External Hemorrhoids Research Articles

Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study.

To date, there have been no reports on the long-term effects of a method that combines external hemorrhoidectomy with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy. This study aimed to investigate the efficacy and safety of external hemorrhoidectomy combined with ALTA sclerotherapy (EA) in reducing postoperative complications associated with conventional hemorrhoidectomy. EA was performed under sacral epidural anesthesia, and ALTA sclerotherapy was applied to the remaining internal hemorrhoids after resection of the external hemorrhoids. Mixed internal and external hemorrhoids were treated with EA, whereas internal hemorrhoids without external hemorrhoids were treated with ALTA sclerotherapy. The three EA patterns were defined as EA1, EA2, and EA3, depending on the number of EAs performed. This study included 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids. EA1 was the most common, with 1,789 (52.6%) cases, followed by EA2 (36.2%) and EA3 (11.2%). Postoperative complications occurred in 120 (3.5%) patients and increased with the number of EAs, with fever and bleeding being common in the early postoperative period, and perianal abscess and/or fistula being common after 1 month. The mean postoperative follow-up period was 26.4 months, and 136 (4.0%) patients underwent reoperation for recurrent internal or mixed hemorrhoids. The reoperation rate for EA1 was significantly higher than that for EA2 and EA3. The 5- and 10-year cumulative recurrence-free rates were 92.5% and 67.2%, respectively. EA is as curative as conventional hemorrhoidectomy and reduces postoperative complications. Therefore, EA is the preferred procedure for patients with mixed hemorrhoids.

High-grade diffuse large B cell non-Hodgkin lymphoma involving the mucosal hemorrhoid tissue: A case report

Non-Hodgkin's lymphomas are a diverse group of immune system cancers that can affect any organ in the body. Few reports describe the development of malignant lymphoma in internal or external hemorrhoids. We present the case of a 67-year-old female with a long-standing history of non-bleeding, prolapsing hemorrhoids, and recent significant weight loss. Following an excisional hemorrhoidectomy, pathological analysis revealed high-grade diffuse large B-cell non-Hodgkin lymphoma (DLBCL) involving the mucosal hemorrhoid tissue. The case underscores the importance of considering malignancy in atypical presentations of common conditions. Treatment for anal canal lymphomas remains uncertain, with medical management generally preferred over surgery. Accurate diagnosis requires histopathologic examination due to the overlap of clinical features with other pathologies.

A case of Russell body gastritis associated with psychiatric disorder

Abstract Introduction/Objective Russell body gastritis is a benign and rare entity characterized by infiltration of lamina propria with plasma cells stuffed with spherical eosinophilic cytoplasmic inclusions known as Russell bodies which represent immunoglobulins. Russell bodies accumulate due to dysfunction in secretion pathway of plasma cells. Plasma cells with Russell bodies are also termed Mott cells. Although exact etiology is unknown, but it can be seen in association with other conditions like mucosa associated lymphoid tissue (MALT) lymphoma, multiple myeloma and plasmacytoma. This condition most commonly affects the antrum and may present as erythema or sometimes nodular lesion. Definitive diagnosis is based on histology. Methods/Case Report A middle-aged male with past medical history significant for polysubstance use disorder, bipolar disorder, and osteoarthritis was evaluated for bleeding per rectum and dyspepsia in the setting of chronic nonsteroidal anti-inflammatory drugs (NSAID) and ethanol use. Physical examination was remarkable for an external hemorrhoid and complete blood count showed anemia. Upper GI endoscopy and colonoscopy was performed. Patchy erythema was seen in antrum and duodenal bulb, and colonoscopy was unremarkable. Microscopic examination showed numerous plasma cells with Russell bodies (Mott cells) in the lamina propria and mild chronic inflammation in gastric mucosa. H. Pylori was negative by immunohistochemistry (IHC). Plasma cells were polyclonal and positive for CD138, and negative for cytokeratin which excluded plasmacytoma and signet-ring adenocarcinoma, respectively. Patient was placed on proton pump inhibitor therapy and discharged. Results (if a Case Study enter NA) Russell body gastritis can be seen in patients with and without H. Pylori infection. Cytokeratin, kappa and lambda immunohistochemistry stains, and gene rearrangement studies may be needed to exclude frequent lesions that may enter in the differential diagnosis. Long term effects and clinical significance of russell bodies accumulation is yet to be determined. Conclusion Russell body gastritis is a rare morphologic variant of chronic gastritis that may enter in the differential diagnosis with other more serious lesions. A careful morphologic examination and occasionally IHC stains / molecular studies are needed to make the correct diagnosis.

