Annals of Coloproctology

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Original Articles

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

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.

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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
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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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Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study
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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
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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
Adolfo Renzi, Luigi Marano, Pasquale Talento, Luigi Brusciano, Angela Pezzolla, Domenico Izzo, Carmine Antropoli, Francesco D’Aniello, Giandomenico Di Sarno, Gianluca Minieri, Grazia Cantore, Gianmattia Terracciano, Domenico Barbato, Ludovico Docimo, Mass
Annals of Coloproctology.2025; 41(4): 330. CrossRef
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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
Annals of Coloproctology.2024; 40(6): 602. CrossRef

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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International Journal of Colorectal Disease.2025;[Epub] CrossRef
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Annals of Coloproctology.2025; 41(6): 573. CrossRef
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Isaac Seow-En, Lionel Raphael Hui Chen, Yun Zhao, Yvonne Ying-Ru Ng, Emile Kwong-Wei Tan
Annals of Coloproctology.2025; 41(6): 537. CrossRef
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Life.2025; 15(11): 1777. CrossRef
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Yu-Tso Liao, Kai-Shing Chang, Bin-Chin Wu, Wan-Xin Cheng, Ho-Hsien Chuan, Kai-Wen Huang, Jin-Tung Liang
Scientific Reports.2025;[Epub] CrossRef
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Cureus.2024;[Epub] CrossRef
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Dheeraj Surya, Pankaj Gharde
Cureus.2024;[Epub] CrossRef
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Po-Lung Cheng, Chang-Cyuan Chen, Jian-Syun Chen, Po-Li Wei, Yan-Jiun Huang
Asian Journal of Surgery.2024; 47(11): 4681. CrossRef
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Lei Jin, Kaijian Qin, Renjie Wu, Haojie Yang, Can Cui, Zhenyi Wang, Jiong Wu
BMC Surgery.2024;[Epub] CrossRef
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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
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Cureus.2024;[Epub] CrossRef
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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
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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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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.

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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

Citations to this article as recorded by

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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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
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
Laser Hemorrhoidoplasty: Procedure, Outcomes and Future Directions
Michele di Schiano di Visconte
ANZ Journal of Surgery.2025; 95(11): 2301. CrossRef
Evaluating Laser Haemorrhoidoplasty as a Short-Term Approach to Advanced Haemorrhoidal Disease
Chin Kiat Tan, Shou Kee Ng, Arijit Mukherjee
Cureus.2025;[Epub] CrossRef
The Outcome of Laser Ablation Hemorrhoidoplasty versus Conventional Hemorrhoidectomy
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
Colorectal Disease.2024; 26(6): 1266. CrossRef
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
Outcomes of laser hemorrhoidoplasty for grade II–IV hemorrhoidal disease in Bangladesh
Md. Saiful Islam, Abhigan B. Shrestha, Faisal Chowdhury, Md. R.K. Ziko
Annals of Medicine & Surgery.2024; 86(11): 6514. CrossRef
Jackknife versus Lithotomy Position for Hemorrhoidectomy Surgery: A Randomized Controlled Trial
Sina Ghasemi, Behzad Imani, Alireza Jafarkhani, Ashkan Karimi, Ali Yamini
Scientific Journal of Kurdistan University of Medical Sciences.2024; 29(5): 76. CrossRef
The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: An observational cohort study
Nadim H. P. Boerhave, Rutger J. Klicks, Kemal Dogan
Colorectal Disease.2023; 25(6): 1202. CrossRef
Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II–III hemorrhoidal disease: a retrospective analysis
Haluk Tümer, Mevlüt Harun Ağca
ANZ Journal of Surgery.2023; 93(7-8): 1885. CrossRef
Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids
Ali Kemal Taşkin, Bülent Özçetin
Journal of Clinical Medicine of Kazakhstan.2023; 20(4): 33. CrossRef
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
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
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

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

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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

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
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
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
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

Citations to this article as recorded by

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

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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

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
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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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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Worldwide prevalence of haemorrhoids: a systematic review and meta-analysis
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
Stapler Hemorrhoidopexy—Tips and Tricks
Devender Singh, Niharika Grover, Yashwant Rathore, Piyush Ranjan, Sunil Chumber
Videoscopy.2025; 35(1): 1. 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
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
Frontiers in Surgery.2022;[Epub] CrossRef
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

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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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.

Citations

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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

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

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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.

Citations

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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
Applied Radiology.2025; 1(1): 1. CrossRef
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
Pathologie hémorroïdaire : étude épidémiologique et analyse des facteurs de risque de chirurgie
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
Journal de Chirurgie Viscérale.2024; 161(3): 177. CrossRef
Imaging for Hemorrhoidal Disease: Navigating Rectal Artery Embolization from Planning to Follow-up
Jonathan Lindquist, James Hart, Katherine Marchak, Eduardo Bent Robinson, Premal Trivedi
Seminars in Interventional Radiology.2024; 41(03): 263. CrossRef
Russian multicenter observational HDQ study on the validation of the questionnaire for hemorrhoidal disease
Yu. A. Shelygin, Yu. M. Stoyko, Ivan V. Kostarev, E. A. Zagriadskiǐ, A. M. Bogomazov, E. B. Golovko, Yu. V. Khomitskaya, B. B. Kvasnikov, O. Zh. Linnik
Koloproktologia.2024; 23(4): 101. CrossRef
Emborrhoid technique performed on a patient with portal hypertension and chronic hemorrhoidal bleeding as a salvage therapy
Filipa Alves e Sousa, Pedro Marinho Lopes, Inês Bolais Mónica, Ana Catarina Carvalho, Pedro Sousa
CVIR Endovascular.2022;[Epub] CrossRef
Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease
Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Vincent Vidal, Farouk Tradi
Seminars in Interventional Radiology.2022; 39(02): 194. CrossRef
Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques
Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Axel Bartoli, Vincent Vidal, Farouk Tradi
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Treatment of Hemorrhoid in Unusual Condition-Pregnancy
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Hemorrhoid embolization: A review of current evidences
Reza Talaie, Pooya Torkian, Arash Dooghaie Moghadam, Farouk Tradi, Vincent Vidal, Marc Sapoval, Jafar Golzarian
Diagnostic and Interventional Imaging.2021;[Epub] CrossRef

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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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

20,181 View
552 Download
15 Web of Science
17 Citations

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

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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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.

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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

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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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
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

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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23 Citations

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.

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Juan Li, Yongcheng Chen, Sen Liao, Dezheng Lin, MingliSu, Jiancong Hu, Qinghua Zhong, Jiaxin Deng, Jiawei Zhang, Xuefeng Guo
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Vasiliki Manaki, Vangelis Bontinis, Alkis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Angeliki Chorti, Kiriakos Ktenidis
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Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
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Xianglu Wang, Xia Wu, Quan Wen, Bota Cui, Faming Zhang
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Anling He, Mingkai Chen
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Hidenori Miyamoto
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A. Tsunoda, H. Kusanagi
Techniques in Coloproctology.2023; 27(12): 1335. CrossRef
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Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki
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Case Report

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.

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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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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.

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Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes
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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
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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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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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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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Surgical Innovation.2019; 26(3): 328. CrossRef
LASER hemorrhoidal dearterialization
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Hadi Skouri, Mohammed Shurrab, Jad Zahnan, Samer Deeba, Pierre Sfeir, Walid Gharzuddin, Saleem Haj-Yahia
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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
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International Journal of Surgery.2016; 28: 39. CrossRef
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Hellenic Journal of Surgery.2013; 85(4): 274. CrossRef
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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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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

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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.

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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.

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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.

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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

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.

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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

Analysis and Measures for Anal Stricture following a Hemorrhoidectomy.: Lim, Seok Won; J Korean Soc Coloproctol. 2006;22(5):293-297.

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Abstract PDF: PURPOSE
The most common cause of anal stricture following a hemorrhoidectomy is excision of too much hemorrhoidal tissue. However, the extent of excision of the hemorrhoid and other factors that can lead to an anal stricture are not yet well known. Thus, the author analyzed cases of anal stricture in order to find a method to prevent anal stricture.
METHODS
The author analyzed 14 patients who had anal stricture following a hemorrhoidectomy among 750 hemorrhoidectomy patients at Hang clinic from Jan. 2003 through Dec. 2003. The author analyzed the relation between the incidence of anal stricture and factors such as the number of hemorrhoids removed, the depth of the ligation, and the preoperative anal tension. The author also analyzed the treatment method for postoperative anal stricture.
RESULTS
1) The male-to-female ratio for these 14 cases was 3 : 11, and the most prevalent age group was the 4th decade, followed by the 5th decade. 2) The incidences of postoperative anal stricture for patients with one to six piles removed were 0%, 0.5%, 0.9%, 4.6%, 6.5%, and 14%, respectively. 3) In analysis of anal stricture according to the depth of ligation, the patient who had two removed hemorrhoids had two high ligations without low ligation (1 case). The patients who had three removed hemorrhoids had three high ligations without low ligation (2 cases). The patients who had four removed hemorrhoids had three high ligations with one low ligaton (3 cases) and four high ligations without low ligation (3 cases). The patients who had 5 removed hemorrhoids had three high ligations with two low ligations (2 cases) and four high ligations with one low ligation (1 case). The patients who had six removed hemorrhoids had three high ligations with three low ligations (2 cases). 4) There were 5 cases (7.6%) of anal stricture for high preoperative anal tension and 9 cases (1.3%) for low preoperative anal tension. 5) The treatment methods for postoperative anal stricture were bougination (10 cases), a sphincterotomy (2 cases), and a sliding skin graft (2 cases).
CONCLUSIONS
For the prevention of postoperative anal stricture, removal of three or fewer hemorrhoids seems ideal. Low ligation may be better than high ligation in preventing anal stricture, and the hemorrhoidectomy should be performed more cautiously in cases of high preoperative anal tension. In conclusion, the number, the width, and the length of the removed hemorrhoid, as well as the preoperative anal tension, should be considered to prevent postoperative anal stricture.

Changes of Symptoms and Manometric Results after Hemorrhoidectomy for Hemorrhoids with Difficulty in Evacuation.: Park, Hye Won , Bang, Seung Ho , Kim, Chang Nam , Kang, Yun Jung , Hwang, Sung Eun , Cho, Byung Sun , Lee, Min Ku , Choi, Yoo Shin , Park, Joo Seung , Kim, Jin Cheon; J Korean Soc Coloproctol. 2006;22(4):235-240.

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Abstract PDF: PURPOSE
We aimed to identify the need for an adjunctive internal sphincterotomy based on an evaluation of the changes in the symptoms and manometric results after a hemorrhoidectomy for hemorrhoids with difficulty in evacuation.
METHODS
Twenty-five (25) patients who had hemorrhoids with difficulty in evacuation and 13 patients who had hemorrhoids without difficulty in evacuation were prospectively evaluated. Patients were interviewed about symptoms and underwent anorectal manometry before and 2 months after surgery. Difficulty in evacuation is defined as the difficulty that a patient has when trying to evacuate the rectum.
RESULTS
There were significant differences in the sex ratio, the frequency of bowel movements, and the duration of bowel movements between the two groups (P<0.05). In cases with difficulty in evacuation, the frequency of bowel movements was significantly higher postoperatively and the duration of bowel movements was significantly shorter (P<0.05). The symptom of difficulty in evacuation disappeared in 21 of the as patients experiencing such a symptom, and was improved in the remaining of patients (P<0.05). Following the hemorrhoidectomy for the patients with difficulty in evacuation in the mean and the maximum resting pressure, and the maximum squeeze pressure decreased significantly (P<0.05).
CONCLUSIONS
An adjunctive internal sphincterotomy was not necessary for patients who had hemorrhoids with difficulty in evacuation because following the hemorrhoidectomy, the resting pressure was significantly decreased, and the difficulty in evacuation had nearly subsided.

Treatment of the Recurrent Hemorrhoids.: Kim, Yeon Dae , Lee, Dong Hee , Kim, Hee Cheol , Jeong, Choon Sik , Kim, Chang Nam , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 1998;14(3):503-508.

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Abstract PDF: The incidence of recurrence and anal stricture after surgical hemorrhoidectomy were reported in about 5% and 2.5~13%, respectively Generally, complete and adequate surgery for hemorrhoids was not infrequently neglected because the treatment of hemorrhoids was based on symptoms rather than pathogenesis. This study was performed to analyze the clinical features of recurrent hemorrhoids and to assess the adequate surgical management for the prevention of recurrence. From June 1989 to December 1997, we reviewed 222 (10.6%) recurrent hemorrhoids of surgically treated at Asan Medical Center. Median follow-up period was 38 months (range, 4 months~8 years 9 months). The most common symptom was prolapse (37%). Previous treatment for hemorrhoids was surgical hemouhoidectorny in 99 cases (45%) and sclerotherapy in 111 cases (50%). The most common location and associated complication of recurrent hemorrhoids were sites of major piles (83%) and anal stricture (37%), respectively. Anal stricture was more prevalent in patients with previous sclerotherapy (P<0.05). In respect to the numbers of combined surgical procedures, one procedure was more frequently performed in the non-complicated recurrent hemorrhoids group (P<0.05) whereas over four in the complicated group (P<0.05). Internal sphincterotomy and anoplasty were frequently needed in the complicated recurrent hemorrhoids (P<0.05). Mean hospital stay and healing time were 5 days (range, 2~26 days) and 21 days (range, 6~180 days), respectively. We had excellent or satisfactory results in 175 of 197 patients (89%). Conclusively, multiple combined surgical procedures in accordance with individual status might be useful in treating the recurrent hemorrhoids. An adequate and complete surgical procedure must be applied during the initial operation of hemorrhoids, especially on major piles.

Ferguson versus Stapled Hemorrhoidectomy.: Lee, Ho Won , Song, Seung Kyu , Suh, Kwang Wook; J Korean Soc Coloproctol. 2006;22(2):81-85.

