Treatment Of Hemorrhoidal Disease Research Articles

Arterial Embolization as a Prominent Option in the Treatment of Hemorrhoid Diseases

Hemorrhoidal disease (HD) is the most common anorectal disease, affecting millions of people worldwide. The most common clinical picture is rectal bleeding, which significantly impairs the quality of life of patients. Treatment of HD varies from diet and lifestyle changes to radical surgery, depending on the degree and severity of symptoms. Endovascular embolization of superior rectal artery (SRA), known as emborrhoid technique, has recently emerged as a promising minimally invasive approach. Because hemorrhoidal plexuses are almost entirely fed through the SRA. They are also fed less by middle rectal artery (MRA) and rarely inferior rectal artery (IRA). Due to some anastomoses and unpredictable variations, vascular structures must be examined before the procedure. So far, there have been reports of studies involving a small number of patients regarding the use of coils and particles as embolization agents. Some of these used particles and coils alone, while others used a combination of particles and/or coils. The studies demonstrated similar clinical efficacy with satisfactory results, and no significant complications such as ischemic necrosis were observed. The use of liquid embolic agents such as N-butyl-cyanoacrylate (NBCA) and ethylene vinyl alcohol copolymer (EVOH) has also recently been suggested to be effective. In conclusion, the current data support the feasibility, effectiveness, and safety of rectal artery embolization for hemorrhoidal disease. However, there is no guideline or consensus in the selection of embolic materials. More randomized controlled studies are needed. This review aims to evaluate the effectiveness and feasibility of embolization applications in hemorrhoidal diseases.

Global International Society of University Colon and Rectal Surgeons in collaboration with European Society of Coloproctology audit on office-based and surgical treatment of haemorrhoidal disease: Study protocol.

Haemorrhoidal disease (HD) is one of the most common anal disorders in the adult population. Despite that, treatment options differ among different countries and specialists, even for the same grade of HD. The aim of this study is to evaluate the differences in patient demographics, surgeon preference for the treatment option, outcomes as well as patient satisfaction rate for the procedure using an office-based or surgical approach for the treatment of HD among International Society of University Colon and Rectal Surgeons (ISUCRS) and European Society of Coloproctology (ECSP) fellows. A panel of the ISUCRS and ECSP members will answer questions that are included in a questionnaire about the treatment of HD. The questionnaire will be distributed electronically to ISUCRS and ECSP fellows included in our database and will remain open from 1 April 2024 to 31 May 2024. This multicentre, global prospective audit will be delivered by consultant colorectal and general surgeons as well as trainees. The data obtained will lead to a better understanding of the incidence of HD, treatment and diagnostic possibilities. This snapshot audit will be hypothesis generating and inform areas the need future prospective study.

Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease

Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease

Hemorrhoidal disease among doctors from grade-A tertiary hospitals in big cities of China: results from web-based doctors as patients survey

BackgroundDoctors are at high risk of developing hemorrhoidal disease (HD), but it is unclear whether doctors are aware of this risk. The OASIS (dOctors AS patIentS) study was performed to examine the prevalence, awareness, diagnosis, and treatment of HD among doctors in big cities in China.MethodsAn online survey consisting of a structured questionnaire was carried out among doctors in grade-A tertiary hospitals in 29 provinces across China from August to October 2020.ResultsA total of 1227 questionnaire responses were collected. HD prevalence was 56.8%, with a significant difference between internists and surgeons (P = 0.01). 15.6% of doctors with HD didn’t have serious concerns about the recurrence and severity of HD. 91.5% of doctors adopted general treatments, and 83.0% considered oral medications only when topical medications were ineffective. Among the oral medications, Micronized Purified Flavonoid Fraction (MPFF) was most effective based on the scores from three important parameters, but only 17% of doctors received MPFF.ConclusionsDoctors are at higher risk of developing HD with a high prevalence among Chinese doctors, but they are not fully aware or not concerned about HD. There is a deficiency in treatment recommendations and clinical management of HD even for doctors, including late initiation and inadequate oral drug therapy. Therefore, awareness and standardized treatment of HD should be improved among Chinese doctors, as well as in the general population.

