Hemorrhoid Surgery Research Articles

Laser hemorrhoidoplasty versus hemorrhoidectomy in the treatment of surgically indicated hemorrhoids in inflammatory bowel patients: a randomized comparative clinical study.

This study aims to assess and compare the outcomes of traditional surgery and laser surgery for anal hemorrhoids in patients with inflammatory bowel disease. This is a single-center prospective randomized comparative clinical trial performed at Zagazig University Hospitals from September 2023 to September 2024. The study comprised 48 patients who were admitted during this period and had inflammatory bowel disease along with hemorrhoids. The patients were randomly allocated into two groups: Group I consisted of 24 patients who underwent laser hemorrhoidoplasty, selected based on odd numbers, while Group II consisted of 24 patients who underwent traditional surgery, selected based on even numbers. Group I, which underwent laser treatment for hemorrhoids in inflammatory bowel patients, demonstrated significantly better outcomes than traditional surgery (p < 0.001) regarding operation time, pain score and duration, postoperative anal discharge, return to work time, and patient satisfaction. Moreover, laser treatment was found to be more effective than traditional surgery for treating hemorrhoids in inflammatory bowel patients in terms of postoperative bleeding and anal stenosis. Additionally, there was a higher frequency of residual hemorrhoids in laser group. Laser treatment is mostly superior to traditional surgery for hemorrhoids in inflammatory bowel patients. Clinical Trial.gov (NCT06216223), registered on December 27, 2023, last updated in May 12, 2024. PROTOCOL REGISTRATION ID: #101080-5-9-2023.

Study on the application of segmented nursing pathway in daytime anorectal surgery patients.

Standardised management of day surgery for haemorrhoids and achieving standardised nursing in the painless ward of colorectal surgery are important. To explore the role of segmented nursing pathways in patients undergoing day surgery for anorectal procedures and to provide theoretical and practical guidance for day surgery nursing. A total of 146 patients undergoing anorectal surgery in our day surgery ward between April 2023 and July 2023 were selected as the study participants, with 74 patients in the control group receiving routine nursing and 72 patients in the experimental group receiving segmented nursing. The preoperative preparedness, preoperative anxiety, complication rate, discharge preparedness and nursing satisfaction were compared between the two groups. The experimental group had higher rates of admission before 8:30 am (77.78% vs 45.95%), awareness of the day surgery process (63.89% vs 24.32%), completion rate of preoperative preparation (81.94% vs 59.46%), satisfaction with preoperative preparation (94.44% vs 74.32%), discharge preparedness (112.42 ± 3.28 vs 95.82 ± 3.41) and nursing satisfaction (97.22% vs 70.27%) compared with the control group (P< 0.05). After the intervention, the self-rating anxiety scale score (43.14 ± 12.44 vs 52.51 ± 13.21) and the self-rating depression scale score (45.03 ± 11.37 vs 55.37 ± 10.14) were lower in the experimental group than in the control group (P< 0.05). Segmented nursing pathways can improve the preoperative preparedness of patients undergoing day surgery for anorectal procedures, alleviate patient anxiety, enhance discharge preparedness, improve the quality of nursing care and increase nursing satisfaction.