EP165 - It is not just a perianal wart! A rare case of perianal lesion

Abstract Perianal skin lesion is a common presentation with a wide range of differentials, including thrombosed external haemorrhoids, perianal abscess, perianal warts, lipoma and sebaceous cysts. Malignant lesions such as squamous cell carcinoma are uncommon but should be considered. Hereby, we present a diagnostically challenging case of a benign looking perianal lesion that ultimately revealed a rare condition. A 50-year old lady presented with a one-year history of perianal lump accompanied with intermittent pain, fresh bleeding and pus-like discharge. A digital rectal examination revealed a well-demarcated 4mm fleshy skin lesion, 2cm from anal verge at 7 o’clock position without surrounding area of inflammation. No lymph nodes were palpable on both groins. Differentials as mentioned above including an infected granuloma and fistula in-ano were considered. Pelvic MRI revealed a well-demarcated, benign-looking subcutaneous lesion. The lesion was excised under general anaesthesia and interestingly, the histopathology report revealed a diagnosis of Hidradenoma Papilliferum (HP) with no dysplasia or malignancy. Patient recovered well, reassured with the above findings and discharged home. HP is an uncommon, benign tumour that occurs in the anogenital region. It is more prevalent in Caucasian middle-aged females, as illustrated in our case. A definite diagnosis necessitates histopathological examination. The management includes a local excision of the lesion, and it is associated with good prognosis, with low chances of recurrence or malignant transformation. HP, although rare, should be included in the differentials of a perianal lump. A surgical excision or diagnostic biopsy should be performed at minimum.

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.

Computational Study and Evaluation of Lidocaine and Nitroglycerin Ointment for External Hemorrhoid Treatment

Computational Study and Evaluation of Lidocaine and Nitroglycerin Ointment for External Hemorrhoid Treatment

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.

Bilateral ovarian mature cystic teratoma co-existing with granulosa cell tumour: a case report

Background: Mature granulosa cell tumour (GCT) is a rare neoplasm. it accounts for about 1-2% of all ovarian tumours. Even more infrequent is the coexistence of GCT with mature cystic teratoma in the same ovary. Case presentation: A 53-year-old woman with constipation, abdominal swelling, and pain presented to our gynaecology clinic. Physical examination revealed a distended abdomen, ascites, cystocele, stress incontinence, and external haemorrhoids. A cystic teratoma co-existing with a granulosa cell tumour was diagnosed histologically. Adjuvant chemotherapy containing Cisplatin [75mg/m2] and Docetaxel [75mg/m2]) was completed, followed by radiotherapy. She has been clinically stable for two years and is currently on long-term follow-up to forestall recurrence. Conclusion: The coexistence of mature granulosa cell tumour (GCT) with mature cystic teratoma especially in the same ovary is an extremely rare pathology. Although total abdominal hysterectomy and bilateral salpingo-oophorectomy are the treatments of choice in postmenopausal and perimenopausal women, these may not always be feasible owing to the nature of the presentation. Adjuvant chemotherapy and radiotherapy may be beneficial as high cases of recurrence have been reported. Follow-ups are strongly advocated due to the recurrence that can occur even as late as 20 years following the removal of the primary neoplasm.

