|
1
|
Lehmann JP, Johansson HÖ, Graf W. Long-term functional results after excisional haemorrhoidectomy. Colorectal Dis 2020; 22:824-830. [PMID: 31912937 DOI: 10.1111/codi.14954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022]
Abstract
AIM The aim of this work was to perform a long-term evaluation of a randomized trial focusing on functional aspects after excisional haemorrhoidectomy with a minimum follow-up of 9 years. METHOD A questionnaire-based study including patients operated on for haemorrhoids in Sweden between 1999 and 2003. A total of 225 patients were randomized to Milligan's or Ferguson's operation. Twenty-six patients had died and 151 (76%) participated after a median follow-up of 10.7 years (range 9.2-12.6 years). RESULTS Seventy-seven patients were in the Milligan group and 74 in the Ferguson group. Forty-eight (32%) reported recurrence. Anal bleeding was reported in 80% at baseline but in 28% at long-term follow-up (P < 0.0001). At baseline, 49% had spontaneous anal pain and 25% pain at defaecation. At follow-up, these figures were 17% and 11%. At follow-up, 19% described a sense of anal stenosis. At baseline, soiling was reported in 51% but in 20% at long-term follow-up (P < 0.001). Nineteen per cent used pads preoperatively and 6% at follow-up (P < 0.0001). Straining at defaecation was reported by 35% at baseline. At follow-up, this figure was 25% (P = 0.055). CONCLUSION Symptoms associated with haemorrhoids were reduced at long-term follow-up. The most common problems were perceived recurrence and a sense of anal stenosis.
Collapse
Affiliation(s)
- J-P Lehmann
- Department of Surgery, Östersunds Hospital, Östersund, Sweden
| | | | - W Graf
- Department of Surgical Sciences, Akademiska Sjukhuset Uppsala, Uppsala University, Uppsala, Sweden
| |
Collapse
|
|
2
|
|
|
3
|
Bashir Y, McGovern B, Tahtouh M, Abbasi T, Murphy M, Neary P. Coloproctology procedure clinic: a novel service developed to reduce suffering of patients with bleeding per rectum. Ir J Med Sci 2018; 188:119-124. [PMID: 29569071 DOI: 10.1007/s11845-018-1796-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 03/14/2018] [Indexed: 01/14/2023]
Abstract
AIMS Evaluation of the role and impact of introducing a dedicated coloproctology procedure clinic in tertiary referral colorectal unit. METHODS A retrospective analysis of 126 consecutive patients managed in the coloproctology clinic between March2015 and September 2016 was carried out. All patients were preselected for attendance based on symptom-based protocol. RESULTS Based on the information available in GP referrals, 126 patients with bleeding per rectum with low risk of cancer were re-triaged from the general outpatient to dedicated coloproctology procedure clinic. Those patients accounted for 14% of waiting list. The average waiting time to attend clinic was 27 months from referral to undergoing definitive procedure. A proctoscopy or/and rigid sigmoidoscopy was performed in patients. Seventy-nine (89.7%) patients were completely managed and discharged after attending their first visit. Sixty-seven (76%) patients had 2nd- or 3rd-degree haemorrhoids and were treated with rubber band ligation (RBL) or phenol injection in outpatient setting. Two patients had an anal fissure and were managed conservatively with medication. After clinic, follow-up was through telephone clinic. This avoids attendance physically in the hospital. Symptoms persisted in nine patients and were subsequently scheduled for colonoscopy, three had benign polyps. With the introduction of the procedure clinic, the waiting time from referral to treatment was reduced from 27 to 6 months (p < 0.05). CONCLUSIONS Establishing a dedicated "Coloproctology procedure clinic" is an effective strategy in reducing number of hospital visits per patient and hospital waiting list. This innovative clinic reduces utilisation of precious endoscopy unit resources. This ultimately will improve endoscopy efficiency.
