Excision Of Hemorrhoids Research Articles

Psychological states could affect postsurgical pain after hemorrhoidectomy: A prospective cohort study.

Open hemorrhoidectomy is one of the standard procedures for grade IV hemorrhoids. Postsurgical pain is a common problem for patients. We aim to prospectively evaluate potential factors affecting postoperative pain among hemorrhoidectomy patients. An observational study was conducted on 360 patients who had undergone Milligan-Morgan open hemorrhoidectomy. Details of the surgery and baseline information were recorded. Preoperative anxiety and depression were analyzed via the self-rating anxiety scale 20 (SAS-20) and self-rating depression scales 20 (SDS-20), respectively. Postoperative pain score was performed daily after surgery until the patient was discharged. The numerical pain score was evaluated by the visual analogue scale (VAS). The association between preoperative psychological states (anxiety or depression) and postoperative pain was analyzed using a generalized additive mixed model. A total of 340 patients eventually provided complete data and were included in our study. The average age was 43.3 ± 14.4 years, and 62.1% of patients were women. In total, 14.9% of patients had presurgical anxiety and 47.1% had presurgical depression. Postsurgical pain reached a peak point 1-2 days after surgery and went down to a very low level around 4-5 days after surgery. More excision of hemorrhoids could lead to more pain experience after surgery. Presurgical depression was associated with postsurgical pain. Patients who had presurgical depression had higher pain scores after surgery (2.3 ± 1.9 vs. 3.3 ± 1.9, p = 0.025). Preoperative depression and the amount of excisional hemorrhoids are positively related to postsurgical pain.

Surgical Outcomes of Ligation and Excision of Hemorrhoids

結紮切除術（LE）はあらゆる形態の内外痔核や随伴病変がある痔核にも対応できる術式であり，汎用性は高く肛門外科医として習得すべき手技の1つであるが，他の治療法と比較して疼痛，出血，狭窄などの合併症や技術習得に時間を要するなどの問題点もある．

The Impact of Antithrombotic Medications on Postoperative Bleeding Events Following Hemorrhoidectomy.

Bleeding complications are a risk associated with hemorrhoid procedures. Despite the prevalence of anticoagulant and antiplatelet therapies, including newer direct oral anticoagulants (DOACs) in the aging patient population there is a paucity of data regarding the impact of the use of antithrombotic therapy (AT) especially DOACs, on bleeding complications of hemorrhoid procedures. We retrospectively reviewed charts of patients who had undergone a total of 1152 procedures, including hemorrhoid excision and ligation, at a single institution in the years 2016-2018. We noted whether they were prescribed AT, the indication for therapy, perioperative medication management, whether a PBE occurred, and how the PBE was managed. PBE's were noted in 5.92% of patients on ATs, as opposed to 2.66% of patients not on ATs (P = .014.) The odds ratio of having a PBE when on ATs vs not on ATs is 2.3 (95% CI 1.21 to 4.38, P = .011). Seven out of 40 (17.5%) total PBE's required hospital admission or repeat procedure, and this was not associated with AT use. Surprisingly, although males represented most of the patients on ATs, females were statistically more likely to have a PBE following a hemorrhoidectomy if on ATs. Patients on AT have an elevated risk of PBE compared to patients not on AT. No significant difference was found between the two groups when considering only those PBE's severe enough to require hospital admission or repeat procedure. Further research is required to establish clear guidelines regarding the perioperative management of AT for hemorrhoid procedures.

