Pile Research Articles

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.

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

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

Background: Laser hemorrhoidoplasty is a minimal invasive procedure to treat hemorrhoids and has shown better outcomes. Less is known about its utility in a Lower middle-income country; Bangladesh. Method: 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 weeks including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction and recurrence. Results: The study included 86 patients, with a higher proportion of male participants (73.3%) with 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±4.70 minutes. 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 6 wks). 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. Conclusion: 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.

Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience.

Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH. To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids. This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

Effectiveness of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on hemorrhoidal disease: A case-matched analysis

BackgroundHemorrhoidal disease (HD) significantly impacts patients’ quality of life. This study aimed to evaluate the effectiveness of preoperative treatment with the micronized purified flavonoid fraction (MPFF) and a sucralfate-based rectal ointment in managing HD symptoms and reducing interventions.MethodsA prospective quasi-experimental study including consecutive cases and controls matched on the basis of sex was performed in a tertiary referral center. Cases received systemic and local therapy for HD, consisting of a rectal ointment containing 3% sucralfate and herbal extracts plus MPFF, in addition to conservative therapy, while controls received conservative therapy alone. The hemorrhoidal disease symptom score (HDSS), the Short Health Scale for HD (SHS-HD) score, and the Vaizey Incontinence Score were used to evaluate symptoms severity and their impact on quality of life and continence. Intervention requirements were assessed at baseline (T0) and after 60 days of treatment (T1).ResultsBetween January and December 2023, a total of 98 patients were assessed for eligibility. After exclusions, 56 patients were enrolled, with 28 in each group. Significant improvements were observed in HD symptom scores from T0 to T1: the intervention group showed a mean change in HDSS of −9 [95% confidence interval (CI) −10 to −8], and the control group showed no significant change (mean change of 0; 95% CI −1.5 to 0). At T1, a higher proportion of patients in the intervention group underwent less invasive interventions compared with controls (18% versus 11%). Age, treatment group, and baseline symptom severity significantly predicted post-treatment symptom scores.ConclusionsIn our study the preoperative treatment with MPFF and a sucralfate-based rectal ointment demonstrated clinical benefits in managing HD symptoms and reducing interventions. Further prospective trials are warranted to confirm and explore additional therapeutic strategies.

Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review

<b><i>Introduction:</i></b> The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews specifically addressing this topic. <b><i>Methods:</i></b> This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies. <b><i>Results:</i></b> Six studies were included – 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents – aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/fissure (1–17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25% within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without significant adverse events, at the cost of a 40% recurrence rate. <b><i>Conclusions:</i></b> All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges previous concerns regarding significant bleeding after office-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam sclerotherapy, a minimally invasive technique that has previously been shown to be more effective than RBL in the general population and in patients with bleeding disorders.

Sclerotherapy with 3% polidocanol foam for the treatment of mucocutaneous bridges and/or residual piles after open excisional hemorrhoidectomy.

Injection sclerotherapy is an effective and safe treatment in selected cases. It might be used as the first treatment for I-III degree hemorrhoidal disease (HD), but also as a bridge therapy for more severe cases not amenable to invasive treatments. However, concerning the long-term recurrence rate, open excisional hemorrhoidectomy remains the gold standard in cases of III- and IV-degree HD. In this context, it is recommended to perform the excision of no more than three piles and to preserve the muco-cutaneous bridges to avoid post-operative anal stenosis. The aim of this study is to evaluate surgical outcomes and efficacy of the combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles. This was a single-center retrospective study and a total of 18 patients with IV-degree HD, aged between 18 and 75years with symptomatic HD according to the Goligher classification, were enrolled between January 2023 and June 2023 and their follow-up continued until October 2023 after reaching 3months of follow-up. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms and their impact on quality of life and continence. A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3months. Moreover, a statistically significant decrease in the median HDSS and short health scale for HD (SHS-HD) score was registered from 16 preoperatively (T0) to 2 at 3-month follow-up (T3). Neither post-operative bleeding nor any type of complications occurred. The use of sclerotherapy in combination with the traditional open excisional hemorrhoidectomy has shown promising results. Further structured studies are needed and greater dissemination and education of the general surgeon on the subject is necessary.

Comparison of Non-Surgical Methods for Treating Hemorrhoids

Introduction and purpose Hemorrhoidal disease is one of the most common proctological problems worldwide. The etiology of hemorrhoidal disease has not been fully explained. Authors note that lifestyle factors and dietary habits are primarily responsible for hemorrhoidal disease. These include: a low-fiber diet, constipation, a sedentary lifestyle, and suboptimal body position during defecation commonly observed in Western societies. Due to the high prevalence of the disease in the population and the associated decrease in quality of life, outpatient procedural treatments that are highly effective and allow for a quick return to normal activity are very popular among patients. The aim of this study is to discuss non-surgical methods of hemorrhoid treatment. Material and methods This paper was based on a review of materials available on PubMed, searched using the following keywords: “hemorrhoids”, “sclerotherapy”, “rubber band ligation”, „infrared coagulation”, „laser hemorrhoidoplasty”, „Doppler guides hemorrhoidal artery ligation”. Results In recent years, there has been a significant development in non-surgical techniques for treating hemorrhoids, which are widely used in patients with grade I-III hemorrhoids and can be performed in an outpatient setting or during short hospital stays with the use of regional anesthesia, such as: Sclerotherapy, rubber band ligation, Infrared coagulation, Laser hemorrhoidoplasty, Doppler Guides Hemorrhoidal Artery Ligation. Conclusion In conclusion, non-surgical methods for the treatment of hemorrhoids offer a range of effective alternatives to conventional surgery. The choice of treatment should be individualized, taking into account the severity of the hemorrhoidal disease, patient preferences, and the potential for complications.

Updates of surgical treatment in hemorrhoidal disease

Updates of surgical treatment in hemorrhoidal disease

An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study).

Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5±13.7years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p<0.001), pain disappearance (69.7 vs diosmin 52.8%, p<0.001), treatment impact at 1week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p<0.001) and shorter times to improvement (mean±SD 3.9±1.5days vs diosmin 4.2±1.7days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.

The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial

BackgroundHemorrhoidal disease, affecting over 20 % of the population, presents management challenges due to its multifaceted nature. While treatments like Micronized Purified Flavonoid Fraction (MPFF) show promise, Aescin's efficacy remains uncertain. This study assesses the combined effectiveness of Aescin with MPFF against MPFF alone in treating Grades 1 and 2 hemorrhoids, focusing on halting bleeding and reducing mass effect. MethodThis study recruited patients from the Division of Colorectal Surgery, Chiang Mai University. Patients were randomly assigned to receive MPFF alone or MPFF with Aescin. Outcomes included the duration until bleeding cessation and resolution of mass effect. ResultsOf 120 patients randomized to each group, the combination therapy demonstrated superiority in halting bleeding (two days VS four days) and resolving mass effect (four days VS five days) compared to MPFF alone with statistically significant differences. Treatment failure rates were lower in the combination therapy group, with high patient satisfaction. ConclusionCombining Aescin with MPFF shows promise as a therapeutic approach for Grades 1 and 2 internal hemorrhoids, offering expedited relief from bleeding and mass effect. These findings suggest the need for further research to validate results in larger cohorts and optimize treatment strategies for hemorrhoidal disease.

A Proposal for Modification of Ferguson's Closed Hemorrhoidectomy Technique Aiming Better Outcomes

AbstractMany technical propositions have been incorporated to the surgical management of hemorrhoidal disease during the recent decades. Besides that, escisional techniques are still considered the best option to control symptoms and reduce recurrence. The present manuscript aims to propose a technical modification of the classical closed hemorrhoidectomy described by Ferguson in America. Our proposition is to perform two sutures to close the wound resulting from hemorrhoidal resection. The first one consists of an anchored continuous suture using a very thin (4–0 or 5–0) monofilamentar thread coming from inside to the outside skin. After tying the stitch, a simple continuous second suture is made over the previous suture only for mucosal approximation, from outside to inside. Finally, the stich that initiated the first suture is tied up to the stich used for the second suture, and the knot remains located above the dentate line, not to disturb the patient. The confection of two layers aims to reinforce the closing of the wound and avoid dehiscence. The idea is that this modification influences postoperative outcomes by reducing symptoms such as wound discharge and pain, and thus improving healing and esthetics. In a next step research, a comparison with the classical technique may bring new insights to this issue.

Inflammatory bowel disease and risk for hemorrhoids: a Mendelian randomization analysis

Observational studies have reported an association between inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), and hemorrhoids (HEM). However, the presence of a causal relationship within this observed association remains to be confirmed. Consequently, we utilized the Mendelian randomization (MR) method to assess the causal effects of IBD on hemorrhoids. We validated the association between IBD and hemorrhoids in humans based on genome-wide association studies (GWAS) data. To investigate the causal relationship between IBD and hemorrhoids, we performed a two-sample Mendelian randomization study using training and validation sets. The genetic variation data for IBD, CD, UC, and hemorrhoids were derived from published genome-wide association studies (GWAS) of individuals of European. Two-sample Mendelian randomization and Multivariable Mendelian randomization (MVMR) were employed to determine the causal relationship between IBD (CD or UC) and hemorrhoids. Genetically predicted overall IBD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.39 × 10−4) and 1.02 (95% CIs 1.01–1.03, P = 4.99 × 10−5) in the training and validation sets, respectively. Furthermore, we found that CD was positively associated with hemorrhoids risk, with ORs of 1.02 (95% CIs 1.01–1.03, P = 4.12 × 10−6) and 1.02 (95% CIs 1.01–1.02, P = 3.78 × 10−5) for CD in the training and validation sets, respectively. In addition, we found that UC in the training set was positively associated with hemorrhoids risk (ORs 1.02, 95% CIs 1.01–1.03, P = 4.65 × 10−3), while no significant causal relationship between UC and hemorrhoids was shown in the validation set (P > 0.05). However, after MVMR adjustment, UC in the training set was not associated with an increased risk of hemorrhoids. Our study showed that there is a causal relationship between CD and hemorrhoids, which may suggest that clinicians need to prevent the occurrence of hemorrhoids in CD patients.

Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study

ObjectiveTo compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methodsPelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. ResultsPuborectal hiatus distance was higher in the HD group (59.2 ​± ​8.7 ​mm vs. 55.5 ​± ​7.1 ​mm, p ​= ​0.03). Similarly, the distance to the M line was greater in the HD group (18.3 ​± ​4.8 ​mm vs. 16 ​± ​4.6 ​mm, p ​= ​0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 ​± ​291.4 ​mm2 vs. 1897.5 ​± ​352.5 ​mm2, p ​= ​0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p ​= ​0.03). There was a negative correlation between birthweight and obturator internus muscle area (r ​= ​−0.388, p ​= ​0.02), and a positive correlation with M line distance (r ​= ​0.344, p ​= ​0.04). ConclusionLevator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.

Timing and Modality of Hemorrhoidal Prolapse Impact on Patients' Quality of Life.

Background: The aim of this study was to assess whether the frequency and presentation modality of hemorrhoidal prolapse may have an impact on patients' quality of life, leading to a different categorization of patients. Methods: A consecutive series of patients affected by primary hemorrhoidal disease were administered specific questionnaires to assess the severity of symptoms and their quality of life. The frequency/modality of prolapse was also assessed, and the classification of the patients into five categories was hypothesized. The severity of disease was assessed using a validated patient-reported score, while the health-related quality of life was evaluated with the Short Health Scale for hemorrhoidal disease. Results: A total of 122 patients were enrolled. The evaluation of the prolapse modality led to the following classification: type I, 5 patients (4.1%); type II, 9 (7.4%), type IIIa, 48 (39.3%); type IIIb, 52 (42.6%); and type IV, 8 (6.6%). The mean total hemorrhoidal disease score was 9.8 ± 3.3, while the mean total Short Health Scale score was 18.6 ± 5.2. Both scores progressively increased in the five types of prolapse identified, thus showing a worsening of symptoms and quality of life related to the increase in the frequency and modality of prolapse. The assessment of the quality of life showed that all four domains of the Short Health Scale score and the total score were significantly worse in group IIIb compared to IIIa. Conclusions: The frequency and modality of hemorrhoidal prolapse has an impact on the quality of life and allows the identification of new types of patients.

Laser Hemorrhoidoplasty vs Conventional Milligan-Morgan Hemorrhoidectomy for Treatment of Third and Fourth Degree Hemorrhoids: A Prospective Comparative Study

Abstract Background Hemorrhoids are the most common disease of anal canal affecting a large number of people at least once during their lifetime and can interfere with their daily functioning. Surgical treatment is the best available option for symptomatic hemorrhoid cases, which are refractory to medical treatment. In spite of many modifications made to the hemorrhoid surgical techniques, postoperative pain and discomfort remain the major concern for patients, which is why they often refuse to undergo surgical treatment. Laser ablation has opened new possibilities for the minimally invasive treatment of hemorrhoids. Objective To compare the outcomes between laser hemorrhoidoplasty and the conventional Milligan-Morgan hemorrhoidectomy for treatment of third and fourth degree haemorrhoids especially postoperative pain, bleeding, and recurrence. Patients and Methods Recent studies have proven that laser ablation was much better regarding postoperative pain and hemorrhage in the various degrees of hemorrhoids. Our study also confirmed that laser ablation technique has shorter operative time, less severe postoperative pain, bleeding and comparable regression of hemorrhoid columns. Studies with longer follow-up period (around 2 years) have also reported effectiveness of laser for the treatment of hemorrhoids which was confirmed in our study over 6 months. Results Although some studies showed that wound inflammation or hemorrhoid thrombosis could be a problem however our study showed no postoperative local infection in the group treated with laser ablation and only two patients were presented with thrombosis of external hemorrhoid 7–10 days after the surgery, which was resolved with medical treatment. Conclusion Laser hemorroidoplasty has better outcomes than the traditional surgical resection of hemorrhoid disease for the control of grade III and IV symptomatic refractory hemorrhoids specially regarding post-operative pain and bleeding which are the main concerns for most patients.

Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study

Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study

A pilot study on the efficacy and safety of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on patients with grade II to IV hemorrhoidal disease

A pilot study on the efficacy and safety of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on patients with grade II to IV hemorrhoidal disease

1254 Radiofrequency Ablation for Treatment of Hemorrhoid Disease, Minimally Invasive Novel Treatment

1254 Radiofrequency Ablation for Treatment of Hemorrhoid Disease, Minimally Invasive Novel Treatment