Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Met...Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications:Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol,which is more effective than the liquid one.Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation(the historical counterpart of sclero-therapy)in a technique called“sclerobanding”.In this article,we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids,and present results compared with endoscopic rubber band ligation.The results achieved are promising.展开更多
BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods hav...BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods have been shown in numerous studies However,only a few studies have compared the effectiveness of combined methods.AIM To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation(DG-HAL)+Ferguson hemorrhoidectomy(FH)technique from the FH in the treatment of hemorrhoidal disease.METHODS In this retrospective cohort,data from a total of 45 patients who underwent DG-HAL+FH(n=24)and FH(n=21)for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.Demographic and clinical data,surgical duration,intraoperative blood loss,hospital stay,postoperative analgesic consumption,pain scores using the Visual Analog Scale(VAS),complications,time to return to normal activities,and the recurrence rate were compared in both groups.RESULTS The study included 45 patients,with 75.6%(n=34)male and 24.4%(n=11)female.The rate of intraoperative blood loss was higher in the FH group(P<0.05).The VAS scores and postoperative complication rates were similar in both groups.The need for postoperative analgesics was lower in the DG-HAL+FH group(2 vs 4 days,P<0.05),while the FH group showed a shorter time to return to normal activities(9.5 vs 6.0 days,P=0.02).The recurrence rate(16.7%vs 0%)and Clavien–Dindo Score-1 complications(20.8%vs 9.5%,P=0.29)were higher in the DG-HAL+FH group but were insignificant.CONCLUSION Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.展开更多
Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional e...Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy,they are often associated with substantial postoperative pain and prolonged recovery.This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty(LHP)versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids.A comprehensive analysis of comparative studies,randomized controlled trials,and meta-analyses published between 2020 and 2025 was conducted,with primary outcomes including postoperative pain,recovery time,operative duration,complication rates,and recurrence.Key findings from studies by Maloku et al and Hassan et al.were analyzed to contextualize real-world LHP use.Across multiple high-quality studies,LHP was consistently associated with significantly lower postoperative pain scores,reduced analgesic requirements,and faster return to daily activities.Maloku et al demonstrated a shorter mean operative time(15.9 minutes)and reduced pain compared to open techniques(26.8 minutes;P<0.01).Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia.Operative time was generally comparable or shorter,and vessel ligation was suggested as an adjunct to improve outcomes in select cases.Complication rates were low and similar between groups,with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence.However,recurrence rates were higher with LHP in some studies,particularly in grade III disease.LHP offers a minimally invasive,low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients.Despite superior short-term recovery profiles,potential for higher recurrence underscores the importance of patient selection and long-term follow-up.The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.展开更多
Objective:To evaluate the clinical effect of combined therapy with Diosmin Tablets and Mayinglong Musk Hemorrhoids Ointment for patients with acute hemorrhoids.Methods:A total of 50 patients with acute hemorrhoids who...Objective:To evaluate the clinical effect of combined therapy with Diosmin Tablets and Mayinglong Musk Hemorrhoids Ointment for patients with acute hemorrhoids.Methods:A total of 50 patients with acute hemorrhoids who visited the hospital from January 2023 to January 2025 were selected as samples and randomly divided into two groups.Group A was treated with Diosmin Tablets combined with Mayinglong Musk Hemorrhoids Ointment,while Group B was treated with Mayinglong Musk Hemorrhoids Ointment only.The efficacy,wound recovery time,perianal pain score,hemorrhoid symptom score,and stress indicators were compared between the two groups.Results:The efficacy of Group A was higher than that of Group B(P<0.05).The postoperative perianal edema time and wound healing time in Group A were shorter than those in Group B,and the Visual Analog Scale(VAS)score was lower than that in Group B(P<0.05).The hemorrhoid symptom score in Group A was lower than that in Group B(P<0.05).The stress level in Group A was lower than that in Group B(P<0.05).Conclusion:The combination therapy of Diosmin Tablets and Mayinglong Musk Hemorrhoids Ointment for postoperative treatment of acute hemorrhoids can effectively relieve perianal pain,shorten the duration of hemorrhoids,and is highly feasible.展开更多
BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different tre...BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.展开更多
Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively i...Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.展开更多
BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prola...BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prolapse and hemorrhoids,and tissue selecting technique,are employed for treatment,they are often associated with postoperative complications,including unsatisfactory defecation,bleeding,and anal stenosis.In contrast,Xiaozhiling injection,a traditional Chinese medicine-based therapy,has emerged as a minimally invasive and effective alternative for internal hemorrhoids.This treatment offers distinct advantages,such as reduced dietary restrictions,broad applicability,and minimal induction of systemic inflammatory responses.Additionally,Xiaozhiling injection effectively eliminates hemorrhoid nuclei,prevents local tissue necrosis,preserves anal cushion integrity,and mitigates postoperative complications,including bleeding and prolapse.Despite its clinical efficacy,the molecular mechanisms underlying its therapeutic effects remain poorly understood,warranting further investigation.AIM To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids.METHODS An internal hemorrhoid model was established in rats,and the rats were randomly divided into a modeling group[control group(CK group)]and a treatment group.One week after injection,Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts.RESULTS Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1,decorin,and actin alpha 2 in fibroblasts between the CK group and the treatment group.Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1(Sphk1)/sphingosine-1-phosphate(S1P)pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway,namely,Sphk1,S1P receptor,and transforming growth factor beta 1,in the treatment group.The proportion of fibroblasts was lower in the treatment group than in the CK group,and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue.Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker.Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen,indicating cell activation.Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site,suggesting that after Xiaozhiling intervention,the Sphk1-S1P pathway could be activated to promote fibrosis.CONCLUSION Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen synthesis and secretion in fibroblasts.After Xiaozhiling intervention,the Sphk1-S1P pathway can be activated to promote fibrosis.展开更多
OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randoml...OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randomly assigned to the following four groups:control,model,AAFL,and positive groups.Following hemorrhoid induction,hemorrhoidal tissues were collected from the rats for analysis.Pathological alterations in these tissues were examined via hematoxylin-eosin staining.Immunohistochemistry was used to detect inflammatory markers.The ultrastructural pathological changes in these tissues were observed by transmission electron microscopy.Reverse transcription-polymerase chain reaction and Western blotting were used to analyze the gene and protein expression of nuclear factor kappa-B(NF-κB)p65,inhibitor of kappa-B(IκB),inhibitor of NF-κB kinase(IκK-β),interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).RESULTS:Compared with the control group,the rats in each treatment group showed general improvements in hemorrhoidal tissue pathology.The AAFL group showed increased IκB expression and decreased IL-1β,IL-6,TNF-α,NF-κB,p65,and IκK-βexpressions.CONCLUSION:AAFL can decrease the production of inflammatory markers by targeting the NF-κB pathway,resulting in improved pathological conditions in mixed hemorrhoids.Our findings will aid in the treatment of mixed hemorrhoids.展开更多
BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in ...BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.展开更多
BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and...BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the...BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.展开更多
Hemorrhoids are a common and painful condition,with conventional treatments such as endoscopic rubber band ligation(ERBL)and injection sclerotherapy often falling short due to high recurrence rates and significant pos...Hemorrhoids are a common and painful condition,with conventional treatments such as endoscopic rubber band ligation(ERBL)and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain.A clinical trial by Qu et al introduces a novel approach called endoscopic polidocanol foam sclerobanding(EFSB).This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL.The study's strengths include its robust design,comprehensive outcome evaluation,and patient-centered approach.Despite limitations such as the single-blind design and relatively short follow-up period,the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option.Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.展开更多
BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-...BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.展开更多
In the study,we comment on the article by Qu et al.Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding,prolapse,and difficulty in defecation.Endoscopic rubber band ligation(ERBL)is a s...In the study,we comment on the article by Qu et al.Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding,prolapse,and difficulty in defecation.Endoscopic rubber band ligation(ERBL)is a safe,convenient,quick,and economical outpatient procedure.The main goal of ERBL is to alleviate prolapse,but the high incidence of recurrence and post-procedural pain are of clinical concern.Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding.Endoscopic polidocanol foam sclerobanding(EFSB)is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h postprocedural pain.The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up.Results showed that EFSB is a novel therapy for internal hemorrhoids,but future studies with a larger sample,multiple treatment sessions,and long-term follow-up are required to confirm these findings.展开更多
We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade Ⅱ-Ⅲ internal hemorrhoids.The auth...We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade Ⅱ-Ⅲ internal hemorrhoids.The authors conducted a prospective,multicenter,randomized study to evaluate the long-term sympto-matic and endoscopic efficacy of this combined intervention.In this discussion,we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.展开更多
This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but i...This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications.In this article,the most appropriate candidate patients,embolization materials,embolization methods,and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.展开更多
Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the under...Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the underlying mechanism and treatment options vary.Hence,the correct identification is of utmost important.Through this letter,we highlight the features of both and listed the distinguishing points between the two etiologies.展开更多
This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemor...This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.展开更多
Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to...Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to analyze the epidemiological, clinical, therapeutic and evolving aspects of hemorrhoidal disease at the stage of surgical treatment at the University Hospital Center of Brazzaville. Patients and Methods: We conducted a retrospective and descriptive study carried out from January 2020 to December 2021, a 24 months period, in the Digestive surgery department of the University Hospital Center of Brazzaville. It concerned patients who underwent a surgical procedure for hemorrhoidal disease. Results: 21 cases were collected, representing a hospital frequency of 2.3%, with a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9 years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding. We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%) of hemorrhoidal prolapse including 12 cases requiring manual integration (Goligher grade III) and four irreducible permanent cases (Goligher grade IV). The Grade III prolapse was associated with a polyp in one patient and with posterior anal fissure in another patient. Out of the 21 patients, 14 underwent a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients underwent mono- and bipedicular hemorrhoidectomy with resection of associated lesions and five patients underwent emergency thrombectomy. The outcome was favorable for all our patients. The average length of hospital stay was 1.5 ± 2.1 days. Conclusion: In the event of failure of medical and instrumental treatment, the hemorrhoidal cure according to Milligan and Morgan is the surgical treatment of reference for hemorrhoidal disease at the University Hospital Center of Brazzaville.展开更多
文摘Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications:Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol,which is more effective than the liquid one.Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation(the historical counterpart of sclero-therapy)in a technique called“sclerobanding”.In this article,we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids,and present results compared with endoscopic rubber band ligation.The results achieved are promising.
文摘BACKGROUND In hemorrhoidal disease,despite the existence of numerous treatment options to alleviate symptoms,surgical intervention continues to be the gold standard.The advantages and disadvantages of many methods have been shown in numerous studies However,only a few studies have compared the effectiveness of combined methods.AIM To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation(DG-HAL)+Ferguson hemorrhoidectomy(FH)technique from the FH in the treatment of hemorrhoidal disease.METHODS In this retrospective cohort,data from a total of 45 patients who underwent DG-HAL+FH(n=24)and FH(n=21)for grade III hemorrhoidal disease between 2020 and 2022 were analyzed.Demographic and clinical data,surgical duration,intraoperative blood loss,hospital stay,postoperative analgesic consumption,pain scores using the Visual Analog Scale(VAS),complications,time to return to normal activities,and the recurrence rate were compared in both groups.RESULTS The study included 45 patients,with 75.6%(n=34)male and 24.4%(n=11)female.The rate of intraoperative blood loss was higher in the FH group(P<0.05).The VAS scores and postoperative complication rates were similar in both groups.The need for postoperative analgesics was lower in the DG-HAL+FH group(2 vs 4 days,P<0.05),while the FH group showed a shorter time to return to normal activities(9.5 vs 6.0 days,P=0.02).The recurrence rate(16.7%vs 0%)and Clavien–Dindo Score-1 complications(20.8%vs 9.5%,P=0.29)were higher in the DG-HAL+FH group but were insignificant.CONCLUSION Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
文摘Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy,they are often associated with substantial postoperative pain and prolonged recovery.This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty(LHP)versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids.A comprehensive analysis of comparative studies,randomized controlled trials,and meta-analyses published between 2020 and 2025 was conducted,with primary outcomes including postoperative pain,recovery time,operative duration,complication rates,and recurrence.Key findings from studies by Maloku et al and Hassan et al.were analyzed to contextualize real-world LHP use.Across multiple high-quality studies,LHP was consistently associated with significantly lower postoperative pain scores,reduced analgesic requirements,and faster return to daily activities.Maloku et al demonstrated a shorter mean operative time(15.9 minutes)and reduced pain compared to open techniques(26.8 minutes;P<0.01).Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia.Operative time was generally comparable or shorter,and vessel ligation was suggested as an adjunct to improve outcomes in select cases.Complication rates were low and similar between groups,with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence.However,recurrence rates were higher with LHP in some studies,particularly in grade III disease.LHP offers a minimally invasive,low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients.Despite superior short-term recovery profiles,potential for higher recurrence underscores the importance of patient selection and long-term follow-up.The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.
文摘Objective:To evaluate the clinical effect of combined therapy with Diosmin Tablets and Mayinglong Musk Hemorrhoids Ointment for patients with acute hemorrhoids.Methods:A total of 50 patients with acute hemorrhoids who visited the hospital from January 2023 to January 2025 were selected as samples and randomly divided into two groups.Group A was treated with Diosmin Tablets combined with Mayinglong Musk Hemorrhoids Ointment,while Group B was treated with Mayinglong Musk Hemorrhoids Ointment only.The efficacy,wound recovery time,perianal pain score,hemorrhoid symptom score,and stress indicators were compared between the two groups.Results:The efficacy of Group A was higher than that of Group B(P<0.05).The postoperative perianal edema time and wound healing time in Group A were shorter than those in Group B,and the Visual Analog Scale(VAS)score was lower than that in Group B(P<0.05).The hemorrhoid symptom score in Group A was lower than that in Group B(P<0.05).The stress level in Group A was lower than that in Group B(P<0.05).Conclusion:The combination therapy of Diosmin Tablets and Mayinglong Musk Hemorrhoids Ointment for postoperative treatment of acute hemorrhoids can effectively relieve perianal pain,shorten the duration of hemorrhoids,and is highly feasible.
文摘BACKGROUND A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options.AIM To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation(RPH).METHODS A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group(n=50)and the treatment group(n=50)by rolling the dice.The procedure for prolapse and hemorrhoids(PPH)was adopted in the control group,while polidocanol foam injection+RPH was adopted in the treatment group.The therapeutic effects,operation time,wound healing time,hospital stay,pain situation(24 hours post-operative pain score,first defecation pain score),quality of life(QOL),incidence of complications(post-operative hemorrhage,edema,infection),incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared.RESULTS Compared with the control group,the total effective rate of treatment group was higher,and the difference was significant(P<0.05).The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group(P<0.05).The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group(P<0.05).After surgery,the QOL scores of the two groups decreased,with the treatment group having higher scores than that of the control group(P<0.05).Compared with the control group,the incidence of postoperative complications in the treatment group was lower,and the difference was significant(P<0.05);However,there was no significant difference in the incidence of postoperative bleeding between the two groups(P>0.05);There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups(P>0.05).CONCLUSION For patients with mixed hemorrhoids,the therapeutic effect achieved by using polidocanol injection combined with RPH was better.The wounds of the patients healed faster,the postoperative pain was milder,QOL improved,and the incidence of complications was lower,and the short-term and long-term prognosis was good.
文摘Hemorrhoids are one of the most common anorectal disorders.Early hemorrhoids are treated conservatively,but advanced hemorrhoids are usually treated with surgery.However,in the last decade,we have worked extensively in the field of conservative management of hemorrhoids.From our experience,we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept(TONEFACT)with a high satisfaction rate.Evidence for the TONEFACT approach primarily comes from observational studies and a prospective,nonrandomized study of 85 patients.This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids,leading to fewer surgical interventions.Although promising,these observations lack validation from more extensive randomized controlled trials to draw firm conclusions.In this opinion review,without using much data,we will discuss our viewpoint based on our experience as specified by the journal guidelines.