The study of the physicochemical properties of rectal cream samples with the carrot extract and rutin

The modern arsenal of drugs aimed at eliminating pathological processes of the anorectal zone, as a rule, consists of suppositories and soft drugs. When using suppositories, hemorrhoidal nodes may be injured, uneven distribution of the drug along the walls of the anal canal may be observed. In addition, with external and combined hemorrhoids, there is a need to apply the drug not only to the walls of the anal canal, but also to the perianal skin. Therefore, preference is given to the use of soft drugs since the process of their introduction is as easy as possible. Today, the pharmaceutical market of Ukraine has a wide range of products for the treatment of diseases of the anorectal zone, but the constant increase in the number of patients indicates that this problem has not been solved. Therefore, the study on the creation of a new rectal soft medicine that will have a complex effect on pathological processes and expand the range of domestic drugs for use in proctology is relevant. Aim. To substantiate the type of base for a soft rectal medicine by studying the organoleptic and physicochemical properties of the experimental samples. Materials and methods. The study objects were samples of a soft dosage form of various compositions and the reference drug “Procto-Glivenol Cream” (VAMPHARMA S.R.L., Italy). Samples on different carrier bases were examined by their organoleptic and textural properties; their colloidal and thermal stability, viscosity and pH were studied. Results and discussion. It has been found that the use of a sample on a gel base with Aristoflex does not ensure the presence of an optimal adhesive layer between the mucous membrane of the anorectal zone and the dispersion medium of the drug. The proxanol-188 sample does not have satisfactory thermal and colloidal stability indicators. The use of an emulsion base provides the necessary ability to spread over the surface, adhesion and cohesion. Conclusions. Therefore, for further research, it is advisable to use a sample of the rectal cream, which is an emulsion system.

The Gracilis Muscle Flap Technique is an Aesthetic and Functional Option in Fournier's Gangrene: Clinical Case

Introduction. The scrotum is a covering of skin that covers and protects the testicles. Although it is not common, some bacterial infections of this skin can extend to deep tissues and produce a severe entity known as Fournier's gangrene. Clinical case. A 62-year-old male patient arrives at the Emergency Department due to increased scrotal volume with extension to the perineal region associated with purulent discharge and fever for one week. The patient has type 2 diabetes mellitus of 10 years duration, with poor control despite consuming oral hypoglycemic agents. He has also had high blood pressure for two years, managed with Losartan 50 mg/day. They observed secretion from perianal fistula drainage and uncomplicated external hemorrhoids. Laboratories: Glucose 260 mg/dL, BUN 23 mg/dL, Urea 49.5 mg/dL, Cr 1.50 mg/dL, Leukocytosis 33.39 x 109/L, Hb 9.9 g/dL, Hct. 30.3%. Discussion. The management of Fournier's gangrene includes both pharmacological measures, such as the use of antibiotic therapy and surgical management. Autologous partial skin graft is one of the most used techniques due to its safety and versatility and the extensive availability of donor areas. The process consists of obtaining a portion of skin taken from a donor area, preferably the thighs, which is obtained with a dermatome, after which the graft is meshed, increasing its extension and increasing the surface to be covered. As for negative aspects, there is possibly an unaesthetic result and possible retractions. Despite this, most authors point to a good result with this technique.

Lower Gastrointestinal Bleeding in Patients with Liver Cirrhosis: Prevalence, Outcomes, and Correlation with MELD Score in an Indian Tertiary Care Facility

Background: Lower gastrointestinal bleeding (LGIB) is responsible for 25 percent of overall GI bleeding patients in the general population. In the US, the LGIB incidence is thought to be 21–27/100,000 per year, while the rate of hospitalization is thought to be 20–30/100,000 per year. According to reports, 2–4% of patients hospitalized with LGIB die. Despite the fact that upper GI complications associated with portal hypertension have received a lot of attention, few studies have explored lower GI complications. Objective: To study the prevalence and 28-day outcome of patients hospitalized with lower gastrointestinal bleeding in liver cirrhosis and its correlation with the model for end-stage liver disease (MELD). Method: A single center-based cross-sectional study was conducted for a duration of eighteen months. The main source of data is from patients hospitalized at the Department of General Medicine and Department of Medical Gastroenterology at the Institute of Medical Sciences and SUM hospital, with a minimum of 100 cases. Results: Out of 100 patients, internal hemorrhoids were observed in 50 patients, external hemorrhoids were found only in 1 patient, and rectal varices were present in 17 patients. The MELD score for the 28th day outcome was found to be 21.85 on follow-up. It was 27.0 in discharged patients by the 28th day. Conclusions: An essential element of the condition, portal hypertension, appears to be responsible for the poor prognosis.

Prevalence of hemorrhoids and associated risk factors among adult patients: a cross-sectional study in Saudi Arabia

Objective: This study aimed to determine the prevalence of hemorrhoidal illness in a representative sample of the general population from various regions of Saudi Arabia and analyze the features of patients with hemorrhoidal disease and how they were treated. Methods: A cross-sectional study was conducted among the adult population in the western region of Saudi Arabia that included all adult men and women who agreed to participate. A pretested questionnaire was used to collect data. Result: The study enrolled 380 participants, most of whom were females (61.6%), whereas males counted for 38.4%. Most common type was external hemorrhoids (59.8%). Sedentary lifestyle was the leading risk factor (19.14%), followed by dehydration (14.49%). Conclusion: The prevalence of hemorrhoids was approximately 40% among participants, more commonly affecting women (more than 50%), with sedentary life as the most common risk factor and anal pain at the top of the associated symptoms list. It was suggested to run campaigns to educate people that it is a common disease and explain the different types and risk factors associated with hemorrhoids.

Is the combination of laser hemorrhoidoplasty and Ferguson hemorrhoidectomy superior to conventional surgical techniques in terms of postoperative pain in hemorrhoid patients? A retrospective comparative analysis

This study aimed to evaluate early and long-term results of three surgical methods (Ferguson hemorrhoidectomy, laser hemorrhoidoplasty, and the combined method), especially for pain management in hemorrhoidal disease. Between January 2018 and January 2020, 154 patients diagnosed with symptomatic grade II–III hemorrhoid disease were treated with three surgical techniques: (1) Ferguson hemorrhoidectomy (FH);(2) laser hemorrhoidoplasty (LHP); (3) combined (Ferguson hemorrhoidectomy + laser hemorrhoidoplasty) method. Patients were retrospectively evaluated for duration of surgery, recovery time of symptoms, postoperative pain, early and late complications, and recurrence. When the postoperative early and mid-term pain levels of the patients were compared, the results showed that patients treated with the Ferguson technique had the most severe pain scores after surgery at postoperative 6th, 12th, 24th hours, and 1st week, compared to the other techniques (LHP and combined method) (p < 0.001). The LHP method had the lowest pain levels when compared to the Ferguson and the combined methods (p < 0.001). The combined method had significantly lower pain scores than the Ferguson method in all periods after surgery (p < 0.001). Upon the development of postoperative perianal thrombosis in two patients in the LHP group, one patient underwent thrombectomy, and the other patient underwent medical treatment. There were two hemorrhoid disease recurrences, with a median follow-up period of 24 (12–36) months in the LHP group. In the FH group, reoperation and hemostasis were done for bleeding on the postoperative sixth day in one patient, and a Foley catheter was applied due to urinary retention in one patient. Two anal fissures were seen postoperatively in one month in the FH group and recovered with medical treatment. In patients with multiple hemorrhoid packages, the combined method can be better used safely and effectively, with significantly lower pain scores than the Ferguson method only.

Hybrid methods treatments for III and IV grade hemorrhoids

Aim: to evaluate hybrid techniques in patients with stage III and IV hemorrhoids.Patients and Methods: from January 2017 to December 2021, 154 patients with external and internal hemorrhoids of the 3rd and 4th stages were treated at the Moscow Medical Center “ON CLINIC”, including men — 118 (76.6%) and women — 36 (23.4%), aged of 45.8 ± 10.3 (27–72) years. The history of the disease was 8.8 ± 2.2 (5–15) years. All patients underwait transanal dearterialization with mucopexy. With its inefficiency, a hybrid operation technique was performed.Results: all patients were operated under spinal anesthesia in a one-day hospital. Operation time was 38.05 ± 4.7 (27–55) min. Postoperative pain syndrome on the first day was 34.1 (30–40) mm on the VAS scale, due to the elective use of Ketorolac tromethamine, 30.1 ± 1.2 (30–40) mg. By the 5–6th day, the pain syndrome decreased to 24.2 (20–30) mm and 15.3 (0–30) mm. Hospital stay was 24.5 ± 2.3 (21–38) hours. The mean period of disability was 12.8 ± 3.1 (10–14) days. When comparing the clinical results of treatment with a follow-up period of 29.9 months, there was no progression of the disease manifestation.Conclusion: the use of hybrid techniques in the treatment of complex forms of hemorrhoids allows to minimize trauma of the anal canal and to reduce the rehabilitation period.

Sodium picosulfate in the clinical practice of a surgeon

Picosulfate, a diphenylmethane derivative, belongs to a group of drugs called stimulant laxatives. It is widely used in surgery to treat various colon evacuation disorders due to its effectiveness, safety of use and ease of dosage selection, as well as the option to combine with other laxatives. It is administered much more frequently for colorectal cancer screening, when the colon is prepared using sodium picosulfate combined with other osmotic laxatives, most often polyethylene glycol, which allows to use smaller volumes of solution. According to the literature, this method for cleaning the colon is used most often, which is associated with better adherence of patients to the intake of small volumes of liquid, as shown by our observations. The article highlights the literature data, and the authors also present their own experience – a clinical case report of the treatment of a 30-year-old patient diagnosed with grade I external and internal hemorrhoids. Laser ablation of internal and excision of external hemorrhoids was performed under local anesthesia. Regulax® Picosulfate was included in the therapy in the postoperative period, along with topical and pain relief drugs. As a result, the patient had a comfortable, not very painful bowel movement on the following day after the surgery. The laxative was used to manage stool for a week. In conclusion, the authors draw attention to the fact that increased patient compliance in preparing the colon for examination leads to better cleaning and more informative results during colonoscopy. Therefore, Regulax® Picosulfate combined with other laxatives to prepare a patient for examination, in particular colorectal cancer screening, where it is used most often, applies to a huge number of patients, so the problem of further study of its use is socially significant.

A Review of a selected Ayurvedic herbal formula in the management of Thrombosed External Hemorrhoids (Bāhya Arshas): A critical analysis

Thrombosed external hemorrhoids (Bāhya Arshas) present a painful and debilitating condition affecting individuals across various socio-economic strata. The affliction's distressing symptoms, including severe bleeding, inflammation, and thrombosis, can disrupt daily activities. Mimosa pudica and Curcuma longa have been traditionally combined into a paste, offering potential relief. This review critically examines the effectiveness of this Ayurvedic herbal paste formula in treating thrombosed piles. Informed by Ayurvedic scriptures, contemporary texts and prior research, comprehensive insights into thrombosed piles were gathered. The two herbs featured in the paste were thoroughly investigated through a survey of literature, assessing their Pancha Padārtha (five elements of the herb) and pharmacological attributes relevant to management of Bāhya Arshas. Analysis of Ayurvedic Pancha Padārtha showed positive impact on derangement of Dōsha involved in Bāhya Arshas and the herbal formula's anti-pile properties, stemming from their alignment with anti-inflammatory, anti-coagulant, and analgesic effects. Numerous studies underscore the anti-pile potential of this herbal formulation, while supplementary attributes that alleviate thrombosed piles' symptoms were also highlighted. Considering both the literature review and Pancha Padārtha analysis, it is evident that the selected herbal formula holds promise for managing thrombosed piles. This investigation sheds light on the therapeutic potential of an Ayurvedic approach in addressing the challenges posed by thrombosed external hemorrhoids.

Clinical efficacy of Jaloukavacharana (Leech Therapy) in Thrombosed External Haemorrhoids – A Case Study

Jalaukavacharana or Leech therapy is medicinal leech therapy which is used in a variety of inflammatory conditions. It is indicated in Raktaja and Pittaja Vikaras. Its mode of action depends on the injection of leech saliva into patient's tissues during the process of blood sucking. Leech’s saliva contains numerous bioactive constituent which possesses anti-inflammatory, analgesic, thrombolytic, anti-coagulant and blood circulation enhancing properties. Thrombosed hemorrhoid is an emergency condition that occurs due to high venous pressure associated with severe pain in the anus. In the present study a thrombosed external haemorrhoids is managed with Jaloukavacharana and its efficacy was observed.

EFFECT OF JALAUKAVACHVARANA IN THROMBOSED HAEMORRHOID: A CASE STUDY

Haemorrhoids are a prevalent anorectal condition. It is of two types: Internal and external. A thrombosed haemorrhoid is a variety of external haemorrhoids in which there is painful swelling in anal tissue caused by a clot in a small vein of the anal skin. Case presentation: A 35 year old male patient visited OPD with complaints of protrusion of mass outside the anal region, constipation and pain during defecation. Routine clinical examinations and investigations are done. Diagnosis and management: Based on clinical examination, the case was diagnosed as thrombosed haemorrhoids and suggested for Jalaukavacharana on an OPD basis. The treatment aims to relieve the pain and reduce the inflammation. Outcome: There is marked improvement in thrombosed haemorrhoids. The inflammation is reduced with relief from pain. Discussion: Satisfactory results were obtained with a decrease in the size of haemorrhoids and relief from pain. This case highlights that Jalaukavacharana is a very effective treatment for thrombosed haemorrhoids.

Local excision versus thrombectomy in thrombosed external hemorrhoids: a multicenter, prospective, observational study

BackgroundAvailable guidelines describing the procedural treatment of thrombosed external hemorrhoids (TEH) rely solely on expert opinion. We aimed to compare local excision (LE) and thrombectomy (incision) in terms of treatment success, factors affecting success, and outcomes.MethodsThis was a multicenter, prospective, observational study conducted in eight centers from September 2020 to September 2021. A total of 96 patients (58 LE, 38 thrombectomy) were included. Risk factors, demographics and clinical characteristics were recorded. Follow-up studies were scheduled for the 1st week, 1st, 3rd and 6th months. Surgical success was assessed at 1 month. Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale (SHS) were applied at baseline and the 6th month. Wexner fecal incontinence score was applied at all follow-up studies.ResultsOverall mean age was 41.5 ± 12.7 years. At baseline, groups were similar with regard to demographics and disease severity (HDSS) (p > 0.05 for all). Success was relatively higher in the thrombectomy group (86.8%) compared to the LE group (67.2%) (p = 0.054). Constipation and travel history were significantly associated with lower likelihood of LE success. Symptoms during follow-up were similarly distributed in the groups. Both methods yielded significant improvements in HDSS, SHS and Wexner scores; however, SHS scores (6 months) and Wexner scores (all time points) were significantly better in the thrombectomy group.ConclusionThe in-office thrombectomy procedure may have better short-term outcomes compared to LE in terms of relative success, recurrence and quality of life–despite the fact that success rates were statistically similar with the two interventions. LE may yield particularly worse results in patients with constipation and travel history; thus, thrombectomy appears to be especially advantageous in these patient subsets.

Diagnosis and treatment of external hemorrhoids on an outpatient basis

Diagnosis and treatment of external hemorrhoids on an outpatient basis