in diabetic patients. Methods: This prospective observational study was conducted at the Department of Surgery in BIRDEM General Hospital, for one year of period following approval of this protocol. A total of 30 patients with diabetes mellitus and 3rd degree haemorrhoid was enrolled in this study. Written informed consent was ensured from each of the participants. A detailed history and thorough clinical examination were carried out in each patient. All patient underwent stapled haemorrhoidoplexy. Follow up was taken at 24 hours of operation, 14th POD, after 1 month, after 3 months and after 6 months. All information was recorded in separate case record form. After collection of all the required data, analysis was done by SPSS 23.0. Results: Mean age of the study participants was 45.53±3.91 (SD) years with a majority in 40-49 years of age. About 70% of the study population were male and 30% were female. Post-operative mean VAS score was 1.83±1.05 (SD) after 24 hours of operation and 0.60±0.89 after 2 weeks. About 66.7% patients experienced single episode of per-rectal bleeding after 24 hours of surgery, 20.7% had 2 episodes and 6.7% had 3 episodes. Mean hospital stay duration was 1.17±0.46 (SD) days. Average usual daily resumption of all patients was 6.90±2.37 (SD) days. Conclusion: The average age of the studied patients was 45 years with clear male predominance. short operative time, less post-operative pain, quicker return from hospital and early return to their normal activity was

Results of sclerotherapy and mucopexy with haemorrhoidal dearterialization in II and III degree haemorrhoids. A 4 years' single centre experience.

Haemorrhoidal disease (HD) affects a considerable portion of the adult population. The aim of this study is to confirm the safety and efficacy of the treatments and to report the long-term outcomes of Sclerotherapy (ST) and Mucopexy and Haemorrhoidal Dearterialization (MHD) performed over the last 4 years in a single tertiary centre. The secondary outcome is to evaluate the usefulness of both techniques and to demonstrate how those can be associated as a bridge to surgery. Patients affected by second-third-degree haemorrhoids and undergoing ST or non-Doppler guided MHD between 2018 and 2021 were enrolled. Safety and efficacy, recurrence rate, Haemorrhoid Severity Score (HSS) and pain resulting from both techniques were evaluated. Out of 259 patients, 150 underwent ST. Further, 122 (81.3%) patients were male and 28 (18.7%) were female. The mean age was 50.8 (range 34-68) years. Most of the patients (103, 68.6%) were affected by second-degree HD, while 47 (31.4%) were affected by third-degree HD. The overall success rate was 83.3%. The median pre-operative HSS score was 3 (IQR 0-4, p = 0.04) and at 2 year the median HSS was 0 (IQR 0-1, p = 0.03). No intraoperative complications and no drug-related side effects occurred. The mean follow-up for ST was 2 years (range 1-4; SD ±0.88). MHD was performed on 109 patients. In detail, 80 patients (73.4%) were male while 29 patients (26.6%) were female. The mean age in this group was 51.3 (range 31-69). Further, 72 patients (66.1%) were affected by third-degree HD and 37 (33.9%) by second-degree HD. The median HSS score was 9 (IQR 8-10, p = 0.001) preoperatively two years after treatment was 0 (IQR 0-1, p = 0.004). Major complications occurred in three patients (2.75%). The overall success rate was 93.5% (second degree 89.2% vs. third degree 95.8%). The mean follow-up for MHD was 2 years (range 1-4; SD ±0.68). The results confirm the usefulness of those techniques, which can be considered safe and easily repeatable procedures, with a low recurrence rate after 2 years of median follow-up.

Postoperative Pain Comparison Between Open Hemorrhoidectomy and Stapled Hemorrhoidopexy on Internal Hemorrhoid at Siloam Hospitals Lippo Village

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hemorrhoids have a prevalence of 4,4%. Surgery is one of the modalities for treating hemorrrhoids. The method accepted as the "golden standard" is open hemorrhoidectomy. Although considered effective, open hemorrhoidectomy is still often associated with a significant rate of morbidity and pain symptoms that are a complaint of most patients. Therefore, another method is an alternative, namely, stapled hemorrhoidopexy. Some studies showed that stapled hemorrhoidopexy has a lower occurrence of postoperative pain, and others offer the opposite.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was conducted at Siloam Hospitals Lippo Village between February and March 2019. Samples were taken as many as 70 patients by taking secondary data from medical records. Patients diagnosed with third or fourth degree hemorrhoids and undergoing open hemorrhoidectomy or stapled hemorrhoidopexy will be taken the pain score from the visual analogue scale. Data is then tabulated using Microsoft Excel and analysed using SPSS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;the occurrence of postoperative pain in the stapled hemorrhoidopexy and open hemorrhoidectomy group, respectively, are 80% and 97%, with a p-value of 0,055. The average visual analogue scale score for open hemorrhoidectomy and stapled hemorrhoidopexy was 3±1,39 and 2±1,39, respectively, with a p-value of 0.003.&lt;/p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;the result showed that the occurrence of postoperative pain was not statistically significant. And the average visual analogue scale score was lower in the stapled hemorrhoidopexy group.

Pain assessment following open hemorrhoidectomy under local anesthesia versus saddle block: a multicenter randomized controlled trial

BackgroundThere is disparity in evidence on pain assessment post open hemorrhoidectomy (OH) using local anesthesia and its use in developing countries compared to developed countries. Therefore, we conducted this study to assess the occurrence of postoperative pain following open hemorrhoidectomy under local anesthesia versus saddle block for uncomplicated 3rd or 4th degree hemorrhoids.MethodsThis was a prospective equivalence randomized, double blind controlled trial conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. Pain severity was assessed at 2, 4 and 6 h post open hemorrhoidectomy using visual analogue scale (VAS). Data was analysed using SPSS version 26 at a p < 0.05 as statically significant using visual analogue scale (VAS).ResultsWe recruited 58 participants in this study who underwent open hemorrhoidectomy under local anesthesia or saddle block (29 participants per group). The sex ratio was of 1.15 of female to male and a mean age of 39 ± 13. VAS was found to be different at 2 h post OH compare to other time of pain assessment but not statically significant by area under the cover (AUC) (95% CI = 486–0.773: AUC = 0.63; p = 0.09) with a none significance by Kruskal–Wallis’s test (p:0.925).ConclusionLocal anesthesia was found to be having a similar pain severity occurrence in post operative period among patients undergoing open hemorrhoidectomy for primary uncomplicated 3rd or 4th degree hemorrhoids. Close monitoring of pain in postoperative period is mandatory especially at 2 h to assess need of analgesia.Trial registrationPan African Clinical Trials Registry, PACTR202110667430356. Registered on 8th October, 2021.

Comparison of the Efficacy of Rubber Band Ligation and Injection Sclerotherapy for 2nd Degree Hemorrhoids

ABSTRACT Background: There are different treatment options for hemorrhoids including rubber band ligation (RBL), sclerotherapy, and hemorrhoidectomy. Variable success rates have been reported for these procedures. The aim of this study was to compare the efficacy of RBL and injection sclerotherapy for 2nd degree hemorrhoids in a large group of samples from an unexplored population. Methodology: It was a randomized controlled trial. The study was conducted at the Department of Surgery, Khafji General Hospital, Khafji, Saudi Arabia, over the period of 14 months, from August 2014 to September 2015. Patients diagnosed with 2nd degree hemorrhoids were enrolled in the study and detailed medical history was taken. The patients were assigned to one of the two predesigned groups. One group was subjected to RBL for 2nd degree hemorrhoids and the other group was treated with injection sclerotherapy. The effectiveness of procedures was recorded on a postprocedure follow-up visit three months later. Results: A total of 720 patients were included in this study, 360 each in band ligation and sclerotherapy groups. Overall, relief of symptoms was observed in 504 (70%) patients. In band ligation group, 272 (75.56%) patients reported relief of symptoms and 232 (64.44%) patients reported relief of symptoms in the sclerotherapy group (P = 0.001). Conclusion: This study showed that band ligation treatment options lead to a significant relief of symptoms and bleeding per rectum in patients with 2nd degree hemorrhoids.