External Hemorrhoids Research Articles

Occlusion of rectal arteries in the treatment of recurrent hemorrhoidal disease after transanal surgical interventions

The article presents data on variant X-ray anatomy of the superior rectal artery and types of arterial architectonics of the rectum. The causes of recurrent hemorrhoidal disease after traditional transanal surgical interventions are highlighted. The possibilities of endovascular occlusion of rectal arteries in the treatment of relapses of chronic hemorrhoids are shown. Its technical variants are given depending on the number of hemorrhoidal arteries and types of arterial architectonics of the rectum.Over a 2-year period, clinical results of endovascular occlusion of hemorrhoidal arteries were evaluated in 11 patients with relapse of the disease after various transanal interventions: after latex ligation of internal hemorrhoids – in 5, transanal desarterization of internal hemorrhoids with mucopexia – in 4, hemorrhoidectomy – in 2. The average age of patients was 44.2 ± 12.5 years. Men – 5, women – 6. Superselective occlusion of the target hemorrhoidal branches of the upper rectal artery was performed with EmboGold (Merit Medical) microparticles, 500–700/300–500 mkm in size. Immediate results: cessation of bleeding on the first day – in 4 patients, after 3 days – in 5, after 7 days – in 2. Terms of hospitalization – 1 day, disability – 4.3 ± 0.7 days. Long-term results (from 1 to 2 years) were observed in all 11 patients. The course is relapse-free.As an illustration, a clinical case is presented – successful treatment of a patient with recurrent hemorrhoidal disease by endovascular occlusion of hemorrhoidal arteries after five traditional transanal surgical interventions: sclerosing, ligation, dearterization of internal hemorrhoids, dearterization of internal hemorrhoids with mucopexia, removal of external hemorrhoids. Within 3 months after endovascular occlusion – complete regression of all symptoms of hemorrhoidal disease. According to the questionnaire (after 1 and 2 years) there is no relapse of the disease, the patient is subjectively satisfied with the endovascular treatment.

A prospective randomized comparative study between Stapler hemorrhoidopexy and laser hemorrhoidoplasty in the management of third-degree piles

Background Hemorrhoidectomies are considered one of the most commonly performed procedures worldwide. Advances in techniques and technology have emerged new modalities in the management of piles with different grades. Aim The aim of this study is to weigh the advantages and disadvantages of laser hemorrhoidoplasty (LH) versus Stapler hemorrhoidopexy (SH). Methods A prospective randomized trial with 120 patients with symptomatic third degree hemorrhoidal disease who presented with pain and bleeding was undertaken in March 2020 and followed patients for two years in Ain Shams University Hospitals until March 2022. The remaining 60 patients (group B) had SH, while the first 60 patients (group A) got LH. The following factors were evaluated: preoperative complaints (bleeding Per rectum, rectal/perianal pain, mass coming out of anus), operative and postoperative outcomes, operative time, postoperative pain, bleeding, urinary retention, fecal/flatus incontinence, thrombosis of external haemorrhoids, anal/rectal stenosis, wound issues, and recurrence. The visual analog scale (VAS), which is based on a numeric pain rating scale with 0 denoting no pain and 10 denoting severe pain, was used to record postoperative discomfort. Results Operative time and blood loss were significantly better in LH than SH with Operative time 23.04±3.42 min in LH compared with SH 33.72±4.48 min (P < 0.001) and Operative blood loss in LH 5.61±1.06 ml compared with SH 11.67±1.92 ml (P < 0.001). There was less postoperative hospital stay in LH group. Postoperative pain was significantly higher in SH verses LH in the first 12 h (5.83±0.86 in stapler vs 5.02±0.6 in laser in the first 12 h) (P < 0.001). Postoperative VAS score at 24 h and 1 week the VAS score was higher for LH in comparison with SH (3.86±0.48 in laser vs 3.39±0.56 in SH at 24 h), (1.59±0.37 in laser vs 1.01±0.43 at 1 week). As regard Returning to activities SH was significantly better than LH. Regarding early postoperative complications like early Postoperative bleeding and urinary retention we found no statistically significant difference between SH and LH in our study. As regard Late Postoperative complications SH was significantly better regarding recurrence after 2 years with only one case of recorded recurrence verses 7 cases in LH group Also, SH was significantly better regarding postoperative flatus incontinence and late anal stenosis with only one patient of Flatus incontinence and late anal stenosis in SH group verses 6 patients of Flatus incontinence and 4 patients of anal stenosis in LH group. While other late postoperative complications were better in SH Group but were not statistically Significant. Conclusions Both SH and LH are probably equally valuable techniques in modern haemorrhoid surgery. However, SH has an advantage because of lower pain after 24 h better, faster recovery and Return to activities and less postoperative complications so SH is a better technique with overall better outcomes. Results of LH showed be revised, liberal use of LH in third degree hemorrhoidal disease according to patient preference should be regulated. LH should be evaluated in depth in a large-volume studies.