Use of laser technologies in the treatment of hemorrhoids (Literature review)

Hemorrhoids are one of the most common diseases of the anorectal region, representing a serious medical and socio-economic problem that significantly affects the quality of life of patients. Surgical treatment of this pathology is necessary in cases where the patient complains of bleeding and prolapse of internal hemorrhoids, which cannot be treated with conservative methods. Traditional methods of surgical treatment of this pathology, despite their effectiveness, have a number of significant disadvantages, such as severe pain after surgery, prolonged healing of anal canal wounds, a long period of incapacity for work, as well as possible complications in the form of strictures of the anal canal, insufficiency of the rectal obturator, and anal fistulas. Recently, due to the active development of medical technology in the surgical treatment of hemorrhoids, many new minimally invasive treatment methods have appeared, including the use of lasers with different wavelengths, which have demonstrated high efficiency along with such advantages as reducing the intensity of postoperative pain syndrome, decreasing the frequency of intraoperative and early postoperative complications, as well as the possibility of outpatient implementation of these techniques. Depending on the stage of hemorrhoidal disease, as well as the type of laser radiation, various methods that affect one or both (vascular and mechanical) links in the pathogenesis of the disease are used. This article provides a review of modern literature data and analyzes the experience of using various lasers in the treatment of hemorrhoidal disease.

Application of biotechnologies in the treatment of haemorrhoidal disease and optimisation of patient management

Application of biotechnologies in the treatment of haemorrhoidal disease and optimisation of patient management

Surgical Treatment of Hemorrhoidal Disease at Brazzaville University Hospital Center

Surgical Treatment of Hemorrhoidal Disease at Brazzaville University Hospital Center

Does routine partial lateral sphincterotomy with open hemorrhoidectomy improve postoperative pain?

Objective In this study we aimed to detect the difference regarding the postoperative pain and continence in patients with third and fourth degree hemorrhoidal disease who underwent either hemorrhoidectomy alone or combined hemorrhoidectomy with partial internal sphincterotomy for the treatment of hemorrhoidal disease. Patients and methods This prospective comparative randomized clinical trial was conducted at hospitals of Tanta University during the period from March 2021 to August 2022 on 100 patients with third or fourth degree hemorrhoids who were randomly assigned either to group A, patients who only underwent hemorrhoidal excision by the classical technique of Milligan–Morgan or group B, with added partial lateral sphincterotomy to the classic technique. All patients in both groups underwent anorectal manometry both preoperatively and postoperatively. Pain following surgery was analyzed by using visual analog scale system at 24 h, 48 h, and on 10th postoperative day, other complications including incontinence, infection, hematoma, bleeding, and anal stricture were evaluated at 24 h, 48 h, 10th postoperative day, 1 month, and after 3 months. Results Total 100 patients were divided among both groups. The mean age of the patients was 37.7±11.3 and 36.3±11.3 years in group A and group B, respectively. Thirty-two males and 18 females were in group A in comparison to 33 males and 17 females in group B. During follow-up periods, patients in group B had less postoperative pain than those in group A with statistically significant difference. None of the patients developed fecal incontinence for solid or liquid stools in both groups, except for nine patients developed only mild degree of incontinence for flatus in the first week that improved gradually till completely resolved before the end of the 3 months follow up. Conclusion The addition of partial internal sphincterotomy to the classical haemorrhoidectomy technique significantly improves postoperative pain without increasing overall related morbidity.

Sclerotherapy with 3% polidocanol foam in the treatment of hemorrhoidal disease: unveiling the missing pieces for a comprehensive evaluation.

Sclerotherapy with 3% polidocanol foam in the treatment of hemorrhoidal disease: unveiling the missing pieces for a comprehensive evaluation.

Hemorrhoid (pile) and its treatment with botanicals: An overview

Abstract: 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.

Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis.

Background and objective Minimally invasive techniques in the surgical treatment of hemorrhoids have been gaining in popularity. Laser hemorrhoidoplasty (LHP) and LigaSure™(LigH; Medtronic, Dublin, Ireland)hemorrhoidectomy methods are the most recent innovative methods that are increasingly used. In this study, we aimed to compare the effectiveness of these two innovative techniques. Methods The data of patients who underwent LHP or LigH for grade III hemorrhoidal disease at our clinic between January 2022 and June 2023 were retrospectively analyzed. Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded. Results A total of 100 patients were included in the study. Of these, 48 patients had LHP surgery and 52had LigH surgery. The demographic characteristics of both groups were similar. The mean operation time was statistically significantly shorter inthe LHP group (p<0.001). The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001). The median time to return to daily activity was 2.3(range: one to three) days in the LHP group and 4.6(range: 3-11)days in the LigH group (p<0.001). Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001). Conclusion Based on our findings, LHP is an effective procedure for the surgical treatment of hemorrhoidal disease as it is associated withless morbidity, less pain, early return to work, and acceptable recurrence rates.

Minimally invasive laser technologies in the surgical treatment of hemorrhoidal disease: problems and prospects (literature review)

Based on the literature data, the article reviews the latest advances in the surgical treatment of patients with hemorrhoids. The methods of historical significance, as well as current surgeries are analyzed.The literature review focuses on laser technologies, in particular, laser hemorrhoidoplasty. The paper considers the historical aspects of the development of this approach in proctology, the main surgical techniques, indications and contraindications, possible intra- and postoperative complications, among which the most common are intraoperative bleeding, delayed bleeding, and pain syndrome. The analysis of clinical efficacy and the structure of recurrences and adverse outcomes are presented. Different regimes of laser exposure are analyzed as well. According to the literature data, laser hemorrhoidoplasty is a relatively clinically effective and safe minimally invasive surgical intervention, characterized by short postoperative rehabilitation and a low number of complications. Laser hemorrhoidoplasty is characterized by a low severity of pain syndrome both during the intervention and in the postoperative period. The high economic efficiency of the considered surgical intervention was noted. Meanwhile, the question of the optimal dosing and parameters of the laser energy used in the course of laser hemorrhoidoplasty remains open and should be answered in the upcoming clinical and experimental studies.

Phlebotonics for conservative treatment of haemorrhoids: when, to whom, how?

Hemorrhoidal disease (HD) is a pathological enlargement of the external and/or internal hemorrhoidal piles, which may be accompanied by the bleeding and prolapse of haemorrhoids outside the anal canal. The incidence of HD among the population of the Russian Federation is 130–145 patients per 1000 people, occurring mainly in patients 45–65 years old. Among all coloproctological diseases in Russia, haemorrhoids became the reason for visiting a coloproctologist in 35–41.9% of cases. In outpatient department, the disease occurs with a frequency of 694 per 100,000 population. The treatment of hemorrhoids often begins at the coloproctologist’s office during outpatient visits. Typical clinical presentations of hemorrhoids include a complex of symptoms: periodic rectal bleeding during defecation, prolapsed hemorrhoids requiring manual reduction. Pain and itching are much less common symptoms. The treatment of hemorrhoidal disease consists of a complex of conservative measures, minimally invasive and surgical treatments, or a combination of above methods. Systemic phlebotropic drugs that affect various pathogenesis links of hemorrhoidal disease hold one of the first rightful places at the very core of modern conservative therapy regimens. Phlebotropic drugs are a large group of biologically active substances that are products of chemical synthesis or plant processing. The venotonic drugs containing flavonoids diosmin and hesperidin are the most studied ones. Various effects of diosmin and hesperidin from anti-ulcerogenic and antitumor to antioxidant and anti-inflammatory ones have been studied in clinical and experimental studies. Its venotonic and angioprotective effects are the most important actions for the treatment of hemorrhoidal disease. This review of literature is aimed determining the place of phlebotonics in outpatient practice for the treatment of haemorrhoidal disease.

