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Background: Diathermy haemorrhoidectomy is an effective technique for the management of 2nd, 3rd and 4th degree haemorrhoids. The anal cushions are excised by use of diathermy without ligature of the vascular pedicles. The aim of the present study is to evaluate the efficacy and tolerability of this technique., Methods: Between September 1999 and September 2003, 84 patients with 2nd, 3rd, and 4th degree haemorrhoids underwent diathermy haemorrhoidectomy. Patients were discharged the same day or the day after. All the patients were asked to complete two questionnaires one on the level of pain they experienced and the other on their expectation of pain. Patients were followed-up for 1 to 4 years (range 12-48 months, mean 20.5)., Results: The average pain severity score on a visual analogue scale (0-10) was 3.06 +/- 0.38 and consistently lower than expected. The majority of patients returned to their usual daily activities within 4 days and all of them returned to work within 11 days. A mild residual secretion persisted for 4 to 5 weeks. None of our patients experienced postoperative haemorrhage, complete stenosis or sphincteric disturbances., Conclusions: Diathermy haemorrhoidectomy appears to be a safe, low cost and effective technique for the treatment of haemorrhoids. It is well tolerated by patients.

Introduction: Ten years after the introduction of stapled haemorrhoidopexy few studies have stratified patients by degree of haemorrhoidal disease when analysing results. Objective The aim of this study was prospectively to evaluate 116 patients who underwent stapled anopexy conducted by the same surgeon for III or IV degree haemorrhoidal prolapse., Materials and Methods: One hundred and sixteen consecutive patients affected by symptomatic haemorrhoids of III or IV degree underwent stapled anopexy using the technique described by Longo in the period January 2001 to October 2003. Mean follow-up was 28.1 months. Fischer's exact test was used for statistical analysis. Results, in terms of morbidity and recurrence rates, were stratified according to degree of haemorrhoidal disease., Results: There was no statistically significant difference between the results for third degree compared with fourth degree prolapse although there was a trend towards increased incidence of postoperative bleeding and recurrence., Conclusion: Third degree haemorrhoidal prolapse remains the best indication for stapled haemorrhoidopexy. This procedure may also be indicated in fourth degree haemorrhoidal prolapse. Patients with fourth degree haemorrhoids may be subjected to this procedure following adequate discussion of the outcome.

Introduction: haemorrhoidal disease symptoms lead frequently to medical consultation. The aims of our study were to determine its epidemiological, clinical and endoscopic characteristics in Dakar., Patients and Methods: we conducted a prospective multicentric study in the hospitals and in the private offices with endoscopic unit in Dakar from November 2nd 2003 to July 31 2004. A questionnaire with clinical and epidemiological features was applied to patients who presented haemorrhoid to the endoscopic exam. We included those who accepted the questionnaire., Results: We recruited 168 patients. The mean age was 39.6 years. The sex ratio was 1.66 (male to female). The mean duration of symptoms was 6 years (range 1 month - 32 years). The symptoms that lead to medical visit were mainly: rectal haemorrhage (50.5%), anal pain (23.2%), constipation (13.1%) and anal tumefaction (9.5%). At the anamnesis the most frequently symptoms noted were constipation (80.4%), anal tumefaction (74.4%), anal pain (73.8%), rectal haemorrhage (64.9%) and anal pruritus (58.3%). The haemorrhoids were internal in 116 cases and external in 52 cases. According to the endoscopic classification, 35% of patients were at the first stage, 43% at stage II, 18% at stage III and 4% at the stage IV. An anitis was noted in 29.1% cases. We noted as associated lesions 18 fistulas and 15 anal fissures., Conclusion: The epidemiological, clinical and endoscopic characteristics of haemorrhoidal disease in Dakar are similar to those described in medical literature.

Acute thrombosis of hemorrhoidal nodes (ATHN) was treated in 402 patients aged from 19 through 73 years of age. It was found that the decision for the volume and method of treatment should be determined individually and differentially, paying special attention to the degree of microcirculatory alterations in the walls of cavernous veins. Multi-component conservative therapy is the method of choice for treatment of ATHN of the 1st severity degree. For the II and III degree operation is indicated which should be fulfilled urgently (within 3 days) or in a postponed (within 5-7 days) order. Hemorrhoidectomy by Milligan-Morgan method with the tight suturing of the postoperative wounds and complete restoration of the mucous membrane of the anal canal allowed getting better immediate and long-term results.

Background: Bleeding is one of the main symptoms of internal hemorrhoids. However, the conventional Goligher's classification of internal hemorrhoids does not consider the severity of bleeding. We intended to establish a useful method for evaluating internal hemorrhoids using a colonoscope that reflected the severity of the symptoms., Methods: Using a colonoscope in the retroflexed and forward viewing position, 104 patients with symptomatic internal hemorrhoids were evaluated based on the criteria of range, form and red color signs (RCS). Range was determined by the circumferential distribution of internal hemorrhoids and scaled from 0 to 4. Form was determined by size and scaled from 0 to 2. The presence of RCS was also evaluated. Symptoms were determined by interview and scaled from 0 to 3. Patients were treated by endoscopic band ligation (EBL) and were examined endoscopically before and 4 weeks after the treatment., Results: Before the treatment, range, form and RCS were significantly correlated to bleeding (P < 0.01), and form was significantly correlated to prolapse (P < 0.05). The endoscopic classification scores at 4 weeks after EBL improved significantly (range from 3.25 +/- 0.05-0.56 +/- 0.08 [P < 0.01] and form from 2.81 +/- 0.04-0.56 +/- 0.07 P < 0.01)., Conclusion: The new endoscopic classification of internal hemorrhoids proved to be closely correlated to symptoms, particularly bleeding, and thus highly useful in evaluating the effectiveness of the treatment.