A Case Series of Large Volume Iii-Degree Hemorrhoidal Disease: A Special Anatomical Condition Requiring Surgical Treatment

Background: Haemorrhoidal Disease (HD) is common and impacts negatively on quality of life with high socio-economic costs. Despite international guidelines aimed to indicate appropriate care in HD, treatment of III-degree HD remains controversial due to the wide range of ambulatory or surgical procedures available. We aimed to analyse treatment options for III-degree HD focusing on special cases characterized by large volume and/or circumferential presentation of intermittent prolapse or recurrence after conservative treatments. Methods: In the period January 2017- December 2018 out of 152 patients treated by excisional haemorrhoidectomy, we collected a case series of 29 patients affected by III-degree symptomatic HD. They showed a very large, single prolapse or circumferential one or failure of previous conservative treatments. Results: 14 (48.2%) patients (median age 45 yrs.) of our series were recurrence of HD following Rubber Band Ligation (RBL) (5pts), Dearterialization (DEART) (5pts), Stapled Haemorrhoidopexy (SH) (4pts). Mean operative time was 35 min. Postoperative severe pain (6.8%) and urinary retention (17.2%) were the main postoperative complications which did not affect the length of stay. All patients showed a good outcome without any complication at follow-up. Conclusion: III-degree HD shows the highest variability in anatomical presentation, and proposed treatment. Thus, the choice of a personalized approach must rely upon objective evaluation of volume of prolapse. Intermittent prolapse, if very large or circumferential, associated or not to large external haemorrhoids, makes a special condition III degree HD, suggesting surgical excision, avoiding conservative approaches.

A234 PARASITIC INFECTION MIMICKING CROHN'S DISEASE: AN UNUSUAL PRESENTATION OF LOWER GASTROINTESTINAL SCHISTOSOMIASIS

Abstract Background Chronic intestinal schistosomiasis (CIS) is a disease caused in humans by infection with one of seven schistosome species. These species are predominantly found in Africa, South America, and East Asia. Symptoms of CIS include abdominal pain, anorexia, weight loss and diarrhea. In cases of large parasitic burden, overt gastrointestinal bleeding can occur. To our knowledge there are only three other cases of CIS mimicking Crohn's Disease that have been published in the literature. In each of these cases, this was associated with ileal disease, perianal fistulas, or both. Purpose We present the first case of CIS in North America that mimicked Crohn's Disease on imaging with no associated ileal or visible perianal disease. Method Case report of a patient presenting to a tertiary care hospital in Edmonton, Alberta. Result(s) A 47 year old man who recently immigrated from Eritrea presented to the emergency department in June 2020 with red blood per rectum. Digital rectum exam revealed small external hemorrhoids. He was discharged with a plan for outpatient abdominal CT scan and colonoscopy. He presented again to the emegency department in January 2021 where he complained of back pain exacerbated by bowel movements productive for small, hard stool. He also began seeing white discharge mixed with his stool. His back pain, white discharge, and blood-streaked bowel movements persisted for over a year, and he developed perianal pain that was exacerbated by valsalva. A CT scan of the abdomen/pelvis revealed extensive soft tissue swelling in the anorectal region, extraluminal gas, and a 15mm fluid collection adjacent to the coccyx. A diagnosis of fistulizing Crohn's Disease was suspected. A digital rectal exam and colonoscopy were performed September 19, 2022 which revealed small hemorrhoids but otherwise endoscopically normal colonic and ileal mucosa. Biopsies from the rectum revealed eosinophilic granulomas associated with parasitic ova; a diagnosis of schistosomiasis was made. Image Conclusion(s) CIS is a rare diagnosis in North America. It is unusual for this disease entity to present is a mimic of fistulizing Crohn's Disease. This case report reminds the clinician that a high index of suspicion in patients presenting from endemic regions is required to make this diagnosis. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Prolapso hemorroidal circunferencial mixto. Tratamiento combinado con sutura mecánica y fotocoagulación con láser