The place of mini-invasive Transanal-Hemorrhoidal-Dearterialisation and Rectopexy technique in the treatment of hemorrhoidal disease, an evaluation from cost-effectiveness point of view

Background. Choosing the most suitable treatment for Hemorrhoidal Disease (HD) still poses problems for both patients and doctors. THD-RAR although it has proven its superiority regarding postoperative complications, length of hospital stay, return to daily activity compared to Hemorrhoidectomy (HE), it still has a low rate of less than 10% in our hospital, the main causative factor being the increased cost of consumables. Our aim is to analyze the veracity of this factor. Methods. We performed a case-control study in the period 2009-2022 and we evaluated two groups of 50 patients, operated by the THD-RAR method and HE respectively. We had as Main Objective the comparison of average hospitalization costs and as Secondary Objectives the evaluation of postoperative hospitalization, complications, recurrences, the influence on the final cost of social costs. Results. Financially, the elderly had less accessibility to THD-RAR. Internal hemorrhoids predominated in the THD-RAR-group and associated ones in the HE-group (64% and 48%, respectively; p&lt;0.001). Bleeding was the predominant symptom in THD-RAR-group versus prolapse in the HE-group. The mean operation time was longer in THD-RAR compared to HE (48 and 56 min respectively; not significant). The significantly longer postoperative hospital stay in the HE-group compared to the THD-RAR-group (2.52 versus 1.74 days; p&lt;0.001), obviously influenced the hospitalization expenses (834 versus 485 EUR; p&lt;0,001). Thus, although the expenses with the operation were higher for THD-RAR compared to HE, in the end summing up the hospitalization expenses and the social expenses, the difference tilted in detriment of HE (277 EUR). Conclusion. Our study shows that if we subtract from the amortization expenses, the savings made from hospitalization expenses and social expenses, then THD-RAR-HE balance will be in favor of THD. THDRAR must take its place both in the hospitals' own therapeutic protocols and in the national guidelines, being a cost-effective method.

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

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

Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial

PurposeTo compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. Material and MethodsThis study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months. ResultsThe mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups. ConclusionsDespite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment.

The importance of hemorrhoidal disease in the modern world

Aim. To study the incidence of hemorrhoidal disease in the Udmurt Republic on the basis of statistical data of the coloproctology department at the Budgetary Healthcare Institution “The First Republican Clinical Hospital of the Ministry of Health of the Udmurt Republic”, Izhevsk, for 2018-2020 and a clinical case of a patient with acute hemorrhoids. Materials and methods. The data of 6506 medical records of outpatients and inpatients with diagnoses K64.0-K64.5 were analyzed. The evaluation of the results was carried out according to the following criteria: gender, age composition, region, diagnosis of patients, progression of the disease, type of surgery. A clinical case of a patient with acute hemorrhoids is presented. Results. Among the hospitalized patients, the male population prevailed (57.1%); among the outpatient patients, the female population prevailed (57.5%). Most of the patients were young and middle-aged patients (77% of hospitalized patients, 70.6% of outpatient patients). The urban population comprised 65.1% of hospitalized patients and 59.1% of outpatient patients. A chronic form of the disease was registered in 94.6% of the hospitalized patients and in 92.3% of the outpatient patients. Among all surgical interventions hemorrhoidectomy was conducted in 73.0% of cases. The analysis of the diagnosis and treatment of hemorrhoidal disease on the basis of a clinical case with positive results was carried out. Conclusions. According to the data obtained by the department, it can be said that among all patients diagnosed with hemorrhoids, the able-bodied and young, mainly urban population prevails, which indicates the influence of urabanization on the development of hemorrhoidal disease. The disease is equally prevalent in men and women. The chronic form prevails in the structure of the incidence of hemorrhoidal disease. The most commonly used surgical treatment of hemorrhoidal disease is hemorrhoidectomy.

Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study

BackgroundSeveral surgical techniques for the treatment of hemorrhoidal disease (HD) have been proposed. However, the selection of the most proper technique for each individual case scenario is still a matter of debate. The purpose of the present study was to compare the Milligan–Morgan (MM) hemorrhoidectomy and the hemorrhoidal artery ligation and rectoanal repair (HAL–RAR) technique.MethodsA retrospective analysis of the prospectively collected database of patients submitted to HD surgery in our department was conducted. Patients were divided into two groups, the MM group and the HAL–RAR group. Primary end points were recurrence rates and patients’ satisfaction rates. The Unpaired t test was used to compare numerical variables while the x2 test for categorical variables.ResultsA total of 124 patients were identified, submitted either to HAL–RAR or MM hemorrhoidectomy. Eight (8) patients were lost to follow up and were excluded from the analysis. Of the remaining 116 patients, 69 patients (54 males and 15 females–male / female ratio: 3.6) with a median age of 47 years old (range 18–69) were included in the HAL–RAR group while 47 patients (40 males and 7 females–male / female ratio: 5.7) with a median age of 52 years old (range 32–71) comprised the MM group. At a median follow up of 41 months (minimum 24 months–maximum 72 months), we recorded 20 recurrences (28.9%) in the HAL–RAR group and 9 recurrences in the MM group (19.1%) (p 0.229). The mean time from the procedure to the recurrence was 14.1 ± 9.74 months in the HAL–RAR group and 21 ± 13.34 months in the MM group. Patients with itching, pain or discomfort as the presenting symptoms of HD experienced statistically significantly lower recurrences (p 0.0354) and reported statistically significantly better satisfaction rates (6.72 ± 2.15 vs. 8.11 ± 1.99—p 0.0111) when submitted to MM. In the subgroup of patients with bleeding as the presenting symptom, patients satisfaction rates were significantly better (8.59 ± 1.88 vs. 6.45 ± 2.70—p 0.0013) in the HAL–RAR group.ConclusionsIn patients with pain, itching or discomfort as the presenting symptoms of HD, MM was associated with less recurrences and better patients satisfaction rates compared to HAL–RAR. In patients with bleeding as the main presenting symptom of HD, HAL–RAR was associated with better patients’ satisfaction rates and similar recurrence rates compared to MM.

Treatment of hemorrhoidal disease in an atypical patient

Therapeutic algorithms and recommendations for haemorrhoidal disease proposed in the literature are based on the stage of the disease. Less typical situations, such as reduced immunity in HIV infection, cancer patients on chemotherapy, chronic immunosuppressive treatment in patients after organ transplantation or patients with inflammatory bowel disease, as well as elderly patients with comorbidities that increase the risk of perioperative complications, are not usually discussed. On the other hand, publications on treatment complications in immunocompromised patients marginalise the problem of anorectal conditions, including common haemorrhoids. This paper presents the therapeutic management of haemorrhoidal disease in atypical patients. Furthermore, the specifics of the management of haemorrhoidal disease in a pregnant patient and in the perinatal period are also discussed.

Sclerotherapy with 3% polidocanol foam to treat second-degree haemorrhoidal disease: Three-year follow-up of a multicentre, single arm, IDEAL phase 2b trial.

Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I-II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow-up of more than 1 year. The purpose of this study was to analyse the long-term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II-degree HD. This was an open label, single-arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS-HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. The overall success rate ranged from 95.6% (175/183) at 1year to 90.2% (165/183) after the final 3year follow-up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow-up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p< 0.001) from a median preoperative value of 11 (10-13) and 18 (15-20) to 0 (0-2) and 4 (0-4), respectively. Symptom-free (HDSS=0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo-sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate.