Annals of Coloproctology

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Original Articles

Anorectal benign disease

Patient-reported outcomes after hemorrhoid surgery: early results from a prospective, nationwide, real-world, cohort study on diverse approaches: Metin Kement, Atıf Tekin, Hakan Baysal, Salih Tosun, Orhan Alimoğlu, İlker Sücüllü, Osman Civil, Nevin Sakoğlu, Naciye Çiğdem Arslan, Cihad Tatar, Ali Emre Naycı, Aziz Arı, Ensar Çakır, Rozan Kaya, İlknur Turan, Taygun Gülşen, Serhat Meriç, Erkan Yavuz, Nihat Buğdaycı, Farid Mohamad Hamad, Sezai Leventoğlu, Ramazan Kozan, Özkan Akpınar, Hakan Yanar, Fatih Yanar, Hasan Fehmi Küçük, Mehmet Karahan, Selçuk Kaya, Nail Can Adıgüzel, Tolga Önder, İlker Abcı, Ahmet Zeki Aydın, Ömer Faruk Özkan, Nurhilal Kızıltoprak, Berkay Özcan, Anıl Orhan, Alp Ömer Cantürk, Murat Tan, Yusuf Bilgin, Harun Çok, Azamet Cezit, Mehmet Mahir Fersahoğlu, Mustafa Öncel; Ann Coloproctol. 2025;41(6):573-585. Published online December 30, 2025; DOI: https://doi.org/10.3393/ac.2025.00710.0101

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Abstract PDF Supplementary Material: Purpose
Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD.
Methods
A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6.
Results
The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively).
Conclusion
This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference. Trial registration: ClinicalTrials.gov identifier: NCT05429060

Anorectal benign disease

New anatomical insight into the muscular structure of the anal canal: revealing Treitz muscle as a directional shift of the internal anal sphincter: Satoru Muro, Kumiko Yamaguchi, Naoko Inoshita, Yasuo Nakajima, Danyo Jennifer Edinam, Akimoto Nimura, Keiichi Akita; Ann Coloproctol. 2025;41(6):501-509. Published online December 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00647.0092

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Abstract PDF: Purpose
Understanding the muscular structure of the anal canal is crucial for the diagnosis and treatment of anorectal diseases. Treitz muscle is a vital yet poorly understood component. It supports the anal venous plexus and contributes to anal cushion formation. However, its anatomical details remain unclear, and various theories suggest different origins for its muscle bundles, which affects our understanding of the pathophysiology of hemorrhoids. In this study, we sought to clarify the origin and localization of Treitz muscle to provide an anatomical foundation for understanding anal function.
Methods
In this descriptive cadaveric study of 11 cadavers, we performed macroscopic examinations and immunohistological analyses on tissues from the anterior, lateral, and posterior walls of the anal canal. The origin and localization of Treitz muscle were qualitatively evaluated.
Results
Treitz muscle is a smooth muscle formed by a directional change in the muscle bundles of the internal anal sphincter, running longitudinally along its surface. A shift in the direction of muscle bundles originating from the internal anal sphincter, giving rise to Treitz muscle, was frequently observed in the anterolateral wall of the anal canal.
Conclusion
In summary, Treitz muscle, a smooth muscle extending from the internal anal sphincter, is considered part of the muscularis propria. Its directional shift was localized to the anterolateral wall, indicating that Treitz muscle is not uniformly distributed around the anal canal. This site-specific localization may influence the risk of hemorrhoids or cancer invasion depending on its anatomical position.

Anorectal benign disease

Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids: Isaac Seow-En, Lionel Raphael Hui Chen, Yun Zhao, Yvonne Ying-Ru Ng, Emile Kwong-Wei Tan; Ann Coloproctol. 2025;41(6):537-544. Published online December 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00549.0078

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Abstract PDF Supplementary Material: Purpose
We aimed to determine whether intra-anal cryotherapy reduces postoperative pain in patients undergoing hemorrhoidectomy.
Methods
This randomized controlled trial was conducted from January 2023 to August 2024. Patients with symptomatic grade III hemorrhoids were randomized 1:1 to receive either 1 minute of intra-anal cryotherapy or standard postoperative care. Because cryotherapy was applied before reversal of general anesthesia, patients were blinded to treatment allocation. The primary outcome was pain at rest on postoperative day (POD) 1. Secondary outcomes included pain after defecation, time to return to work or non-work activities, 30-day complications, and compliance with analgesia. Pain was measured using the visual analog scale.
Results
A total of 50 patients were randomized (25 per group). All 50 were included in the analysis. Baseline clinicodemographic characteristics were comparable between groups. The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046). On POD 2, median pain scores at rest and after defecation were both significantly lower in the cryotherapy cohort (at rest: 2.0 vs. 4.0, P=0.043; after defecation: 2.0 vs. 5.0, P=0.001).
Conclusion
Intra-anal cryotherapy significantly reduces pain after defecation in the early postoperative period following surgery for grade III hemorrhoids. Its therapeutic efficacy, ease of application, and safety support consideration for routine use. Trial registration ClinicalTrials.gov identifier: NCT06005727

Anorectal benign disease

Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids: Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong; Ann Coloproctol. 2025;41(5):409-416. Published online September 30, 2025; DOI: https://doi.org/10.3393/ac.2025.00458.0065

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Abstract PDF: Purpose
Hemorrhoidal disease impacts quality of life, with hemorrhoidectomy being the standard treatment for grades II–III hemorrhoids. Radiofrequency ablation (RFA) using the Rafaelo technique offers a less invasive alternative; however, comparative data remain limited. This study evaluated short-term outcomes following RFA versus conventional hemorrhoidectomy.
Methods
A single-center retrospective cohort study was conducted at a medical university hospital in Thailand, involving patients who underwent either RFA or hemorrhoidectomy between January 2023 and September 2024. Propensity score matching was utilized to minimize selection bias. Primary outcomes were postoperative pain and opioid consumption.
Results
After propensity score matching, 102 patients were analyzed (51 patients in each group). Baseline characteristics were well-balanced between the 2 groups. The RFA group had higher pain scores at 8 hours postoperatively (1 vs. 0, P=0.002) but lower scores at 20 hours (0 vs. 1, P<0.001). Opioid consumption was significantly lower in the RFA group (9.8% vs. 31.4%, P=0.007), with a reduced morphine-equivalent dose (0.7 mg vs. 3.5 mg, P=0.003). Additionally, the RFA group had a shorter operative time (20 minutes vs. 30 minutes, P<0.001) and less intraoperative blood loss (0 mL vs. 5 mL, P<0.001). Hospital stays and complication rates were comparable between groups.
Conclusion
RFA resulted in improved postoperative pain control, reduced opioid use, shorter operative duration, and decreased blood loss compared to hemorrhoidectomy, with similar hospital stay durations and complication rates.

Anorectal benign disease

A comparative study on efficacy and safety of modified partial stapled hemorrhoidopexy versus conventional hemorrhoidectomy: a prospective randomized controlled trial: Tae Gyu Kim, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Seung Han Kim, Sang Hwa Yu, Jeong Eun Lee, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Gyu Young Jeong; Ann Coloproctol. 2025;41(2):145-153. Published online April 28, 2025; DOI: https://doi.org/10.3393/ac.2024.00535.0076

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Abstract PDF Supplementary Material: Purpose
The long-term outcomes and efficacy of partial stapled hemorrhoidopexy (PSH) compared with those of conventional hemorrhoidectomy (CH) are not fully understood. This study aimed to introduce a modified PSH (mPSH) and compare its clinical efficacy and safety with those of CH.
Methods
A prospective randomized controlled trial was conducted. This study was performed at a single hospital and involved 6 colorectal surgeons. In total, 110 patients were enrolled between July 2019 and September 2020. Patients were randomly assigned to undergo either mPSH group (n=55) or CH group (n=55). The primary outcome was to compare postoperative average pain and postoperative peak pain using visual analog scale score between the 2 groups.
Results
The required duration of analgesia was shorter in the mPSH group than in the CH group, although the difference was not statistically significant (P=0.096). However, the laxative requirement duration (P<0.010), return to work (P<0.010), satisfaction score (P<0.010), and Vaizey score (P=0.014) were significantly better in the mPSH group. The average and peak postoperative pain scores were significantly lower in the mPSH group during the 15 days after surgery (P<0.001). The overall complication rate in both groups was 9.1%, with no significant difference between the groups (P=0.867).
Conclusion
The mPSH group demonstrated better improvement in symptoms, lower pain scores, and greater patient early satisfaction after surgery than the CH group. Therefore, this surgical technique appears to be a safe and effective alternative for CH.

Anorectal benign disease

Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study: Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano, Luana Passariello, Pasquale Talento, Giovanna Ioia, Corrado Rispoli, Mariano Fortunato Armellino, Vincenzo Bottino, Adolfo Renzi, Carlo Bartone, Luigi Monaco, Paolino Mauro, Stefano Picardi, Maria Paola Menna, Elisa Palladino, Mario Massimo Mensorio, Vinicio Mosca, Claudio Gambardella, Luigi Brusciano, Ludovico Docimo; Ann Coloproctol. 2024;40(6):602-609. Published online December 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00570.0081

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Abstract PDF

Purpose
Postoperative pain is a major concern for patients undergoing ultrasound scalpel-assisted hemorrhoidectomy, potentially exacerbated by delayed wound healing. This study aimed to evaluate the impact of an intimate cleansing gel containing chlorhexidine, hyaluronic acid, and other anti-inflammatory agents (Antroclean Fisioderm) on postoperative pain, itching, and wound healing in patients who had undergone this procedure.
Methods
This multicenter observational case-control study involved a cohort of consecutive adult patients who underwent hemorrhoidectomy using an ultrasound device. The study compared 2 different postoperative wound management strategies over 1 month after surgery: washing with warm water twice per day (control group) versus a 2-minute topical application of intimate cleansing gel (Antroclean Fisioderm) followed by a warm water wash (intervention group).
Results
The median postoperative pain score was significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). The percentage of patients reporting anal itching was also significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). All patients in the intervention group achieved complete wound healing 4 weeks after surgery, compared to 88 (82%) in the control group (P<0.01). No adverse events were reported.
Conclusion
The topical application of intimate cleansing gel (Antroclean Fisioderm) twice daily for 1 month following ultrasound scalpel-assisted hemorrhoidectomy appears to be associated with faster healing, reduced pain, decreased itching, and improved quality of life, without any adverse effects. Further larger and prospective randomized trials are recommended to confirm these findings.

Citations

Citations to this article as recorded by

Enhancing Proctological Outcomes: The Role of Hyaluronic Acid in Hemorrhoid Care – An Innovative Adjunct to Surgery
Riddhi Upadhyay, Akshat Vadaliya, Haryax V. Pathak, Soham Upadhyay
Journal of Coloproctology.2025; 45(03): 001. CrossRef

Technical Note

Anorectal benign disease

Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery: Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya; Ann Coloproctol. 2024;40(6):610-612. Published online December 2, 2024; DOI: https://doi.org/10.3393/ac.2023.00696.0099

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PDF Supplementary Material

Guideline

Anorectal benign disease

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease: Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Claudio Gambardella, Luigi Monaco, Ilaria Ferrante, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferreri, Andrea Braini, Umberto Cocozza, Massimo Pezzatini, Valeria Gianfreda, Alberto Di Leo, Vincenzo Landolfi, Umberto Favetta, Sergio Agradi, Giovanni Marino, Massimiliano Varriale, Massimo Mongardini, Claudio Eduardo Fernando Antonio Pagano, Riccardo Brachet Contul, Nando Gallese, Giampiero Ucchino, Michele D’Ambra, Roberto Rizzato, Giacomo Sarzo, Bruno Masci, Francesca Da Pozzo, Simona Ascanelli, Patrizia Liguori, Angela Pezzolla, Francesca Iacobellis, Erika Boriani, Eugenio Cudazzo, Francesca Babic, Carmelo Geremia, Alessandro Bussotti, Mario Cicconi, Antonia Di Sarno, Federico Maria Mongardini, Antonio Brescia, Leonardo Lenisa, Massimiliano Mistrangelo, Matteo Zuin, Marta Mozzon, Alessandro Paolo Chiriatti, Vincenzo Bottino, Antonio Ferronetti, Corrado Rispoli, Ludovico Carbone, Giuseppe Calabrò, Antonino Tirrò, Domenico de Vito, Giovanna Ioia, Giovanni Luca Lamanna, Lorenzo Asciore, Ettore Greco, Pierluigi Bianchi, Giuseppe D’Oriano, Alessandro Stazi, Nicola Antonacci, Raffaella Marina Di Renzo, Gianmario Edoardo Poto, Giuseppe Paolo Ferulano, Antonio Longo, Ludovico Docimo; Ann Coloproctol. 2024;40(4):287-320. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2023.00871.0124

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Abstract PDF

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Citations

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Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease
Gaetano GALLO, Mario TROMPETTO
Minerva Surgery.2025;[Epub] CrossRef
Milligan–Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study
Qing Long, Yong Wen, Jun Li
BMC Gastroenterology.2025;[Epub] CrossRef
Critical appraisal of transperineal Doppler ultrasound as a diagnostic tool for hemorrhoidal recurrence
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International Journal of Colorectal Disease.2025;[Epub] CrossRef
Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis
Marcelo Albuquerque Barbosa Martins, Luiz Felipe Costa de Almeida, Anelise Poluboiarinov Cappellaro, Luís Fernando Rosati Rocha, Rachid Eduardo Noleto da Nobrega Oliveira
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Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study
Antonio Brillantino, Francesca Iacobellis, Luigi Marano, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Claudio Gambardella, Umberto Favetta, Michele Schiano Di Visconte, Luigi Monaco, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palum
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Postoperative Perianal Abscess and Concomitant Anorectal Fistula: An Extremely Rare Complication After Emergency Transanal Hemorrhoidal Dearterialization With Mucopexy for Hemorrhoidal Disease
Charito Chatzinikolaou, Konstantinos Perivoliotis, Amalia Moula, Kyriakos Psarianos, Alexios Stavrou, Ioannis Baloyiannis, George Rallis
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Transverse perineal support improves long-term outcomes in patients undergoing stapled transanal rectal resection for obstructed defecation syndrome: a multicenter observational case-control study
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Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
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Review

Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis: Ian Jun Yan Wee, Chee Hoe Koo, Isaac Seow-En, Yvonne Ying Ru Ng, Wenjie Lin, Emile John Kwong-Wei Tan; Ann Coloproctol. 2023;39(1):3-10. Published online January 3, 2023; DOI: https://doi.org/10.3393/ac.2022.00598.0085

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Abstract PDF Supplementary Material

Purpose
This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids.
Methods
PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities.
Results
Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], –2.09; 95% confidence interval [CI], –3.44 to –0.75; P=0.002) and postoperative day 7 (MD, –3.94; 95% CI, –6.36 to –1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42–0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12– 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240).
Conclusion
LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

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Patient-reported outcomes after hemorrhoid surgery: early results from a prospective, nationwide, real-world, cohort study on diverse approaches
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Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids
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Quand et comment traiter des hémorroïdes
Thierry Higuero
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Sana Sahar, Tamjeed Gul, Muhammad Ihtesham Khan
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Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management
Dheeraj Surya, Pankaj Gharde
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Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis
Po-Lung Cheng, Chang-Cyuan Chen, Jian-Syun Chen, Po-Li Wei, Yan-Jiun Huang
Asian Journal of Surgery.2024; 47(11): 4681. CrossRef
Laser hemorrhoidoplasty vs. rubber band ligation: a randomized trial comparing 2 mini-invasive treatment for grade II hemorrhoids
Lei Jin, Kaijian Qin, Renjie Wu, Haojie Yang, Can Cui, Zhenyi Wang, Jiong Wu
BMC Surgery.2024;[Epub] CrossRef
Quality of Life of Patients Before and After Hemorrhoid Surgery: A Single-Center Study in Vietnam
Nguyen Thi Thuy Anh, Nguyen Ngoc Huynh Nhu, Tran Ngoc Hong, Pham Thi Ly, Nguyen Thi Hong Huyen, Doan Thi Minh, Ho Tat Bang, Nguyen Trung Tin
Journal of Nursing and Midwifery Sciences.2024;[Epub] CrossRef
Propensity-Score Matching Analysis for Laser Hemorrhoidoplasty Versus Circumferential Stapler Hemorrhoidectomy: One-Year Outcomes
Tran V Hung, Duong V Hai
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Md. Saiful Islam, Abhigan B. Shrestha, Faisal Chowdhury, Md. R.K. Ziko
Annals of Medicine & Surgery.2024; 86(11): 6514. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
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N. D. Yartseva, L. V. Kornev, E. K. Naumov, G. V. Rodoman, L. A. Laberko
Hirurg (Surgeon).2023; (3): 20. CrossRef
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P. C. Ambe
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Comments on “Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis”
Mohamed Ali Chaouch, Amine Gouader, Bassem Krimi, Hani Oweira
Annals of Coloproctology.2023; 39(5): 442. CrossRef

Original Articles

Anorectal benign disease

The importance of compression time in stapled hemorrhoidopexy: is patience a virtue?: Byung Eun Yoo, Wook Ho Kang, Yong Teak Ko, Young Chan Lee, Cheong Ho Lim; Ann Coloproctol. 2024;40(2):176-181. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00556.0079

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Abstract PDF

Purpose
The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.
Methods
This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grades III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.
Results
A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).
Conclusion
Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by

Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef

Anorectal benign disease

What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: “no pain, no gain” or “no pain but a gain”?: Jean-Michel Didelot, Benjamin Raux, Romain Didelot, Franz Rudler, Aurelien Mulliez, Anthony Buisson, Armando Abergel, Pierre Blanc; Ann Coloproctol. 2024;40(5):481-489. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00311.0044

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Abstract PDF

Purpose
The purpose of this study was to assess the long-term efficacy of hemorrhoidal radiofrequency thermocoagulation (RFT) on bleeding, prolapse, quality of life (QoL), and recurrence.
Methods
This retrospective, single-center study, with RFT performed using procedure modified via hemorrhoid exteriorization assessed the evolution of hemorrhoidal prolapse rated by Goligher scale; bleeding and discomfort (0–10), feeling of improvement and satisfaction (–5 to +5/5) by analog scales; the impact of hemorrhoids on QoL by HEMO-FISS-QoL score.
Results
From April 2016 to January 2021, 124 patients underwent surgery and 107 were interviewed in September 2021. The average follow-up was 30 months (range, 8–62 months). The mean work stoppage was 3 days, none in 71.0% of the cases. A mean of 4,334 J was applied. No analgesics were required for 66.4% of patients. External hemorrhoidal thrombosis was the only immediate complication in 9 patients, with no long-term reported complication. Bleeding disappeared in 53 out of 102 patients or dropped from 7 to 3 out of 10 (P<0.001). Prolapse reduced from mean grade 3 to 2 (P<0.001), discomfort from 7 to 2 out of 10 (P<0.001). HEMO-FISS-QoL score improved from 22 to 7 out of 100 (P<0.001). Feeling of improvement and overall satisfaction rate were +4/5. Recurrence occurred in 21.5% of patients at 22 months, and 6 required reoperation. Of the patients, 91.6% would choose the same procedure again and 96.3% recommend it.
Conclusion
RFT, although imperfect, leads to a significant improvement in hemorrhoidal symptoms and a lasting increase in QoL with minimal pain and downtime, high acceptance, and low complication and recurrence rates.

Citations

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Hämorrhoidalleiden und stadienabhängige Behandlung (inklusive Analprolaps)
Oliver Schwandner
Die Chirurgie.2025; 96(9): 709. CrossRef
Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids
Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong
Annals of Coloproctology.2025; 41(5): 409. CrossRef
Laser Hemorrhoidoplasty: Postoperative Outcomes and Predictive Factors for Pain, Bleeding, and Recovery
Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Tiberiu Stefăniță Țenea Cojan, Mădălina Costinela Stănică, Irina Enăchescu, Ana-Maria Țenea Cojan, Valentina Căluianu, Gabriel Florin Răzvan Mogoș, Liviu Vasile
Life.2025; 15(11): 1777. CrossRef
Quand et comment traiter des hémorroïdes
Thierry Higuero
La Presse Médicale Formation.2024; 5(1): 24. CrossRef
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef

Anorectal benign disease

Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study: Anshini Jain, Chen Lew, Gamze Aksakal, Richard Hiscock, Naseem Mirbagheri; Ann Coloproctol. 2024;40(1):52-61. Published online May 19, 2022; DOI: https://doi.org/10.3393/ac.2022.00164.0023

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18 Citations

Graphical Abstract Abstract PDF

Purpose
Traditional therapeutic approaches to the surgical management of hemorrhoid disease such as hemorrhoidectomies are plagued with severe postoperative pain and protracted recovery. Our pilot study aims to the laser hemorrhoidoplasty (LH) patients with symptomatic hemorrhoid disease that have failed conservative management for the first time in an Australian population.
Methods
Thirty patients were prospectively enrolled to undergo LH. Postoperative pain, time to return to function, and quality of life (QoL) were determined through the Hemorrhoid Disease Symptom Score and Short Health Scale adapted for hemorrhoidal disease and compared to a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon at 3, 6, and 12 months.
Results
The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4. The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001). Similarly, the median days to return to the workplace was significantly lower in the LH group (6 days vs. 13 days, P=0.007). During long-term follow-up (12 months), hemorrhoid symptoms and all QoL measures were significantly improved, especially among those with grade II to III disease.
Conclusion
This pilot study demonstrates low pain scores with this revivified procedure in an Australian population, indicating possible expansion of the therapeutic options available for this common condition. Further head-to-head studies comparing LH to other hemorrhoid therapies are required to further determine the most efficacious therapeutic approach.

Citations

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Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations
P. C. Ambe, G. P. Martin-Martin, N. Vasas, I. Piponski, I. H. Roman, J. D. P. Hernandez, H. Ma, H.C. Lin, G. Weyand, L. Mazlan, L. J. García Flórez, K. Wolff, M. Dessily, C. Wang, V. Dobricanin, W. Yang, T. Bruketa, X.D. Zeng, S. Avdicausevic, Z.G. Zhang,
Techniques in Coloproctology.2025;[Epub] CrossRef
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Sung Il Kang
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Evaluation of Doppler-guided Hemorrhoid Artery Ligation and Recto anal Repair Procedure: A Single-center Analysis in Indonesia
Amanda Putri Halim, Livia Taniwangsa, Joanna A. Kosasih, Anthony Berlim Lioe
Indian Journal of Colo-Rectal Surgery.2025; 8(1): 9. CrossRef
Laser Hemorrhoidoplasty: Procedure, Outcomes and Future Directions
Michele di Schiano di Visconte
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Evaluating Laser Haemorrhoidoplasty as a Short-Term Approach to Advanced Haemorrhoidal Disease
Chin Kiat Tan, Shou Kee Ng, Arijit Mukherjee
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Mohammed Yousef Alessa, Loai Saleh Albinsaad, Arshadullah Khan, Laila Zamil Alzamil, Raghad Mabrouk Alanazi, Najd Mabrouk Alanazi, Abeer Mabrouk Alanazi
Annals of African Medicine.2025; 24(4): 811. CrossRef
Laser Hemorrhoidoplasty: Postoperative Outcomes and Predictive Factors for Pain, Bleeding, and Recovery
Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Tiberiu Stefăniță Țenea Cojan, Mădălina Costinela Stănică, Irina Enăchescu, Ana-Maria Țenea Cojan, Valentina Căluianu, Gabriel Florin Răzvan Mogoș, Liviu Vasile
Life.2025; 15(11): 1777. CrossRef
Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV Hemorrhoids: A non-randomized prospective trial
Mohammad Ashour Khadr, Walid Galal El Shazly, Mohamed Mazloum Zakria, Ahmed Mohamed Moaz
Surgery Open Digestive Advance.2024; 13: 100129. CrossRef
Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease
Adas Cemil, Kesici Ugur, Genc M. Salih, Karadag Merve, Duman M. Guray, Boluk S. Emine
The American Surgeon™.2024; 90(4): 662. CrossRef
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
Audrius Dulskas, Dovile Cerkauskaite, Joseph Nunoo‐Mensah, Richard Fortunato, Gaetano Gallo, Alaa El Hussuna, Varut Lohsiriwat, Tomas Aukstikalnis, Narimantas E. Samalavicius
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Ethnomedical knowledge of plants used in alternative medicine to treat hemorrhoidal diseases in Lubumbashi, Haut-Katanga province, Southern Democratic Republic of Congo
Bashige Chiribagula Valentin, Okusa Ndjolo Philippe, Muhona Melman, Manya Mboni Henry, Bakari Amuri Salvius, Lumbu Simbi Jean Baptiste
BMC Complementary Medicine and Therapies.2024;[Epub] CrossRef
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Md. Saiful Islam, Abhigan B. Shrestha, Faisal Chowdhury, Md. R.K. Ziko
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Jackknife versus Lithotomy Position for Hemorrhoidectomy Surgery: A Randomized Controlled Trial
Sina Ghasemi, Behzad Imani, Alireza Jafarkhani, Ashkan Karimi, Ali Yamini
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Nadim H. P. Boerhave, Rutger J. Klicks, Kemal Dogan
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Haluk Tümer, Mevlüt Harun Ağca
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Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids
Ali Kemal Taşkin, Bülent Özçetin
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Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
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Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

Anorectal benign disease

Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome: Mahdi Alemrajabi, Abolfazl Akbari, Sara Sohrabi, Mohammad Rezazadehkermani, Mohammad Moradi, Shahram Agah, Mohsen Masoodi; Ann Coloproctol. 2023;39(4):351-356. Published online May 16, 2022; DOI: https://doi.org/10.3393/ac.2022.00017.0002

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Abstract PDF

Purpose
Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide.
Methods
This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods.
Results
There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups.
Conclusion
Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

Citations

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Comparison of “Mucopexy with Haemorrhoidal Artery Ligation with Open Hemorrhoidectomy in Terms of Effectiveness and Outcome
Muhammad Asad, Kiran Rehman, Muhammad Ismail Seerat, Maryam Iftikhar, Bilal Ahmed, Adil Hameed, Sufyan Rauf
Pakistan Journal of Health Sciences.2025; : 191. CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Evaluation of Doppler-guided Hemorrhoid Artery Ligation and Recto anal Repair Procedure: A Single-center Analysis in Indonesia
Amanda Putri Halim, Livia Taniwangsa, Joanna A. Kosasih, Anthony Berlim Lioe
Indian Journal of Colo-Rectal Surgery.2025; 8(1): 9. CrossRef
Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta‐analysis of randomized controlled trials
Roberta Tutino, Arcangelo Picciariello, Mauro Santarelli, Veronica De Simone, Pierluigi Lobascio, Gianfranco Cocorullo, Marco Massani, Giusi Graziano, Giulio Aniello Santoro, Gaetano Gallo
Colorectal Disease.2025;[Epub] CrossRef
Defining recurrence in haemorrhoidal disease and comparing Doppler systems: Are we evaluating Doppler fairly
Ugo Grossi, Pasquale Giordano
Colorectal Disease.2025;[Epub] CrossRef
Doppler-Guided Versus Digitally Guided Transanal Hemorrhoidal Dearterialization: A Systematic Review and Meta-Analysis
Marília Cardoso Massoni, Felipe Santos Marimpietri, Paulo André Lago Silva, Glicia Estevam de Abreu
Journal of Coloproctology.2025; 45(03): 001. CrossRef
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef
Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis
Juliana Jee, Lauren Vourneen O’Connell, Ishapreet Kaur, Shaheel Mohammad Sahebally
Digestive Surgery.2024; 41(4): 204. CrossRef
Haemorrhoid artery ligation – recto anal repair (HAL‐RAR) blind versus Doppler: a systematic review and meta‐analysis
Amos Nepacina Liew, Jason Wang, Michelle Zhiyun Chen, Yeng Kwang Tay, Joseph C.H. Kong
ANZ Journal of Surgery.2024; 94(11): 2053. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study
Sara Z. Kuiper, Kayleigh A. M. Van Dam, Merel L. Kimman, Litza Mitalas, Paula G. M. Koot, Jarno Melenhorst, Sander M. J. Van Kuijk, Carmen D. Dirksen, Stephanie O. Breukink
Journal of Clinical Medicine.2023; 12(1): 391. CrossRef

A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids: Dong Wan Kang, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim, Gyong Suk Kang; Ann Coloproctol. 2023;39(1):41-49. Published online December 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00717.0102

12,335 View
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6 Citations

Graphical Abstract Abstract PDF

Purpose
Rubber band ligation (RBL) for grade 1 to 3 internal hemorrhoids is a well-established modality of choice. But RBL is also a kind of surgical treatment; it is not free from complications (e.g., delayed bleeding [DB], rectal stenosis). This study aimed to investigate the results of the comparative treatment of RBL and BANANA-Clip (BC; Endovision).
Methods
Study participants were 632 consecutive patients with grade 1 to 3 internal hemorrhoids attended to Department of Colorectal Surgery at Wellness Hospital between January 2010 and May 2019. We retrospectively reviewed the incidence rate of complications, including DB between RBL and BC.
Results
There were 304 male and 328 female patients, whose ages ranged from 15 to 84 years, with a mean age of 45.7 years. The common symptom and cause of treatment was prolapse (70.1%). The number of ligated sites was 1.49±0.57 in the RBL group and 1.99±0.77 in the BC group. RBL showed a significantly higher incidence of DB (3.5%) compared to BC (0%) (P=0.001). The 1-year success rate was 95.9% in the RBL group and 99.7% in the BC group (P=0.005).
Conclusion
In our study, BC was more reliable in treating grade 1 to 3 internal hemorrhoids with higher success rates and less post-ligation complications, especially DB, compared to RBL.

Citations

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Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
The BANANA-Clip: an innovative solution for hemorrhoidal pile ligation?
Kyung Uk Jung
Annals of Coloproctology.2023; 39(1): 1. CrossRef
Banana Clip: Advancing Hemorrhoid Ligation Beyond Rubber Bands
Navneet Arora, Ranjeet Kumar
Journal of Coloproctology.2023; 43(04): e324. CrossRef
Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy
Sen Lin, Meichun Zang, Zhaoqi Dong
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Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation—a retrospective study
Jiazi Yu, Jie Zhong, Tao Peng, Liangbin Jin, Leibin Shen, Mian Yang
BMC Surgery.2022;[Epub] CrossRef

Benign proctology,Postoperative outcome & ERAS,Surgical technique

Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids: Shunya Takada, Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi; Ann Coloproctol. 2022;38(4):290-296. Published online November 2, 2021; DOI: https://doi.org/10.3393/ac.2020.00920.0131

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Abstract PDF

Purpose
Aluminum potassium sulfate and tannic acid (ALTA; Zion, Mitsubishi Pharma Corp.) is an effective sclerosing agent for internal hemorrhoids. ALTA therapy with a rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study compared the early postoperative outcomes of AM surgery with Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (DM) in patients with third-degree hemorrhoids.
Methods
AM surgery was performed on 32 patients with grade III hemorrhoids and was compared with a cohort of 22 patients who underwent DM surgery in a previous randomized controlled trial.
Results
The pain scores during defecation were significantly lower in the AM patients beginning 4 days after surgery. The total use of analgesics 2 weeks postoperatively was significantly lower in the AM patients than in the DM patients (3.5 tablets [range 1.6–5.5] vs. 7.6 tablets [range 3.3–11.9], P=0.04). The length of operation, blood loss, and incidence of postoperative complications were significantly lower in the AM patients than in the DM patients. During 12 months follow-up, recurrence of prolapse occurred in 1 patient who underwent AM surgery.
Conclusion
AM surgery is effective, with lower complication rates and postoperative analgesic requirements, and is a less invasive treatment for patients with grade III hemorrhoids compared to DM surgery.

Citations

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Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
A. Tsunoda, H. Kusanagi
Techniques in Coloproctology.2023; 27(12): 1335. CrossRef

Radiofrequency ablation (Rafaelo Procedure) for the treatment of hemorrhoids: a case series in the United Kingdom: Sarah Hassan, Daniel McGrath, Richard Barnes, Simon Middleton; Ann Coloproctol. 2023;39(2):164-167. Published online August 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00276.0039

9,031 View
352 Download
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9 Citations

Abstract PDF

Purpose
Hemorrhoidal disease remains a common condition that can have a significant effect on a patient’s quality of life. Various methods have been introduced over the years; however, their overall success rates remain low. Although the traditional Milligan Morgan technique is effective, the associated pain level prevents it from being an attractive form of treatment. This study was devised to assess the safety and efficacy associated with a novel minimally invasive approach, radiofrequency ablation (RFA).
Methods
Forty-two patients underwent RFA at a single center, by 1 of 2 surgeons. This was performed under local anesthetic and sedation. Outcomes including postoperative pain levels, recurrence rates, and patient satisfaction scores were recorded and analyzed using medians and interquartile ranges
Results
The median postoperative pain score was 2.5/10 (interquartile range [IQR], 0–4.5) and the overall patient satisfaction score was 9 out of 10 (IQR, 6.5–10). Recurrence rates (6–12 months following the procedure) were low at 12% and all patients reported milder symptoms at recurrence. There were no serious adverse complications
Conclusion
The results from this case series supports other limited data in concluding that RFA is a safe and effective method in the treatment of hemorrhoids and patients report a high level of satisfaction following

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Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids
Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong
Annals of Coloproctology.2025; 41(5): 409. CrossRef
Radiofrequency Ablation for Internal Hemorrhoids: A Case Series
Kean leong Koay, Nabil Mohammad Azmi, Soma Chandrakanthan, Nurafdzillah Abdul Rahman, Diana Melissa Dualim
Cureus.2024;[Epub] CrossRef
What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: “no pain, no gain” or “no pain but a gain”?
Jean-Michel Didelot, Benjamin Raux, Romain Didelot, Franz Rudler, Aurelien Mulliez, Anthony Buisson, Armando Abergel, Pierre Blanc
Annals of Coloproctology.2024; 40(5): 481. CrossRef
Protocol for the ORION trial (RadiO fRequency ablatION for haemorrhoids): a randomised controlled trial
C. Girling, M. J. Lee, D. Vimalchandran, D. J. Jayne, S. Stancliffe, A. Wailoo, M. Bradburn, D. Hind, M. Bursnall, L. K. Robinson, S. R. Brown
Techniques in Coloproctology.2023; 27(2): 117. CrossRef
The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis
Prokopis Christodoulou, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, George Tzovaras
Techniques in Coloproctology.2023; 27(2): 103. CrossRef
Radiofrequency thermocoagulation of haemorrhoids: learning curve of a novel approach
Valentin Butnari, Ahmer Mansuri, Sandeep Kaul, Veeranna Shatkar, Richard Boulton
Journal of Surgical Case Reports.2023;[Epub] CrossRef
French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease
A. Laurain, D. Bouchard, J.-M. Rouillon, P. Petit, A. Liddo, B. Vinson Bonnet, A. Venara, J.-M. Didelot, G. Bonnaud, A. Senéjoux, T. Higuero, P. Delasalle, A.-L. Tarrerias, F. Devulder, A. Castinel, C. Thomas, H. Pillant Le Moult, C. Favreau-Weltzer, L. A
Techniques in Coloproctology.2023; 27(10): 873. CrossRef
Early and midterm results of radiofrequency ablation (Rafaelo® procedure) for third-degree haemorrhoids: a prospective, two-centre study
S. Tolksdorf, D. Tübergen, C. Vivaldi, M. Pisek, F. Klug, M. Kemmerling, H. Schäfer
Techniques in Coloproctology.2022; 26(6): 479. CrossRef

Long-term outcomes of high-volume stapled hemorroidopexy to treat symptomatic hemorrhoidal disease: Alessandro Sturiale, Raad Dowais, Bernardina Fabiani, Claudia Menconi, Felipe Celedon Porzio, Virginia Coli, Gabriele Naldini; Ann Coloproctol. 2023;39(1):11-16. Published online July 29, 2021; DOI: https://doi.org/10.3393/ac.2020.00227.0032

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6 Web of Science
9 Citations

Abstract PDF

Purpose
The study aimed to assess the long-term results of the stapled hemorrhoidopexy (SH) using high-volume devices equipped with innovative technology, evaluating recurrence rate, complications rate, and patients’ satisfaction.
Methods
All the patients who underwent SH using high-volume devices (TST Starr plus, Touchstone International Medical Science Corp., Ltd.) for II to IV symptomatic hemorrhoidal disease from November 2012 to December 2014 were enrolled. Between December 2019 and January 2020, all of them were phone called to come to undergo a proctological reevaluation and asked to fill some questionnaires about hemorrhoidal prolapse recurrence, symptoms recurrence, and surgery satisfaction.
Results
Fifty-nine patients with a mean age of 47 years completely answered the questionnaires. Twenty-two of them accepted to come to undergo a proctological reevaluation while 27 preferred to answer only by phone due to their referred wellbeing. The median follow-up was 70.5 months (range, 60–84 months). The recurrence rate was 5.1% with a mean satisfaction level after surgery was 9.1 (range, 0–10) and 84.7% of patients whose satisfaction scored ≥8. The mean value of Cleveland Global Quality of Life assessment was 0.79 (range, 0.71–0.93). There were no cases of new onset of impaired anal continence after surgery.
Conclusion
The new generation high-volume devices to perform SH resulted to be safe and effective for II to IV degree hemorrhoidal prolapse leading to a lower long-term recurrence rate with an evident reduction of postoperative complications in comparison with the low-volume SH.

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Amin Esmaeilnia Shirvani, Kimia Pakdaman, Zahra Maleki, Soroush Soraneh, Fatemeh Rezaei chegini, Kasra Pakdaman, Mohebat Vali, Hossein-Ali Nikbakht, Layla Shojaie, Pouyan Ebrahimi
Annals of Medicine.2026;[Epub] CrossRef
A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis
Sadaf Khalid, Zameer Hussain Laghari, Muhammad Kashif Rafiq, Ghashia Khan, Hiba Manzoor, Pavisankar Biju Seena, Saud Hussain, Fahmida Khatoon, Farook Ayyub Kantharia, Sana Farook Kantharia
Cureus.2025;[Epub] CrossRef
A comparative study on efficacy and safety of modified partial stapled hemorrhoidopexy versus conventional hemorrhoidectomy: a prospective randomized controlled trial
Tae Gyu Kim, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Seung Han Kim, Sang Hwa Yu, Jeong Eun Lee, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Gyu Young Jeong
Annals of Coloproctology.2025; 41(2): 145. CrossRef
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Devender Singh, Niharika Grover, Yashwant Rathore, Piyush Ranjan, Sunil Chumber
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The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
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Annals of Coloproctology.2024; 40(4): 287. CrossRef
Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study
Antonio Brillantino, Luigi Marano, Maurizio Grillo, Alessio Palumbo, Fabrizio Foroni, Luciano Vicenzo, Alessio Antropoli, Michele Lanza, Maria Laura Sandoval Sotelo, Nicola Sangiuliano, Mauro Maglio, Rosanna Filosa, Lucia Abbatiello, Maria Preziosa Romano
Annals of Coloproctology.2024; 40(6): 602. CrossRef
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review
Lorenzo Ripamonti, Angelo Guttadauro, Giulia Lo Bianco, Maria Rennis, Matteo Maternini, Gerardo Cioffi, Marco Chiarelli, Matilde De Simone, Ugo Cioffi, Francesco Gabrielli
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Indications, Feasibility, and Safety of TST STARR Plus Stapler for Degree III Hemorrhoids: A Retrospective Study of 125 Hemorrhoids Patients
Jun Wei, Xufeng Ding, Jie Jiang, Lijiang Ji, Hua Huang
Frontiers in Surgery.2022;[Epub] CrossRef

Case Report

Benign proctology,Complication,Biomarker & risk factor

Recurrent bleeding after posthemorrhoidectomy caused by factor V deficiency: a case report and review of the literature: Jun Seong Chung, Han Deok Kwak, Jae Kyun Ju; Ann Coloproctol. 2022;38(6):449-452. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2021.00185.0026

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Abstract PDF

Congenital factor V (FV) deficiency is a rare hemorrhagic disorder that can cause excessive bleeding during and after surgery in the affected patient. This report is the case of a patient who had FV deficiency with recurrent posthemorrhoidectomy bleeding treated with the hemostatic procedure and fresh frozen plasma (FFP) transfusions. A 45-year-old male patient had previously undergone hemorrhoidectomy for multiple hemorrhoids at a local hospital. Hemorrhoidectomy was successful; however, he was transferred to our hospital for evaluation of the origin of the recurrent posthemorrhoidectomy bleeding and underwent a hemostatic procedure. This bleeding was treated with coagulation using electrocautery, multiple sutures, and FFP transfusion (1,600 mL/day) for 7 consecutive days. The patient’s plasma FV activity was 23%. Early detection of clotting factor deficiency in patients with hemorrhagic events after surgical treatments may prevent unnecessary procedures such as reoperations and minimize the cost of replacement therapy such as large-volume FFP transfusion.

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Rare Inherited Coagulation Deficiencies: A Single-center Study
Özlem Terzi, Sadik Sami Hatipoğlu
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Plasma/tranexamic-acid/vitamin-k

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Original Articles

Benign proctology,Surgical technique

Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up: Lisette Dekker, Michiel T.J. Bak, Willem A. Bemelman, Richelle J.F. Felt-Bersma, Ingrid J.M. Han-Geurts; Ann Coloproctol. 2022;38(2):146-152. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.01011.0144

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4 Citations

Abstract PDF

Purpose
Standard therapy for grade III hemorrhoids is rubber band ligation (RBL) and hemorrhoidectomy. The long-term clinical and patient-reported outcomes of these treatments in a tertiary referral center for proctology were evaluated.
Methods
A retrospective analysis was performed in all patients with grade III hemorrhoids who were treated between January 2013 and August 2018. Medical history, symptoms, reinterventions, complications, and patient-reported outcome measurements (PROM) were retrieved from individual electronic patient files, which were prospectively entered as standard questionnaires in our clinic.
Results
Overall, 327 patients (163 males) were treated by either RBL (n=182) or hemorrhoidectomy (n=145). The median follow-up was 44 months. The severity of symptoms and patient preference led to the treatment of choice. The most commonly experienced symptoms were prolapse (83.2%) and blood loss (69.7%). Hemorrhoidectomy was effective in 95.9% of the cases as a single procedure, while a single RBL procedure was only effective in 51.6%. In the RBL group, 34.6% received a second RBL session. Complications were not significantly different, 11 (7.6%) after hemorrhoidectomy versus 6 (3.3%) after RBL. However, 4 fistulas developed after hemorrhoidectomy and none after RBL (P<0.05). The pre-procedure PROM score was higher in the hemorrhoidectomy group whereas the post-procedure PROM score did not significantly differ between the groups.
Conclusion
Treatment of grade III hemorrhoids usually requires more than one session RBL whereas 1-time hemorrhoidectomy suffices. Complications were more common after hemorrhoidectomy. The patient-related outcome did not differ between procedures.

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Hämorrhoidalleiden und stadienabhängige Behandlung (inklusive Analprolaps)
Oliver Schwandner
Die Chirurgie.2025; 96(9): 709. CrossRef
Cost-Effectiveness of Rubber Band Ligation Versus Hemorrhoidectomy for the Treatment of Grade III Hemorrhoids: Analysis Using Evidence From the HOLLAND Randomized Controlled Trial
Justin Y. van Oostendorp, Lisette Dekker, Susan van Dieren, Ruben Veldkamp, Willem A. Bemelman, Ingrid J.M. Han-Geurts
Diseases of the Colon & Rectum.2025; 68(9): 1100. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef

Benign proctology,Postoperative outcome & ERAS,Complication

Predictors of postoperative urinary retention after semiclosed hemorrhoidectomy: Hong Yoon Jeong, Seok Gyu Song, Jong Kyun Lee; Ann Coloproctol. 2022;38(1):53-59. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00304.0043

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17 Citations

Abstract PDF

Purpose
This study was performed to analyze the predictors that might contribute to urinary retention following semiclosed hemorrhoidectomy under spinal anesthesia.
Methods
This retrospective study enrolled 2,176 consecutive patients with symptomatic grade III to IV hemorrhoids who underwent semiclosed hemorrhoidectomy between September 2018 and September 2019.
Results
Among the 2,176 patients, 1,878 (86.3%) had no postoperative urinary retention, whereas 298 (13.7%) developed urinary retention after hemorrhoidectomy. The percentage of males was significantly higher in the retention group than in the non-retention group (60.4% vs. 48.1%; P=0.001). The risk of urinary retention was 1.52-fold higher in males than in females (95% confidence interval [CI], 1.13–2.04; P=0.005), 1.62-fold higher in old age (95% CI, 1.14–2.28; P=0.006), and 1.37-fold higher with high body mass index (BMI) (95% CI, 1.04–1.81; P=0.025). Patients with ≥4 resected hemorrhoids had a higher odds ratio (OR) of 1.46 (95% CI, 1.12–1.89; P=0.005) than patients with <4 resected hemorrhoids. Among the supplementary medication, patients who used analgesics had a higher OR of 2.06 (95% CI, 1.57–2.68; P=0.001) than those who did not.
Conclusion
Male sex, age, high BMI, number of resected hemorrhoids, and supplementary analgesics are independent risk factors for urinary retention after semiclosed hemorrhoidectomy.

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Assessment of the efficacy and safety of pudendal nerve block in post-hemorrhoidectomy pain: A meta-analysis of randomized controlled trials
Jun Li, Hai-Qiong Wu, Jun-Tao Zhang, Shi-Jian Liu, Ke-Lin Peng
Asian Journal of Surgery.2025; 48(3): 1607. CrossRef
Latest Research Trends on the Management of Hemorrhoids
Sung Il Kang
Journal of the Anus, Rectum and Colon.2025; 9(2): 179. CrossRef
Ice Packing Versus Warm Sitz Baths for Post-hemorrhoidectomy Pain Management: A Randomized Controlled Trial
Pin-Chun Chen, Yi-Kai Kao, Po-Wen Yang, Chia-Hung Chen, Chih-I Chen
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Parit T. Mavani, Pranay S. Ajay, Heather B. Wagner, Benjamin I. Meyer, Monali Shah, Caitlin P. Sok, Adriana C. Gamboa, Subir Goyal, Jeffrey M. Switchenko, Shishir K. Maithel, David A. Kooby, Mihir M. Shah
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International Journal of Surgery Case Reports.2025; 134: 111790. CrossRef
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Jean H. Ashburn
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Ahmet Cihangir Emral, Gökay Çetinkaya, Merter Gülen, Bahadır Ege
Anatolian Current Medical Journal.2025; 7(5): 652. CrossRef
Ultrasound-guided trans-perineal pudendal nerve block for post-hemorrhoidectomy voiding complications: a prospective randomized double-blinded study
Alrefaey K. Alrefaey, Shaimaa Ezzat Amin, Fahad S AL Amri
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Tayebeh Mirzaei, Farkhondeh Roudbari, Ali Ravari, Sakineh Mirzaei, Elham Hassanshahi
International Journal of Urological Nursing.2024;[Epub] CrossRef
General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy
Chun-Yu Lin, Yi-Chun Liu, Jun-Peng Chen, Pei-Hsuan Hsu, Szu-Ling Chang
Frontiers in Surgery.2024;[Epub] CrossRef
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Juan Cabrera Garrido, Gonzalo López González
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Chen Li, Ningyuan Liu, Zichen Huang, Zijian Wei, Keyi Li, Wenxiao Hou, Sangyu Ye, Lihua Zheng
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World Journal of Clinical Cases.2023; 11(2): 366. CrossRef
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Lei-lei Wang, Meng Kang, Li-xin Duan, Xu-fei Chang, Xiao-xin Li, Xiang-yang Guo, Zhi-yu Kang, Yong-zheng Han
Frontiers in Surgery.2023;[Epub] CrossRef
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Mina Olia, Aliakbar Jafarian, Masood Mohseni
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The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
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Case Report

Benign proctology,Complication,Surgical technique

Rectal perforation and perirectal abscess following stapled hemorrhoidectomy for prolapsed hemorrhoids successfully managed with Endo-SPONGE endoluminal vacuum-assisted wound closure system: Emanuele Rosati, Manuel Valeri, Luigina Graziosi, Lavinia Amato, Stefano Avenia, Annibale Donini; Ann Coloproctol. 2022;38(5):387-390. Published online June 9, 2021; DOI: https://doi.org/10.3393/ac.2021.02.07

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190 Download
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2 Citations

Abstract PDF

Active drains, which work by negative pressure, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum-assisted wound closure dressings. Gastrointestinal leaks may be difficult to treat by surgical approach because of their association with high morbidity and mortality. Recently, endoscopic approaches have been applied with several degrees of success. Most recently, endoluminal vacuum-assisted wound closure (EVAC) has been employed with high success rates in decreasing both morbidity and mortality. In the present paper, the authors describe the successful use of Endo-SPONGE (B. Braun Medical B.V.) EVAC system therapy to drain an open rectal wound, following a perforation occurred during stapled hemorrhoidectomy.

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Yafa Shani Parnasa, Oded Cohen-Arazi, Gad Marom, Mahmoud Abu-Gazala, Noam Shussman, Miklosh Bala
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Alper Sozutek, Ekin Y Tas, Kemal Yener, Julia Ozcomert
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Original Articles

Benign proctology

Proposal for a New Score: Hemorrhoidal Bleeding Score: Nadia Fathallah, Hélène Beaussier, Gilles Chatellier, Jean Meyer, Marc Sapoval, Nadia Moussa, Vincent de Parades; Ann Coloproctol. 2021;37(5):311-317. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.19

7,517 View
218 Download
8 Web of Science
13 Citations

Abstract PDF

Purpose
We conducted a prospective study to evaluate a new hemorrhoidal bleeding score (HBS).
Methods
All consecutive patients who had consulted between May 1, 2016 and June 30, 2017 for bleeding hemorrhoidal disease were prospectively assessed at a proctological department. The study was conducted in 2 stages. The first stage assessed the validity of the score on a prospective patient cohort. A second stage assessed the interobserver reproducibility of the score on another prospective cohort.
Results
One hundred consecutive patients were studied (57 males; mean age, 49.70 years). A positive association between HBS and surgery indication was found (P<0.001). A cut-off value of the score of 5 (≤5 vs. >5) separated patients from surgical to medical-instrumental treatment with a sensitivity and specificity of 75.00% and 81.25%, respectively. In the multivariate analysis, only HBS was significantly associated with the operative decision (odds ratio, 12.22). Prolapse was no longer significantly associated with the surgical indication. After a mean follow-up after treatment of 7 months, HBS improved statistically significantly (P<0.0001). For the reproducibility of the score, an additional 30 consecutive patients (13 males; mean age, 53.14 years) were enrolled with an excellent agreement between 2 proctologists (kappa=0.983).
Conclusion
HBS is sensitive, specific, and reproducible. It can assess the severity of hemorrhoidal bleeding. It can discriminate between the most severe surgery-indicated patients and does so in a more efficient way than the Goligher prolapse score. It also allows quantifying the extent of change in hemorrhoidal bleeding after treatment.

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Arterial Embolization for the Internal Hemorrhoids Management: A Systematic Review
Mohammad Hossein Golezar, Hamed Ghorani, Fakhroddin Alemi, Farzad Fayedeh, Maryam Yeganegi, Samaneh Toutounchian, Hanieh Amani, Hadi Rokni Yazdi
Health Science Reports.2026;[Epub] CrossRef
The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial
Suwan Sanmee, Witcha Vipudhamorn, Pawit Sutharat, Ekkarin Supatrakul
Asian Journal of Surgery.2025; 48(1): 193. CrossRef
Hemorrhoidal disease: what role can rectal artery embolization play?
Julien Panneau, Diane Mege, Mathieu Di Bisceglie, Julie Duclos, Idir Khati, Vincent Vidal, Gaetano Gallo, Farouk Tradi
Frontiers in Surgery.2025;[Epub] CrossRef
Artery Embolization in the Treatment of Refractory Internal Hemorrhoids
Layth Alkhani, Jessica Stewart, Osman Ahmed
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Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management
Nadia Fathallah, Amine Alam, Anne L. Rentien, Giorgio La Greca, Joshua Co, Elise Pommaret, Amélie Barré, Stéphane Kegne, Hélène Beaussier, Lucas Spindler, Vincent de Parades
Journal of Visceral Surgery.2024; 161(3): 161. CrossRef
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Nadia Fathallah, Amine Alam, Anne-Laure Rentien, Giorgio La Greca, Joshua Co, Elise Pommaret, Amélie Barré, Stéphane Kegne, Hélène Beaussier, Lucas Spindler, Vincent de Parades
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Jonathan Lindquist, James Hart, Katherine Marchak, Eduardo Bent Robinson, Premal Trivedi
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Russian multicenter observational HDQ study on the validation of the questionnaire for hemorrhoidal disease
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Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Vincent Vidal, Farouk Tradi
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Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Axel Bartoli, Vincent Vidal, Farouk Tradi
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Reza Talaie, Pooya Torkian, Arash Dooghaie Moghadam, Farouk Tradi, Vincent Vidal, Marc Sapoval, Jafar Golzarian
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Benign proctology,Postoperative outcome & ERAS

Is There a Relationship Between Stool Consistency and Pain at First Defecation After Limited Half Hemorrhoidectomy? A Pilot Study: Takaaki Yano; Ann Coloproctol. 2021;37(5):306-310. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.10

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2 Citations

Abstract PDF

Purpose
While the first defecation pain is a problem following hemorrhoidectomy, it is unknown whether the stool consistency has an influence on pain. This pilot study aimed to investigate whether the intensity of defecation pain varied according to stool consistency.
Methods
This prospective cohort study evaluated patients who underwent hemorrhoidectomy in combination with injection sclerotherapy for grade III or IV hemorrhoids. The pain intensity and stool form during the first postoperative defecation were self-recorded by the patients using a visual analogue scale (score of 0–10) and Bristol Stool Form Scale, respectively. The patients were classified into 3 groups according to stool consistency, and the intensity of defecation pain was compared among the groups using analysis of variance.
Results
A total of 61 patients were eligible for this study and were classified into the hard stool (n=15), normal stool (n=21), and soft stool groups (n=25). No significant intergroup differences were identified in the intensity of pain at defecation (P=0.29).
Conclusion
This pilot study demonstrated that there were no clear differences in pain intensity during the first defecation after surgery among the 3 groups with different levels of stool consistency.

Citations

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Pain at the First Post-hemorrhoidectomy Defecation Is Associated with Stool Form
Takaaki Yano, Daijiro Kabata, Seiichi Kimura
Journal of the Anus, Rectum and Colon.2022; 6(3): 168. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology

A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice: Carlos Walter Sobrado Júnior, Carlos de Almeida Obregon, Afonso Henrique da Silva e Sousa Júnior, Lucas Faraco Sobrado, Sérgio Carlos Nahas, Ivan Cecconello; Ann Coloproctol. 2020;36(4):249-255. Published online June 1, 2020; DOI: https://doi.org/10.3393/ac.2020.02.06

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Abstract PDF

Purpose
Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years.
Methods
Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification.
Results
Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed.
Conclusion
Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.

Citations

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Percepción y conocimiento de la enfermedad hemorroidal en los profesionales sanitarios en España
M. Frías Vargas, N. Fontanillas Gamilla, I. Rivera Panizo, D. Fuertes Domínguez, C. Granja Ortega, J.F. Peiró Morant
Medicina de Familia. SEMERGEN.2025; 51(3): 102393. CrossRef
Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease
Gaetano GALLO, Mario TROMPETTO
Minerva Surgery.2025;[Epub] CrossRef
Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations
Gaetano Gallo, Ugo Grossi, Veronica De Simone, Arcangelo Picciariello, Elia Diaco, Pin Fan, Hongbo He, Jun Li, Hongcheng Lin, Marco La Torre, Rita Laforgia, Pierluigi Lobascio, Hui Ma, Francesco Pata, Roberto Perinotti, Vincent De Parades, Mauro Pozzo, Al
Updates in Surgery.2025; 77(5): 1439. CrossRef
Surgical outcomes of modified Ferguson hemorrhoidectomy for grade IV hemorrhoidal disease
Ahmet Cihangir Emral, Gökay Çetinkaya, Merter Gülen, Bahadır Ege
Anatolian Current Medical Journal.2025; 7(5): 652. CrossRef
Propensity score–matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II–III internal hemorrhoids
Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Nataphon Santrakul, Rangsima Thiengthiantham, Punnawat Chandrachamnong
Annals of Coloproctology.2025; 41(5): 409. CrossRef
Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review
Gaetano Gallo, Arcangelo Picciariello, Antonella Tufano, Giuseppe Camporese
Updates in Surgery.2024; 76(2): 423. CrossRef
The role of flavonoids in the pharmacological treatment of haemorrhoids
SS Singh, MA Strydom, M Balmith, C Megaw, MJ Nell
South African General Practitioner.2024; 5(1): 36. CrossRef
Timing and Modality of Hemorrhoidal Prolapse Impact on Patients’ Quality of Life
Carlo Ratto, Angelo Parello, Angelo Alessandro Marra, Paola Campennì, Veronica De Simone, Francesco Litta
Journal of Clinical Medicine.2024; 13(13): 3946. CrossRef
Topical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective 3-Armed Randomized Controlled Trial
Allan M.F. Kwok, Stephen R. Smith, Jie Zhao, Rosemary Carroll, Lucy Leigh, Brian Draganic
Diseases of the Colon & Rectum.2023; 66(8): 1110. CrossRef
Time to change? Present and prospects of hemorrhoidal classification
Ling Wang, Jiachun Ni, Changcheng Hou, Di Wu, Li Sun, Qiong Jiang, Zengjin Cai, Wenbin Fan
Frontiers in Medicine.2023;[Epub] CrossRef
Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults
Yun Soo Hong, Kyung Uk Jung, Sanjay Rampal, Di Zhao, Eliseo Guallar, Seungho Ryu, Yoosoo Chang, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun, Chong Il Sohn, Hocheol Shin, Juhee Cho
Scientific Reports.2022;[Epub] CrossRef
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
Varen Zhi Zheng Tan, Ern-wei Peck, Sharmini S. Sivarajah, Winson J. Tan, Leonard M. L. Ho, Jia-Lin Ng, Cheryl Chong, Darius Aw, Franky Mainza, Fung-Joon Foo, Frederick H. Koh
International Journal of Colorectal Disease.2022; 37(8): 1759. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study
Dimitrios Symeonidis, Michail Spyridakis, Dimitrios Zacharoulis, George Tzovaras, Athina A. Samara, Alexandros Valaroutsos, Alexandros Diamantis, Konstantinos Tepetes
BMC Surgery.2022;[Epub] CrossRef
Management of Stage 3 Haemorrhoids with Homoeopathy – A case report
Jyothi Vijaykumar, Dhanya Deepak Bhat
Journal of Integrated Standardized Homoeopathy.2022; 5: 107. CrossRef
The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment
Carlos Walter Sobrado, Carlos de Almeida Obregon, Lucas Faraco Sobrado, Lucas Morales Bassi, José Américo Bacchi Hora, Afonso Henrique Silva e Sousa Júnior, Sergio Carlos Nahas, Ivan Cecconello
Annals of Medicine and Surgery.2021; 61: 97. CrossRef
Evaluation Of Anti-inflammatory Mediated Anti-hemorrhoidal Activity of Lawsonia inermis on Croton Oil Induced Hemorrhoidal Rats
Sai Krishna Nallajerla, Suhasin Ganta
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry.2021; 21(1): 62. CrossRef

Benign proctology

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial: Kyung Jin Cho, Do Yeon Hwang, Hyun Joo Lee, Ki Hoon Hyun, Tae Jung Kim, Duk Hoon Park; Ann Coloproctol. 2020;36(5):344-348. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2020.02.12

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Abstract PDF

Purpose
This study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.
Methods
One hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).
Results
Baseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).
Conclusion
Patients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

Citations

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Reducing Pain, Spasm, and Vasovagal Syndrome in Transradial Cardiac Angiography: The Role of Lidocaine Cream and Injectable Lidocaine
Behrang Bahreini, Saeed Alipour Parsa, Vahid Eslami, Mohammad Khani, Abdolhamid Bagheri
International Journal of Cardiovascular Practice.2024;[Epub] CrossRef
PROSPECT guideline for haemorrhoid surgery
Alexis Bikfalvi, Charlotte Faes, Stephan M. Freys, Girish P. Joshi, Marc Van de Velde, Eric Albrecht
European Journal of Anaesthesiology Intensive Care.2023; 2(3): e0023. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy
Hyeonseok Jeong
Annals of Coloproctology.2020; 36(5): 291. CrossRef

Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study: Ana Célia Caetano, Catarina Cunha, Bruno Arroja, Dalila Costa, Carla Rolanda; Ann Coloproctol. 2019;35(6):306-312. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.09.18

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182 Download
4 Web of Science
6 Citations

Abstract PDF

Purpose
Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.
Methods
Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.
Results
Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).
Conclusion
A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.

Citations

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A Substance-Based Medical Device for Managing Hemorrhoidal Disease: Output from a Cross-Sectional Survey
Roberto Cioeta, Paola Muti, Marta Rigoni, Roberta La Salvia, Elena Gabriele, Andrea Cossu, Emiliano Giovagnoni
Journal of Clinical Medicine.2025; 14(17): 6069. CrossRef
The role of flavonoids in the pharmacological treatment of haemorrhoids
SS Singh, MA Strydom, M Balmith, C Megaw, MJ Nell
South African General Practitioner.2024; 5(1): 36. CrossRef
The influence of supportive therapy with a six-component myophlebotropic preparation on the reduction of symptoms in patients with symptoms of hemorrhoidal disease
Anna Kwiatkowska, Maciej Borejsza-Wysocki, Michał Głyda, Anna Maria Pietrzak, Marek Szczepkowski, Andrzej Organ, Tomasz Banasiewicz
Polish Journal of Surgery.2024; 96(3): 1. CrossRef
Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study
Chun-Ying Qu, Fei-Yu Zhang, Wen Wang, Feng-Yu Gao, Wu-Lian Lin, Hao Zhang, Guang-Yu Chen, Yi Zhang, Ming-Ming Li, Zheng-Hong Li, Mei-Hong Cai, Lei-Ming Xu, Feng Shen
World Journal of Gastroenterology.2024; 30(27): 3326. CrossRef
Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial
Sara Razdar, Yunes Panahi, Ramtin Mohammadi, Leila Khedmat, Hossein Khedmat
BMJ Open Gastroenterology.2023; 10(1): e001158. CrossRef
Phlebotonics for conservative treatment of haemorrhoids: when, to whom, how?
D. D. Shlyk, I. A. Tulina, P. V. Tsarkov
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2023; 20(1): 148. CrossRef

Case Reports

Hidradenoma Papilliferum of the Anus: A Report of 2 Cases and Review of the Literature: Guh Jung Seo, Ju Heon Seo, Kyung Jin Cho, Hyung-Suk Cho; Ann Coloproctol. 2019;35(6):361-363. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.08.03

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Abstract PDF

Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.

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Perianal hidradenoma papilliferum—a case report
Kamal Hummedah, Mario Kaufmann, Bruno Reibel, Dieter Bussen
coloproctology.2025; 47(4): 293. CrossRef
Three Cases of Papillary Hidradenoma of the Anus
Satoka Nasu
Nihon Daicho Komonbyo Gakkai Zasshi.2024; 77(6): 360. CrossRef
Hidradenoma papilliferum of the perineum; a rare tumour in a rare location
Saliha Sağnıç, Sinan Serdar Ay, Hasan Aykut Tuncer, Selen Doğan, Tayup Şimşek
Journal of Obstetrics and Gynaecology.2023;[Epub] CrossRef

Bilateral Rotational S Flap Technique for Preventing Restenosis in Patients With Severe Circular Anal Stenosis: A Review of 2 Cases: Yuda Handaya, Mukhamad Sunardi; Ann Coloproctol. 2019;35(4):221-224. Published online February 19, 2019; DOI: https://doi.org/10.3393/ac.2017.10.16

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2 Citations

Abstract PDF

Anal stenosis is a late hemorrhoidectomy complication. Sphincterotomy and various anoplasty techniques are used for treatment severe anal stenosis, such as the C flap, House flap, U flap, and rotational S flap, but no procedure is ideal for every patient. We review 2 cases of severe circular anal stenosis. Their complaints included narrow caliber of the stool and feeling unsatisfied defecation. Excision of scar tissue using the circular technique was followed by reconstruction using the bilateral rotational S flap procedure. At the 1-year follow-up, the patient had complaints about neither defecation nor pain, and no longer needed laxative agents. In conclusion, the bilateral rotational S flap technique should be considered as a viable treatment because it can also prevent the occurrence of restenosis, especially given the consideration of adequate blood supply.

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Is anoplasty superior to scar revision surgery for post-hemorrhoidectomy anal stenosis? Six years of experience
Yu-Tse Weng, Kuan-Jung Chu, Kuan-Hsun Lin, Chun-Kai Chang, Jung-Cheng Kang, Chao-Yang Chen, Je-Ming Hu, Ta-Wei Pu
World Journal of Clinical Cases.2022; 10(22): 7698. CrossRef
Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences
Gaetano Gallo, Arcangelo Picciariello, Gian Luca Di Tanna, Patrizia Pelizzo, Donato Francesco Altomare, Mario Trompetto, Giulio Aniello Santoro, Franco Roviello, Carla Felice, Ugo Grossi
Colorectal Disease.2022; 24(12): 1462. CrossRef

Original Article

Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids: Hyeonseok Jeong, Sunghwan Hwang, Kil O Ryu, Jiyong Lim, Hyun Tae Kim, Hye Mi Yu, Jihoon Yoon, Ju-Young Lee, Hyoung Rae Kim, Young Gil Choi; Ann Coloproctol. 2017;33(1):28-34. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.28

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Abstract PDF

Purpose

Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH.

Methods

We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler.

Results

Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur.

Conclusion

PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.

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Jun Li, Hai-Qiong Wu, Jun-Tao Zhang, Shi-Jian Liu, Ke-Lin Peng
Asian Journal of Surgery.2025; 48(3): 1607. CrossRef
Efficacy of metronidazole in reducing pain after hemorrhoidectomy: a meta-analysis of randomized controlled trials
Hui Dong, Wen-Xing Chen, Yue-Juan Li, Deng-Chao Wang
BMC Surgery.2025;[Epub] CrossRef
A comparative study on efficacy and safety of modified partial stapled hemorrhoidopexy versus conventional hemorrhoidectomy: a prospective randomized controlled trial
Tae Gyu Kim, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Seung Han Kim, Sang Hwa Yu, Jeong Eun Lee, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Gyu Young Jeong
Annals of Coloproctology.2025; 41(2): 145. CrossRef
Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience
Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Ta-Wei Pu
World Journal of Gastrointestinal Surgery.2024; 16(9): 2787. CrossRef
Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids
Chenchen Yuan, Chongjun Zhou, Rong Xue, Xiaofeng Jin, Chun Jin, Chenguo Zheng
Frontiers in Surgery.2022;[Epub] CrossRef
Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids
Liu Tao, Jun Wei, Xu-Feng Ding, Li-Jiang Ji
World Journal of Clinical Cases.2022; 10(18): 6060. CrossRef
Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
Georgi Popivanov, Piergiorgio Fedeli, Roberto Cirocchi, Massimo Lancia, Domenico Mascagni, Michela Giustozzi, Ivan Teodosiev, Kirien Kjossev, Marina Konaktchieva
Medicina.2020; 56(6): 269. CrossRef
The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy
Hyeonseok Jeong
Annals of Coloproctology.2020; 36(5): 291. CrossRef
Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial
Hong-Cheng Lin, Qiu-Lan He, Wan-Jin Shao, Xin-Lin Chen, Hui Peng, Shang-Kui Xie, Xiao-Xue Wang, Dong-Lin Ren
Diseases of the Colon & Rectum.2019; 62(2): 223. CrossRef
Transanale Hämorrhoiden-Dearterialisation vs. selektive Stapler-Hämorrhoidopexie
R. Proßt
coloproctology.2018; 40(1): 47. CrossRef
Hemorrhoids
Danny O. Jacobs
Current Opinion in Gastroenterology.2018; 34(1): 46. CrossRef
Partial Stapled Hemorrhoidopexy Versus Circular Stapled Hemorrhoidopexy
Jin Sub Kim
Annals of Coloproctology.2017; 33(1): 7. CrossRef
A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique
A. L. H. Leung, T. P. P. Cheung, K. Tung, Y. P. Tsang, H. Cheung, C. W. Lau, C. N. Tang
Techniques in Coloproctology.2017; 21(9): 737. CrossRef

Case Report

Persistent Bleeding Following a Stapled Hemorrhoidopexy: Seong Dae Lee, Sung Taek Jung, Jae-Bum Lee, Mi Jung Kim, Doo-Seok Lee, Eui-Gon Youk, Do-Sun Kim, Doo-Han Lee; Ann Coloproctol. 2016;32(3):120-122. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.120

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1 Citations

Abstract PDF

A stapled hemorrhoidopexy (SH) is widely used for treatment of patients with grades III and IV hemorrhoids. The SH is easy to perform, is associated with less pain and allows early return to normal activities. However, complications, whether severe or not, have been reported. Here, we present the case of a female patient with persistent bleeding after a SH. The bleeding was caused by the formation of granulation tissue at the stapler line, diagnosed with sigmoidoscopy, and successfully treated via transanal excision (TAE) under spinal anesthesia. The biopsy showed inflammatory granulation tissue. After the TAE, her symptom was completely gone.

Citations

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A comparative study on efficacy and safety of modified partial stapled hemorrhoidopexy versus conventional hemorrhoidectomy: a prospective randomized controlled trial
Tae Gyu Kim, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Seung Han Kim, Sang Hwa Yu, Jeong Eun Lee, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Gyu Young Jeong
Annals of Coloproctology.2025; 41(2): 145. CrossRef

Original Articles

Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy: Dae Ro Lim, Dae Hyun Cho, Joo Hyun Lee, Jae Hwan Moon; Ann Coloproctol. 2016;32(3):111-116. Published online June 30, 2016; DOI: https://doi.org/10.3393/ac.2016.32.3.111

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22 Citations

Abstract PDF

Purpose

A variety of instruments, including circular staplers, ultrasonic scalpels, lasers, and bipolar electrothermal devices, are currently used when performing a hemorrhoidectomy. This study compared outcomes between hemorrhoidectomies performed with an ultrasonic scalpel and conventional methods.

Methods

The study was a randomized prospective review of data available between May 2013 and December 2013, involving 50 patients who had undergone a hemorrhoidectomy for grade III or IV internal hemorrhoids. The hemorrhoidal pedicle was coagulated with an ultrasonic device in the ultrasonic scalpel group (n = 25) and sutured with 3-0 vicryl material after excision in the conventional method group (n = 25).

Results

The patients' demographics, clinical characteristics, and lengths of hospital stay were similar in both groups. The mean ages of the conventional and the ultrasonic scalpel groups were, respectively, 20.8 ± 1.6 and 22.4 ± 5.0 years (P = 0.240). In comparison with the conventional method group, the ultrasonic scalpel group had a shorter operation time (P < 0.005), less postoperative pain on the visual analogue scale score (for example, P = 0.211 on postoperative day 1), and less postoperative bleeding (P = 0.034). No significant differences in postoperative complications were observed between the 2 groups.

Conclusion

A hemorrhoidectomy using an ultrasonic scalpel is an effective and safe procedure. The ultrasonic scalpel reduces the operation time, the postoperative blood loss, and the postoperative pain. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with an ultrasonic scalpel.

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Shweta B. Gupta, Arti S. Mitra
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Lu Lu, Qiang Hou, Zheyuan Hu, Zuochao Yao, Jiachao Xiong, Jianghui Ying, Meiqing Sun, Hui Wang, Hua Jiang
Aesthetic Plastic Surgery.2024; 48(3): 273. CrossRef
Laser hemorrhoidoplasty procedure versus harmonic scalpel hemorrhoidectomy: a comparative study for the treatment of grades III and IV hemorrhoids
Ehab Loutfy, Hatem Elgohary, Mahmoud E. Elkashlan, Mohamed G. Abdelrahman, Wael Omar
The Egyptian Journal of Surgery.2024; 43(2): 572. CrossRef
Hemorrhoidectomy Using the Harmonic Scalpel versus the Ferguson Technique
Mustafa Abdullah Aldawoodi, Raed Esttaifan Rezqallah
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Psychological states could affect postsurgical pain after hemorrhoidectomy: A prospective cohort study
Geng Wang, Yuanjue Wu, Yang Cao, Rui Zhou, Kaixiong Tao, Linfang Wang
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Modified ultrasound scalpel haemorrhoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial
Keqiang Yu, Haijun Li, Ping Xue, Zhidi Xie, Minghui Tang, Hongbo He, Jing Wu
Trials.2023;[Epub] CrossRef
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Alexis Bikfalvi, Charlotte Faes, Stephan M. Freys, Girish P. Joshi, Marc Van de Velde, Eric Albrecht
European Journal of Anaesthesiology Intensive Care.2023; 2(3): e0023. CrossRef
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ThomasOlagboyega Olajide, OlanrewajuSamuel Balogun, ChristopherO Bode, OluwoleAyoola Atoyebi
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V. V. Balytskyy, M. P. Zakharash, O. G. Kuryk
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Takaaki Yano, Daijiro Kabata, Seiichi Kimura
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Vitaliy V. Balytskyy
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Philippe Godeberge, Parvez Sheikh, Varut Lohsiriwat, Abel Jalife, Yury Shelygin
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Have Any Changes in Pain Been Noted After a Hemorrhoidectomy Since the Establishment of the Milligan-Morgan Hemorrhoidectomy?
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Comparison of Injection Sclerotherapy Between 5% Phenol in Almond Oil and Aluminum Potassium Sulfate and Tannic Acid for Grade 3 Hemorrhoids: Takaaki Yano, Kenji Yano; Ann Coloproctol. 2015;31(3):103-105. Published online June 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.3.103

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Abstract PDF

Purpose

Injection sclerotherapy for hemorrhoids has been performed for many years. Currently, 5% phenol in almond oil (PAO) and aluminum potassium sulfate and tannic acid (ALTA) are used as the agents. The purpose of this study was to compare the efficacy of the two agents.

Methods

A retrospective study was conducted involving 135 patients who underwent injection therapy for grade 3 hemorrhoids for the first time between 2013 and 2014 (PAO, 55 patients; ALTA, 80 patients). The efficacy was established as the proportion (%) of patients without symptoms such as hemorrhage and prolapse one year after treatment. We investigated four factors—sex, age, number of hemorrhoids, and agent—that might have an influence on the efficacy.

Results

The efficacies of ALTA and PAO one year after treatment were 75% and 20%, respectively. Only the agent was a significant independent factor (P < 0.01).

Conclusion

The results suggest that ALTA is markedly more useful than PAO for injection sclerotherapy for grade 3 hemorrhoids.

Citations

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Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis
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Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
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Case Reports

Iatrogenic Rectal Diverticulum With Pelvic-Floor Dysfunction in Patients After a Procedure for a Prolapsed Hemorrhoid: Sun Kyung Na, Hye-Kyung Jung, Ki-Nam Shim, Sung-Ae Jung, Soon Sup Chung; Ann Coloproctol. 2014;30(1):50-53. Published online February 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.1.50

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Abstract PDF

Diverticula are frequently seen in the sigmoid, descending, ascending and transverse colons whereas rectal diverticula are extremely rare. The stapled rectal mucosectomy for the treatment of a prolapsed hemorrhoid is less painful and has lower morbidity; therefore, it has been commonly used despite possible complications. This paper reports a case of a rectal diverticulum that developed after a procedure for prolapsed hemorrhoids (PPH). A 42-year-old man with a history of hemorrhoidectomies came to the hospital because of constipation. On sigmoidoscopy, a 2-cm-sized, feces-filled pocket was located just above the anorectal junction. After removal of the fecal material, a huge rectal diverticulum (-4 cm in diameter) was seen. Pelvic magnetic resonance imaging (MRI) confirmed the diagnosis of rectal diverticulum outpouching through the muscular layer of the intestine in a left posterolateral direction. The patient was discharged without complication after a transanal diverticulectomy had been performed, and the direct rectal wall had been repaired.

Citations

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Kassandra G. Tulenko, Samantha H. Epstein, Brett R. Kurpiel, Rachita Khot
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Şehmus ÖLMEZ, Adnan TAŞ, Nevin AKÇAER ÖZTÜRK, Bünyamin SARITAŞ
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Rectal Pocket Syndrome: A Symptomatic Rectal Pseudodiverticula as a Long-Term Complication of Failed Purse-String Suture During Stapled Hemorrhoidopexy
Cristopher Varela, Adrian Terán, Sthephfania Lopez, German Millan
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Xing-Yang Wan, Yuan-Ji Fu, Gui-Ming Li, Guo-Zhong Xiao, Zhi-Wei Guo, Dong-Lin Ren, Bo Cao, Hong-Cheng Lin
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Gary G Ghahremani, Ravinder K Mittal
Journal of Medical Imaging and Radiation Oncology.2021; 65(3): 286. CrossRef
Stapled Hemorrhoidopexy: “Mucosectomy or Not Only Mucosectomy, This Is the Problem”
Chiara Eberspacher, Fabio M. Magliocca, Stefano Pontone, Pietro Mascagni, Lisa Fralleone, Gaetano Gallo, Domenico Mascagni
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A case of solitary rectal diverticulum presenting with a large retrorectal abscess
Stefanos Gorgoraptis, Sofia Xenaki, Elias Athanasakis, Anna Daskalaki, Konstantinos Lasithiotakis, Evangelia Chrysou, Emmanuel Chrysos
Annals of Medicine and Surgery.2020; 49: 57. CrossRef
Mucocele complicating stapled hemorrhoidopexy
Asia Grapsi, Alessandro Sturiale, Bernardina Fabiani, Gabriele Naldini
International Journal of Surgery Case Reports.2017; 33: 38. CrossRef

Pneumoretroperitoneum After Procedure for Prolapsed Hemorrhoid: Young Jin Park; Ann Coloproctol. 2013;29(6):256-258. Published online December 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.6.256

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3 Citations

Abstract PDF

Procedure for prolapsed hemorrhoid (PPH) is well recognized alternative to the traditional hemorrhoidectomy, and is associated with reduced pain and earlier return to normal activity. Over the past decade, there have been reports of severe life-threatening complications after a PPH, although the incidence is very low. Rectal perforation due to staple-line dehiscence is one of the serious complications that can cause severe pelvic sepsis or a pneumoretroperitoneum. Here, the first Korean case of a pneumoretroperitoneum due to staple-line dehiscence is described.

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The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy
Hyeonseok Jeong
Annals of Coloproctology.2020; 36(5): 291. CrossRef
Partial Stapled Hemorrhoidopexy Versus Circular Stapled Hemorrhoidopexy
Jin Sub Kim
Annals of Coloproctology.2017; 33(1): 7. CrossRef
Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids
Hyeonseok Jeong, Sunghwan Hwang, Kil O Ryu, Jiyong Lim, Hyun Tae Kim, Hye Mi Yu, Jihoon Yoon, Ju-Young Lee, Hyoung Rae Kim, Young Gil Choi
Annals of Coloproctology.2017; 33(1): 28. CrossRef

Original Article

Correlation of Histopathology With Anorectal Manometry Following Stapled Hemorrhoidopexy: Young Ki Hong, Yoon Jung Choi, Jung Gu Kang; Ann Coloproctol. 2013;29(5):198-204. Published online October 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.5.198

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8 Citations

Abstract PDF

Purpose

The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy.

Methods

Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated.

Results

Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence.

Conclusion

Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.

Citations

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James Z. Jin, Velia Men, Praharsh Bahl, Harshitha Penneru, Robin Yang, Niket Shah, Andrew G. Hill
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Chia-Cheng Wen, Shih-Ming Huang, Yi-Wen Wang
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Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes
Chetty Y. V. Narayanaswamy, M. R. Sreevathsa, G. Akhil Chowdari, Koteshwara Rao
The Surgery Journal.2022; 08(03): e199. CrossRef
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Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha, Tran Quang Hung, Do Van Loi, Tran Manh Hung, Nguyen Van Son, Vu Duy Kien
Advances in Therapy.2020; 37(3): 1136. CrossRef
Post-surgical fecal incontinence
Filippo Pucciani
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Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions
Franciszek Burdan, Iwona Sudol-Szopinska, Elzbieta Staroslawska, Malgorzata Kolodziejczak, Robert Klepacz, Agnieszka Mocarska, Marek Caban, Iwonna Zelazowska-Cieslinska, Justyna Szumilo
European Journal of Medical Research.2015;[Epub] CrossRef
Histopathology and Physiological Alterations After Procedure for Prolapsed Hemorrhoids
Do Sun Kim
Annals of Coloproctology.2013; 29(5): 179. CrossRef

Case Report

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment: Yong Joon Suh, Heon-Kyun Ha, Heung-Kwon Oh, Rumi Shin, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(1):28-30. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.28

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2 Citations

Abstract PDF

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.

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The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study
Masoumeh Ebrahimi Tavani, Yegane Partovi, Tahmineh Poursaki, Farid Gharibi
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Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
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Review

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids: Seok Won Lim; J Korean Soc Coloproctol. 2012;28(2):73-77. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.73

46,383 View
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14 Citations

Abstract PDF

A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment.

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Comparison of Injection Sclerotherapy Between 5% Phenol in Almond Oil and Aluminum Potassium Sulfate and Tannic Acid for Grade 3 Hemorrhoids
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Original Article

One Year Follow-up Result of Doppler-guided Hemorrhoidal Artery Ligation and Recto-Anal Repair in 97 Consecutive Patients: Wan Jo Jeong, Sung Wook Cho, Kyung Tae Noh, Soon Sup Chung; J Korean Soc Coloproctol. 2011;27(6):298-302. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.298

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Abstract PDF

Purpose

Doppler-guided hemorrhoidal artery ligation and recto-anal repair (DG-HAL & RAR) is known for low recurrence, high patient satisfaction, and less postoperative pain. The purpose of this study is to analyze the 1-year follow-up results in patients who underwent a DG-HAL & RAR and to establish the benefits of the procedure.

Methods

Among the hemorrhoid patients who were admitted to our hospital from March 2008 to May 2010 and who underwent a DG-HAL & RAR, 97 patients who were followed up for a year were investigated. Recurrence, complications, admission period, difference in preoperative and postoperative pain, operation time, and time to return to daily activities were investigated.

Results

The average admission period was 1.6 ± 1.1 days. Pain at postoperative day 7 showed no significant difference from preoperative pain (P > 0.05). The operation time was 34.0 ± 7.3 minutes on average, and return to daily activities was timed at 2.3 ± 2.0 days postoperatively. At the one year follow-up, no serious complications were noted, and preoperative symptoms recurred only in 14 patients (14.4%).

Conclusion

In most patients with hemorrhoids, excluding those with severe prolapsed hemorrhoids, less pain, no serious complications, and good long-term outcome can be expected from a DG-HAL & RAR.

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Nevin SAKOĞLU, Aziz OCAKOĞLU
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E. A. Zagriadskiǐ, V. S. Tolstyh
Koloproktologia.2021; 20(1): 87. CrossRef
TRANSANAL HAEMORRHOIDAL DEARTERIALIZATION WITH MUCOPEXY (THD-M) FOR TREATMENT OF HEMORRHOIDS: IS IT APPLICABLE IN ALL GRADES? BRAZILIAN MULTICENTER STUDY
Carlos Walter SOBRADO, Sidney KLAJNER, José Américo Bacchi HORA, Anderson MELLO, Fabricio Marcondes Luciano da SILVA, Marcos Onofre FRUGIS, Lucas Faraco SOBRADO
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2020;[Epub] CrossRef
Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life
Fernando Carvajal López, Carlos Hoyuela Alonso, Montserrat Juvany Gómez, Daniel Troyano Escribano, Miguel Angel Trias Bisbal, Antoni Martrat Macià, Jordi Ardid Brito
Surgical Innovation.2019; 26(3): 328. CrossRef
LASER hemorrhoidal dearterialization
Paulo Boarini, Lucas Rodrigues Boarini, Paulo de Azeredo Passos Candelaria, Edgard Mesquita de Lima, Marcelo Rodrigues Boarini
Journal of Coloproctology.2017; 37(01): 038. CrossRef
Hemorrhoids screening and treatment prior to LVAD: is it a necessity?
Hadi Skouri, Mohammed Shurrab, Jad Zahnan, Samer Deeba, Pierre Sfeir, Walid Gharzuddin, Saleem Haj-Yahia
Journal of Cardiothoracic Surgery.2016;[Epub] CrossRef
A Randomized Controlled Trial Comparing Suture-Fixation Mucopexy and Doppler-Guided Hemorrhoidal Artery Ligation in Patients with Grade III Hemorrhoids
Min Zhai, Yong-An Zhang, Zhen-Yi Wang, Jian-Hua Sun, Jie Wen, Qi Zhang, Jin-De Li, Yi-Zheng Wu, Feng Zhou, Hui-Lei Xu
Gastroenterology Research and Practice.2016; 2016: 1. CrossRef
HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up
Carlos Hoyuela, Fernando Carvajal, Montserrat Juvany, Daniel Troyano, Miquel Trias, Antoni Martrat, Jordi Ardid, Joan Obiols
International Journal of Surgery.2016; 28: 39. CrossRef
DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study
S. Roka, D. Gold, P. Walega, S. Lancee, E. Zagriadsky, A. Testa, A. N. Kukreja, A. Salat
European Surgery.2013; 45(1): 26. CrossRef
Remarks and results from the use of the HAL/RAR technique in the management of patients with haemorrhoids
Christos Farazi-Chongouki, G. Doulgerakis, A. Pantelis, M. Vidali, G. Papaioannou, C. Iordanou, I. Pougouras, L. Palyvos, I. Papandrikos, S. Pierrakakis
Hellenic Journal of Surgery.2013; 85(4): 274. CrossRef
Clinical outcome following Doppler‐guided haemorrhoidal artery ligation: a systematic review
P. H. Pucher, M. H. Sodergren, A. C. Lord, A. Darzi, P. Ziprin
Colorectal Disease.2013;[Epub] CrossRef
Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD
Carlos Walter Sobrado-Junior, José Américo Bacchi Hora
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2012; 25(4): 293. CrossRef

Review

Optimal Treatment of Symptomatic Hemorrhoids: Seok-Gyu Song, Soung-Ho Kim; J Korean Soc Coloproctol. 2011;27(6):277-281. Published online December 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.6.277

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Abstract PDF

Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used.

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Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment
Ismail Cem Eray, Ugur Topal, Serdar Gumus, Kubilay Isiker, Burak Yavuz, Ishak Aydin
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
HEMORRHOIDS: A COMPREHENSIVE REVIEW OF ETIOLOGY, PATHOPHYSIOLOGY, RISK FACTOR AND TREATMENT OPTION
YADAV AKASH RAMNAYAN, JIMISHA KHER, SNIGDHA DAS MANDAL
Innovare Journal of Medical Sciences.2025; : 1. CrossRef
Outcomes of embolization therapy of superior rectal arteries for the management of grade 1 to 3 internal hemorrhoids: a systematic Review of clinical studies
Mustafa Al Jnainati, Niharika Ikkurthy, Mohammad Ayoub, Areeba Shahid, Mirza Taha Baig, Muhammad Iltaf, Jana Al Jnainati
International Journal of Colorectal Disease.2025;[Epub] CrossRef
A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India
Samrobinson J, Jeyaganesh R, Geetha Arumugam, Nawin J Vignesh
Cureus.2024;[Epub] CrossRef
A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids
Dong Wan Kang, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim, Gyong Suk Kang
Annals of Coloproctology.2023; 39(1): 41. CrossRef
Treatment of haemorrhoids: rubber band ligation or sclerotherapy (THROS)? Study protocol for a multicentre, non-inferiority, randomised controlled trial
J. Y. van Oostendorp, T. C. Sluckin, I. J. M. Han-Geurts, S. van Dieren, R. Schouten
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Finding Molecular Inhibitors of the Inflammatory Pathway in the Large Intestine Along with Molecular Dynamics with Emphasis on the Use of TCM Database
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Hybrid methods treatments for III and IV grade hemorrhoids
E. A. Zagriadskiǐ
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Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults
Yun Soo Hong, Kyung Uk Jung, Sanjay Rampal, Di Zhao, Eliseo Guallar, Seungho Ryu, Yoosoo Chang, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun, Chong Il Sohn, Hocheol Shin, Juhee Cho
Scientific Reports.2022;[Epub] CrossRef
Doppler-guided hemorrhoidal dearterialization. Technical evolution and results of treatment (review)
E. A. Zagriadskiǐ, V. S. Tolstyh
Koloproktologia.2021; 20(1): 87. CrossRef
Treatment for Hemorrhoids: Conservative Treatment and Office-based Treatments
Tsutomu Masuda, Naoki Inatsugi, Shusaku Yoshikawa, Seiji Terauchi, Hideki Uchida, Takeshi Nakao, Kentaro Yamaoka, Mizumi Inagaki, Takashi Yokoo, Kohei Okamoto
Nihon Daicho Komonbyo Gakkai Zasshi.2021; 74(10): 521. CrossRef
Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids
Zhixian Liu, Xianqing Song, Feng Ye
Indian Journal of Surgery.2020; 82(3): 345. CrossRef
THE CHOICE OF TREATMENT IN PATIENTS WITH HEMORRHOIDAL DISEASE (THE RESULTS OF THE OBSERVATIONAL PROGRAM RE-VISION)
E. A. Zagriadskiy, A. M. Bogomazov, E. В. Golovko
Koloproktologia.2019; 18(4): 100. CrossRef
Postoperative Pain as a Decision-Making Tool in Treating Hemorrhoids on an In- or Out-Patient Basis After Stapled Mucosectomy (Longo Procedure)
D. Kovacevic, G. Gubler, M. Turina, M. K. Muller, A. Nocito, N. Attigah, M. Weber
International Surgery.2019; 104(9-10): 461. CrossRef
Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study
Gabriella Giarratano, Edoardo Toscana, Claudio Toscana, Giuseppe Petrella, Mostafa Shalaby, Pierpaolo Sileri
Surgical Innovation.2018; 25(3): 236. CrossRef
Conservative Treatment of Hemorrhoids: Results of an Observational Multicenter Study
Evgeny A. Zagriadskiĭ, Alexey M. Bogomazov, Evgeny B. Golovko
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CONSERVATIVE TREATMENT OF HEMORRHOIDS. AN ALTERNATIVE TO SURGICAL METHODS OR COMPONENTS? CHORUS PROGRAM RESULTS
E. A. Zagryadskiy, A. M. Bogomazov, E. B. Golovko
Koloproktologia.2018; (1): 27. CrossRef
Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux
JM Holdstock, SJ Dos Santos, CC Harrison, BA Price, MS Whiteley
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A prospective, randomized, three arm, open label study comparing the safety and efficacy of PP110, a novel treatment for hemorrhoids to preparation-H® maximum strength cream in the treatment of grade 2–3 hemorrhoids
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World Journal of Gastroenterology.2015; 21(23): 7305. CrossRef

Original Articles

Comparison of Early Clinical Outcomes Between ALTA (Aluminum Potassium Sulfate and Tannic Acid, Ziohn(R)) Injection Therapy and a Submucosal Hemorrhoidectomy in Patients with Internal Hemorrhoids.: Lee, Young Chan , Shin, Hyun Keun , Lim, Cheong Ho , Yang, Hyung Kyu , Kang, Jung Hyun , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2010;26(3):179-185.; DOI: https://doi.org/10.3393/jksc.2010.26.3.179

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Abstract PDF

PURPOSE
The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid, Ziohn(R)) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids.
METHODS
From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV) were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared.
RESULTS
The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P<0.001). However, there was no significant difference in the satisfaction level between two groups. One case of treatment failure was found in the ALTA injection group. There was no difference in complications between the injection group (n=4) and the operation group (n=5) (P=0.725).
CONCLUSION
When compared with a submucosal hemorrhoidectomy, ALTA injection showed less post-treatment pain and less analgesics use. Overall complication rates were not different between the two groups. We found the early outcomes of ALTA injection for the treatment of internal hemorrhoids to be comparable to those of surgery. Thus, large-scale and long-term follow-up studies are needed to clarify the proper indications for ALTA injection.

Citations

Citations to this article as recorded by

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids
Seok Won Lim
Journal of the Korean Society of Coloproctology.2012; 28(2): 73. CrossRef

The Significance of Staple Line Height in a Stapled Hemorrhoidopexy.: Min, HoKyun , Kim, Hungdai , Kim, Hyungook , Han, Won Kon; J Korean Soc Coloproctol. 2010;26(1):8-11.; DOI: https://doi.org/10.3393/jksc.2010.26.1.8

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Abstract PDF: PURPOSE
In 1998, Longo introduced a novel operative technique for hemorrhoids. That technique uses a prolapse and hemorrhoid (PPH) stapler. His results showed minimal pain, short hospital stay, and rapid return to normal social life. However, a higher height of staple line yields less postoperative pain, but more residual piles, and vice versa. This study was designed to find the optimal height of the staple line for a PPH hemorrhoidopexy.
METHODS
A total of 65 consecutive patients scheduled for a PPH hemorrhoidopexy on grade II or higher internal hemorrhoids were included in this study. The hemorrhoidopexy was performed as in the literature. A purse-string suture was made 5 cm from the anal verge. Remaining piles were excised immediately after the firing of the PPH stapler. Patients were divided into 2 groups. In group A, the staple line was located above 2 cm proximal to the dentate line, and in group B, it was located below 2 cm proximal to the dentate line.
RESULTS
The mean subjective pain score of group A was 2.00, and that of group B was 1.98 (P=0.898). The mean hospital stay of group A was 2.5 days, and that of group B was 2.7 days (P=0.431). Group A returned to normal life in a mean of 7.1 days whereas group B returned to normal life in a mean of 6.8 days (P=0.474). Complications included 6 cases of voiding difficulty, 3 cases of heavy sensation in anus, 1 case of temporary fecal incontinence, and 1 case of anal pain caused by long-standing residual staples.
CONCLUSION
No meaningful relationship was found to exist between the staple line height and either pain or the number of days to return to normal life. However, the incidence of residual piles was lower in cases with a low staple line height. Therefore, the level of the staple line should be lower than it is for a conventional Longo procedure.

Histological Differences between Vascular and Mucosal Hemorrhoids.: Lim, Cheong Ho , Lee, Hun Kyung , Shin, Hyeon Keun , Lee, Young Chan , Choi, Dong Hyun , Hwang, Jae Kwan , Chang, Han Jeong , Ko, Yong Taek , Jeong, Seung Kyu , Yang, Hyung Kyu; J Korean Soc Coloproctol. 2009;25(6):372-379.; DOI: https://doi.org/10.3393/jksc.2009.25.6.372

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Abstract PDF: PURPOSE
The aim of this study is to compare and analyze the histological differences between vascular and mucosal hemorrhoids, two structurally different types of hemorrhoids. METHODS: Internal hemorrhoidal tissue samples were fixed in 10% Formalin solution, and coronal sections included 10-mm proximal and 5-mm distal of the dentate line. Routine Masson-Trichrome and H&E were performed to evaluate the thickness of the mucosa and changes in the structure and the densities of submucosal vessels, connective tissue, and muscle. RESULTS: Compared with the corresponding tissues of mucosal hemorrhoids, the submucosal connective tissue and perivascular connective tissue of vascular hemorrhoids showed a loosened density, severe fragmentation, and an irregular arrangement. The submucosal vascular dilatation was more frequent and more severe in vascular hemorrhoids, but the number of vessels between both types of hemorrhoids did not show much difference. Hypertrophy and regular arrangement of the submucosal muscles were observed more frequently in the mucosal than in the vascular hemorrhoids.
CONCLUSION
Compared to mucosal hemorrhoids, vascular hemorrhoids showed augmented damage in submucosal connective tissue and intense dilatation of vessels with a thinner mucosa. On the other hand, compared to vascular hemorrhoids, mucosal hemorrhoids showed hypertrophy of submucosal muscle and relatively minor alterations in vessels with a thicker mucosa. These histological differences may provide the basis for different etiologies between vascular and mucosal hemorrhoids.

Early Experience with Doppler-guided Hemorrhoidal Artery Ligation.: Lim, Minho , Kim, Kwang Ho , Chung, Soon Sup , Nam, Sun Young , Lee, Ryung Ah; J Korean Soc Coloproctol. 2009;25(4):215-220.; DOI: https://doi.org/10.3393/jksc.2009.25.4.215

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Abstract PDF

PURPOSE
Doppler-guided hemorrhoidal artery ligation (HAL) is an alternative technique to the standard Milligan-Morgan hemorrhoidectomy. The purpose of this pilot study is to introduce the HAL technique for grade 2-3 internal hemorrhoids and to evaluate the efficacy of this technique in Korea in terms of results and patient satisfaction.
METHODS
The HAL procedure was performed on 29 patients with grade 2 or 3 internal hemorrhoids. Twenty-eight procedures were performed under local anesthesia with lidocaine, and one procedure was performed under general anesthesia due to synchronous surgery for gallstones. With the lithotomy position, the pulsation of the hemorrhoidal artery was localized using a doppler probe, and 3-6 branches of the hemorrhoidal artery were ligated with vicryl 2-0. Patient course was evaluated before and after the procedure by using questionnaires with a visual analog scale. RESULTS: The mean age of the patients was 44+/-24 yr. There were no significant complications with this procedure. At 3 mo after the operation, symptom scores of anal pain, anal bleeding, and anal prolapse were significantly improved (0.4, 1.0, and 2.4, respectively) compared to the symptom scores before the operation (3.4, 4.6, and 5.9, respectively). The postoperative satisfaction score was 8.1, and the recommendation score was 8.5. CONCLUSION: HAL is a safe and effective technique to relieve anal pain, bleeding, and prolapse of internal hemorrhoids. A comparative study with other procedures and a long-term follow-up after HAL should be the basis for valdating the efficacy of this procedure.

Citations

Citations to this article as recorded by

Early Experience of Treatment for Symptomatic Hemorrhoids with Doppler Guided Hemorrhoidal Artery Ligation and Recto-anal Repair
Byoung-Hoon Jo, Jong Kyung Park, In Kyu Lee, Hyung-Jin Kim, Yoon-Suk Lee, Jae-Im Lee, Soo-Hong Kim, Won-Kyung Kang
Journal of the Korean Surgical Society.2010; 79(2): 116. CrossRef

Randomized Controlled Trial

Randomized Trial Comparing a Starion(TM) and a Harmonic Scalpel(TM) Hemorrhoidectomy.: Kim, Joo Hyung , Lee, Yong Pyo; J Korean Soc Coloproctol. 2009;25(1):8-13.; DOI: https://doi.org/10.3393/jksc.2009.25.1.8

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Abstract PDF

PURPOSE
The present study was designed to evaluate the efficacy and the outcome when using the Starion(TM) and the Harmonic Scalpel(TM) vessel sealing systems for a sutureless hemorrhoidectomy.
METHODS
This study is a randomized, controlled trial. Patients with Grade 3 and 4 hemorrhoids were categorized into two groups: the Starion(TM) hemorrhoidectomy (30 patients) group and the Harmonic Scalpel(TM) hemorrhoidectomy (30 patients) group. The measures of the primary outcomes were the operating time, the postoperative pain score, and the patient satisfaction score. Secondary outcome criteria included early and delayed complications: postoperative bleeding, anal stenosis, urinary difficulty, and skin tag.
RESULTS
The satisfaction scores 4 wk postoperatively were not significantly different between the two groups (P=0.186). However, the operating time was reduced (P=0.019), the pain score was lower (P=0.009), and the satisfaction score 1 wk postoperatively (P=0.001) was lower in the Starion(TM) hemorrhoidectomy group. In addition, there were no differences in early and delayed postoperative complications between the two groups (all P>0.05).
CONCLUSION
Both methods were found to be surprisingly equivalent in all major aspects analyzed. A Starion(TM) hemorrhoidectomy with submucosal dissection can provide a safe, fast, bloodless, reduced-pain, and low-priced surgical alternative to hemorrhoidal surgery. More studies are needed to determine whether similar favorable results can be attained in patients with more severe, strangulated hemorrhoids.

Citations

Citations to this article as recorded by

Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids
C Simillis, S N Thoukididou, A A P Slesser, S Rasheed, E Tan, P P Tekkis
British Journal of Surgery.2015; 102(13): 1603. CrossRef

Review

Minor Procedures of Hemorrhoids.: Hwang, Do Yeon; J Korean Soc Coloproctol. 2008;24(3):228-237.; DOI: https://doi.org/10.3393/jksc.2008.24.3.228

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Abstract PDF

Hemorrhoids have afflicted man since the dawn of history. They are among the first conditions described as contributing to the discomfort of humans. When we consider over 90 percent of accurately diagnosed, symptomatic hemorrhoids can be treated without an operation, we have to get detailed information on the several techniques of nonsurgical treatment of hemorrhoids. Modern as well as traditional, drugs are being increasingly used in all grades of symptomatic hemorrhoids. Although drugs can reduce edema, relieve pain, and help in thrombosis, they cannot definitively cure hemorrhoids. Several modes of therapy, not involving surgical excision, have been advocated for the treatment of hemorrhoid patients. These include injection sclerotherapy, cryotherapy, rubber band ligation, infrared photocoagulation, and diathermy. The mechanisms are principally the same, irrespective of which is chosen, as all function ablatively by thrombosis, sclerosis, or necrosis of a part of the internal portion of the hemorrhoidal complex and thereby decrease the volume of the cushions, possibly fixating them in the distal rectum. Usually, rubber band ligation is considered the first treatment for first- to third- degree hemorrhoids, and a hemorrhoidectomy should be reserved for those failing to respond to a ligature procedure. Recently, new treatment modalities for hemorrhoids, such as radiofrequency or hemorrhoidal artery ligation, have been developed to treat symptomatic hemorrhoids. We can choose suitable procedures according to the degree of the hemorrhoids.

Citations

Citations to this article as recorded by

A Case Study of Four Hemorrhoid Patients Treated by Korean Medical Treatment
Jin-hyuk Lee, Min-ji Oh
The Journal of Internal Korean Medicine.2018; 39(2): 209. CrossRef
Comparison of Early Clinical Outcomes Between ALTA (Aluminum Potassium Sulfate and Tannic Acid, Ziohn®) Injection Therapy and a Submucosal Hemorrhoidectomy in Patients with Internal Hemorrhoids
Young Chan Lee, Hyun Keun Shin, Cheong Ho Lim, Hyung Kyu Yang, Jung Hyun Kang, Kang Young Lee, Nam Kyu Kim
Journal of the Korean Society of Coloproctology.2010; 26(3): 179. CrossRef

Original Articles

Clinical Characteristics of a Hand-sewn Circumferential Mucosectomy in Hemorrhoids.: Kang, Jung Gu , Kim, Kang Mi , Ahn, Young Jae; J Korean Soc Coloproctol. 2008;24(1):7-12.; DOI: https://doi.org/10.3393/jksc.2008.24.1.7

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Abstract PDF: PURPOSE
A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids.
METHODS
We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common.
CONCLUSIONS
A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.

Clinical Experience with a Circular Stapled Hemorrhoidopexy without Circular Anal Dilator (CAD).: Yun, Kyung Jin , Cho, Hae Chang; J Korean Soc Coloproctol. 2007;23(6):431-436.; DOI: https://doi.org/10.3393/jksc.2007.23.6.431

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Abstract PDF

PURPOSE
The circular stapled hemorrhoidopexy (SH) reduces mucosal prolapse and interrupts the end branches of the upper hemorrhoidal artery through a suitable instrument, Procedure for Prolapse and Hemorrhoids (PPH). However, there are some technical difficulties in routine use of the circular anal dilator (CAD). The goal of this study was to evaluate the efficacy and the safety of a CSH without use of a CAD.
METHODS
Between April 2005 and November 2006, 250 patients with Grade III and IV prolapsed hemorrhoids who had undergone CSH with PPH without using a CAD were retrospectively analyzed. The sex and age, the operation time, the type of anesthesia, the number of excised hemorrhoid piles, the degree of hemorrhoids and postoperative pain (consumed analgesics), the hospital stay, the postoperative complications, and the number of follow-up examinations at the outpatient clinic were analyzed.
RESULTS
The operation time was 17.76 minutes (10~35 minutes). Most patients (89%) experienced spinal anesthesia. The degrees of hemorrhoids were Grade III (45%) and Grade IV (55%). The numbers of excised piles were 3 (44%), 4 (43%), and more than 5 (13%). The number of consumed postoperative analgesics was 0.97 times (mean). The mean hospital stay was 2.83 days. The postoperative complications were pain, bleeding, and urinary retention.
CONCLUSIONS
A CSH without use of a CAD was an effective and safe surgical modality compared with other procedures for treating hemorrhoids. This procedure is feasible and convenient. The procedure is a new alternative in the treatment of severe hemorrhoids.

Citations

Citations to this article as recorded by

Partial Stapled Hemorrhoidopexy Versus Circular Stapled Hemorrhoidopexy
Jin Sub Kim
Annals of Coloproctology.2017; 33(1): 7. CrossRef
Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids
Hyeonseok Jeong, Sunghwan Hwang, Kil O Ryu, Jiyong Lim, Hyun Tae Kim, Hye Mi Yu, Jihoon Yoon, Ju-Young Lee, Hyoung Rae Kim, Young Gil Choi
Annals of Coloproctology.2017; 33(1): 28. CrossRef

Detection of HBV DNA and HCV RNA in Public Bath; A Study about Safety of Prolapsed Hemorrhoidal Patients.: Lee, Jin kwon , Kim, Hyun sung , Lee, Eun yup , Choi, In seok , Oh, Nahm gun; J Korean Soc Coloproctol. 2007;23(5):297-304.; DOI: https://doi.org/10.3393/jksc.2007.23.5.297

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Abstract PDF

PURPOSE
The Sitz bath is a commonly used nonsurgical treatment for patients with hemorrhoids. When these patients use public baths, possibilities exposure to infectious diseases due to public-bath utilization by exist for person infected with many kinds of diseases. In particular, because Hepatitis type B and type C viruses are infection sources for chronic liver diseases, we shall examine the risks of infections of HBV and HCV in acute hemorrhoids patients by examining the existences of HBV DNA and HCV RNA in the waters of public baths.
RESULTS
From March 2005 to March 2006, 29 hot-water samples and 22 cold-water samples were obtained from public baths within Busan. With each sample, COBAS Amplicor HBV DNA monitor and HCV RNA monitor were used to run a quantitative (PCR) for HBV DNA and HCV RNA. Additionally, HBsAg and HBeAg were examined through chemiluminescent microparticle immuno assay (CMIA).
RESULTS
HBV DNA was detected in 4 samples and HCV RNA was detected in an other 4 samples of the 29 samples from the hot baths. In 22 samples from the cold baths, HBV DNA was detected in 3 samples and HCV RNA in an other 2 samples. The mean levels of HBV DNA detected were 162.8 IU/ml and 1,586 IU/ml and the mean levels of HCV RNA were 276 IU/ml and 3,067 IU/ml from specimens in hot and cold baths, respectively. In the tests for HBs Ag and HBeAg, among 51 samples, 2 hot-water samples showed positive for HBs Ag while the others showed negative.
CONCLUSIONS
HBV DNA and HCV RNA were detected in both the hot and the cold waters of public baths. However, this result cannot be regarded as demonstrating infectivity, but further studies are thought to be needed to examine the risks of infections to patients with acute hemorrhoids of higher than third degree or patients with open wounds or external orifices. A patient with hemorrhoids or fistulas with external orifices should not use public baths and should undergo curative surgery.

Citations

Citations to this article as recorded by

Investigation of Microbial Contamination of Public Bath in Jongno-gu, Seoul
Mi-Soon Kim, Young-Min Lee, Seong-Keun Kim, Ji-Hyun Seo, Kyung-Hee Ji, Ji-Yoon Oh, Ki-Dong Ko, Gwang-Pyo Ko
Korean Journal of Environmental Health Sciences.2009; 35(3): 162. CrossRef

Review

Open Hemorrhoidectomy.: Kim, Do Sun; J Korean Soc Coloproctol. 2007;23(4):279-285.; DOI: https://doi.org/10.3393/jksc.2007.23.4.279

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Abstract PDF

The open hemorrhoidectomy has been recognized as the treatment of choice for symptomatic prolapsing hemorrhoids. Although the open hemorrhoidectomy is thought to be associated with more postoperative pain and delayed wound healing compared with other conventional procedures such as a closed hemorrhoidectomy, and a semi- closed or submucosal hemorrhoidectomy, it is still unclear which procedure is preferable in terms of postoperative pain, wound healing, hospital stay, and time off work. To address this issue, several studies have been performed. According to randomized controlled studies comparing an open hemorrhoidectomy to a closed hemorrhoidectomy, there are no significant differences in the severity of pain and the hospital stay between the two procedures; however, the healing time in the closed hemorrhoidectomy is faster and the operation time in the open hemorrhoidectomy is shorter. Since there are few randomized controlled studies comparing an open hemorrhoidectomy with a semi-closed hemorrhoidectomy or submucosal hemorrhoidectomy, it is difficult to conclude which procedure is superior to the others. Yet, there seems to be no significant difference between these procedures. In 1998, a novel procedure, a stapled hemorrhoidopexy, was introduced by Longo. Several randomized controlled studies comparing the open hemorrhoidectomy with the stapled hemorrhoidopexy showed that the latter was associated with less pain, shorter hospital stay, and earlier return to work. However, considering the lack of long- term data and the disastrous complications, such as retroperitoneal sepsis and rectal perforation, there is still controversy about its efficacy and safety as a definitive treatment of hemorrhoids. The open hemorrhoidectomy is time-tested and is comparable to other conventional techniques in terms of postoperative pain, hospital stay, and time off work. Further study should be performed to assess the long-term results of a stapled hemorrhoidopexy.

Citations

Citations to this article as recorded by

Long-term follow-up of Starion™ versus Harmonic Scalpel™ hemorrhoidectomy for grade III and IV hemorrhoids
Joo Hyung Kim, Dae Hyun Kim, Yong Pyo Lee, Kwang Wook Suh
Asian Journal of Surgery.2019; 42(1): 367. CrossRef
Have Any Changes in Pain Been Noted After a Hemorrhoidectomy Since the Establishment of the Milligan-Morgan Hemorrhoidectomy?
Do Sun Kim
Annals of Coloproctology.2016; 32(3): 90. CrossRef
Randomized Trial Comparing a Starion™ and a Harmonic Scalpel™ Hemorrhoidectomy
Joo Hyung Kim, Yong Pyo Lee
Journal of the Korean Society of Coloproctology.2009; 25(1): 8. CrossRef

Original Article

Clinical Analysis of the Hemorrhoidectomy with Pure Local Anesthesia.: Oh, Chang Seok , Lee, Yong Jik , Ko, Soo Jong , Lee, Young Taek; J Korean Soc Coloproctol. 2007;23(1):22-27.; DOI: https://doi.org/10.3393/jksc.2007.23.1.22

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Abstract PDF: PURPOSE
We hoped to evaluate the possibility of substitution of the local anesthesia for the spinal anesthesia in hemorrhoidectomy.
METHODS
We did Milligan-Morgan hemorrhoidectomy under local anesthesia for the sixty- eight patients from January 1998 to December 2005. These patients were compared with seventy-nine patients of spinal anesthesia, sampled with similar gender, age, a surgeon, retrospectively. We used a mixture of 0.5% lidocaine and 1:200,000 epinephrine into perianal skin and intersphincteric space.
RESULTS
The male-to-female ratio was 1:1 in local anesthesia group and 1:0.84 in spinal anesthesia group. The mean age was 50 and 46 respectively. The number of excised pile was 3.9 and 3.8 respectively. The frequency of the analgegics injected within first 24 hours was 1.79 and 2.70 respectively (P=0.001). The frequency of the urinary catheterization was 0.07 and 0.69 respectively (P < 0.001). The first bowel movement after surgery was 1.2 days and 1.6 days respectively. The hospital stay was 6.4 days and 8.1 days respectively (P=0.06). CONCLUISIONS: Local anesthesia is simple, safe and effective in the hemorrhoidectomy.

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