Management of circumferential hemorrhoidal prolapse represents a challenge for surgeons. There are currently many alternatives to conventional procedures.; however, none of these techniques consider treatment of external disease. Even procedures associated with less postoperative pain as stapled hemorrhoidectomy or Doppler-guided hemorrhoidal artery ligation do not involve treatment of the external component. The aim of this publication is to present the technique detailed to treat patients with mixed hemorrhoidal prolapse, combining stapled hemorrhoidopexy with laser coagulation of external hemorrhoids. The results have been previously documented in a total of 25 patients, with 4% of complications. We conclude that the procedure is an option to consider in patients with circumferential hemorrhoidal prolapse with external component.

Herbal Treatment for Hemorrhoids (Piles)

Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the cutaneous anus region (external hemorrhoids). Nearly three out of every four adults will get haemorrhoids occasionally. Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal displacement of the normal anal cushions.They are a significant medical and economical issue that affects millions of people worldwide. There have been numerous claims made regarding the etiologies of hemorrhoid development, involving continuous straining and constipation. One of the most important symptoms of hemorrhoid disease is aberrant vascular channel dilatation and distortion, together with damaging changes in the connective tissue that supports the anal cushion. Hemorrhoids may show signs of vascular hyperplasia and an inflammatory response. The etiology and other clinical contexts of hemorrhoid illness were first covered in this article, followed by a discussion of the most recent non-surgical and operative therapy strategies.[1]

Comparision of Ligasure hemorrhoidectomy and conservative treatment for thrombosed external hemorrhoids (TEH) in pregnancy

BackgroundLigasure hemorrhoidectomy for thrombosed external hemorrhoids in pregnancy has been rarely studied.ObjectiveThe purpose of this article is to study the efficacy and safety of Ligasure hemorrhoidectomy comparing with conservative treatment for thrombosed external hemorrhoids in pregnancy.DesignThis was a retrospective cohort study.SettingThe patients were treated at a tertiary referral center in China.Patients94 pregnant patients hospitalized for thrombosed external hemorrhoids from September 2020 to December 2021.InterventionsLigasure hemorrhoidectomy treatment or conservative treatment according to the patient’s wishes.Main outcome measuresSymptom relief, recurrence and satisfaction of thrombosed external hemorrhoids in pregnancy with different interventions.ResultsThere were no differences between groups in maternal age, gestational age, body mass index, parity, constipation and a prior history of thrombosed external hemorrhoids. The pain scores were less in surgical group than in conservative group in post-treatment days 1 and 7. Time to return to normal activities was shorter in surgical group than in conservative group (6.51 vs. 13.52 days, P < 0.001). Post-treatment complications were mild in surgical group and there were no significant differences concerning the rate of abortion, preterm birth, cesarean delivery and weight of fetus. Recurrence rate was significantly lower in surgical group (8.57% vs. 30.43%, P = 0.017). The patient satisfaction scores were significantly higher in surgical group than in conservative group (Z = − 2.979, P = 0.003).LimitationsThis was a retrospective study with a limited number of patients, the data was obtained from only one center.ConclusionsComparing with conservative treatment, Ligasure hemorrhoidectomy for TEH in pregnancy results in more rapid pain relief, shorter time to return to normal activities, lower incidence of recurrence, and better patient satisfaction. This type of surgery has low and mild postoperative complications, is not attended by any risk to the mother or her fetus.

Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients.