Collapse
Affiliation(s)
- Yasir Bashir
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland. .,Professorial Surgical Unit, Department of Surgery, The University of Dublin Trinity College, Tallaght Hospital, Dublin, Ireland.
| | - Bernadette McGovern
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Mohammed Tahtouh
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Tahir Abbasi
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Maria Murphy
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| | - Paul Neary
- Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
| |
Collapse
|
|
4
|
Titov AI, Abritsova MV, Mudrov AA. [Comparison of Doppler-assisted dearterialization with mucopexy and hemorrhoidectomy]. Khirurgiia (Mosk) 2016:24-32. [PMID: 26977864 DOI: 10.17116/hirurgia2016224-28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM To compare two methods of hemorrhoid treatment. MATERIAL AND METHODS This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE). RESULTS Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days. CONCLUSION DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.
Collapse
Affiliation(s)
- A Iu Titov
- A.N. Ryzhykh State Research Center of Coloproctology, Health Ministry of the Russian Federation, Moscow
| | - M V Abritsova
- A.N. Ryzhykh State Research Center of Coloproctology, Health Ministry of the Russian Federation, Moscow
| | - A A Mudrov
- A.N. Ryzhykh State Research Center of Coloproctology, Health Ministry of the Russian Federation, Moscow
| |
Collapse
|
|
5
|
Sajid MS, Bhatti MI, Caswell J, Sains P, Baig MK. Local anaesthetic infiltration for the rubber band ligation of early symptomatic haemorrhoids: a systematic review and meta-analysis. Updates Surg 2015; 67:3-9. [PMID: 25724281 DOI: 10.1007/s13304-015-0286-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/17/2015] [Indexed: 12/12/2022]
Abstract
The objective of this article is to systematically analyse the randomized, controlled trials evaluating the effectiveness of local anaesthetic infiltration prior to the rubber band ligation of early symptomatic haemorrhoids. Published randomized, controlled trials comparing the use of local anaesthetic (LA) versus no-local anaesthetic (NLA) for the rubber band ligation of early symptomatic haemorrhoids were analysed using RevMan®, and the combined outcomes were expressed as odds ratios (OR) and standardized mean difference (SMD). Four randomized, controlled trials evaluating 387 patients were retrieved from the standard electronic databases. The risk of treatment failure (OR 0.44; 95% CI 0.07, 2.79; z = 0.87; p = 0.39) and post-procedure complications (OR 0.48; 95% CI 0.08, 2.76; z = 0.83; p = 0.41) was similar between two techniques. However, the post-procedure pain score (SMD -5.19; 95% CI -9.08, -1.30; z = 2.62; p < 0.009) was significantly lower in the group of patients undergoing rubber band ligation of haemorrhoids under local anaesthetic injection. The use of LA appears to have clinically measurable advantages over NLA in the rubber band ligation of early symptomatic haemorrhoids to lessen post-procedure pain.
Collapse
Affiliation(s)
- M S Sajid
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK,
| | | | | | | | | |
Collapse
|
|
6
|
Tsang YP, Fok KLB, Cheung YSH, Li KWM, Tang CN. Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review. Tech Coloproctol 2014; 18:1017-22. [PMID: 24906978 DOI: 10.1007/s10151-014-1170-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 05/10/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to evaluate and compare transanal haemorrhoidal dearterialisation (THD) and stapled haemorrhoidopexy [also called procedure for prolapsed haemorrhoids (PPH)] in the management of haemorrhoidal disease, in terms of short-term outcomes and efficacy. METHODS Patients presenting with symptomatic haemorrhoids were treated with THD. Patient demographics, pre-operative data, post-operative pain scores, complications, recurrence, and patient satisfaction scores were evaluated and recorded. Patients with acute thrombosed haemorrhoids, external haemorrhoids only, or other concomitant anal diseases were excluded. These data were compared with the historical data of PPH. RESULTS Forty consecutive patients underwent THD from February 2012 to July 2013 and were compared to 37 patients who underwent PPH taken from a medical records database. There were no significant differences in terms of demographic data, type of anaesthesia, operative time, and blood loss. Length of hospital stay, time to first post-operative bowel movement, and complications were similar between the two groups. The median pain score after THD and PPH was 1.71 and 5.00, respectively, on a scale of 0-10 (10 = worst possible pain) (p = 0.000). There was a significant improvement in bleeding and prolapse scores after THD. THD patients had an earlier return to normal daily activities (3.13 vs. 6.78 days, p = 0.001) when compared with the PPH group. Upon follow-up, patients in both groups had similar satisfaction scores, and complication and recurrence rates. CONCLUSIONS Both THD and PPH appear to be safe procedures for haemorrhoidal disease, and they appear to have similar short-term outcomes. In particular, THD seems to be associated with a lower pain score than PPH, an earlier return to normal daily activities, and similar rates of complication and recurrence.
Collapse
Affiliation(s)
- Y P Tsang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hongkong, SAR, China,
| | | | | | | | | |
Collapse
|
|
7
|
Treatment of the hemorrhoids and anal mucosal prolapse using elastic band ligature--early and long term results. POLISH JOURNAL OF SURGERY 2012; 83:654-61. [PMID: 22343202 DOI: 10.2478/v10035-011-0105-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED THE AIM OF THE STUDY was to evaluate the results of the treatment of internal hemorrhoids and anal mucosal prolapse using elastic band ligation and to compare this method to chosen surgical procedures. MATERIAL AND METHODS The study included 648 patients (363 males and 285 females). 474 patients were treated using an elastic band ligature and 174 patients underwent surgical hemorrhoidectomy. The average age of the patients in both groups was similar--49 years. The treatment tolerance was evaluated in the prospective study group. The intensity and duration of pain was assessed on the first and second postoperative day using a Verbal Rating Scale. RESULTS 86.5% of the patients were cured using Barron's procedure, success rate for second-degree hemorrhoids was 89% and for third degree--85.2%. Surgical hemorrhoidectomy was effective in 92% of patients. Early failure of elastic ligature was noted in 2.5% of patients. The recurrences of hemorrhoidal symptoms were observed in 11% of Barron's group and in 8% after hemorrhoidectomy. The intensity of pain was much higher among patients after surgical hemorrhoidectomy. The average of the pain score in the 4th hour was 0.3 for the elastic band ligation and 1.4 for the surgical treatment. In the 24th hour--0.2 and 1.7 respectively. Mean postoperative stay was 3.8 days. CONCLUSIONS Rubber band ligation is highly effective and well tolerated. Relatively minor pain following this procedure is found in only 9.5% of patients. The disadvantages of surgical hemorrhoidectomy are: important postoperative pain and long time of wound healing that impair the recovery to professional activity.
Collapse
|
|
8
|
Sajid MS, McFall MR, Sains P, Whitehouse PA, Baig MK. Trans anal haemorrhoidal de-arterialisation versus stapled haemorrhoidopexy for the management of haemorrhoidal disease. Hippokratia 2012. [DOI: 10.1002/14651858.cd009614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Muhammad S Sajid
- Department of Colorectal Surgery; Worthing Hospital; Worthing UK
| | - Malcolm R McFall
- Department of Colorectal Surgery; Worthing Hospital; Worthing UK
| | - Parv Sains
- Department of Colorectal Surgery; Worthing Hospital; Worthing UK
| | | | - Mirza K Baig
- Department of Colorectal Surgery; Worthing Hospital; Worthing UK
| |
Collapse
|
|
9
|
A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Tech Coloproctol 2011; 16:1-8. [PMID: 22183450 DOI: 10.1007/s10151-011-0796-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 11/23/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to systematically analyse the clinical trials on the effectiveness of transanal haemorrhoidal de-arterialisation (THD) and stapled haemorrhoidopexy (SH) in the management of haemorrhoidal disease (HD). METHODS Clinical trials on the effectiveness of THD and SH in the management of HD were analysed systematically using RevMan(®), and combined outcomes were expressed as risk ratio (RR) and mean difference (MD). RESULTS Three randomised, controlled trials encompassing 150 patients were analysed systematically. There were 80 THD patients and 70 SH patients. There was no significant heterogeneity (P = 0.40) among included trials. Therefore, in the fixed effects model, THD and SH were statistically equivalent in terms of treatment success rate (P = 0.19), operation time (P = 0.55), postoperative complications (P = 0.11) and recurrence (P = 0.46) of HD. THD was associated with significantly less postoperative pain (MD, -2.00; 95% CI, -2.06, -1.94; z = 63.59; P < 0.00001) compared to SH. CONCLUSIONS Both THD and SH are equally effective and can be attempted for the management of HD. However, THD is associated with significantly lesser postoperative pain and therefore may be considered a preferred procedure. This conclusion is based only on treating 150 patients by THD or SH in three moderate-quality randomised trials. A major, multicenter, randomised trial is required to validate this conclusion and investigate other variables like hospital stay, cost-effectiveness and health-related quality of life measurement.
