Pile Research Articles

A COMPARATIVE STUDY BETWEEN MIPH VERSUS OPEN HAEMORRHOIDECTOMY

Objective: Hemorrhoidal disease is a prevalent anorectal disorder that significantly impacts patients' quality of life. Surgical intervention, including Minimally Invasive Procedure for Hemorrhoids (MIPH) and Open Hemorrhoidectomy, plays a crucial role in managing symptomatic hemorrhoids. However, the comparative effectiveness and safety of these surgical techniques remain debated. Methods: This retrospective cohort study compared the clinical outcomes, safety profile, and cost-effectiveness of MIPH versus Open Hemorrhoidectomy. A total of 130 patients diagnosed with symptomatic hemorrhoids underwent either MIPH or Open Hemorrhoidectomy at our institution. Data on demographic characteristics, presenting complaints, degree of hemorrhoids, operative outcomes, and postoperative complications were collected and analyzed. Statistical analysis was performed using appropriate tests to compare outcomes between the two groups. Results: The study included 65 patients in each group (MIPH and Open Hemorrhoidectomy). MIPH was associated with shorter mean duration of surgery, reduced postoperative bleeding and intraoperative blood loss, shorter hospital stay, lower incidence of residual prolapse, faster wound healing, and quicker return to work compared to Open Hemorrhoidectomy. However, Open Hemorrhoidectomy demonstrated advantages in direct tissue visualization and precise surgical technique. Conclusion: Minimally Invasive Procedure for Hemorrhoids (MIPH) offers several benefits, including shorter operative duration, reduced postoperative pain, and faster recovery, making it a viable option for patients with hemorrhoids. However, Open Hemorrhoidectomy remains a suitable alternative, particularly in cases where MIPH may not be feasible or contraindicated. Individualized decision-making, considering patient preferences and surgeon expertise, is essential in selecting the optimal surgical approach for hemorrhoidal disease.

Emborrhoid technique in hemorrhoidal disease: Retrospective analysis of data from a single center.

This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated. Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at 1, 3, and 6 months. All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month. Clinical success was 95% at the first month and 85% at the third and sixth months. Re-embolization was not performed in patients with recurrence. In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention.

CLINIC, DIAGNOSIS AND EFFICIENCY OF NONINVASIVE METHOD OF TREATMENT YOUNG CHILDREN WITH HAEMORRHOIDS

Hemorrhoids have been known since ancient times. They have always been considered the prerogative of adult patients. Methods of conservative and surgical treatment of hemorrhoids in adults are still used in children and often have negative results. Pediatric surgical practice has not optimized methods of diagnosis and treatment of hemorrhoids in infants and preschool children. Materials and methods. The work was based on retrospective and prospective analysis of medical records and case histories of 112 children with hemorrhoids treated in the last 11 years. The number of patients under 1 year of age was 4 (0.4%); 1-3 years - 30 (26.4%); 3-6 years - 50 (44.6%); 7-12 years - 16 (14.2%); 13-18 years - 12 (10.7%). External hemorrhoids were found in 107 (95.5%), internal hemorrhoids in 4 (3.8%) and combined hemorrhoids in 1 (0.9%) patient. There were 70 (62.5%) boys and 42 (37.5%) girls. All cases underwent general clinical and laboratory examination, orthostatic exercise (squatting), rectal palpation, anoscopy and rectoscopy. Statistical processing of the research materials was carried out using the method of variance statistics. All values in the work are presented in the form of arithmetic mean with calculation of standard deviation within the confidence interval. For all compared values the achieved level of significance (p) was considered statistically reliable - < 0.05. Student's t-distribution was used to compare data with normal distribution of means. When comparing 2 related groups, calculations were performed using Student's paired t-criterion. Microsoft Excel and Statistica computer programs were used for statistical data processing. Results and discussion. This paper presents clinical material from the examination and treatment of 112 children with hemorrhoids over the past 11 years. The authors compare the characteristics of the etiopathogenesis of hemorrhoids in children from the literature and their own research data. The proposed non-invasive compression methods in the complex treatment of hemorrhoids in children are more effective in children of early and preschool age. A study of long-term results of complex conservative treatment of 84 patients of young age with hemorrhoids showed good results in 86,9%, satisfactory - in 9,5% and unsatisfactory (recurrence) - in 3,6% of patients. Surgical treatment of hemorrhoids in children was used only when conservative treatment was unsuccessful in 11 (12.6%) patients, with good long-term results in all cases. Indications for hemorrhoidectomy were: frequent prolapse of hemorrhoids (HU). After surgical treatment, good results were obtained in all cases; no recurrence was observed. The optimization of conservative and surgical treatment, respecting the age characteristics of children, led to good results. Conclusions: 1. Examination of children with GU enlargement with the use of additional methods (ultrasound, RRS, FACS, PCI) of research allows to reveal and treat concomitant intestinal pathologies, which are the causes of secondary transient hemorrhoids development. For children of preschool age the most effective non-invasive method of treatment is rectal balonocompression. 3. After complex conservative treatment with rectal balonocompression of children with hemorrhoids good results were observed in 86,9% of children, satisfactory - in 9,5% and unsatisfactory - in 3,6%.