Anorectal diseases are common in the population and include internal, external, and mixed hemorrhoids. Although hemorrhoid surgery is a brief operation, anesthesia, anesthetic drugs, drug concentrations, and anesthesia level control are closely related to postoperative uroschesis. For hemorrhoid surgery, a single spinal block with ropivacaine is commonly used that blocks the S2-S4 parasympathetic nervous system, which in turn governs the voiding reflex, causing postoperative urinary retention; this affects the recovery of patients. This study was performed to investigate the effects of two doses ropivacaine that provided satisfactory analgesia and muscle relaxation and inhibited adverse reflexes on urinary retention after hemorrhoidectomy. The study included 200 male patients who underwent anorectal surgery with American Society of Anesthesiologists (ASA) grade I-II single elective spinal anesthesia between March 2021 and March 2022. Patients were randomly assigned to 2 groups using a random number table: Group A (n = 100) received 10 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml), and Group B (n = 100) received 15 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml). The anal sphincter exhibited good relaxation, and no obvious traction pain or significant difference in the time of muscle strength recovery was observed between the 10 mg and 15 mg 0.5% ropivacaine groups (P > 0.05). The 10 mg 0.5% ropivacaine group had shorter time of micturition exceeding 100 ml and lower voiding International Prostate Symptom Score than the 15 mg 0.5% ropivacaine group (P < 0.01). Single spinal anesthesia with 10 mg 0.5% ropivacaine not only provides satisfactory anesthetic effect for hemorrhoidectomy but also has less influence on postoperative uroschesis and is worthy of clinical application. The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR2,100,043,686) on February 27, 2021.

Mucosal Schwann cell hamartoma: a benign and little-known entity.

Dear editor, 50 years-old female with personal history of mutation of the gene BRCA1 and previous prophylactic double anexectomy consulted for rectal bleeding without pain since two weeks. A blood test was performed, with hemoglobin levels of 13.1g/dl and without iron deficiency. In the anal inspection there were neither external hemorrhoids nor anal fistulas, so a colonoscopy was requested. In the colonoscopy, all the colon mucosa was normal but, in the rectal retroflexion, apart from internal engorged hemorrhoids, surrounding the 50% of the anal opening an erythematous and indurated mucosa was found (figure 1). Biopsies were taken. The pathology report informed of proliferation of spindle-shaped cells exclusively in the lamina propria with eosinophilic cytoplasm and unclear cell borders (figure 2). Not nuclear atypia or mitotic activity were observed. On immunohistochemistry, S-100 protein was strongly positive (figure 3) and CD34, SMA, EMA and c-kit were negative. These results are concordant with the diagnosis of Schwann cells in the context of a mucosal Schwann cell hamartoma (MSCH). Given that these lesions seem to not have malignant potential, the patient was discharged without control colonoscopies. The episodes of rectorrhagia were attributed to the presence of internal hemorrhoids. Discussion: MSCH are benign and intramucosal tumors with a mesenchymal origin. They are most commonly located in the distal colon, but they were also found in the gallbladder, the esophagogastric union and in the antrum. They are observed most frequently in middle aged women (around 60 years-old) and they are generally asymptomatic. They are presented as polyps between 1 and 6mm, but in other cases they appeared as small whitish nodules, protruding lesions with normal superficial mucosa or even they were found in random biopsies of the colon. The MSCH are a rare entity with an unknown prevalence. Less than 100 cases are described in the literature. It is essential the differentiation between this entity and the Schwanomas or the gastrointestinal stromal tumors (GIST). Schwanomas are rare in the colon, they are well circumscribed (in contrast with the MSCH) and they are not limited to the lamina propria. GIST are more frequently located in the stomach and they are positive for c-kit. MSCH are not associated with hereditary syndromes such as neurofibromatosis and, in contrast with Schwanomas or GIST, they do not require surveillance because they are benign.

Diagnosis and Management of Hemorrhoids

Hemorrhoid, also known as piles is a dilatation and inflammation of the veins in the anal region originating from the hemorrhoidal plexus. Hemorrhoid is a severe disease than can interfere with daily activities and causing a degradation of a person's quality life. Hemorrhoids is divided into internal and external hemorrhoids. Factors that can cause hemorrhoids are low fiber diet, constipation, pushing for too long, pregnancy, and obesity. A thorough history, physical examination, and further evaluations are needed in order to establish the diagnosis of hemorrhoids. The management of hemorrhoids depends on the severity of the disease that consist of medical and operative management.