基金Supported by the National Natural Science Foundation of China,No.81774118the Foreign Cooperation Project of Science and Technology Department of Fujian Province,No.2023I0021the Medical Innovation Project of Fujian Province,No.2024CXB013.
文摘BACKGROUND Hemorrhoids,a prevalent chronic condition globally,significantly impact patients'quality of life.While various surgical interventions,such as external stripping and internal ligation,procedure for prolapse and hemorrhoids,and tissue selecting technique,are employed for treatment,they are often associated with postoperative complications,including unsatisfactory defecation,bleeding,and anal stenosis.In contrast,Xiaozhiling injection,a traditional Chinese medicine-based therapy,has emerged as a minimally invasive and effective alternative for internal hemorrhoids.This treatment offers distinct advantages,such as reduced dietary restrictions,broad applicability,and minimal induction of systemic inflammatory responses.Additionally,Xiaozhiling injection effectively eliminates hemorrhoid nuclei,prevents local tissue necrosis,preserves anal cushion integrity,and mitigates postoperative complications,including bleeding and prolapse.Despite its clinical efficacy,the molecular mechanisms underlying its therapeutic effects remain poorly understood,warranting further investigation.AIM To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids.METHODS An internal hemorrhoid model was established in rats,and the rats were randomly divided into a modeling group[control group(CK group)]and a treatment group.One week after injection,Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts.RESULTS Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1,decorin,and actin alpha 2 in fibroblasts between the CK group and the treatment group.Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1(Sphk1)/sphingosine-1-phosphate(S1P)pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway,namely,Sphk1,S1P receptor,and transforming growth factor beta 1,in the treatment group.The proportion of fibroblasts was lower in the treatment group than in the CK group,and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue.Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker.Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen,indicating cell activation.Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site,suggesting that after Xiaozhiling intervention,the Sphk1-S1P pathway could be activated to promote fibrosis.CONCLUSION Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen synthesis and secretion in fibroblasts.After Xiaozhiling intervention,the Sphk1-S1P pathway can be activated to promote fibrosis.
基金Supported by the Science and Technology Innovation Project of the Chinese Academy of Traditional Chinese Medicine:Mechanism of An's Anorectal Fumigation Lotion in the Treatment of Inflammatory Mixed hemorrhoids based on Nuclear Factor Kappa-B Pathway(No.CI2021A02104)。
文摘OBJECTIVE:To investigate the mechanism by which An's anorectal fumigation lotion(AAFL)treats inflammatory mixed hemorrhoids.METHODS:Eighty Sprague-Dawley rats,with an equal number of males and females,were randomly assigned to the following four groups:control,model,AAFL,and positive groups.Following hemorrhoid induction,hemorrhoidal tissues were collected from the rats for analysis.Pathological alterations in these tissues were examined via hematoxylin-eosin staining.Immunohistochemistry was used to detect inflammatory markers.The ultrastructural pathological changes in these tissues were observed by transmission electron microscopy.Reverse transcription-polymerase chain reaction and Western blotting were used to analyze the gene and protein expression of nuclear factor kappa-B(NF-κB)p65,inhibitor of kappa-B(IκB),inhibitor of NF-κB kinase(IκK-β),interleukin-1 beta(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α).RESULTS:Compared with the control group,the rats in each treatment group showed general improvements in hemorrhoidal tissue pathology.The AAFL group showed increased IκB expression and decreased IL-1β,IL-6,TNF-α,NF-κB,p65,and IκK-βexpressions.CONCLUSION:AAFL can decrease the production of inflammatory markers by targeting the NF-κB pathway,resulting in improved pathological conditions in mixed hemorrhoids.Our findings will aid in the treatment of mixed hemorrhoids.
