Annals of Coloproctology

Original Articles

Anorectal physiology & pelvic floor disorder

Efficacy and safety of anal encirclement combining the Leeds-Keio artificial ligament with injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of rectal prolapse: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2023;39(3):210-215. Published online November 12, 2021; DOI: https://doi.org/10.3393/ac.2021.00731.0104

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Purpose
Perineal procedures are an important surgical option for frail and high-risk patients with rectal prolapse. This study aimed to evaluate the efficacy and safety of combined therapy using injection sclerotherapy, with aluminum potassium sulfate and tannic acid (ALTA), and the Thiersch procedure, using the Leeds-Keio ligament (ALTA-Thiersch).
Methods
This study included 106 consecutive patients (mean age, 81.2 years) who underwent ALTA-Thiersch for rectal prolapse. The procedure was performed under caudal epidural anesthesia. ALTA was injected into the submucosa from the tip of the prolapsed rectum down to the dentate line, circumferentially, at 20 to 40 locations. The ligament tape was placed outside the external sphincter muscle and at an approximate depth of 2 cm into the middle anal canal.
Results
Of 106 patients, rectal prolapse was cured shortly after surgery in 105 patients. An additional tape was inserted in 1 patient who had persistent prolapse. Postoperative complications were observed in 27 patients (25.5%). Fecal impaction occurred in 12 patients; however, since it was temporary, no tape removal was required. Of the 12 cases in which the tape was infected or exposed, 11 required tape removal. There were 18 cases of recurrence at a mean follow-up of 22.1 months. Cumulative recurrence rates at 3 and 5 years were 21.3% and 38.6%, respectively.
Conclusion
ALTA-Thiersch is a simple and safe procedure for rectal prolapse, having reasonable outcomes. The use of the Leeds-Keio ligament for anal encircling can help compensate for the disadvantages of the Thiersch operation.

Citations

Citations to this article as recorded by

Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. 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
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Benign proctology,Surgical technique

Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2022;38(6):403-408. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00248.0035

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Graphical Abstract Abstract PDF

Purpose
Perianal injection of bulking agents is an attractive treatment option for patients with mild to moderate fecal incontinence (FI). Various bulking agents have been used for injection therapy, but the optimal injection materials and methods are yet to be standardized. This study aimed to evaluate the effects of injection therapy using aluminum potassium sulfate and tannic acid (ALTA) in the management of FI.
Methods
This study included consecutive patients who underwent ALTA injection therapy for FI at our institution. The procedure was performed with the patient in the jackknife position, under caudal epidural anesthesia. The procedure consisted of a 4-step injection to the 3 main cushions and a multipoint injection to the remaining submucosa of the anal canal.
Results
Seventy-seven patients (mean age, 76 years) were enrolled in the study. The mean Cleveland Clinic incontinence score of 11.9 ± 4.1 at baseline significantly improved to 7.3 ± 5.2 at 3 months following treatment. The mean maximal resting pressure also increased significantly 3 months after the intervention. Postoperative complications were observed in 3 patients (3.9%), and all events were mild. The mean duration of postoperative follow-up was 17.5 months. The cumulative recurrence-free rate at 3 years was 72.4%.
Conclusion
ALTA injection for FI is safe, easy to perform, and provides reasonable mid-term outcomes. Moreover, concomitant anorectal diseases that may be contraindicated by other injectable bulking agents could be treated simultaneously. Therefore, ALTA injection is a promising alternative in the absence of other injectable agents.

Citations

Citations to this article as recorded by

Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. 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
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. 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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57 Download
22 Web of Science
22 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.