Expert consensus on clinical application of Fufang Jingjie for Fumigation and Washing

Fufang Jingjie for Fumigation and Washing is one of the commonly used and effective drugs for external fumigation and washing of traditional Chinese medicine, it has the functions of dispelling wind, drying and dampness, alleviating edema, and reducing swelling, relieving pain and relieving itching. It is widely used for the treatment of external hemorrhoids, mixed hemorrhoids, internal hemorrhoids prolapse and incarceration, anal fissures, perianal abscess, anal fistula acute attack, perianal eczema and other diseases. It has a significant effect on the uncomfortable symptoms caused by various anal diseases, such as swelling, pain, wet itching, falling and swelling, and many secretions, as well as various postoperative complications. Fufang Jingjie for Fumigation and Washing has been used in clinic for many years, it has a lot of research evidence and experience in clinical application. In order to further improve the clinicians' knowledge of Fufang Jingjie for Fumigation and Washing and guide clinical medication more reasonably, this consensus invites front-line clinical experts from anorectal department to compile, referring to the relevant clinical literature and guide, combining with the clinical treatment experience of experts, the function, usage, dosage, adverse reactions and points for attention were discussed of Fufang Jingjie for Fumigation and Washing. This consensus was formed to provide reference for the clinical application of Fufang Jingjie for Fumigation and Washing.

S2173 A Twist of Fate: The Cecal Bascule

Introduction: Cecal volvulus is a rare clinical entity with an incidence of 2.8-7.1 per million per year and accounts for 1-2% of large bowel obstruction. The rarest type of cecal volvulus is cecal bascule, accounting for 5-20% of all cases. It occurs when the cecum folds up over itself in an anteromedial orientation with a competent ileo-cecal valve. This allows for gaseous and fluid distention. The pathogenesis is still unclear but the literature suggests that congenital or acquired adhesion may be responsible as a mobile cecum. Symptoms consist of abdominal pain, distention, nausea and obstipation. Diagnosis may be challenging due to its rarity. Here we present a male with an incidental imaging finding suggestive of cecal bascule. Case Description/Methods: An 82-year-old male patient with history of prostate cancer, atrial fibrillation on Apixaban, diabetes and chronic kidney disease who was consulted to gastroenterology services due to rectal bleeding. He reported an episode of intermittent rectal bleeding in the past year mostly secondary to straining due to constipation. Last colonoscopy on 2010 showed diverticulosis plus internal and external hemorrhoids; no polyps or masses. He denied abdominal pain, weight loss, or early satiety. Hemoglobin was stable and normal rectal exam. In view of risk vs benefits patient opted for CT colonography. Study with evidence of diverticulosis and a large cecal bascule. Upon follow-up, he reported feeling well and denied abdominal pain or recurrence of rectal bleeding. He had a complicated appendectomy 7 years ago. Patient was consulted to general surgery for possible cecopexy. Discussion: Cecal bascule is a rare subtype of cecal volvulus that mostly occur in older patients and usually presents with marked GI symptoms, such as obstruction, needing emergent treatment. Risk factors are mostly due to embryogenic defects or iatrogenic (abdominal surgery). Diagnosis is made via imaging study, such as CT, or laparoscopy showing the cecum folding upward resulting in obstruction. Management is mostly surgical with resection and cecopexy. Here with present a case of cecal bascule with a rare presentation of minimal symptoms. The patient had history of a complicated appendectomy most likely being the inciting factor of the cecal bascule. Most cases in literature present after a more recent surgical procedure. The importance of this case is to bring attention of this rare clinical entity, its diagnosis and how it may present with non-specific chronic symptoms.

S2021 Dilemma of a Rectal Mass

Introduction: Mucosal prolapsing polyps of the colon are uncommon findings during colonoscopy that are often misdiagnosed as malignant lesions that many times lead to unnecessary endoscopic and surgical resection. At times rectal prolapse/ mucosal prolapse syndrome can present as rectal submucosal mass similar to one another. Herein we present a case of a 63-year-old male with rectal prolapse that mimicked Submucosal rectal mass. Case Description/Methods: A 63-year-old male with prior medical history of hypertension, hyperlipidemia, obesity, treated Heliobacter pylori, hemorrhoids presented to the gastroenterology clinic due to 3-month history of dizziness, abdominal pain and bright red blood per rectum. Initial vitals were stable except for tachycardia. Physical examination was unremarkable except for external rectal hemorrhoids that were appreciated. Labs were also unremarkable on admission except for Normocytic anemia. Patient was planned and taken for colonoscopy which had poor bowel preparation, revealed large rectal mass, 2 small polyps in ascending and transverse colon which were resected. Patient was planned for flexible sigmoidoscopy and lower endoscopic ultrasound evaluation of rectal mass which revealed a hypoechoic, submucosal lesion measuring 14mm by 7mm. Patient underwent endoscopic submucosal resection of the rectal mass and removal of lesion. Post op he had rectal pain along with hypotension, which led patient to be admitted for overnight observation. On follow up patient complained of recurrent dizziness and BRBPR, sigmoidoscopy was planned and revealed superficial mucosal ulceration which was treated with bipolar cautery. Pathology of the rectal mass revealed largely denuded benign appearing congested polyp with granulation tissue and cautery artifacts. Patient’s symptoms improved on subsequent follow ups (Figure). Discussion: Mucosal prolapse presents as a common underlying mechanism rectal prolapse, inflammatory polyps, solitary rectal ulcer syndrome that were previously proposed to be grouped under the umbrella term “mucosal prolapse syndrome”. Mucosal prolapse can manifest as ulcerated, flat erythematous, or polypoid lesions. At times they can even mimic adenocarcinomas, adenomas both endoscopically and histologically. Most of the time rectal prolapses polyps have been seen in patients with mucosal prolapse syndrome. Thus, it is vital to differentiate and diagnose rectal prolapse versus true rectal mass in order to exclude malignancies. This will help guide management and surveillance strategy.Figure 1.: Nodules from Colonoscopy.