Risk factors for constipation during pregnancy: a multicentre prospective cohort study

BackgroundConstipation is frequently encountered in the population of pregnant women. Physical activity and nutritional factors are considered common causes of constipation; however, their impact on this population has not yet been evaluated precisely. This study aimed to assess the prevalence of constipation and its risk factors during pregnancy and postpartum.MethodsA prospective observational cohort study was conducted in 3 hospitals in Lithuania, including women with early viable pregnancies using questionnaires on demographic, obstetric, nutrition, behaviour, peri-anal disease, and birth data. All women with an early viable pregnancy (<12 weeks’ gestation) aged 18 - 45 years who gave written informed consent were included. The Rome III criteria defined constipation. Independent risk factors were identified using multivariate analysis.ResultsIn all, 263 (55.9%) women developed constipation. Multivariate analysis identified haemorrhoidal disease during pregnancy (OR 8.25, 95% CI 4.41-15.4, p < 0.001), inadequate physical activity (OR 1.66, 95% CI 1.03-2.69, p=0.038), not participating in sports (OR 1.98, 95% CI 1.24-3.17, p=0.004), and monthly income 300-500 euros (OR 1.97, 95% CI 1.22-3.19, p=0.006) as significant predictors of constipation during pregnancy. Lower education was defined as a protective factor (retrospectively, secondary education by 2.2 times (OR 0.45, 95% CI 0.22-0.89, p=0.022) and unfinished secondary - by 1.84 times (OR 0.20, 95% CI 0.05-0.90, p=0.036) reduced the possibility of constipation development).ConclusionsIn conclusion, haemorrhoidal disease during pregnancy, low physical activity, and low monthly income are independent risk factors for constipation during pregnancy. Lower education significantly reduces the incidence of this condition.

Embolization of Rectal Arteries for Treating Hemorrhoidal Disease Using a Combination of Microspheres and Microcoils: A Pilot Study.

To investigate the feasibility and initial results of superior (SRA) and middle (MRA) rectal artery embolization for patients with symptomatic hemorrhoidal disease. Prospective, single-center cohort that included ten consecutive patients (Goligher classification was II in 70% and III in 30%.) who underwent SRA and MRA embolization using a combination of microspheres and metallic coils, who completed a follow-up period of 12months. Technical success was defined as embolization of SRA and MRA whenever MRA dominance was observed. Clinical success was defined as an improvement of the hemorrhoid severity score (HSS) and quality of life (QoL) scores without recurrence, with the need for additional treatment. Procedure-related adverse events (AEs) were recorded and defined according to CIRSE classification as minor or major complications. Technical success was achieved in all patients. SRA was embolized in 100% of patients and MRA in 80%. The improvement in HSS and QoL scores was 88% and 88% (p < 0.05), respectively, without clinical recurrence in the 12-month follow-up. One patient had a major complication (level D), a rectal ischemia and perforation of the rectosigmoid leading to perforative acute abdomen with sepsis that required surgical treatment (Hartmann's procedure). Embolization of both SRA-MRA using a combination of microspheres and metallic coils was feasible and significantly improved HSS and QoL scores. One major complication was observed and therefore it is essential to further investigate the safety boundaries of this technique.