Collapse
|
|
10
|
Abstract
Hemorrhoids are normal vascular structures underlying the distal rectal mucosa and anoderm. Symptomatic hemorrhoidal tissues located above the dentate line are referred to as internal hemorrhoids and produce bleeding and prolapse. Thrombosis in external hemorrhoids results in painful swelling. Symptomatic internal hemorrhoids that fail bowel management programs may be amenable to in-office treatment with rubber band ligation or infrared coagulation. Internal hemorrhoids that fail to respond to these measures or complex internal and external hemorrhoidal disease may require a surgical hemorrhoidectomy, either open or closed. A stapled hemorrhoidopexy treats symptomatic internal hemorrhoids and should be employed with care and only after thorough training of the surgeon because of the risk of rare, severe complications. The choice of procedure should be based on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon.
Collapse
Affiliation(s)
- Amy Halverson
- Division of Surgical Oncology, Northwestern Medical Faculty Foundation, Chicago, Illinois 60611, USA.
| |
Collapse
|
|
11
|
Nakeeb AME, Fikry AA, Omar WH, Fouda EM, Metwally TAE, Ghazy HE, Badr SA, Elkhar MYA, Elawady SM, Elmoniam HHA, Khafagy WW, Morshed MM, Lithy REE, Farid ME. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol 2008; 14:6525-30. [PMID: 19030206 PMCID: PMC2773340 DOI: 10.3748/wjg.14.6525] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method.
METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years).
RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometric changes after band ligation.
CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn’t alter ano-rectal functions.
Collapse
|
|
12
|
Cazemier M, Felt-Bersma RJF, Cuesta MA, Mulder CJJ. Elastic band ligation of hemorrhoids: Flexible gastroscope or rigid proctoscope? World J Gastroenterol 2007; 13:585-7. [PMID: 17278225 PMCID: PMC4065981 DOI: 10.3748/wjg.v13.i4.585] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare rigid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids.
METHODS: Patients between 18 and 80 years old, with chronic complaints (blood loss, pain, itching or prolapse) of internal hemorrhoids of grade I-III, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope (preloaded with 7 bands). Patients were re-treated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed.
RESULTS: Forty-one patients were included (median age 52.0, range 27-79 years, 20 men). Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade I hemorrhoids, 9 patients had grade II hemorrhoids and 3 patients had grade III hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group (P < 0.05). Pain after ligation tended to be more frequent in patients treated with the flexible endoscope (first treatment: 3 vs 10 patients, P < 0.05). Three-dimensional endosonography showed no sphincter defects or alterations in submucosal thickness.
CONCLUSION: Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive.
Collapse
Affiliation(s)
- M Cazemier
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.
| | | | | | | |
Collapse
|
|
13
|
Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology 2004; 126:1463-73. [PMID: 15131807 DOI: 10.1053/j.gastro.2004.03.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
|
14
|
Kanellos I, Goulimaris I, Christoforidis E, Kelpis T, Betsis D. A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial. Colorectal Dis 2003; 5:133-8. [PMID: 12780901 DOI: 10.1046/j.1463-1318.2003.00395.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately for the treatment of 2nd degree haemorrhoids. PATIENTS AND METHODS Between 1993 and 1996, 255 patients that suffered from 2nd degree haemorrhoids were divided into 3 groups of 85 patients, each to receive either simultaneous sclerotherapy for smaller and rubber band ligation for larger piles (SCL/RBL) in one session, or sclerotherapy (SCL), or rubber band ligation (RBL), respectively. After a period of 4 years all patients were examined and their symptoms were recorded. RESULTS The patients of the SCL group developed significantly fewer complications after treatment compared to the other two methods (P < 0.001), which did not differ from each other. After the SCL/RBL treatment, significantly more patients were symptom free (46%) than after SCL (8%), P < 0.001. There was no significant difference between the SCL/RBL (46%) and the RBL (31%) groups (P = 0.217), although the combined treatment seemed to be more effective than rubber band ligation. Only 10% of the patients of the SCL/RBL group needed additional sessions 6-24 months after the initial treatment compared to 30% of the patients of the SCL group (P = 0.001). However, there was no significant difference between SCL/RBL and RBL (17%) groups (P = 0.151). CONCLUSION The combination of sclerotherapy and rubber band ligation for treatment of 2nd degree haemorrhoids is significantly more efficient than sclerotherapy on its own.
Collapse
Affiliation(s)
- I Kanellos
- 4th Department of Surgery, Aristotle University of Thessaloniki, Antheon 1, GR 55236, Panorama, Thessaloniki, Greece.
| | | | | | | | | |
Collapse
|
|
15
|
Abstract
Technologic advances have contributed to numerous diverse approaches to the management of hemorrhoid disease over the past centuries. Better understanding of the pathophysiology and anatomy of the anal canal has also added to the increased success in the treatment of hemorrhoids. This article reviews the clinical and pathological aspects of hemorrhoid disease, emphasizing new therapeutic modalities.
Collapse
Affiliation(s)
- T Cristina Sardinha
- Department of Surgery, North Shore-Long Island Jewish Medical Center, New Hype Park, NY 11040, USA
| | | |
Collapse
|
|
16
|
Placer C, Ángel Medrano M, Goena I, Bollo E. Ligadura hemorroidal mediante aspiración con dispositivo desechable. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71984-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
|
17
|
Abstract
PURPOSE Destruction of the anchoring tissue system is considered to be the essential prerequisite to the pathogenesis of advanced hemorrhoidal disease. Ligation-anopexy was designed to 1) restore fixation of the hemorrhoidal cushions to the underlying internal sphincter, 2) reduce hemorrhoidal prolapse, and 3) minimize the hemorrhoidal blood flow. The purpose of this study was to evaluate the ligation-anopexy as a new technique for the treatment of advanced stages of hemorrhoidal disease. METHODS This study included 40 patients with hemorrhoidal disease (mean age 29.63 +/- 9.79 years, male/female ratio 34:6). Twenty-two patients had third-degree and 18 patients had fourth-degree hemorrhoids; of those with fourth-degree hemorrhoids, two patients had associated anal fissure and three patients had partial mucosal prolapse. Informed consent was obtained from all patients. After reduction of hemorrhoidal prolapse and under general or spinal anesthesia, a needle with 2-0 polyglactin (Vicryl) was inserted 1.5 cm above the dentate line using a Sims' speculum. The needle was inserted deep enough to fix the mucosa and the submucosa to the underlying internal sphincter. After the suture was tied, the redundant mucosa was pulled distally to be incorporated in the ligature, and the thread was relegated around it to form a mucosal tag. RESULTS Inclusion of a part of the internal sphincter with ligation of the redundant mucosa ensures adequate retraction of prolapsed hemorrhoids (hemorrhoid lift). Postoperative pain was accepted by 90 percent of the patients and disappeared after treatment with oral diclofenac. The immediate complications included anal spasm in 10 percent, postoperative bleeding in 2.5 percent, and thrombosis of the external hemorrhoids in 2.5 percent of patients. Neither recurrence nor anal stenosis was observed after 12 months of follow-up. CONCLUSION Despite the limited number of patients and the short follow-up, the preliminary results of ligation-anopexy in the treatment of advanced hemorrhoidal disease are encouraging.
Collapse
Affiliation(s)
- A M Hussein
- Unit of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine, University of Alexandria, 11, Mohamed Rafat St., El Ramel Station, Alexandria, Egypt
| |
Collapse
|
|
18
|
|
|
19
|
Hayssen TK, Luchtefeld MA, Senagore AJ. Limited hemorrhoidectomy: results and long-term follow-up. Dis Colon Rectum 1999; 42:909-14; discussion 914-5. [PMID: 10411438 DOI: 10.1007/bf02237100] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Three-column excision has traditionally been the preferred treatment for symptomatic hemorrhoidal disease in patients failing nonoperative treatments. There are few data evaluating focused surgical management of only the symptomatic hemorrhoidal complexes by limited hemorrhoidectomy. The purpose of this study was to evaluate patient outcome after one-quadrant or two-quadrant hemorrhoidectomy for symptomatic hemorrhoids. METHODS We retrospectively studied patients undergoing a one-quadrant or two-quadrant hemorrhoidectomy as initial surgical treatment of symptomatic columns from April 1987 to July 1993. Patients undergoing a traditional three-quadrant hemorrhoidectomy during the same time period were used as controls. Statistical analysis was used to determine significance. RESULTS There were 115 evaluable patients who had undergone a one-quadrant or two-quadrant hemorrhoidectomy. One hundred thirty-three three-quadrant patients were studied as the control group. The mean follow-up was 8.1 years and 7.2 years for the limited and three-quadrant hemorrhoidectomy group, respectively. The majority of patients (96 percent limited and 98 percent three-quadrant) experienced initial relief of symptoms after surgery. There was no significant difference between the two groups in the development of recurrent anorectal symptoms (34 percent limited and 29 percent three-quadrant), in the need for additional medical therapy (11.3 percent limited and 15.8 percent three-quadrant), or in the need for additional interventional therapy (2.9 percent limited and 0.8 percent three-quadrant). No patients in either group required additional surgical hemorrhoidectomy. CONCLUSIONS The majority of patients with hemorrhoidal disease requiring excision can be managed effectively by focused treatment of the problematic columns. With this approach fewer than 2 percent of patients will require further procedural intervention of their hemorrhoidal disease.
Collapse
Affiliation(s)
- T K Hayssen
- Spectrum Health-Ferguson Center, The Ferguson Clinic, Digestive Disease Services, Grand Rapids, Michigan, USA
| | | | | |
Collapse
|
|
20
|
Abstract
We have reviewed and summarized 12 years of experience in treating hemorrhoids, a condition that affects 4.4% of the Western population, of whom a third are symptomatic and need treatment. During this time, in a proctological outpatient clinic of an urban hospital, 2,934 patients with second- and third-degree hemorrhoids were treated by rubber band ligation (RBL), usually one ligation per session. Of these patients, 79% were completely cured, 18% needed one or more additional sessions of treatment, and 2.1% failed to be cured by RBL and were referred for conventional hemorrhoidectomy. We found that by using this safe and convenient treatment we can save hundreds of hospitalization days and thousands of sick-leave days per year.
Collapse
Affiliation(s)
- I Bayer
- Proctology Unit, Rabin Medical Center, Petach-Tikva, Israel
| | | | | |
Collapse
|
|
21
|
Abstract
PURPOSE The aim of our study was to evaluate the risks of multiple hemorrhoidal bandings in a single session. METHODS We retrospectively examined all of the patients who had hemorrhoidal bandings from July 1989 to August 1992. RESULTS Patients with multiple hemorrhoidal banding in a single session when compared with patients with single banding had greater discomfort and pain (29 percent vs. 4.5 percent), but this discomfort was usually manageable with oral analgesia of limited duration. There were also more vasovagal symptoms (5.2 percent vs. 0 percent), local swelling and edema (2.6 percent vs. 0 percent), and urinary hesitancy and frequency (12.3 percent vs. 0 percent) in the multiple-banded patients. No major complication such as massive delayed bleeding and perineal or pelvic sepsis was noted. CONCLUSION Most patients tolerated multiple hemorrhoidal banding in a single session with acceptably low complications. Multiple banding in a single session is a safe and cost-effective alternative.