S1913 A Rare Case of Spindle Cell Carcinoma of the Hepatobiliary System

Introduction: Spindle cell also known as undifferentiated carcinomas of the pancreas (UCP) are rare anaplastic deviations of ductal adenocarcinomas of the pancreas. The general nature of these tumors is associated with destructive biological behavior and usually have a poor prognosis compared to most common variants of ductal adenocarcinoma. UCP include spindle cell carcinoma, sarcomatoid carcinoma and carcinosarcoma. In practice, it is hard to differentiate these subtypes since most of them possess a spindle element. UCPs are extremely rare tumors with a frequency of less than 2% of pancreatic exocrine tumors. Furthermore, UCP with focal osteochondroid differentiation are even rarer. Case Description/Methods: A 50-year-old man with past medical history of cardiovascular disease, hypertension, hepatitis C & external hemorrhoids presented with worsening abdominal pain, nausea, vomiting. CT was notable for evidence of a hepatobiliary mass. Gastroenterology was consulted and performed an EGD. Upon initial evaluation of the stomach into the antrum, a large, perforated ulcer was identified with omental tissue. Additionally, liver parenchyma was visualized along with severe LA Grade D Esophagitis throughout the entire esophagus. Interventional radiology was consulted and subsequently performed a biopsy of the mass in which the pathological findings were suggestive of Spindle cell carcinoma/carcinosarcoma. CT chest was ordered for staging and showed several nodules of unclear origin. Oncology was consulted and patient was initiated on chemotherapy (Carboplatin/Gemcitabine). Once on chemotherapy, the patient grew reluctant about receiving medical management. Palliative care was consulted. Considering advanced stage spindle cell hepatopancreatic biliary carcinoma leading to multiple complications including duodenal perforation, peritonitis, sepsis, encephalopathy leading to terminal delirium, patient's prognosis was deemed very poor with less than 6 months requiring hospice care. Patient was then transferred to inpatient hospice service (Figure). Discussion: The reported prognosis of each of the histologic subtypes of UCP have overall poor prognosis. Surgery is the first choice for a resectable undifferentiated carcinoma. In a previous study it was identified that average post-operative survival interval was 6 months and the longest living patient survived for 15 months.Figure 1.: H&E immunochemistry stain of liver biopsy.

Comparative study between conventional hemorrhoidectomy and electrothermal bipolar vessel sealer for Grade IV hemorrhoids

Background: Hemorrhoids are vascular formations in the anal canal that is also known as piles. They serve as a cushioning of anterior venous channels and connective tissue in its natural condition, which aids in stool management. During defecating, internal hemorrhoids are frequently accompanied by painless, bright crimson rectal discharge. External hemorrhoids can cause discomfort and edema in the anus region. Aims and Objectives: The objectives of this study are to “compare between electrothermal bipolar vessel sealer hemorrhoidectomy versus conventional hemorrhoidectomy in patient of Grade IV hemorrhoids. Materials and Methods: The present study conducted in patients admitted in Gandhi medical college associated Hamidia Hospital, Bhopal carried out in the Department of General Surgery from April 2015 to September 2017. A total of 80 patients were included in the study with comparison between conventional hemorrhoidectomy (n=36) and electrothermal bipolar vessel sealer (ETBVS) (n=44) and comparison of recurrence of complications in them. Results: The mean surgical time was much shorter in ETBVS, as was post-operative pain, which was primarily reduced on the third and 4th post-operative days: discomfort also vanished quicker in ETBVS than in conventional procedure. ETBVS patients had less time off work, a shorter hospital stay, and a reduced risk of total problems. When compared to conventional procedures, the average length of operation in ETBVS was also much shorter (P&lt;0.0001). Conclusion: When a considerable amount of tissue needs to be removed, ETBVS hemorrhoidectomy is a good option. This research confirms its usage as a first-line therapy for Grade IV hemorrhoids.