Comparison of Post-Hemorrhoid Surgery Pain Profiles in Older and Younger Adults

IntroductionOlder and younger adults are offered similar analgesic options after hemorrhoid surgery (HS), but the differences in pain between the two populations are unknown. This study aims to compare postoperative pain outcomes after HS in older and younger individuals. MethodsThis is a retrospective analysis of electronic medical records of patients who underwent HS between 2018 and 2023. Patients were excluded if additional anorectal procedures were performed at the time of HS. Data related to pain-related outcomes were compiled: (1) need for narcotic prescription refills; (2) documentation of a pain-related phone call within 30 d; (3) urgent postoperative office visit before regular scheduled follow-up; and (4) pain-related postoperative emergency department visits. Associations between age and pain-related outcomes were tested using Fisher's exact test, chi-square test, and covariate adjusted logistic regression modeling. ResultsThere were a total of 249 patients, 60 older adults, and 189 younger adults. Compared to younger patients, older adults demonstrated a reduced frequency of pain-related phone calls (10.3 versus 32.1%, P < 0.01) and opioid refills (0 versus 14.4%, P < 0.01). After adjusting for confounders, older age remained inversely associated with pain-related postoperative phone calls (odds ratio = 0.25, 95% confidence interval = [0.1-0.6], P = 0.003). ConclusionsOlder adults had better pain outcomes after HS in comparison to younger patients. These findings suggest that the postoperative analgesic needs of older patients after HS are lower than those of younger patients. Decisions regarding opioid prescription in older adults recovering from HS should be tailored to avoid narcotic-related complications.

Exploring factors impacting patient decisions in hemorrhoid surgery: A questionnaire survey in Taiwan

BackgroundMinimally invasive hemorrhoid surgeries like Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) and Stapled Hemorrhoidopexy (PPH) offer benefits over traditional methods. This study investigated public perceptions and attitudes towards these surgeries, exploring awareness, preferences, and influencing factors. MethodsA detailed questionnaire was disseminated to 2011 participants from various regions of Taiwan in December 2023, gathering data on demographics, understanding of minimally invasive surgery, and attitudes towards hemorrhoid surgery. Chi-square tests were used for analysis (p < 0.05). ResultsHemorrhoid prevalence was similar across sexes and age groups. About 70 % preferred medical centers or district hospitals for surgery. Postoperative complications were a primary concern, with significant sex differences. Approximately 70 % preferred minimally invasive surgery if costs were below NT$50,000. Medical personnel showed higher awareness of minimally invasive surgery benefits. Most participants relied on personal networks and medical social media for information. ConclusionsThe study revealed generally positive perceptions of minimally invasive hemorrhoid surgery, with cost being a significant factor. Knowledge gaps exist, particularly among non-medical personnel. Future initiatives should aim to enhance public awareness of minimally invasive surgery benefits, and policy considerations should address financial aspects of healthcare decisions.

Implementation of a Multimodal Enhanced Recovery Protocol in Ambulatory Anorectal Surgery: A Randomized Trial.

Few studies report outcomes for enhanced recovery pathways in ambulatory anorectal surgery. We hypothesize that an ambulatory anorectal enhanced recovery pathway with multimodal analgesia can reduce postoperative opioid use. To compare postoperative opioid use in patients undergoing ambulatory anorectal surgery who receive multimodal analgesia vs. standard of care without multimodal analgesia. A prospective randomized trial of patients undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Urban teaching hospital. Adults aged 18 to 70 undergoing elective anal fistula or hemorrhoid surgery from September 2018 to May 2022. Multimodal enhanced recovery pathway including pre- and postoperative non-opioid analgesia with oral acetaminophen, gabapentin and ketolorac. Primary endpoint was oral opioid use during the first postoperative week. Secondary endpoints included maximum pain and nausea scores, adverse events and emergency room or hospital admissions during the first 30 days postoperatively. Of the 109 enrolled patients, 20 were lost to follow-up. The remaining 89 patients had a median age of 38 (range, 20-67) years and included 41 (46%) females. There were no significant differences between the enhanced recovery protocol (Arm E) and non-enhanced recovery protocol (Arm NE) groups in terms of preoperative and surgical characteristics. The study primary endpoint, oral MME use during the first week, was significantly higher among patients in the NE arm (79 mg; range, 0-600) than patients in the E arm (8 mg; range, 0-390) (p = 0.002). On subgroup analysis, both fistula and hemorrhoid surgery patients assigned to the NE arm took significantly higher oral MME in the first week than patients in the E arm. There was no significant difference in secondary endpoints. Patients and providers were not blinded. Our findings are limited to hemorrhoid and fistula surgery and may not be applicable to other anorectal procedures. Enhanced recovery protocols including multimodal analgesia should be used in elective anal fistula and hemorrhoid surgery to decrease postoperative opioid use. See Video Abstract . ClinicalTrials.gov ID NCT03738904.

Quality of Life of Patients Before and After Hemorrhoid Surgery: A Single-Center Study in Vietnam

Background: Hemorrhoids are a prevalent condition that significantly impacts the quality of life (QoL) of affected patients. Despite their common occurrence, few studies have thoroughly investigated the changes in health-related QoL in patients undergoing hemorrhoid surgery, particularly in Vietnam. Objectives: This study aims to assess and compare the mean quality of life (QoL) scores across various dimensions before and after hemorrhoid surgery, providing insights into the effectiveness of surgical interventions. Methods: This before-and-after study was conducted on 246 patients at the University Medical Center HCMC, Vietnam, from February 2023 to February 2024. Participants were evaluated using the HEMO-FISS-QoL questionnaire before and eight weeks post-surgery. The Wilcoxon Signed Rank test was used to determine the association between the patients' quality of life (QoL) and the scores of each dimension before and after hemorrhoid surgery at eight weeks, with statistical significance set at P &lt; 0.05. Results: The study included 246 participants with a mean age of 42.80 ± 14.22 years. The results indicated a significant enhancement in QoL post-surgery, with mean scores decreasing from 42.37 ± 12.74 before surgery to 23.54 ± 2.19 after surgery (P &lt; 0.001), reflecting considerable improvements across all measured dimensions. Conclusions: The findings demonstrate a statistically significant improvement in both overall QoL and individual health dimensions following hemorrhoid surgery, confirming the procedure's effectiveness. This study contributes valuable data to the limited existing literature on the impact of hemorrhoid surgery on patient outcomes in Vietnam.

Surgical repair of rectovaginal fistula by combined transanal and transvaginal endoscopy: a case report

The common causes of rectovaginal fistula include obstetric trauma, local infection, and rectal surgery, while rectovaginal fistula following hemorrhoid surgery is extremely rare. Rectovaginal fistulae (RVF) rarely heal without intervention. Surgical treatment is usually performed, but the optimal surgical method remains controversial. The patient was a 37-year-old woman who was transferred to our hospital due to an unsuccessful repair of a rectovaginal fistula after hemorrhoid surgery in a local hospital. The next day after admission, she had prophylactic ileostomy, fecal diversion and combined treatment with cephalosporin antibiotic to create a clean postoperative area. However, there was still fecal outflow from the vagina, with no significant reduction in excretion compared to previous surgery. Digestive endoscopy confirmed a failure of the repair for rectovaginal fistula. Therefore, preventive ileostomy was continued to reduce the accumulation of bacteria in the fistula and control the inflammation. After 8 weeks, the endoscopic fistula inflammation disappeared, and the condition of endoscopic surgery was considered to be mature. Subsequently, a new surgical method combining transanal endoscopy and transvaginal endoscopy was performed. After 12 weeks of surgery, a follow-up endoscopic examination showed that the fistula had been repaired and healed. During the 1-year follow-up, no serious complication was encountered, no recurrence was found, and the repair effect was satisfactory. In conclusion, a new technique combining transanal endoscopy and transvaginal endoscopy can effectively be used for the surgical repair of rectovaginal fistula after a hemorrhoid operation.

Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management

There are very few French studies on hemorrhoidal disease and its management. Prospective single-center study from July to December 2021 including 472 patients. Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.

Metastatic anorectal melanoma presenting with bilateral orbital mass – A rare case

Due to the increased longevity of patients and advances in diagnostic modalities, an increase in the prevalence of patients with orbital metastasis is being observed. Here, we report a lady in her 40s who presented with complaints of painless protrusion of the left eyeball with restricted motility and reduced vision. She gave history of surgery for hemorrhoids. Based on clinical and imaging findings, a diagnosis of orbital metastasis was made. Thorough systemic evaluation revealed the primary tumor to be a melanoma of anorectal origin with widespread metastasis. An orbital surgeon should keep high suspicion for metastasis while working up cases of orbital malignancy, especially in the elderly population.

Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial

BackgroundHaemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. ObjectiveTo investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DesignThis was a longitudinal double-blind study with a permuted block randomization design. Setting(s)This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. ParticipantsA total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) MethodsPatients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. ResultsThere was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = −0.81, 95 % CI: −1.44 to −0.18). ConclusionsEarly warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. RegistrationClinicalTrials.gov ID: NCT04535765

Effect of Diosmin Tablets Combined with Mayinglong Shexiang Hemorrhoid Ointment on Wound Healing, Edema and Anal Function after Mixed Hemorrhoid Surgery

Effect of Diosmin Tablets Combined with Mayinglong Shexiang Hemorrhoid Ointment on Wound Healing, Edema and Anal Function after Mixed Hemorrhoid Surgery

Impact of preoperative antiplatelet / anticoagulant therapy on postoperative bleeding rate in anorectal surgery. Analysis of a high-volume proctologic and pelvic floor clinical center

IntroductionThe aim of the present study is to analyze the impact of preoperative antiplatelet and/or anticoagulant therapy on postoperative bleeding in proctologic surgery. Material and MethodsA retrospective study was conducted on a consecutive series of patients who underwent to proctologic surgery between January 2016-December 2018. The patients were divided in two groups: non-therapy group without any cardiovascular problem and therapy group that received antiplatelet and/or anticoagulant therapy. A sub analysis was carried out stratifying the patients according to the type of preoperative therapy and the type of surgery. ResultsA total of 1832 operated patients were collected; 8.7 % of them received antiplatelet or anticoagulant therapy preoperatively. The postoperative bleeding rate was 2.8 % (2.1 % in the non-therapy group, and 10.1 % in the therapy group). The re-operation rate after bleeding was 1.2 % (1.1 % of non-therapy group, and 3.1 % therapy group). The re-operation rate in patients with postoperative bleeding was 51.4 % and 31.3 % for therapy and non-therapy group, respectively. The interval time between surgery and bleeding, was 7.8 days (non-therapy) and 8.5 days (therapy). Hemorrhoid's surgery showed to have the higher postoperative bleeding rate. The use of DOACs and OAC showed the highest rates of bleeding (20 % vs 36.4 %). ConclusionThe constant increase of patients with antiplatelet/anticoagulant treatment requiring surgery for benign diseases reveals a significant increase the post-operative risk of bleeding. The management of these complex patients needs to be discussed in a multidisciplinary team with the aim to follow shared guidelines but also to customize the approach.

Parameters predicting postoperative pain and quality of life after hemorrhoidectomy: follow-up results from a prospective multicenter randomized trial

PurposePain and reduced quality of life (QoL) are major subjects of interest after surgery for hemorrhoids. The aim of this study was to find predictive parameters for postoperative pain and QoL after hemorrhoidectomy.MethodsThis is a follow-up analysis of data derived from a multicenter randomized controlled trial including 770 patients, which examines the usefulness of tamponade after hemorrhoidectomy. Different pre-, intra-, and postoperative parameters were correlated with pain level assessed by NRS and QoL by the EuroQuol.ResultsAt univariate analysis, relevant (NRS > 5/10 pts.) early pain within 48 h after surgery was associated with young age (≤ 40 years, p = 0.0072), use of a tamponade (p < 0.0001), relevant preoperative pain (p = 0.0017), pudendal block (p < 0.0001), and duration of surgery (p = 0.0149). At multivariate analysis, not using a pudendal block (OR 2.64), younger age (OR 1.55), use of a tamponade (OR 1.70), and relevant preoperative pain (OR 1.56) were significantly associated with relevant early postoperative pain. Relevant pain on day 7 was significantly associated only with relevant early pain (OR 3.13, p < 0.001). QoL overall remained at the same level. However, n = 229 (33%) patients presented an improvement of QoL and n = 245 (36%) an aggravation. Improvement was associated with a reduction of pain levels after surgery (p < 0.0001) and analgesia with opioids (p < 0.0001).ConclusionEarly relevant pain affects younger patients but can be prevented by avoiding tamponades and using a pudendal block. Relevant pain after 1 week is associated only with early pain. Relief in preexisting pain and opioids improve QoL.Trial registrationDRKS00011590 12 April 2017.

Comparison the effect of gelatin sponge and epinephrine-soaked gauze for hemostasis and pain control after hemorrhoidal surgery

Post-operative pain and bleeding are the main complications following hemorrhoidal surgery. This study aimed to investigate whether an absorbable gelatin sponge is a superior hemostatic and analgesic agent compared to gauze soaked in epinephrine for post-hemorrhoidal surgery care. A retrospective study was conducted using data from a single institute. Data were collected from the electronic medical record database and outpatient patient questionnaire archive. The study encompassed 143 patients who received gauze soaked in epinephrine as the hemostatic agent after hemorrhoidal surgery and 148 patients who received an absorbable gelatin sponge. Most patients underwent stapled hemorrhoidopexy, with 119 (83.2%) in epinephrine group and 118 (79.7%) in gelatin sponge group. The primary outcome measurements were postoperative pain score, oral analgesic dosage and complications. Patients in the absorbable gelatin sponge group reported significantly lower pain scores from 8 h after their hemorrhoidal surgery (postoperative day 0) through postoperative day 2. The average pain scores in the absorbable gelatin sponge group and gauze soaked in epinephrine group were 5.3 ± 3.2 and 6.2 ± 3.2 (p = 0.03) on postoperative 8 h; 4.7 ± 3.0 and 5.8 ± 2.9 (p ≤ 0.01) on postoperative day one; and 4.4 ± 2.8 and 5.3 ± 2.9 (p = 0.01) on postoperative day two, respectively. There were no significant differences in postoperative recovery or complication rates between the two groups. Our study revealed that absorbable gelatin sponges provide more effective pain relief to patients during the initial postoperative days after hemorrhoidal surgery, without any adverse impact on patient outcomes. Consequently, absorbable gelatin sponges are recommended as a replacement for gauze soaked in epinephrine following hemorrhoidal surgery.

Comparison of ointment-based agents after excisional procedures for hemorrhoidal disease: a network meta-analysis of randomized controlled trials.

Efficient postoperative pain control is important after hemorrhoidal surgery. Although several locally applied medications have been used, current evidence regarding the optimal strategy is still conflicting. This network meta-analysis assessed analgesic efficacy and safety of the various topical medications in patients submitted to excisional procedures for hemorrhoids. The present study followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The last systematic literature screening was performed at 15 June 2023. Comparisons were based on a random effects multivariate network meta-analysis under a Bayesian framework. Overall, 26 RCTs and 2132 patients were included. Regarding postoperative pain, EMLA cream (surface under the cumulative ranking curve (SUCRA) 80.3%) had the highest ranking at 12-h endpoint, while aloe vera cream (SUCRA 82.36%) scored first at 24 h. Metronidazole ointments had the highest scores at 7 and 14 days postoperatively. Aloe vera had the best analgesic profile (24-h SUCRA 84.8% and 48-h SUCRA 80.6%) during defecation. Lidocaine (SUCRA 87.9%) displayed the best performance regarding overall morbidity rates. Due to the inconclusive results and several study limitations, further RCTs are required.

Comparison of Pedicle Coagulation Hemorrhoidectomy With LigaSure Versus Conventional Milligan Morgan Hemorrhoidectomy in Reducing Post-operative Pain: A Randomized Controlled Trial.

Background Hemorrhoids refer to the abnormal enlargement of the anal cushions. They are a common anorectal problem with a prevalence of 5% in the general population aged greater than 40 years. The objective of this study was to compare Milligan-Morgan open hemorrhoidectomy with pedicle ligation with LigaSure (Medtronic, Dublin, Ireland) in terms of postoperative pain on day 1 and day 7. It is important to assess the technique that is associated with lower postoperative pain because both of these techniques are still practiced in the developing world. Methods It was a randomized controlled trial conducted in the Department of Surgery, Rawalpindi, Pakistan. A total of 100 patients were selected and were allotted into the two groups by lottery method. Patients aged from 15 to 60 years who presented with symptomatic third and fourth-degree hemorrhoids were included after taking informed consent. Patients who had a previous or concomitant anorectal disease, patients who had undergone previous surgery for hemorrhoids, and those who were anesthetically unfit for surgery (American Society of Anesthesiologists (ASA) class 3 or above) were excluded from the study. Pain was assessed using the Visual Analogue scale (VAS). Data was entered and analyzed using SPSS v. 23.0 (IBM Corp., Armonk, USA). Chi-square tests were applied. P-value <0.05 was taken as statistically significant. Results Out of 100 patients, 68 (68%) were males while 32 (32%) were females. The mean age was 40.56±9.24 years. Postoperative pain at day 1 was 9.24±0.51 in the Milligan-Morgan group while that in the LigaSure group was 8.44±0.64 (p<0.0001). Postoperative pain at day 7 was 5.00±0.85 in the Milligan-Morgan group while it was 3.04±1.08 in the LigaSure group (p<0.0001). Conclusion LigaSure is a newer technique that helps to reduce complications as compared to other traditional hemorrhoidectomy procedures. Many patients avoid hemorrhoidectomy as it is associated with painful postoperative recovery. Pedicle coagulation with LigaSure was better than conventional Milligan-Morgan hemorrhoidectomy in terms of reducing the mean postoperative pain on 1st day and 7th day. Reducing the postoperative painhelps in greater patient satisfaction and lesser requirement of analgesiaamong patients of 3rd and 4th-degree hemorrhoids undergoing hemorrhoidectomy.

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

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

A qualitative study of Traditional Chinese Medicine nursing needs in elderly patients after surgery for mixed hemorrhoids

A qualitative study of Traditional Chinese Medicine nursing needs in elderly patients after surgery for mixed hemorrhoids

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 &lt; 0.001) and Operative blood loss in LH 5.61±1.06 ml compared with SH 11.67±1.92 ml (P &lt; 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 &lt; 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.

Pica sebagai Manifestasi Anemia Defisiensi Besi: Suatu Laporan Kasus

Prevalence of anemia in Indonesia based on Basic Health Research (2018) was 23.7%. Symptoms of iron deficiency anemia were pallor, malaise, palpitation, shortness of breath, headache, sore tongue. But sometimes can be found abnormal behavior in the form of PICA. This article reports on a-52-year-old man who sought medical treatment and was diagnosed with iron deficiency anemia with pica manifestation. The pica manifestation was characterized by a repeated desire to consume raw rice due to bleeding from hemorrhoids. Patient was given oral iron replacement therapy contain 100 mg of Fe (III) hydroxide polymaltose complex and folic acid 0.35 mg alternating with vitamin C 500 mg daily. Total iron daily dose given were 200 mg, divided in two doses. The patient received dietary education and was advised to consult a Gastroenterohepatology Subspecialist for the management of hemorrhoids, but it has not been done yet. The desire for raw rice consumption disappeared and the hemoglobin level increased to 12.4 g/dL after six weeks of therapy. The patient continued to take iron supplements until January 2023 but did not have follow-up visits to the clinic. In January 2023, the patient underwent hemorrhoid surgery due to bleeding accompanied by and a non-reducible lump that had been present for three days. Iron supplements continued for one month post-operation and then discontinued. The latest hemoglobin level was 15.3 g/dL without iron supplements. The symptoms of pica in this patient disappeared along with an increased hemoglobin level, and the management of severe anemia in this patient showed an adequate response. Bleeding has never occurred again after the surgery. Curative measures for hemorrhoidal bleeding are crucial, while iron supplementation is only a supportive therapy.