Russian multicenter observational HDQ study on the validation of the questionnaire for hemorrhoidal disease

AIM: to develop and validate hemorrhoidal disease (HD) specific national questionnaire.MATERIALS AND METHODS: the Russian questionnaire, which included questions on the most typical HD symptoms, was developed by leading national specialists-proctologists. The regression analysis was used to evaluate linear and nonlinear relationships between the fact of the HD presence, objectively confirmed by a doctor, and the patients’ answers to the questions from the questionnaire. The final version of the questionnaire included only questions regarding clinical characteristics typical for hemorrhoids that were significantly associated with the presence of the disease. Validation of the questionnaire was performed on both training and test samples of patients to determine its sensitivity (Se) and specificity (Sp) in identifying patients with HD.RESULTS: initially, 7 main domains reflecting the presence and severity of symptoms typical for HD were included in the questionnaire. A training sample of patients was used to search for linear and nonlinear relationships between objectively confirmed hemorrhoids and responses to questions in the initial questionnaire. The final version of the questionnaire, consisting only of questions regarding symptoms that have demonstrated to be significant predictors of hemorrhoids, was validated on a training sample (Se = 86.5%, Sp = 73.4%, and the probability of identifying a patient with HD, according to Bayes’ theorem = 66.6%). After the developed version of the questionnaire was validated on a test sample, the final screening questionnaire for HD demonstrated Se 83.7%, Sp 74.1%, and the probability of identifying patients with HD with a positive questionnaire result, calculated according to Bayes’ theorem, was 67%.CONCLUSION: the first national questionnaire for screening HD has diagnostic characteristics indicating its high accuracy in identifying patients with HD and allowing it to be recommended for use in the general population.

Modern Views on the Treatment of Hemorrhoid Disease Complicated by Post Hemorrhagic Anemia

Research purpose: to improve the surgical treatment results of patients with bleeding hemorrhoids complicated by posthemorrhagic anemia through the development of rational methods of surgical treatment. Patients and methods: A method of operation by first ligating blood vessels to the internal hemorrhoids without any instruments with simultaneous removal of external hemorrhoids has been developed. Research design: The study included 56 patients operated on for chronic bleeding hemorrhoids complicated with posthemorrhagic anemia from 2018 to 2022. All patients underwent a method to ligate blood vessels to internal hemorrhoids without any instruments along with simultaneous removal of external hemorrhoids. In the postoperative period in these patients, the pain syndrome was less pronounced, the patients behaved relatively actively, reflex urinary retention was not noted, postoperative bleeding and postoperative stricture of the anal canal were not observed, the patients were in the hospital for an average of 11.08 hospital days, and closed hemorrhoidectomy was 16.09 bed days. Findings: The operation is low-cost; there is no need for expensive high-tech equipment; it is effective for all stages of hemorrhoids; the surgical field is wide; visibility is unlimited; the operation is performed by all proctologists without special training. Low trauma; there is no open wound in the anal canal, i.e., “X”-shaped and interrupted sutures are applied for transanal hemorrhoidal ligation of blood vessels to internal hemorrhoids and mucopexy. Conclusion: short recovery period, low intensity of postoperative pain, absence of postoperative urinary retention, postoperative bleeding, and anal stricture.

The Analysis Study of Surgical Management, Outcome, Recovery and Complication of Haemorrhoid : A Comprehensive Systematic Review

Background: Despite its prevalence, hemorrhoidal disease remains a major challenge for healthcare systems, often requiring significant resources to manage and treat effectively. This systematic review examines the surgical management of hemorrhoids, focusing on patient outcomes, recovery, and complications based on literature from the past decade. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 2,172 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Hemorrhoid management offers various surgical options, including SPH, THD, and hemorrhoidal embolization, each providing quicker recovery and reduced pain. Traditional excisional surgery remains the gold standard for long-term outcomes, with pain management strategies enhancing recovery and patient satisfaction.

Use of mesoglycan in the acute phase of hemorrhoidal disease (the CHORMES study): study protocol for a double-blind, randomized controlled trial

BackgroundHemorrhoidal disease (HD) is associated with substantial economic burden and negative effects on health-related quality of life (HRQoL). The aCute HaemORrhoids treatment with MESoglycan (CHORMES) study aims to evaluate the effects of orally administered mesoglycan, a natural preparation of glycosaminoglycans with antithrombotic and profibrinolytic properties, as an acute treatment in patients with HD.MethodsCHORMES is a phase 2, double-blind, randomized controlled trial being conducted at two centers in Italy. Adults aged 18–75 years with Grade I–III HD according to Goligher classification or external thrombosed hemorrhoids, and a Hemorrhoidal Disease Symptom Score (HDSS) of ≥ 5, will be randomly allocated in a 1:1 ratio to mesoglycan or placebo and will be treated for 40 days (two capsules for the first 5 days and one capsule for the subsequent 35 days twice daily [after breakfast and dinner], equivalent to 200 mg in the first 5 days and 100 mg subsequently). Concomitant use of analgesics is permitted in both treatment groups. The trial aims to enroll 50 patients, with 25 patients in each treatment group. The primary objective of the trial is to evaluate the efficacy of mesoglycan in reducing symptoms of HD, assessed via change in HDSS from baseline (day 0) to day 40 in the intention-to-treat population. Secondary objectives include changes in HRQoL from baseline to day 40 using the Short Health Scale for Hemorrhoidal Disease, safety (adverse effects, physical assessments, vital signs and laboratory parameters in the safety population), fecal continence assessed using the Vaizey score, bleeding assessed using the Bleeding score, the amount and type of analgesic taken, and pain. Patient enrolment began on 11 December 2023, and trial completion is expected by December 2024.DiscussionThe CHORMES trial will evaluate the efficacy and safety of mesoglycan, in addition to its impact on HRQoL, analgesic use and pain, in patients with HD. The results of the trial will assist clinicians in determining the most effective treatment for patients with HD.Trial registrationClinicalTrials.gov NCT06101992. Prospectively registered on 26 October 2023 at https://clinicaltrials.gov/ct2/show/NCT06101992.

Anti-Hemorrhoidal Action of Aqueous Pithecellobium Dulce (Fabaceae) Seed Extract Through Anti-Inflammatory, Antioxidant and Vasoconstriction Pathways

Objective The aim of this study was to determine the mechanism of action of Pithecellobium dulce aqueous extract on Jatropha oil-induced hemorrhoidal disease in rats. Methods 36 Wistar rats were divided into 6 groups of 6 animals, including 3 controls (normal, negative and positive) and 3 tests groups. Hemorrhoidal disease was induced with Jatropha oil (100 μL) for 5 days in all animals except the normal control group. Recto-anal coefficient, hemorrhoidal permeability, hematological parameters, oxidative stress parameters and inflammatory cytokines were evaluated. Results Quantitative phytochemistry and in-vitro anti-inflammatory and anti-radical activity of the extract were determined. Extract of P. dulce at doses of 100, 200 and 400 mg/kg significantly (p ˂ 0.01) reduced recto-anal coefficient, prostaglandin E2 (PGE2), TNF-α, IL-6, nitric oxide (NO) and C-reactive protein (CRP) concentrations, accompanied by a significant (p &lt; 0.001) increase of IL-5 and IL-10. Extract of P. dulce at different doses significantly reduced leukocyte and platelet counts and increased erythrocyte and hematocrit levels. Extract of P. dulce also significantly (p &lt; 0.05, p &lt; 0.01 and p &lt; 0.001) increased superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) activities and significantly (p &lt; 0.001) decreased malondialdehyde (MDA) levels. Extract of P. dulce was able to trap DPPH (2,2-Diphenyl-2-picrylhydrazyl) radicals (64.9%) and ABTS (2,2'-azinobis-3-ethylbenzothiaoline-6-sulfonic acid) radicals (69.1%), as well as a high iron reducing power (FRAP) of 56.2% and the 50% inhibitory concentration (IC50) of the ABTS radical was 150 μg/mL compared to the butylhydroxytoluene (BHT) control (130μg/mL). In addition, extract of P. dulce showed high concentrations of polyphenols, flavonoids and saponins. Conclusion extract of P. dulce possesses anti-hemorrhoidal properties via mechanisms involving vasoconstriction, alongside enhancement of anti-inflammatory and antioxidant status.

Hemorrhoid (Pile) and its Treatment with Botanicals: An Overview

: Hemorrhoid disease is a common condition that can have a significant impact on an individual's quality of life due to its associated symptoms. A wide range of management options are available for the treatment of hemorrhoid disease, including various yogic kriyas, herbal remedies, flavonoids, tocotrienols, topical treatments, hydrotherapy, dietary approaches, and surgical procedures. This review aims to focus specifically on the use of botanicals for the treatment of hemorrhoid disease, covering various aspects of its treatment.