Analysis of results of primary closure in fistula in ANO

Aim: Prospective analysis of results of primary closure in fistula in ano in terms of (a) Immediate- Bleeding, perianal haematoma, pain, suture line dehiscence and healingperiod. (b) Later - Incontinence &amp; reccurence rate and Patient’s compliance &amp; feasibility of technique in NSCBMC Jabalpur. Methods: Prospective study was conducted in Department of Surgery, NSCB Medical College, Jabalpurbetween Aug. 2012 to Sept. 2013. Total 60 patients were taken and divided in two groups, group-A (30 patients) taken as case study in which pimary closure was done and group-B (30 patients) taken as control group in which open fistulectomy was done. Results: Majority of patients were 31 to 60 years (80%). More number of males than females. (M=93.3%, F=6.7%). Perianal Discharge (90%), Pain (56.7%) and Swelling (33.3%) were the main complaints. Fistula-in-ano with a single opening (83.3%) was the commonest occurrence and posterior opening (70%) situation was more common. Bleeding was seen in open method (group-B=30%) whereas none of the patients shows bleeding in primary closure technique (group-A). Perianal haematoma was more seen in open method (group-B=20%) compare to primary closure method (group-A=6.6%).

Minimally invasive treatment of combined hemorrhoids

Purpose. To study outcomes after the minimally invasive treatment of combined hemorrhoids.Material and methods. Two hundred and three patients with combined hemorrhoids were included in the study. Patients of the main group (n = 101) had laser coagulation of internal hemorrhoids; patients of the control group (n = 102) – ligation of internal hemorrhoids. Then, excision of external hemorrhoids was made in both groups.Results. The intensity of postoperative pain syndrome decreased more rapidly in patients from the main group comparing to the controls. The number of early postoperative complications in patients of the main group was 2 times less than in the controls. Relapse of the disease one year after the treatment was seen in 5.94 % of patients of the main group and in 22.55 % of the controls.Conclusion. Laser coagulation of internal hemorrhoids followed by the excision of external ones in patients with combined hemorrhoids can improve outcomes and reduce the number of relapses.

To investigate the efficacy of topical application of heparin sodium, benzyle nicotinate and nifedipine paste in external thrombosed prolapsed haemorrhoids

Eighty-six patient (49males, 37 females) with acute thrombosed external prolapsed haemorrhoids from January 2019 to January 2022 were treated topically with heparin sodium plus benzyl nicotinate along with 0.5% nifedipine ointment paste (t.i.d.) for 8 wk. All the patients were advised to take a high-fibre diet and assessed post-treatment at 2, 4 and 8 weeks. The healing of external thrombosed haemorrhoids and any side effects were recorded. The patients were again followed up subsequently in the outpatient department for the period of 2years and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred. Seventy-nine of the 86 patients followed the instruction regularly and completed the 8-wk treatment course, of them 77 patients (85.2%) achieved a complete remission indicated by resolution of pain and swellings symptoms and resolution of the thrombosis of haemorrhoids. Of the remaining nine unhealed patients (14.8%), 5 opted to undergo haemorrhoidectomy and the other 4 to continue therapy for four additional weeks, resulting in healing and resolution of pain and swellings symptoms and resolution of the thrombosis of haemorrhoids.

Clinical Observation on the Treatment of Thrombotic External Hemorrhoids with the Method of "Regulating Blood and Regulating Qi"

Clinical Observation on the Treatment of Thrombotic External Hemorrhoids with the Method of "Regulating Blood and Regulating Qi"

The Opportunity of Using Diode Laser with the Length of 1940 nm in the Treatment of Hemorrhoids

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis.