Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2015; 7(10): 273-278
Published online Oct 27, 2015. doi: 10.4240/wjgs.v7.i10.273
Anal cushion lifting method is a novel radical management strategy for hemorrhoids that does not involve excision or cause postoperative anal complications
Gentaro Ishiyama, Toshihiko Nishidate, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Kenji Okita, Toru Mizuguchi, Mineko Fujimiya, Koichi Hirata
Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan
Gentaro Ishiyama, Mineko Fujimiya, Department of Anatomy II, Graduate School of Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-0061, Japan
Toshihiko Nishidate, Kenji Okita, Toru Mizuguchi, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Graduate School of Medicine, Sapporo Medical University, Sapporo, Hokkaido 060-8543, Japan
Author contributions: Ishiyama G and Nishidate T designed the study; Ishiyama G, Ishiyama Y, Nishio A, Tarumi K and Kawamura M acquired the data; Ishiyama G, Nishidate T, Mizuguchi T, Fujimiya M and Hirata K analyzed and interpreted the data; Ishiyama G, Nishidate T, Mizuguchi T and Hirata K drafted this paper; Okita K provided the statistical advice.
Institutional review board statement: The study was reviewed and approved by the Ishiyama Clinic and Hospital Institutional Review Board.
Clinical trial registration statement: This study is registered at http://www.ishiyamahp.jp/index.html [Anorectal clinical trial registry (ACTR)]. The registration identification number is #IS 10012006.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors have any conflicts-of-interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at (nisidate@sapmed.ac.jp). Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshihiko Nishidate, MD, PhD, Department of Surgery, Surgical Oncology and Science, Graduate School of Medicine, Sapporo Medical University, S-1, W-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. nisidate@sapmed.ac.jp
Telephone: +81-11-6112111 Fax: +81-11-6131678
Received: February 13, 2015
Peer-review started: February 13, 2015
First decision: May 13, 2015
Revised: June 1, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: October 27, 2015
Processing time: 262 Days and 18.8 Hours
Abstract

AIM: To describe the anal cushion lifting (ACL) method with preliminary clinical results.

METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher’s classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or the ligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery.

RESULTS: A total of 127 patients were enrolled. Their median age was 42 (19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median follow-up period was 26 (0-88) mo, and the median operative time was 15 (4-30) min. After surgery, analgesics were used for a median period of three days (0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients’ postoperative hospital stay was 7 (2-13) d. A total of 10 complications (7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred.

CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.

Keywords: Hemorrhoidectomy; Anal stenosis; Anal cushion lifting method

Core tip: Hemorrhoidectomy, e.g., the ligation and excision method, is still the gold standard surgical technique for hemorrhoids. All of the classical surgical techniques for hemorrhoids are fundamentally based on the resectioning of the hemorrhoids, which can result in anal stenosis. We developed the anal cushion lifting method, in which the prolapsed anal cushion is restored to its original position, as a way of preventing various postoperative complications. We recruited 127 patients and conducted a prospective clinical study. By the end of the study, none of the patients had suffered anal stenosis or persistent anal pain.