Collapse
Affiliation(s)
- H H Lee
- Mayo Clinic Scottsdale, Arizona
| | | | | |
Collapse
|
|
22
|
Senagore A, Mazier WP, Luchtefeld MA, MacKeigan JM, Wengert T. Treatment of advanced hemorrhoidal disease: a prospective, randomized comparison of cold scalpel vs. contact Nd:YAG laser. Dis Colon Rectum 1993; 36:1042-9. [PMID: 8223057 DOI: 10.1007/bf02047297] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Recently, laser technology has been advocated for the treatment of hemorrhoids. However, there has been little scientific evaluation of the use of the Nd:YAG laser for excisional treatment of hemorrhoidal disease. The purpose of this study was to perform a prospective randomized study of the Nd:YAG laser vs. scalpel excision, when performing a standard Ferguson-closed hemorrhoidectomy. METHODS Patients presenting for internal-external hemorrhoidectomy were eligible for study. Hemorrhoidectomies were performed under epidural or caudal blocks. The standard Ferguson closed hemorrhoidectomy technique was used. Data evaluated included: age, sex, estimated blood loss, operative time, postoperative pain scores, postoperative analgesic use, wound healing, and time for return to work. Eighty-six patients were eligible for study (laser, N = 51; scalpel, N = 35). RESULTS There were no significant differences between the groups, except for a greater degree of wound inflammation and dehiscence at the 10 day postoperative visit for the laser group (laser, 1.7 +/- .2; scalpel, 0.8 +/- .2; P < 0.05, t-test). The use of the Nd:YAG laser added $480 per case; as a result, the treatment cost for the laser group was $15,360 higher than that of the conventional group. CONCLUSION The results indicate that there are no patient care advantages associated with the use of the Nd:YAG laser for excisional hemorrhoidectomy compared with scalpel excision. As new technology becomes available, surgeons must rigorously assess therapeutic efficacy and cost-benefit ratio before deciding to employ this technology for patient care.
Collapse
Affiliation(s)
- A Senagore
- Department of Surgery, Ferguson Hospital, Grand Rapids, Michigan 49503
| | | | | | | | | |
Collapse
|
|
23
|
Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E. Complications of rubber band ligation of symptomatic internal hemorrhoids. Dis Colon Rectum 1993; 36:287-90. [PMID: 8449135 DOI: 10.1007/bf02053512] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.
Collapse
Affiliation(s)
- L Bat
- Gastroenterology Department, H. Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | |
Collapse
|
|
24
|
Abstract
Hemorrhoids should be classified so that the treatment can be individualized. Minor or asymptomatic hemorrhoids usually do not require any treatment. Diet modification is a useful adjunct in all degrees of hemorrhoids. Fixation procedures may be employed in the office for first-, second-, and minor third-degree hemorrhoids. These techniques are valuable in elderly and poor-risk patients. Excisions may be performed by standard instruments or lasers with good results. These techniques may be employed with local anesthesia and in an outpatient setting. Lasers may be effective as either a fixation device or an excisional tool. The problem is cost and maintenance of the equipment and the cost of the disposable apparatus. If the equipment is already available or can be shared for multidisciplinary use, hemorrhoidectomy can be accomplished in a cost-effective manner with excellent results.
Collapse
Affiliation(s)
- L E Smith
- Division of Colon and Rectal Surgery, George Washington University, Washington, D.C
| |
Collapse
|
|
25
|
Abstract
Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation (470 patients), injection sclerotherapy (280 patients), or cryosurgery (98 patients). The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery.
Collapse
Affiliation(s)
- A M Jamjoom
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | |
Collapse
|
|
26
|
Marshman D, Huber PJ, Timmerman W, Simonton CT, Odom FC, Kaplan ER. Hemorrhoidal ligation. A review of efficacy. Dis Colon Rectum 1989; 32:369-71. [PMID: 2714125 DOI: 10.1007/bf02563683] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Two hundred forty-one patients undergoing hemorrhoidal rubber band ligation over a five-year period were reviewed to focus on complications. Three patients (1.2 percent) were hospitalized. Two, on oral anticoagulants, recovered from bleeding complications. One patient developed a band-related abscess that resolved with drainage. Twenty patients (8.3 percent) reported pain associated with the procedure. Three patients went on to subsequent surgical hemorrhoidectomy. There were no deaths in the series. This report agrees with previously published series highlighting the efficacy and cost containment of hemorrhoidal ligation. Continued reliance on this approach to hemorrhoidal disease is justified.
Collapse
Affiliation(s)
- D Marshman
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | | | | | | | | | | |
Collapse
|
|
27
|
Mattana C, Maria G, Pescatori M. Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients. Dis Colon Rectum 1989; 32:372-5. [PMID: 2714126 DOI: 10.1007/bf02563684] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Rubber band ligation was used in 160 patients with internal hemorrhoids; 43 of them also had rectal anterior mucosal prolapse; 13 had prolapse alone. Two thirds of the patients underwent a single rubber band ligation and one third a double rubber band ligation in one session without anesthesia. Ninety-four required repeated ligations. A follow-up of 25 +/- 16 months (mean +/- SD) was carried out in 153 of them. Rubber band ligation was followed by prolonged bleeding in six patients and severe pain requiring removal of the rubber band in 12 patients. The complication rate decreased significantly (P less than .05) in the last 80 patients. Compared with multiple ligation, single rubber band ligation in one sitting was followed by a lower complication rate (P less than .01). Long-term results were good in 71 percent of the patients. (A formal hemorrhoidectomy was needed within two years in 6 percent.) A significantly lower recurrence rate of 9 percent was noted in those with normal bowel habits, when compared with constipated subjects whose symptoms recurred in 85 percent (P less than .001). Constipation seems to be a predictable factor in worsening the outcome of rubber band ligation. Rubber band ligation is followed by a lower complication rate when performed in a single ligation.
Collapse
Affiliation(s)
- C Mattana
- Istituto di Clinica Chirurgica, Policlinico Gemelli, Rome, Italy
| | | | | |
Collapse
|
|
28
|
|
|
29
|
Dixon AR, Harris AM, Baker AR, Barrie WW. Fatal hemorrhage following rubber band ligation of hemorrhoids. Dis Colon Rectum 1988; 31:156. [PMID: 3257436 DOI: 10.1007/bf02562654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
|
30
|
Shemesh EI, Kodner IJ, Fry RD, Neufeld DM. Severe complication of rubber band ligation of internal hemorrhoids. Dis Colon Rectum 1987; 30:199-200. [PMID: 3829863 DOI: 10.1007/bf02554339] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In light of recent reports describing severe and even fatal complications, the authors would like to report good results in two patients with massive edema and one with localized necrosis following rubber band ligation of internal hemorrhoids, which were recognized early and treated aggressively. The potential for severe complications emphasizes the need for determining other causes of rectal symptoms before ligation of hemorrhoids is undertaken.
Collapse
|
|
31
|
Abstract
Rubber band ligation of hemorrhoids has had a low incidence of complications until recently, when five deaths resulted from bacterial septicemia or toxemia. The case presented describes a severe soft-tissue infection following banding successfully treated with antibiotics, surgical debridement, and hyperbaric oxygen.
Collapse
|
|
32
|
Poon GP, Chu KW, Lau WY, Lee JM, Yeung C, Fan ST, Yiu TF, Wong SH, Wong KK. Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial. Dis Colon Rectum 1986; 29:836-8. [PMID: 3539557 DOI: 10.1007/bf02555358] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Two hundred five patients with symptomatic first- and second-degree hemorrhoids were randomized to receive either conventional rubber band ligation or triple rubber band ligation. In conventional rubber band ligation, the hemorrhoids were ligated at one primary site per session at intervals of four weeks until symptoms were relieved or when all three hemorrhoids were ligated. In triple rubber band ligation, all three primary hemorrhoids were ligated in a single session. After completion of treatment, the patients were examined every three months, or earlier if symptoms recurred. Both methods were effective in the treatment of early hemorrhoids and the incidence of postligation pain and complications was similar. The advantages of having the treatment completed at the initial visit in triple rubber band ligation are obvious. Furthermore, less treatment sessions were required for triple rubber band ligation to control symptoms than for conventional rubber band ligation. Triple rubber band ligation is more cost-effective and therefore is recommended.
Collapse
|
|
33
|
|
|
34
|
Abstract
Band ligation of symptomatic internal hemorrhoids is a well-established and accepted outpatient procedure. The purpose of this paper is to alert the medical profession to potential complications and death following this procedure. Each of the four patients described in this report experienced pain and inability to urinate following banding. This report does not condemn banding but, rather, focuses on problems associated with a procedure perceived by many to be risk free.
Collapse
|
|
35
|
Abstract
One hundred consecutive office patients with internal hemorrhoidal disease were treated by rubber band ligations. They were assigned randomly to one, two, or three ligations at one session. No statistically significant differences in morbidity or complications resulted from multiple ligations, as compared with one ligation. No serious complications were encountered in any of the treatment groups. These results confirm that multiple rubber band ligation is as safe and effective a procedure for managing internal hemorrhoidal disease as single ligations.
Collapse
|
|
36
|
|