文摘BACKGROUND Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery.They are venous clusters formed by con-gestion,expansion,and flexion of the venous plexus in the lower part of the rec-tum.Mixed hemorrhoids bleed easily and recurrently,and this can result in severe anemia.Hence,they may have a negative effect on the health of the patient and surgical treatment is required.Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids.How-ever,most patients experience different degrees of postoperative pain that may cause anxiety.with mixed hemorrhoids post-surgery.METHODS The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively.The basic character-istics of the enrolled patients with mixed hemorrhoids were recorded,and based on the Goligher clinical grading system,the hemorrhoids were classified as grades III or IV.The endpoint of this study was the disappearance of pain in all patients.Quantitative data were presented as mean±SD,such as age,pain score,and QoL score.Student’s t-test was used to compare the groups.RESULTS A total of 164 patients were enrolled.The distribution of the visual analog scale pain scores of all patients at 3,7,14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time.Fourteen days after the operation,the pain had completely disappeared in some patients.Twenty-eight days after the surgery,none of the patients experienced any pain.Comparing the World Health Or-ganization Quality of Life-BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery,we observed that the quality-of-life scores of the patients post-surgery had significantly improved.There were six items that were compared at 14-and 28-d post-surgery.The mean QoL score 28 d after surgery(4.79±0.46)was higher than that at 14 d post-surgery(3.79±0.57).The mean health condition score 28 d after surgery(4.80±0.41)was also higher than that at 14 d post-surgery(4.01±0.62).The mean physical health score 28 d after surgery(32.10±2.96)was significantly higher than that at 14 d post-surgery(23.41±2.85).The mean psychological health score 28 d after surgery(27.22±1.62)was significantly higher than that at 14 d post-surgery(21.37±1.70).The mean social relations score 28 d after surgery(12.21±1.59)was significantly higher than that at 14 d post-surgery(6.32±1.66).The mean surrounding environment score 28 d after surgery(37.13±2.88)was significantly higher than that at 14 d post-surgery(28.42±2.86).The differences in quality-of-life scores at day 14 and day 28 post-surgery were ob-served to be statistically significant(P<0.001).CONCLUSION Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients.Age,sex,and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.
基金This study is registered at clinicaltrials.gov.The registration identification number is NCT05627999.
文摘BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
文摘Hemorrhoids are a common and painful condition,with conventional treatments such as endoscopic rubber band ligation(ERBL)and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain.A clinical trial by Qu et al introduces a novel approach called endoscopic polidocanol foam sclerobanding(EFSB).This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL.The study's strengths include its robust design,comprehensive outcome evaluation,and patient-centered approach.Despite limitations such as the single-blind design and relatively short follow-up period,the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option.Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.
基金Supported by the Hospital Funded Clinical Research of Xinhua Hospital,No.19XHCR16D.
文摘BACKGROUND Endoscopic rubber band ligation(ERBL)is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain.AIM To evaluate satisfaction,long-term recurrence,and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL.METHODS This was a prospective,multicenter,randomized study.A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding(EFSB)or an ERBL group.All patients were followed-up for 12 months.Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score(HSS)and a visual analog scale(VAS).Continuous variables were reported as medians and interquartile range.RESULTS One hundred and ninety-five patients were enrolled,with 98 in the EFSB group.HSS was lower in the EFSB group than in the ERBL group at 8 weeks[4.0(3.0-5.0)vs 5.0(4.0-6.0),P=0.003]and 12-month[2.0(1.0-3.0)vs 3.0(2.0-3.0),P<0.001]of follow-up.The prolapse recurrence rate was lower in the EFSB group at 12 months(11.2%vs 21.6%,P=0.038).Multiple linear regression analysis demonstrated that EFSB treatment[B=-0.915,95%confidence interval(CI):−1.301 to−0.530,P=0.001]and rubber band number(B=0.843,95%CI:0.595-1.092,P<0.001)were negatively and independently associated with the VAS score 24 hours post-procedure.The median VAS was lower in the EFSB group than in the ERBL[2.0(1.0-3.0)vs 3.0(2.0-4.0),P<0.001].CONCLUSION Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.
文摘In the study,we comment on the article by Qu et al.Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding,prolapse,and difficulty in defecation.Endoscopic rubber band ligation(ERBL)is a safe,convenient,quick,and economical outpatient procedure.The main goal of ERBL is to alleviate prolapse,but the high incidence of recurrence and post-procedural pain are of clinical concern.Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding.Endoscopic polidocanol foam sclerobanding(EFSB)is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h postprocedural pain.The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up.Results showed that EFSB is a novel therapy for internal hemorrhoids,but future studies with a larger sample,multiple treatment sessions,and long-term follow-up are required to confirm these findings.
文摘We have read the article by Qu et al with great interest,as it presents an inte-gration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade Ⅱ-Ⅲ internal hemorrhoids.The authors conducted a prospective,multicenter,randomized study to evaluate the long-term sympto-matic and endoscopic efficacy of this combined intervention.In this discussion,we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.
基金National Natural Science Foundation of China(General Program),No.82070540The Taishan Scholars Program of Shandong Province,No.tsqn202211309Program of Medical and Health Research Guidance in Qingdao City,No.2022-WJZD108.
文摘This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology.Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment,but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications.In this article,the most appropriate candidate patients,embolization materials,embolization methods,and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.
文摘Rectal varices are an uncommon manifestation of portal hypertension.Although hemorrhoids can be seen in cirrhotic patients,distinguishing between rectal varices and hemorrhoids can be challenging.Furthermore,the underlying mechanism and treatment options vary.Hence,the correct identification is of utmost important.Through this letter,we highlight the features of both and listed the distinguishing points between the two etiologies.
文摘This work was a retrospective prospective study carried out in the general surgery department of the Cs ref of commune I from January 2009 to December 2012. Our study aimed to determine the hospital frequency of hemorrhoidal disease, to identify the contributing factors, describe the clinical and therapeutic aspects and analyze the surgical consequences. We collected 73 patients with an average age of 37.8 years (range: 19 years and 77 years) with a sex ratio of 2.5 in favor of men. We operated on 49 patients or 67.1% of cases. 71.2% of our patients were married and lived in Bamako. Schoolchildren and middle managers made up 39.8% of cases. 82.2% of patients were seen in ordinary consultation and 69.9% complained of progressive anal pain in 66.7% of cases. This pain was triggered by defecation in 88.2% of our patients. The contributing factors were dominated by constipation (53.4%), working in a seated position (41.1%) and a sedentary lifestyle (16.4%) of cases. Stage IV external hemorrhoids and hemorrhoidal thrombosis represented 53.8% of surgical indications. The most used surgical technique was that of Milligan-Morgan, i.e. 51.9% of cases and 45.2% of patients treated medically received a combination of transit regulator, venotonics and analgesics. The surgical aftermath was marked by hemorrhage (3 cases), delayed healing (5 cases), urinary retention (1 case) and scarring anal stenosis (1 case). The morbidity rate was 5.48% of cases and a zero mortality rate. The average length of hospitalization was 2 days with extremes of 1 and 5 days.
文摘Introduction: Hemorrhoidal disease is a common pathology and its surgical treatment is based, among other things, on pedicular resection after failure of medical and instrumental treatment. The aim of this study is to analyze the epidemiological, clinical, therapeutic and evolving aspects of hemorrhoidal disease at the stage of surgical treatment at the University Hospital Center of Brazzaville. Patients and Methods: We conducted a retrospective and descriptive study carried out from January 2020 to December 2021, a 24 months period, in the Digestive surgery department of the University Hospital Center of Brazzaville. It concerned patients who underwent a surgical procedure for hemorrhoidal disease. Results: 21 cases were collected, representing a hospital frequency of 2.3%, with a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9 years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding. We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%) of hemorrhoidal prolapse including 12 cases requiring manual integration (Goligher grade III) and four irreducible permanent cases (Goligher grade IV). The Grade III prolapse was associated with a polyp in one patient and with posterior anal fissure in another patient. Out of the 21 patients, 14 underwent a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients underwent mono- and bipedicular hemorrhoidectomy with resection of associated lesions and five patients underwent emergency thrombectomy. The outcome was favorable for all our patients. The average length of hospital stay was 1.5 ± 2.1 days. Conclusion: In the event of failure of medical and instrumental treatment, the hemorrhoidal cure according to Milligan and Morgan is the surgical treatment of reference for hemorrhoidal disease at the University Hospital Center of Brazzaville.