A new technique for surgical haemorrhoidectomy without post-operative complication: A case series

IntroductionHemorrhoids are a common coloproctology problem and among 10% of cases need surgical intervention. However, the established surgical interventions still have many complications. Case presentationWe reported three female patients, who presented with circular 3rd degree internal hemorrhoids. The surgical treatment was performed with pre-operative anal dilatation using a 33 mm dilator for 20 minutes, followed by triangle incision above the dentate line. The hemorrhoid excision was performed, and the wound was sutured with simple interrupted radial sutures using a multifilament absorbable 3-0 thread. There were neither complaints of pain, bleeding, anal incontinence, anal stenosis, wound dehiscence, nor recurrence at the first, second, and fourth weeks of follow-ups in all patients. DiscussionPost-operative bleeding, pain, and anal incontinence are common after an open hemorrhoidectomy, while suture breakage and anal stenosis were reported after the old technique of closed hemorrhoidectomy. Stapled hemorrhoidectomy had less complications but requires a relatively more expensive cost for the device itself. We performed a combination of preoperative anal dilatation, above dentate line triangle incision, and simple interrupted radial sutures to treat the patients with 3rd degree internal hemorrhoids, which resulted in no post-operative complications within the first month of follow-up. ConclusionA combination of preoperative anal dilatation, above dentate line triangle incision, and radial suture technique is a simple and effective surgical option for treating a 3rd degree hemorrhoid.

Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery.

Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model. A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity. Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014-2016. All face and content validity measures achieved a median score greater than 4 (range 4.0-5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477s and transverse closure: 79 vs. 192s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons). Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

External hemorrhoidal thrombosis in the elderly patients: conservative and surgical management.

External hemorrhoidal thrombosis is a common disease with an acute anal pain as the major symptom. It is astonishing the lack of studies which investigates the most effective treatment and there are not guidelines. Furthermore, nobody has ever evaluated this peculiar condition in an elderly population. We have considered 87 patients aged >75 years who were visited and treated for this condition in our clinic, dividing them in three groups according the curative option chosen together with them after anamnesis and an interview: a conservative medical treatment (Group A), an immediate incision and evacuation of the thrombus (Group B) and the excision of hemorrhoid with the thrombus, with hemorrhoidectomy technique (Group C). The mean follow-up was 12.3 months. We analyzed immediate pain relief and time of remission of symptoms, bleeding, recurrences and major complications. The Group A presented a remission of symptoms in 11.8 days, Group B in 1.58 ad Group C in 7.8 days. The recurrence rate was very similar for the first two options (19.4% and 16.1%) and lower in the excision group (no recurrence during follow-up). Bleeding is the common adverse event observed with a high frequency in the immediate incision and evacuation of thrombus, less common in hemorrhoidectomy, that did not present major complication. Surgical option is often refused by elderly patient evaluating comorbidities in the fear of adverse events. The surgical treatment for EHT in elderly is safe and effective, but not the most common choice for fear of complications. Medical treatment or immediate incision of thrombus can be preferred and well accepted by elderly even if followed by a higher rate of recurrences.

Haemorrhoids-Current Management Overview

Symptomatic haemorrhoidal disease is a common ailment in the western world. Common symptoms are bright red bleeding, pruritus, hygiene issues and prolapse. Visual inspection and digital rectal examination usually confirm the diagnosis, assisted by procto-sigmoidoscopy to evaluate the internal extent. Management options range from conservative measures to a variety of outpatient and surgical procedures. Outpatient treatments include injection sclerotherapy, rubber band ligation (RBL). Surgical options include hemorrhoid excision, Doppler guided ligation of the feeding haemorrhoidal vessels by haemorrhoidal artery ligation operation (HALO), transanal haemorrhoidal dearterialisation (THD) or stapled haemorrhoidopexy. Excision is usually the treatment of choice where haemorrhoids are irreducible and largely external, or particularly where there is a large skin tag element. There is an increasing trend towards minimally invasive treatment methods which aim to not only preserve function but enable an enhanced recovery.

Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire.

Dear Editor, We read the article entitled ‘Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire’ by Erdoǧdu and friends published in the last issue of Ulusal Cerrahi Dergisi (Ulusal Cer Der 2013; 29: 59–62) with great interest (1). We presume that the author thinks “stapled hemorrhoidectomy” process is the same process as “stapled hemorrhoidopexy“. The procedure is named as stapled hemorrhoidectomy in the title, as “stapled hemorrhoidopexy” in the introduction, and as “stapled hemorrhoidectomy “ in material and methods section. In fact, these two definitions describing different surgical procedures also have different meanings according to their terminology (Hemorrhoidectomy; excision of hemorrhoids - hemorrhoidopexy ; hanging of hemorrhoids), and we see that they are used as synonyms in the literature. The aim of this letter is to correct this misperception and emphasize that the term that best describes the procedure is “stapled hemorrhoidopexy”. Koblandin and Schalkow from Kazakhstan, first described excision of hemorrhoids with circular stapler in 1981 (2). First publication on this subject from Europe was by Allegra in 1990, where he described anal purse-string stitches by finger retraction of the anal region followed by hemorrhoidectomy with circular stapler (3). In both studies, the methods described stapled excision of hemorrhoids, thus stapled hemorrhoidectomy (4). However, in stapled hemorrhoidopexy a hemorrhoidectomy is not performed, instead an annular tissue containing mucosa and submucosa layers from the proximal of internal hemorrhoids is removed. In this way, both hemorrhoidal arterial and venous devascularization and fixation of hemorrhoids to their anatomical location are provided. The purpose of this procedure is to hang the hemorrhoids to their original location and to reduce their blood supply, rather than removing them (4). The literature published in the first five years following implementation of this surgery, various terms like stapled hemorrhoidectomy, stapled anopexy, the Longo procedure has been extensively used in addition to “stapled hemorrhoidopexy”. In order to prevent using different names for the same surgery the consensus study published in 2003 suggested that the method should be defined as “stapled hemorrhoidopexy” (5). Currently this recognition is mostly complied. We believe preferring this terminology in publications originating from Turkey is important to avoid any further confusion and to show that we carry the correct point-of-view.

The use of a detachable anvil enables an easier and safer stapled hemorrhoidopexy

Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks. Hemorrhoidopexy, an alternative treatment for hemorrhoids introduced in the late nineties, replaced hemorrhoid excision by a reduction of the hemorrhoids to their normal anatomical position, via an excision of a mucosal ring above the internal hemorrhoidal cushions. The latter excision results in minimal or no postoperative pain. In 2010, a new variant of the hemorrhoidopexy set was introduced in the European market. The variations of this set, including a detachable anvil and a lined proctoscope, aid the surgeon in performing an easier and safer hemorrhoidopexy.

Circumferential Excisional Hemorrhoidectomy for Extensive Acute Thrombosis: A 14-Year Experience

Recurrence and/or complications after 3-quadrant hemorrhoidectomy or stapled hemorrhoidopexy still remain a challenging problem. This challenge is even greater for massive hemorrhoidal thrombosis leading to edema, ulceration, and/or gangrene. To address this challenge, we developed a further modification of the Whitehead procedure termed circumferential excisional hemorrhoidectomy. The proposed procedure allows access to a submucoanodermal/skin workspace that provides a "view from inside" the hemorrhoidal disease, and therefore facilitates the precise excision of even each hemorrhoidal vein while preserving the overlying normal tissues. This study aimed to describe the circumferential excisional hemorrhoidectomy procedure and to demonstrate its results in patients presenting with total hemorrhoidal thrombosis. DESIGN, SETTINGS, PATIENTS: This prospective, descriptive study was conducted with 294 consecutive patients who underwent urgent circumferential excisional hemorrhoidectomy at our coloproctological center from January 1996 to June 2009. Circumferential excisional hemorrhoidectomy involves the stripping and excision of hemorrhoids from the submucoanodermal space with reconstruction of the anal canal by the use of an undermined irregular/zigzag-shaped mucoanodermal flap and accurately trimmed skin. The main outcome measures were the surgical outcomes and complications. The mean patient age was 41.7 for both sexes. There were 215 men and 79 women. The mean operative time was 26.4 (range, 17-43) minutes. In terms of postoperative complications, there were 39 (13.2%) urinary retentions, 1 (0.3%) fecal impaction, and 3 (1%) delayed complete wound epithelization. The mean hospital stay was 3.1 (range, 2-5) days, and the mean time off from work was 10 (range, 7-18) days. At the fifth week after surgery, digital rectal examination revealed easily dilated mild stricture in 26 (8.8%) patients. At a mean follow-up of 6.8 (range, 2-14) years, 271 (92.2%) accessible patients were actually symptom-free. This study did not have a control group. Circumferential excisional hemorrhoidectomy is an anatomically safe surgical procedure with a low rate of complications and no recurrences, even after a long-term follow-up.