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Abstract PDF: PURPOSE
The circular stapled hemorrhoidectomy is a newly introduced treatment modality for hemorrhoids. This study was aimed to prove the clinical efficacy of a stapled hemorrhoidectomy.
METHODS
This prospective study analyzed 100 patients who underwent a hemorrhoidectomy from Jan 2002 to June 2004 at Ajou University Hospital. Among them, 50 patents underwent a stapled hemorrhoidectomy and the remaining patients underwent Ferguson's closed hemorrhoidectomy. The surgical severity and the postoperative complications were analyzed based on the medical records.
RESULTS
Neither groups showed significant postoperative complications. In the stapled hemorrhoidectomy group, the hospital stay and the mean operation time were shorten during the postoperative period, and the analagesic requirement was lower (P<0.05).
CONCLUSIONS
The circular stapled hemorrhoidectomy is safe, less painful, and those related easy to perform. Also, the complications related to this procedure are similar to those related to a conventional hemorrhoidectomy. Considering the advantages, the circular stapled hemorrhoidectomy is an acceptable modalities for hemorrhoids requiring surgical treatment.

The Ultraslow Wave in Patients with Hemorrhoids and Chronic Anal Fissure.: Kim, Jin Cheon , Kim, Sook Yeong , Kim, Hee Cheol , Yu, Chang Sik , Park, Sang Kyu; J Korean Soc Coloproctol. 2001;17(5):227-231.

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Abstract PDF: PURPOSE
We assessed the nature of the ultraslow wave in patients with hemorrhoids and chronic anal fissure according to clinical findings and manometry in this study.
METHODS
Three hundred and thirty-three patients with hemorrhoids and 88 patients with chronic anal fissure were included. Anorectal manometry was performed according to a modified protocol based on the Coller's study. The ultraslow wave was determined as an undulating wave equal or less than two waves/min.
RESULTS
The ultraslow wave was found in 142 of the 333 patients (42.6%) with hemorrhoids and 44 of the 88 patients (50%) with chronic anal fissure. The pressure variables (maximal resting and squeeze pressure, rectal pressure at the beginning of rectoanal inhibitory reflex, rectal pressure on sense or fullness of balloon) were significantly higher in patients with ultraslow wave than in those without (P<0.001-0.05). The ultraslow wave frequency was inversely proportional to aging and to its amplitude (P=0.006 and <0.001, respectively). Maximal squeeze pressure was closely correlated with maximal resting pressure in a multiple regression analysis (P=0.002). The defecation difficulty and anorectal bleeding were more frequent in patients with ultraslow wave than those without in the hemorrhoids (P=0.008 and 0.021, respectively).
CONCLUSIONS
The ultraslow wave closely correlates with an anorectal pressure and frequently occurs in patients with hemorrhoids and chronic anal fissure. It appears to be associated with the internal anal sphincter as well as with the external anal sphincter and levator ani muscles.

A Clinical Study of Bipolar Diathermy (BICAP) in Hemorrhoids.: Choi, Dong Ha; J Korean Soc Coloproctol. 1998;14(1):91-100.

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Abstract PDF: Many nonsurgical techniques are currently employed for outpatient treatment of hemor rhoids. Sclerotherapy, rubber band ligation, cryotherapy, laser therapy, infrared photocoagula tion and direct current therapy have been utilized in the management of hemorrhoids in the outpatient setting, but bipolar diathermy(BICAP) has not been introduced in korea yet. This study is a clinical analysis of 472 patients of hemorrhoids treated with BICAP bipolar diathermy at outpatient department from July 1996 to June 1997. Among them, 396 patients had been followed up for 3 to 15 months. Male to female ratio was 2.2:1 and mean age of male and female was 42.8 and 39.7 years, respectively. Duration of symptoms in 216 patients(57.6%) was below 5 years. The most frequent degree of internal hemorrhoids was second degree(62.7%), followed by third degree(23.9%), first degree (7.8%) and fourth degree(5.5%). Major presenting symptoms were prolapse combined with bleeding(45.8%), prolapse(21.2%) and bleeding(19.7%). In 62.9% of patients 3 piles were treated. Associated anorectal diseases with hemorrhoids, such as skin tags, thrombi and anal polyps were present in 179 patients. Among them, 126 patients were operated as outpatient operation procedure with BICAP therapy. Previous medical managements of hemorrhoids, such as use of rectal suppositories(32%), injection of sclerosing agents(8.6%) and hemorrhoidectomy(7.8%) were done in 240 patients(51%). Number of treatments was one session(88.7%), two sessions(10%), three sessions(1.1%) and four sessions(0.2%) in order of frequency. Mild to moderate anal discomfort was experienced during BICAP therapy by 215 patients(46%), mild sensation of local heat by 95 patients(20%) and mild bleeding by 10 patients(2%). No postdiathermy discomfort was observed in 337 patients(85.1%). However, postdiathermy bleeding and pain were present in 41 patients (10.4%) and 18 patients(4.5%), respectively. Results of followed up patients for 3 to 15 months were asymptomatic in 270 patients(68.2%), improved in 88 patients (22.2%), and no changed in 38 patients(9.6%). Among 18 patients with fourth degree hemorrhoids, only 2 patients(11%) became asymptomatic, 5 patients(28%) improved and 11 patients(61.9%) were not changed in their symptoms. Six patients experienced recurrent hemorrhoids requiring hemorrhoidectomy. In conclusion, bipolar diathermy(BICAP) for hemorrhoids is safe, easy to apply, painless, needs no anesthesia and bowel preparation with short time and repeated treatments and can be applied to first, second, third and some patients of fourth degree hemorrhoids. The effect of treatment was satisfactory in about 90%. Side effects were minimal compared to other nonoperative treatments. Therefore, the auther believes that bipolar diathermy(BICAP) is a desirable nonoperative treatment for internal hemorrhoids.

Secondary Hemorrhage after Hemorrhoidectomy.: Kye, Kishik; J Korean Soc Coloproctol. 1997;13(3):461-466.

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Abstract PDF: Delayed, or secondary hemorrhage after hemorrhoidectomy is a troublesome complication and it occurs in 0.2 to 4% of the hemorrhoidectomies. The nature of the bleeding is a diarrhea consisted of blood clots and dark blood. It usually occurs at the patients home between 7 to 14 days after the operation. Emergency treatment may include bed rest, suture ligation, and various forms of tamponade. At the Seoul Surgical Clinic in Wonju, 7 patients(11%) were seen with the complication of secondary hemorrhage among 642 hemorhoidectomies. The prevalent interval from the operation to hemorrhage was 10-13 days. Treatment modalities included Foley catheter tamponade in one patient, and observation and bed rest alone in 6 patients.

Randomized Controlled Trial

Comparative Analysis of Open Versus Semi-Closed Hemorrhoidectomy for 200.: Son, Woo Young , Sim, Myung Suk , Kang, Jin Kook; J Korean Soc Coloproctol. 1997;13(3):451-460.

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Abstract PDF: Conventional hemorrhoidectomy is still the main stairway to the treatment of the third or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy, open hemonhoidectomy is claimed to decrease postoperative pain and wound infection, but to have disadvantage of long period of wound healing. Semi-closed hemorrhoidectomy has the advantage of rapid wound healing without increased risk of wound infection, but more painful postoperative course than open hemorrhoidectomy is suggested. To assess this conventional concept, two hundreds of patients were randomly allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the average time for disappearance of wound edema was 4.9days, average time for disappearance of wound pain was 9.0days, average time for painless defecation was 14.1 days, average time for complete wound healing was 28.4days. The main complications were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires curettage, the skin tags were resected under local anesthesia. Anal discharge and pruritus were spontaneously disappeared after the healing of the wound. In group B, the average time for disappearance of wound edema was 6.1 days, average time for disappearance of wound pain was 6.3days, average time for painless defecation was 9.2days, average time for complete wound healing was 20.7days. The main complications were skin tags, more prevalent than group 4, requiring resection under local anesthesia. No infectious complications were noted in both groups. Consequently, the old concept that open hemorrhoidectomy has advantage of less painful postoperative course than semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers more rapid loss of pain and more rapid healing of the wound than open hemorrhoidectomy, without increased risk of infectious complications. In conclusion, semi-closed hemorrhoidectomy is superior method to open hemorrhoidectomy in third or fourth degree hemorrhoids.

Original Article

Complication of the Hemorrhoid Treatment by Sclerotherapy.: Lee, Dong Shik , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 1997;13(3):443-450.

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Abstract PDF: The technique of the sclerotherapy for hemorrhoid treatment was introduced in the late 19th century. The sclerotherapy is a simple method with lesser pain or complication, in case of being operated with an exact indication. But the fact is that this sclerotherapy is used imprudently and secretly by quack, owing to misunderstanding of its simplicity. This thesis is a clinical analysis of 575 patients who were diagnosed hemorrhoids, anal stenosis, anal incontinence and admitted from Jan. 1994 to Dec. 1995. 99 patients(17.1%) of them were taken sclerotherapy Previously The Peak incidence was in the 4th decade of male(41.8%) and the 5th decade of female(40.6%). From five to ten years of the time lapse between onset of symptoms and admission was 27.3% and it appeared most frequently. It seems that the incompleteness of the first treatment cased the extension of illness period to the patients. The most frequent complaint was prolapse(72.7%). The 3rd and 4th degree of hemorrhoid were 58.5%. Combined diseases were anal stenosis(22.2%), fissure and skin tag(16.1%), and rectocele(11.1%). Owing to incompleteness of the sclerotherapy, the degree and symptoms of hemorrhoids were more severe than the general hemorrhoids and combined diseases also were more complicated. So conservative treatment and non-surgical treatment were impossible, and Left lateral internal sphinterotomy, rectopexcy, anoplasty, fistulotomy, sphinteroplasty, colostomy with hemorrhoidectomy performed. but the treatment itself was more complex and difficult. In conclusion, it is thought that the national and positive medical education about hemorrhoids and the controls about the abnormal treatment are needed.

Randomized Controlled Trial

The Effects of Pudendal Block in Voiding Complication after Anal Surgery.: Kim, Jae Hwang , Jang, Seon Mo , Shim, Min Chul , Jee, Dae lim; J Korean Soc Coloproctol. 2000;16(6):365-370.

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Abstract PDF: Urinary retention in common benign anal surgery is a burden to ambulatory surgery. PURPOSE: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery.
METHODS
We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1: 20,000 epinephrine or SA with 0.5% bupivacaine (n=83).
RESULTS
There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001) CONCLUSIONS: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

Original Article

New Technique for Treatment of Hemorrhoids by Using Bipolar.: Yoo, Jung Joon , Lee, Chul Ho , Lee, Kwang Real , Park, Se Young , Lim, Seok Won; J Korean Soc Coloproctol. 1997;13(2):229-238.

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Abstract PDF: Hemorrhoids are the most common problem in anorectal disease, presenting bleeding and prolapse. The definitive treatmant for severe hemorrhoids is surgery, but for milder cases, it is difficult to recommend a hemonhoidectomy. Some patients, especially relatively young and active males, don't want to be admitted, and they ask for ambulatory surgery. For that reason, we have developed a modified bipolar probe which can be simply and conveniently applied and which produces as good a result as that produced by a radical hemouhoidectomy. We restrospectively analyzed the cases of 341 patients who had received a BHC(bipolar homo-coagulation) between July 1994 and December 1995 and who had been followed up for at least six months. The results are as follows: 1) 309 cases(90.6%) were Grade II, and 32 cases(9.4%) were Grade III hemorrhoids. The chief complaint was bleeding in 179 cases(52.5%) and prolapse in 148 cases(43.4%). 2) Evaluation of the BHC procedure was based on patient satisfaction. About threefourths of the patients were very satisfied, and 59 patients(17.3%) were somewhat satisfied. Grade III patients were relatively more satisfied than others, regardless of the number of piles managed by BHC, and patients whose symptom was bleeding were significantly more satisfied, in general, than those with prolapse. Only 26 patients(7.6%) were dissatisfied. 3) No postoperative discomfort was observed in 153 cases(44.9%). However, post-operalive pain and bleeding were present in 92 and 50 cases, respectively. 4) Complications were observed in a total of 26 cases(7.6%). Skin tags were the most frequently observed complication(13 cases), followed by secondary bleeding which was managed by sutures(6 cases). 5) Three patients experienced recurrent hemorrhoids. Two were treated by using a radical hemorrhoidectomy, and one by using a second BHC. Based on these five results, we consider BHC to be a very useful technique for treating Grade II and early Grade III hemorrhoids by outpatient surgery and to be a time-saving procedure for treating accessory piles after main pile extirpation. Furthermore, early detection of hemorrhoids along with their early management by BHC will reduce the need for more radical surgery at some later time.

Clinical Trial

Circular Stapled Hemorrhoidectomies in the Treatment of Hemorrhoids.: Kim, Jin Sub; J Korean Soc Coloproctol. 2004;20(4):240-248.

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Abstract PDF: The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.

Original Article

Laser Surgery To The Circumferential Hemorrhoids.: Kim, Kwang Chul , Lee, Hruck Sang; J Korean Soc Coloproctol. 1997;13(1):121-130.

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Abstract PDF: BACKGROUND
This study was undertaken to evaluate the treatment of circumferential hemorrhoids using the CO2 laser.
METHOD
Five hundred seventy-two consecutive patients with circumferential hemorrhoids(411 males, 161 females) had hemorrhoidectomy performed with CO2 laser under caudal or epidural anesthesia during the 2 year-period between July 1994 and June 1996. The follow-up period was a minimum of 3 months after hemorrhoidectomy. The standard Milligan-Morgan open technique was used for most full three-quadrant hemorrhoidectomies. For the excision of necessary piles, "core-ablation" technique was employed.
RESULTS
The postoperative pain lasted for an average of 2.10 days. Comlications of hemorrhoidectomy included Postoperative skin tags, bleeding, wound infection, delayed wound healing, urinary retention and anal fistula in only a few of the cases, none of which caused any long-term problems.
CONCLUSIONS
These results indicate that CO2 laser hemorrhoidectomy is feasible and safe provided it is used with care, and that it seems to cause no significant alteration in anorectal physiology.

Case Report

A Clinical Analysis of 429 Cases of Hemorrhoids.: Jang, Tong Seog , Kim, Jae Jun; J Korean Soc Coloproctol. 1997;13(1):111-120.

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Abstract PDF: The clinical analysis was made on 429 patients with hemorrhoids who have been dmitted and operated at the department of Surgery, Soonchunhyang University Hospital,from January, 1986 to December, 1995 and the statistical interpretation was made to get the interval changes between the 1st half of period (1986-1990) and the 2nd half of period (1991-1995). The results were as follows: 1) The average distribution rate of hemorrhoids among benign anal diseases including hemorrhoids, fistula in auto, fissure in auto, and perianal abscess in the past one decade was 44.9% and the rate of the 2nd half(49.2%) was higher than one of the 1st half(41.2%). 2) The sex ratio of male to female was 1.65: 1 and the peak incidence was at 30s in age. In the 2nd half period the number of female patients and patients in 20s & 30s of age decreased but the number of patients in 40s of age increased. 3) 27 Patients had one hemorrhoidectomy and 3 Patients, two hemorrhoidectomies before. The average interval inbetween two different hemorrhoidecomies was 11 years involving 8.5 years of the 1st half and 13.2 years of the 2nd half. 4) The frequent symptoms were mass(34.6%), pain(26.1%), and bleeding(25.1%) but there was no interval change between the 1st half and the 2nd half. 5) The patient was first seen between 1 and 5 years after symptom development with 30.1% in frequency and the patients in the 2nd half came to hospital sooner. 6) The ratio of internal, mixed, and external type was 60.9.34:5.1 and there was no interval change. 7) The predominant location of hemorrhoids were right posterior(38.5%), left lateral(33.6%), right anterior(29.8%) and left posterior(23.8%) and there was no interval change. 8) The third grade of hemorrhoids was most frequent(52.4%) with no interval change. 9) The most of patients were operated by semi-open hemorrhoidectomy with mainly modified Nesselrod method and the number of open hemorrhoidectomies in the 1st half was larger than in the 2nd half. The most common associated anal surgery with hectorrhoidectomy was lateral internal partial sphincterotomy. 10) The associated anal diseases with hemorrhoids were skin tag(11.6%), anal fistula(6.1%), anal fissure(5.4%), and anal polyp(5.1%) in the order of frequency. There was no interval change. 11) The most common method of anesthesia for hemorrhoidectomy was the caudal anewthesia(79.2%) but hemorrhoidectomy incidence under the local anesthesia was only 0.5%. There was no interval change. 12) The common post-hemorrhoidectomy complications were urinary retention(7.7%), edema(7.5%), and bleeding(2.6%) in the order of frequency with no interval change. 13) The duration of hospitalization was between 4 to 7 days(42%) and the mean time was 8.78 days. The number of patients of the 2nd half was smaller than the number of patients of the 1st half in 7 days of admission.

Original Articles

Whitehead's Operation: Should We Abandon It?.: Kim, Hong , Jeong, Inho , Suh, Kwang Wook; J Korean Soc Coloproctol. 2004;20(2):75-79.

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Abstract PDF: PURPOSE
Total prolapse of internal hemorrhoids around the entire anal circumference still remains as a challenging problem. Whitehead's circumferential hemorrhoidectomy is one of the surgical options. To elucidate efficacy of Whiteheads operation, we analyzed the surgical outcomes of Whiteheads operation.
METHODS
The medical records of 165 consecutive patients who underwent Whiteheads operation for end-stage hemorrhoids were retrospectively reviewed. The mean operation time, the mean blood loss, and the mean hospital stay were examined. Also the types of complications were identified. All patients were followed for extended periods and in May 2003 they were asked to appraise their satisfaction (mean follow-up duration was 45.5 months, 12~93 month range).
RESULTS
The mean operation time was 21.5+/-5.3 minutes, the mean blood loss was 50.5+/-22.0 cc, and the average hospital stay was 5.5+/-1.5 days. Early postoperative complications were fecal incontinence (60.6%) and voiding difficulty (53.3%). These problems were spontaneously resolved within 2 weeks. Pain was the most difficult problem, and all patients required a parenteral opioid for relief of pain. The only late complication was anal stenosis. Objectively, anal stenosis was found in 66 patients; however, 22 patients (13.3%) complained of defecation difficulty. Among them, only 4 patients required surgical treatment. The average score of satisfaction according to the patients themselves was 4.0+/-2.2, 0 being no satisfaction and 5 being complete satisfaction.
CONCLUSIONS
The Whitehead operation, if performed properly for the selected patients, still remains as one of the best surgical options for end-stage hemorrhoids.

Clinical Effectiveness of a Circular Stapled Hemorrhoidectomy.: Yun, Seong Hyeon , Min, Byung Soh , Kang, Jung Gu; J Korean Soc Coloproctol. 2004;20(1):32-38.

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Abstract PDF: PURPOSE
The circular stapled hemorrhoidectomy established by A. Longo involves reducing the mucous membrane prolapse and blocking the end branches of the upper hemorrhoidal artery through transverse incision of a suitable section of the mucosa between the rectum and the anal canal. This study was undertaken to determine the efficacy and the safety of a circular stapled hemorrhoidectomy by comparing it with a conventional Milligan-Morgan hemorrhoidectomy.
METHODS
One hundred thirty (130) patients with prolapsed hemorrhoids underwent surgical treatment with either a conventional (n=66)(conventional group) or a circular stapled (n=64) (stapled group) hemorrhoidectomy. The operation time was recorded, and the resected specimen was examined. The patients assessed their postoperative pain. Time to first bowel movement, hospital stay, and postoperative complications were analyzed. All patients received follow-up examinations at the out-patient clinic, and the time to return to work and the degree of their satisfaction were checked.
RESULTS
The stapled group had a shorter average operation time (19.2 min. vs 26.1 min., P=0.016). The postoperative pain score in the stapled group was significantly lower than it was in the conventional group (P<0.05). Time to first bowel movement and hospital stay were not significantly different between the groups. Return to work was significantly faster in the stapled group (6.5 days vs 15.8 days, P<0.05). The degrees of satisfaction for the two groups were similar, and postoperative complications in the two groups were both similar and acceptable (6.1% vs 11.0%, P>0.05).
CONCLUSIONS
A circular stapled hemorrhoidectomy offers a significantly less painful alternative to the conventional technique and is associated with an earlier return to normal activity. However, the long-term outcome needs to be evaluated further.

Is a Hemorrhoidectomy Safe in Patients Requiring Anticoagulation?.: Cho, Jai Young , Lim, Suk Byung , Lee, Min Ro , Park, Kyu Joo; J Korean Soc Coloproctol. 2003;19(6):360-366.

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Abstract PDF: PURPOSE
The aim of this study was to determine the risks of a hemorrhoidectomy in patients requiring long-term anticoagulation.
METHODS
Between March 1998 and February 2001, 13 patients requiring long-term oral anticoagulation because of prosthetic valve replacement (n=4), atrial fibrillation (n=7), and coronary artery disease (n=2) underwent a hemorrhoidectomy at Seoul National University Hospital. We performed a retrospective analysis on these patients regarding the results of the hemorrhoidectomy. The control group consisted of 148 patients without any medical problems who had undergone a hemorrhoidectomy during the same period. Patients on anticoagulation stopped their oral medication three days before the operation and full intravenous (IV) heparinization was commenced. Heparin was stopped six hours before the operation and restarted postoperatively, and warfarin was re-started on the evening of postoperative day 1. The hemorrhoidectomy consisted of excising three main piles, followed by submucosal excision of all intervening piles. Student's t-test and Fisher's exact test were used for statistical analysis.
RESULTS
The PTs (prothrombin times) of the anticoagulation group and the control group obtained at admission were INRs (international normalized ratios) of 1.75+/-0.54 and 1.04 0.08, respectively (P=0.0005). After discontinuation of oral medication and full IV heparinization, the INR of the anticoagulation group at the time of operation was 1.06+/-0.09, which was not statistically different from the PT (INR) of the control group at admission (P=0.603). There were two cases of postoperative bleeding requiring blood transfusions in the anticoagulation group (15.4%), and four cases of postoperative bleeding requiring blood transfusions in the control group (2.7%), but there was no statistical difference between the rates for the two groups (P=0.075). The mean postoperative hospital stays were 6.69+/-3.68 and 3.64+/-2.98 for the anticoagulation and control groups, respectively (P=0.074). Postoperative analgesic requirements and urinary difficulty were similar in both groups (P=0.478 and 0.397, respectively). No systemic thromboembolism in both groups, and there was no bacterial endocarditis or valvular thrombosis was seen in patients with prosthetic heart valves.
CONCLUSIONS
Our results indicate that patients taking oral warfarin for anticoagulation may safely undergo a hemorrhoidectomy after strict heparinization.

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