Citations

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Rubber band ligation or shaobei injection for the endoscopic treatment of symptomatic hemorrhoids? A retrospective study
Juan Li, Yongcheng Chen, Sen Liao, Dezheng Lin, MingliSu, Jiancong Hu, Qinghua Zhong, Jiaxin Deng, Jiawei Zhang, Xuefeng Guo
Surgical Endoscopy.2025; 39(3): 1555. CrossRef
Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis
G. Gallo, A. Picciariello, C. Armellin, E. Lori, G. Tomasicchio, G. L. Di Tanna, G. A. Santoro, M. Alharbi, S. Sorrenti, U. Grossi
Techniques in Coloproctology.2024;[Epub] CrossRef
Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis
Vasiliki Manaki, Vangelis Bontinis, Alkis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Angeliki Chorti, Kiriakos Ktenidis
Acta Chirurgica Belgica.2024; 124(4): 253. 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
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
Shifting Paradigms in Hemorrhoid Management: The Emergence and Impact of Cap-Assisted Endoscopic Sclerotherapy
Xianglu Wang, Xia Wu, Quan Wen, Bota Cui, Faming Zhang
Journal of Clinical Medicine.2024; 13(23): 7284. CrossRef
Sclerotherapy in Hemorrhoids
Anling He, Mingkai Chen
Indian Journal of Surgery.2023; 85(2): 228. CrossRef
Minimally Invasive Treatment for Advanced Hemorrhoids
Hidenori Miyamoto
Journal of the Anus, Rectum and Colon.2023; 7(1): 8. CrossRef
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
Long-term Outcomes of Aluminum Potassium Sulfate and Tannic Acid Sclerotherapy for Prolapsed Hemorrhoids: A Single-Center, Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki
Diseases of the Colon & Rectum.2022; 65(2): 271. CrossRef
The comeback of hemorrhoidal sclerotherapy?
V. de Parades, M. Aubert, N. Fathallah, A. A. Alam, L. Spindler, P. Benfredj
Techniques in Coloproctology.2022; 26(8): 599. CrossRef
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
Annals of Coloproctology.2022; 38(4): 290. CrossRef
A Stepwise Proposal for Low-Grade Hemorrhoidal Disease: Injection Sclerotherapy as a First-Line Treatment and Rubber Band Ligation for Persistent Relapses
Roberta Tutino, Marco Massani, Leonel Jospin Kamdem Mambou, Paolina Venturelli, Immacolata Della Valle, Giuseppina Melfa, Matilde Micheli, Gaia Russo, Gregorio Scerrino, Sebastiano Bonventre, Gianfranco Cocorullo
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Short-Term Results of Sclerotherapy with 3% Polidocanol Foam for Symptomatic Second- and Third-Degree Hemorrhoidal Disease
Pierluigi Lobascio, Rita Laforgia, Eugenio Novelli, Fabrizio Perrone, Maria Di Salvo, Angela Pezzolla, Mario Trompetto, Gaetano Gallo
Journal of Investigative Surgery.2021; 34(10): 1059. CrossRef
Medical uses for phenol in the urinary tract: A possible forgotten treatment (Review)
Takuya Sadahira, Yuki Maruyama, Toyohiko Watanabe, Takanori Sekito, Yosuke Mitsui, Koichiro Wada, Motoo Araki, Masami Watanabe
Medicine International.2021;[Epub] CrossRef
Finding possible pharmacological effects of identified organic compounds in medicinal waters (BTEX and phenolic compounds)
István Szabó, Csaba Varga
International Journal of Biometeorology.2020; 64(6): 989. CrossRef
Hämorrhoidenoperation
T. Laubert, V. Kahlke
coloproctology.2020; 42(1): 30. CrossRef
Le traitement instrumental : « Qu’en reste-t-il aujourd’hui ? »
L. Spindler, E. Pommaret, V. de Parades
Côlon & Rectum.2020; 14(1): 15. CrossRef
Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids
Yuichi Tomiki, Jun Aoki, Shunsuke Motegi, Rina Takahashi, Toshiaki Hagiwara, Yu Okazawa, Kosuke Mizukoshi, Masaya Kawai, Shinya Munakata, Shun Ishiyama, Kiichi Sugimoto, Kazuhiro Sakamoto
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids
Bradley R. Davis, Steven A. Lee-Kong, John Migaly, Daniel L. Feingold, Scott R. Steele
Diseases of the Colon & Rectum.2018; 61(3): 284. CrossRef
Alles beim Alten in der Hämorrhoidalchirurgie?
M. H. Roblick, S. Farke
coloproctology.2018; 40(4): 271. CrossRef
Aluminum Potassium Sulfate and Tannic Acid - A New Option for the Treatment of Grade 3 Hemorrhoids
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Comparison of Early Clinical Outcomes Between ALTA (Aluminum Potassium Sulfate and Tannic Acid, Ziohn(R)) Injection Therapy and a Submucosal Hemorrhoidectomy in Patients with Internal Hemorrhoids.: Lee, Young Chan , Shin, Hyun Keun , Lim, Cheong Ho , Yang, Hyung Kyu , Kang, Jung Hyun , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2010;26(3):179-185.; DOI: https://doi.org/10.3393/jksc.2010.26.3.179

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Abstract PDF

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

Citations

Citations to this article as recorded by

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

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.

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