Hemorrhoidectomy Using the Harmonic Scalpel versus the Ferguson Technique

Abstract Introduction Hemorrhoidal disease is an anorectal condition commonly encountered in the clinical practice. Various instruments, such as circular staplers, harmonic scalpels, lasers, and bipolar electrothermal devices, are used in different modalities of hemorrhoidectomy in cases of high-grade hemorrhoids. Objective T compare the results of hemorrhoidectomy using the Ferguson technique and the harmonic scalpel. Materials and Methods The present is a randomized prospective study involving 60 patients submitted to hemorrhoidectomy from February 2022 to January 2024. The patients were randomly grouped: group I was composed of 30 patients who underwent the operation through the conventional Ferguson technique, and group II was composed of 30 patients submitted to hemorrhoidectomy with the use of the harmonic scalpel. Results The demographic and clinical features of the patients in the two groups were identical. We found a significant difference in the mean operative time: for the Ferguson technique, it was of 21.9 ± 4.6 minutes, while for the harmonic scalpel, it was of 17.9 ± 3.1 minutes (p = 0.003). The mean postoperative pain scores on the Visual Analog Scale (VAS) were of 7.1 ± 1.2 points for group I, and of 6.5 ± 0.5 points for group II (p = 0.024). And the mean hospital stay was of 1.23 ± 2.1 days for group I, and of 1.03 ± 0.1 for group II (p = 0.023). No statistical significance was observed regarding the other parameters. Conclusion Hemorrhoidectomy using the harmonic scalpel seems to be a superior approach to treat high-grade hemorrhoids; it has the advantage of reduced hospital stay, decreased postoperative pain, and shorter operative time.

Shifting Paradigms in Hemorrhoid Management: The Emergence and Impact of Cap-Assisted Endoscopic Sclerotherapy.

Hemorrhoidal disease (HD) is a prevalent proctological condition that has puzzled people since ancient times, and the most common symptom is painless bleeding. Traditional treatments include conservative treatment, nonsurgical office-based treatments, and surgery. Sclerotherapy is one of the oldest forms of nonoperative intervention and is widely used to treat internal hemorrhoids with the development of endoscopy technology. However, sclerotherapy is always accompanied by complications such as bleeding, pain, abscess, etc., when the sclerosant is injected into the wrong site. Cap-assisted endoscopic sclerotherapy (CAES), a new minimally invasive technology, was first time coined in 2015 for the treatment of hemorrhoidal disease. The left-posterior-right-anterior (LPRA) anus positioning method under endoscopy provides reliable methodological support for advancing hemorrhoidal treatment via endoscopy. The current trend is that treatment for HD has shifted from being performed predominantly by the Department of Proctology Surgery to being managed mostly by the Department of Gastroenterology. This review reviewed the shifting paradigms of sclerotherapy for HD and discussed the emerging development of CAES.

Shared genetic architecture of psychiatric disorders and hemorrhoidal disease: a large-scale genome-wide cross-trait analysis.

The genetic association between psychiatric disorders and hemorrhoidal disease (HEM) is still not well known. The work aims to investigate their comorbidity at a genetic level. Utilizing recent large-scale genome-wide association studies (GWAS), we investigated the genetic overlap at the single nucleotide polymorphism (SNP), gene, and molecular level between depression and HEM, bipolar disorder (BD) and HEM, neuroticism and HEM, as well as schizophrenia (SCZ) and HEM. The cross-trait genes were validated through the utilization of transcriptome and proteome methodologies. The causal link was assessed using bidirectional two-sample Mendelian randomization analysis (MR) analysis. MRlap corrects for the potential bias in estimation caused by sample overlap. We discovered significant positive genetic associations between these four types of psychiatric disorders and HEM. Cross-phenotypic association analyses identified shared SNPs along with 17 specific loci between psychiatric disorders and HEM. MAGMA identified a total of 2304 pleiotropic genes, several of which showed significant expression in the results of transcriptome and proteome analyses. We observed that these genes are mostly associated with the regulation of transcription factors and particular DNA binding activities. Lastly, MR analysis provided evidence supporting a correlation between these conditions. This study revealed a genetic correlation between four psychiatric disorders and HEM, identified pleiotropic loci, found multiple candidate genes, and confirmed causal relationships. This has enhanced our comprehension of the common genetic mechanisms of psychiatric disorders and HEM.

Outcomes of laser hemorrhoidoplasty for grade II-IV hemorrhoidal disease in Bangladesh.

Laser hemorrhoidoplasty is a minimally invasive procedure to treat hemorrhoids and has shown better outcomes. Less is known about its utility in a lower middle-income country; Bangladesh. Between March 2023 and December 2023, 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty. Follow up was assessed on 1st week, 2nd week, and 6th week including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction, and recurrence. The study included 86 patients, with a higher proportion of male participants (73.3%) and a mean age of 55.43±13.6 years. The majority of subjects (68.60%) had grade 3 hemorrhoids. The average surgery duration was 14.70±4.70minutes All individuals experienced substantial decreases in the size of their hemorrhoids (100%) and reported high levels of satisfaction after the operation (97.7%). The use of the Wilcoxon signed-rank test demonstrated a statistically significant reduction in both the Visual Analog Scale (VAS) and Patient Global Impression of Improvement (PGI-I) ratings during the three subsequent observation periods (1st week, 2nd week, and 6th week). The 6th week complication rate was 19.8%. Additional mucopexy was performed on all patients with grade IV and three patients with grade III hemorrhoids. Laser hemorroidoplasty is a day-care procedure, that is safe and efficacious and can be used in rural area settings with good patient satisfaction. Mucopexy is required in some cases of large hemorrhoidal mass to prevent recurrence.

Effectiveness of Thantrikai Chooranam in the Treatment of Raththa Moolam (Bleeding Hemorrhoids)

Hemorrhoidal disease, a prevalent benign anorectal disorder, has a substantial influence on patients' quality of life and entails significant health and financial strains. The focus of this study is to evaluate the therapeutic value of Siddha medicine, Thantrikai Choornam, in alleviating first-degree internal hemorrhoids (Raththa Moolam). Method: A descriptive case series was carried out at the Government Siddha Medical College &amp; Hospital in Palayamkottai, involving 20 patients (80% male, mean age 45.94±2.60 years) reported having bleeding hemorrhoids. Participants were prescribed Thantrikai Choornam (2 g, twice daily) for 24 days. Clinical symptoms such as bleeding, discomfort, constipation, and other parameters were graded both before and after treatment. Results: Substantial improvements were observed following treatment, with 75% of patients observing an overall decrease in bleeding severity from grade 3 to 0, along with a resolution of anal pain. Constipation alleviated for 85% of individuals. The average hemoglobin level raised from 11.88 to 12.25 g/dL. The statistical analysis demonstrated noteworthy reductions in the majority of complaints (p &lt; 0.05). Conclusion: This case series illustrates that Thantrikai Choornam delivers a beneficial intervention for first-degree hemorrhoids, with considerable improvements in primary symptoms. The outcomes offer a call to further investigations into Siddha medicines role in contemporary therapeutic practices for managing hemorrhoidal disease.

Associations of intestinal diseases with anal diseases: a Mendelian randomization study

Although observational clinical studies have established an association between Intestinal Diseases (IDS) and Anal Diseases (ADS), the causal relationship is still not fully understood due to the limitations of observational studies. Genome-wide association study (GWAS) statistical data for IDS and ADS were obtained from publicly available databases. To assess the causal effects of IDS on ADS, we conducted Mendelian randomization analysis. The inverse variance weighted method indicated that Inflammatory bowel disease (IBD) had a significant causal relationship with three kinds of ADS: Anorectal abscess (ARB), Haemorrhoidal disease (HEM), and Fissure and fistula of anal and rectal regions (FISSANAL). Crohn’s disease (CD) and Ulcerative colitis (UC) also showed significant causal effects with three ADS: ARB, HEM, and FISSANAL. Furthermore, a potential link between CD and BNA(Benign neoplasm of anus and anal canal), Irritable bowel syndrome (IBS) and HEM, Colorectal cancer (CRC) and BNA, and Celiac disease and MNA (Malignant neoplasm of anus and anal canal) was observed. This comprehensive MR analysis highlight the significant and increased risk of common Anal Diseases (ARB, FISSANAL, and HEM) in patients with IBD, CD, and UC. Additionally, potential positive causal associations emerged between IBS and HEM, CRC and BNA, as well as between celiac disease and MNA.

Propensity-Score Matching Analysis for Laser Hemorrhoidoplasty Versus Circumferential Stapler Hemorrhoidectomy: One-Year Outcomes.

Laser hemorrhoidectomy (LHP) is a minimally invasive procedure with less pain, short operative time and length of stay, and a low recurrent rate. This study aimed to analyze the surgical outcomes of the circumferential stapler hemorrhoidectomy (CSH, Longo operation) by propensity score-matching analysis, including perioperative outcomes and quality of life. Between March 2022 and March 2023, 216 patients underwent CSH and 198 LHP in Binh Dan Hospital, Ho Chi Minh City, Vietnam. Potential confounding factors for operative outcomes were adjusted by propensity score-matching analysis. The gender, age, Goligher classification, symptoms, Hemorrhoidal Disease Symptom Score (HDSS), and the number of hemorrhoidal columns were matching variables. After 1:1 propensity score-matching, 115 patients from each group were evaluated for perioperative outcomes and compared for a prospective study. There was no difference in potential preoperative confounders such as gender, hemorrhoid classification, symptoms, and HDSS between the two groups after propensity score-matching. However, there was a difference in age (52 in the Longo group and 43 in the LHP group) and the number of columns (the LHP group had more). Postoperative outcomes such as operative time, blood loss, general complications, and postoperative interventions were less in the LHP group. However, Visual Analog Scale (VAS) (4 vs. 4), length of stay (1 day vs. 1 day), quality of life (both groups improved quality of life after the procedure), and recurrence rate (2 in the Longo group vs. 0 in the LHP group, p=0.5) had no difference between the two groups. Propensity-score matching analysis showed that the LHP procedure was superior to the Longo operation (CSH) in operative time, blood loss, general complications, and postoperative intervention. Other outcomes such as VAS, length of stay, quality of life, and recurrence rate have no difference.

Ethnomedical knowledge of plants used in alternative medicine to treat hemorrhoidal diseases in Lubumbashi, Haut-Katanga province, Southern Democratic Republic of Congo

BackgroundA variety of medicinal plants are used in traditional medicine in Lubumbashi for the management of hemorrhoidal diseases. However, no investigation has been conducted to gather the knowledge required for this type of management in the region. The present study was conducted to inventory the plants used in Lubumbashi to treat hemorrhoidal diseases and to relate their ethnomedical characteristics.MethodsThis study was conducted between March 2022 and February 2023 by interviews using semi-structured questionnaire with households (n = 1520), herbalists (n = 25), and traditional healers: THs (n = 59).ResultsThe 1,604 respondents (sex ratio M/F = 0.9; mean age: 56 ± 3 years; experience: 12 ± 3 years) provided information on 100 taxa, 84 of which are used against internal hemorrhoids, Phyllanthus amarus being the most cited (Citation Index, CI: 0.76). Most of them are trees (38%) or shrubs (32%), belonging to 90 genera and 45 families dominated by the Fabaceae (10%) and Asteraceae (9%). They are indicated in 76 other pathologies, dominated by gastrointestinal disorders (GID), wounds and sexually transmitted infections (CI > 0.57). From these 100 taxa, 117 anti-hemorrhoidal formulations were derived, 11 of which combined more than one plant. In all these recipes, the leaf is the most commonly used part (> 60%) and the liniment (> 45%) is the most popular form of application. For the first time, this study reports 14 taxa as plants used in the treatment of hemorrhoids. Among these taxa, Ficus stuhlmannii, Ficus laurifolia, and Ocimum centraliafricanum are listed as medicinal plants for the first time. Khaya nyasica, and Syzygium cordatum, each with 11 uses, have the highest traditional medicinal value.ConclusionThe findings of this study indicate that a significant number of medicinal plants are used in traditional medicine in Lubumbashi for the treatment of hemorrhoidal diseases. Some of these plants are endemic to the biodiversity area, while others are shared with other cultures and regions. A series of pharmacological studies is currently underway with the objective of validating the anti-hemorrhoidal properties of these plants and in order to identify phytochemical compounds responsible of this activity.Graphical

Short and Long - Term Results of Harmonic Scalpel Hemorrhoidectomy versus Stapler Hemorrhoidopexy in Treatment of Hemorrhoidal Disease

Short and Long - Term Results of Harmonic Scalpel Hemorrhoidectomy versus Stapler Hemorrhoidopexy in Treatment of Hemorrhoidal Disease