Factors associated with incontinence following anorectal procedures

To investigate the factors associated with postoperative fecal incontinence after anorectal procedures. A total of 1074 patients underwent anorectal procedures in the Department of Colorectal Surgery at the Coloproctology Hospital of Shenyang. Factors associated with postoperative fecal incontinence were analyzed retrospectively. Follow-up was available in all the patients. One hundred and forty-four(13.4%) patients developed mild incontinence, and 57(5.3%) moderate incontinence. There was no complete incontinence. The overall incontinence rate was 18.7%. The incontinence rate was 41.8%(107/256) after fistula procedures, higher than that after hemorrhoid procedures(12.4%,73/591) and fissure procedures(9.2%,21/227), and the differences were statistically significant (P<0.01). Among 490 patients who received injection therapy for internal hemorrhoids, patients who received 10 ml of Xiaozhiling or more had a mild incontinence rate of 10.4%(27/259) and a moderate incontinence rate of 2.3%(6/259), and in those who received less than 10 ml of Xiaozhiling, the mild incontinence rate was 9.5%(22/231) and moderate incontinence rate was 4.3%(10/231). The differences were not statistically significant (all P>0.05). In 354 patients who underwent hemorrhoidectomy, the mild incontinence rate and moderate incontinence rate were both 14.1% in those who had excision of 3 or more hemorrhoids, and were 3.9%(11/283) and 2.1% (6/283) in those who had excision of less than 3 hemorrhoids, and the differences were statistically significant (P<0.01). There was no difference in Incontinence rate was not associate with fistula or fissure procedure (P>0.05). The incidence of incontinence is high after fistula procedures. Excision of hemorrhoids should not exceed 3 hemorrhoids. Wider adoption of injection therapy is encouraged.

Does Intrathecal Morphine Sulfate Provide Preemptive Analgesia for Patients Undergoing Stapled Hemorrhoidopexy?

Surgical excision of hemorrhoids is characterized by a prolonged and painful postoperative course. This double-blind, randomized, prospective, controlled trial was conducted to determine if morphine sulfate provides additional pain relief after stapled hemorrhoidopexy when added to a standard lidocaine spinal anesthetic. It was hypothesized that the addition of morphine sulfate to a spinal anesthetic would decrease postoperative pain. Thirty-four patients were randomized prospectively to receive a spinal block with either lidocaine or lidocaine plus morphine sulfate. Patients were followed postoperatively for 42 days to record Numeric Pain Scale (NPS) values and to record analgesic use. Patients also filled out a Short Form 36 (SF-36) Health Survey Questionnaire preoperatively and at days 3, 14, and 28 after their operation to assess physical and mental well-being. Longitudinal mixed models were used to determine whether there was a difference in maximum pain, average pain, narcotic analgesic use, and physical or mental well-being over time. No group differences were found in maximum or average NPS, analgesic use, mental well-being, or time to complete pain relief. There was a four-point difference in mean scores for physical well-being, favoring the lidocaine plus morphine group. This study provides evidence that intrathecal morphine sulfate does not significantly alter postoperative pain, narcotic use, or well-being when used as preemptive analgesia for patients undergoing stapled hemorrhoidopexy.

Efficacy of the procedure for prolapse and hemorrhoids combined with external hemorrhoids excision in the treatment of III or IV mixed hemorrhoids

To investigate the efficacy of the procedure for prolapse and hemorrhoids (PPH) combined with external hemorrhoids excision in the treatment of III or IV mixed hemorrhoids. One hundred and twelve patients with III or IV mixed hemorrhoids admitted for surgical treatment were randomly divided into three groups: PPH 1 group (34 cases), PPH2 group (36 cases), and Milligan-Morgan group (42 cases). PPH1 group received the standard PPH operation, PPH2 received PPH and external hemorrhoids excision, and Milligan-Morgan group received Milligan-Morgan hemorrhoidectomy. Postoperative 24 h-pain index, pain index when defecating, bleeding, anal discomfort feeling , wound edema, the ability of controlling feces, operating time, hospitalization time and charges were recorded. The change of anal dynamics was detected by anorectal manometry. All the patients were followed-up for 0.5-1 year. There were no significant differences among the three groups in bleeding, anal discomfort feeling, the ability of controlling feces (P>0.05). The postoperative 24 h-pain index of PPH1 group was lower than those of the other two groups (P<0.05). PPH1 group and PPH2 group were better than Milligan-Morgan group in pain index when defecating, wound edema, operating time, and hospitalization time (P<0.05). Milligan-Morgan group was better than the other two groups in postoperative urinary retention and hospital charges (P<0.05). The change of anal duct pressure of Milligan-Morgan group was less than those of the other two groups (P<0.05). Within 0.5-1.0 year follow-up, 3 patients got thrombosed external hemorrhoid in PPH1 group, 2 patients recurred and 1 patient got thrombosed external hemorrhoid in Milligan-Morgan group, no recurred patients in PPH2 group. PPH combined with external hemorrhoid excision is a safe and effective treatment for mixed hemorrhoids, which is suitable for mixed hemorrhoids with severe external hemorrhoids.

A Comparison of Open versus Closed Techniques Using the Harmonic Scalpel in Outpatient Hemorrhoid Surgery

Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third- and fourth-degree hemorrhoids. The resulting mucosal defect is then left open or sutured closed depending on surgeon preference. The purpose of this study was to compare the open vs. closed techniques of hemorrhoid excision using the Harmonic Scalpel in an outpatient setting. From July 2000 through October 2001, 42 patients underwent surgical excision of complex grade III or grade IV hemorrhoids via the Harmonic Scalpel with closure of the overlying mucosa (closed), and without closure of the overlying mucosa (open). Quality of life was assessed using the Short Form-36 survey. Both groups were comparable in terms of patient demographics and type of anesthesia. There were no late complications. Mean follow-up was 16.9 (range, 12-27) months. Leaving the mucosal defect open following Harmonic Scalpel hemorrhoidectomy significantly reduces operative time, and thus operative costs, without diminishing quality of life. Although morbidity was equivalent, this requires further evaluation with a prospective study to ensure patient safety.

Acute Hemorrhoidal Crisis

Acute hemorrhoidal crisis results from prolapse, incarceration, and thrombosis of internal or external hemorrhoids. Treatment can range from observation to outpatient treatment, which is limited to excision of symptomatic quadrants, or inpatient surgery, which can include multiple quadrant hemorrhoidectomy. While emergency hemorrhoidectomy has complications rates that are similar to elective surgery, the degree of hemorrhoid excision during an acute crisis depends on the patient’s disease burden and overall state of health. If a patient has both internal and external components of thrombosis and prolapse, an extensive hemorrhoid excision is associated with increased rates of anal stenosis. Alternatively, limited hemorrhoidectomy in the setting of isolated external thrombosis may leave hemorrhoidal disease untreated and allow for recurrence of an acute crisis. In addition, certain patient populations suffer from increased rates of hemorrhoid disease or may be at increased risk for surgical intervention. Treatment strategies should include consideration of these variables before a specific treatment course is recommended. Overall, hemorrhoidectomy during acute hemorrhoidal crises can result in rapid relief of symptoms. The extent of hemorrhoidectomy may be limited to symptomatic quadrants with further elective surgical intervention if required.

Is There Any Benefit from Laser Excision of Hemorrhoids?

Journal of Clinical Laser Medicine & SurgeryVol. 12, No. 6 Is There Any Benefit from Laser Excision of Hemorrhoids?NAOMI PFEIFFERNAOMI PFEIFFERSearch for more papers by this authorPublished Online:29 Apr 2009https://doi.org/10.1089/clm.1994.12.341AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Is There Any Benefit from Laser Excision of Hemorrhoids?." , 12(6), pp. 341–342FiguresReferencesRelatedDetails Volume 12Issue 6Dec 1994 To cite this article:NAOMI PFEIFFER.Is There Any Benefit from Laser Excision of Hemorrhoids?.Journal of Clinical Laser Medicine & Surgery.Dec 1994.341-342.http://doi.org/10.1089/clm.1994.12.341Published in Volume: 12 Issue 6: April 29, 2009PDF download

Comparative study between transcutaneous electrical nerve stimulation and analgesic in the treatment of post operative anal pain

Acute hemorrhoidal crisis results from prolapse, incarceration, and thrombosis of internal or external hemorrhoids. Treatment can range from observation to outpatient treatment, which is limited to excision of symptomatic quadrants, or inpatient surgery, which can include multiple quadrant hemorrhoidectomy. While emergency hemorrhoidectomy has complications rates that are similar to elective surgery, the degree of hemorrhoid excision during an acute crisis depends on the patient’s disease burden and overall state of health. If a patient has both internal and external components of thrombosis and prolapse, an extensive hemorrhoid excision is associated with increased rates of anal stenosis. Alternatively, limited hemorrhoidectomy in the setting of isolated external thrombosis may leave hemorrhoidal disease untreated and allow for recurrence of an acute crisis. In addition, certain patient populations suffer from increased rates of hemorrhoid disease or may be at increased risk for surgical intervention. Treatment strategies should include consideration of these variables before a specific treatment course is recommended. Overall, hemorrhoidectomy during acute hemorrhoidal crises can result in rapid relief of symptoms. The extent of hemorrhoidectomy may be limited to symptomatic quadrants with further elective surgical intervention if required.

Classic articles in colonic and rectal surgery. Walter Whitehead 1840-1913: The surgical treatment of haemorrhoids.

Walter Whitehead was born in 1840 at Haslem Hey, Bury, where his father's family had resided for more than 200 years. For a short time, he worked for his father in the bleaching business, but at the age of 19, he decided that he would prefer to enter the medical profession. His initial practice was in Manfield where he organized a small cottage hospital, but in 1867, he was appointed to the St. Mary's Hospital for Women and Children in Manchester. He became actively involved in many charities and organizations devoted to the protection of infants, and, in 1871, was called upon to give evidence before the Committee of the House of Commons on a Bill for the Protection of Infant Life. In 1870, he founded, and for a time served as Editor of theManchester Medical and Surgical Reports, a periodical which contained papers contributed chiefly by local members of the profession. In 1885, he was elected President of the Manchester Medical Society, and at his inaugural address attracted much attention for the first time recognizing the increased incidence of cancer. Doctor Whitehead's operative technique seemed to be characterized by originality as well as a certain simplified approach, often using scissors only. An example of these traits is seen in the two operations which to this day bear his name—his method of excising the tongue, and the other, of course, excision of hemorrhoids. His hemorrhoidectomy was severely criticized in his own day because of the characteristic “deformity”. Even today, the value of his operation continues to be debated. However, many surgeons continue to employ his technique in the primary treatment of hemorrhoidal disease. The following article is his procedure, as it was published inThe British Medical Journal in 1882.

Exstrophy of rectal mucosa

1. 1. Exstrophy of the rectal mucosa may produce crippling symptomatology. 2. 2. It may be a late complication of the radical excision of hemorrhoids or even follow simple hemorrhoidectomy injudiciously performed. 3. 3. Usually it may be avoided by a more careful selection of cases and a more thorough training for surgeons. 4. 4. A plastic operation for its cure is described together with three variations in technic.