A number of new surgical treatments have led to a reappraisal of haemorrhoid disease over the last few decades. Despite a range of treatment modalities, the options are limited in their effectiveness and can lead to a number of complications. An inadequate classification system based on appearance rather than symptoms makes the choice of appropriate therapy difficult. More recent techniques have led to a move away from surgical excision. However, further research is required to establish their precise indications and long-term efficacy.

Objective: In this study, we have developed an electrotherapy device in order to improve the outcome and decrease the number of referrals and duration of treatment of internal hemorrhoid., Methods: We treated 2015 hemorrhoids among 931 patients (382 males and 549 females); 319 hemorrhoids were grade 1, 1158 grade 2 and 538 grade 3, from May 1995 to October 2002, at Nemazee and Faghihee Hospitals in Shiraz University of Medical Sciences, Shiraz, Iran. All patients were referred due to fresh rectal bleeding or reducible prolapsed hemorrhoid with no response to medical treatment. After introduction of anesthesia, 27-30 mAmp direct current was applied to each hemorrhoid with durations of 4.5 minutes for grade 1, 5.5 minutes for grade 2 and 7 minutes for grade 3., Results: Our results showed that 97.1% of patients responded well to the treatment and 27 patients returned with fresh rectal bleeding or prolapsed hemorrhoid in 2 weeks to 2 months postoperatively. Ninety-six percent of the patients were discharged on the same operating day. After 24 hours postoperation, 92% of the patients had no any pain and no need any analgesic. Among those patients who had not responded to the treatment; 24 cases underwent electrotherapy for a 2nd time and 3 patients were treated excising their prolapsed hemorrhoids. No other complications were detected., Conclusion: Postoperative pain was mild and tolerable and 93.2% of patients returned to normal activity after 2 days. Electrotherapy with the above mentioned method is considered safe and effective without any major complications and with acceptable patient's satisfaction. This method can be used for treatment of grades 1, 2 and 3 hemorrhoids.

In the absence of an internationally agreed classification of haemorrhoids, evaluation of the ever increasing number of therapeutic options available is impossible. A new classification is proposed which relates symptoms to our knowledge of haemorrhoidal development, the use of which should provide a more accurate way of comparing treatments and in the evaluation of new techniques. The evidence for such a classification is presented in detail.

In 2000, the Italian Society of Coloproctology and the UCP (Coloproctology Units) devised a new haemorrhoid classification system, named PATE 2000 Sorrento, which is capable of defining all the main characteristics of the disease. Any new system should be able to predict the real extent of hemorrhoids by means of a specific index in order to help physicians in choosing the best therapeutic option. The authors present the results of a national multicentre study of 930 patients with symptomatic haemorrhoids. Nineteen patients (2%) could not be classified with the old haemorrhoid classification, while PATE 2000 Sorrento proved successful in classifying all patients. The difference was statistically significant. The new classification enables us to establish a specific score for the disease. In order to better evaluate the clinical impact of the scores obtained with PATE 2000 Sorrento, the authors analyzed the correlation between the score itself and the therapy chosen by each individual centre. The highest scores always corresponded to the choice of surgical hemorrhoidectomy, while in the case of lower values each centre seemed to be in doubt between medical therapy and other less invasive procedure such as sclerotherapy or rubber band ligation. These data were statistically significant (P < 0.0001). On the basis of our findings, PATE 2000 Sorrento seems to confirm its scientific and clinical relevance and could be a useful tool for the choice of the best treatment for each individual patient.

Hemorrhoidal disease results from the pathological enlargement and distal displacement of the upper hemorrhoidal plexus. This disorder is very widespread in modern industrial society. Hereditary predisposition, malnutrition with constipation and abnormal bowel habits seem to be the most relevant causes for pathogenesis. The exact classification of hemorrhoids according to the degree of prolapse as well as the correct evaluation of accompanying anal diseases are very important in order to choose the appropriate conservative or surgical treatment with the goal of long-term avoidance of recurrence.

Hemorrhoidal disease is a very common and widespread disease, and it is estimated that about one subject out of three may suffer from this pathology. Hemorrhoids generally cause symptoms when enlarged, inflamed, thrombosed, or prolapsed. Internal hemorrhoids arise above the dentate line (in comparison to external hemorrhoids perianal phlebothrombosis) and are covered by transitional or columnar epithelium. Scleotherapy is one of the oldest therapy forms mainly for bleeding hemorrhoids. The so called Barron ligature is an office procedure in which a small rubber band is placed at the base of the internal hemorrhoid with a special applicator.

The spectrum of procedures for hemorrhoidal disease can deal with all developmental stages if carried out in a differential way. Stapled hemorrhoidopexy is an effective supplement to actual conventional surgical procedures. Hemorrhoidectomies performed with the stapler were compared with segmental hemorrhoridectomies according to Milligan-Morgan as well as anoplasty according to Fansler-Arnold, and proved to be superior as regards complication rate, need for analgesics and operation time, stay in hospital and time off work. But despite the justified euphoria about this innovative method, its necessary limitations should not be disregarded.

Haemorrhoidal symptoms have been known from time immemorial; they are considered to be a widespread problem, which is progressive if untreated. Treatment is according to the proctological qualification of the doctor and the degree of the changes. If possible, it should be carried out from the point of view of causal therapy. The most frequently occurring 1st degree haemorrhoids can almost always be treated conservatively, i.e. with sclerotherapy. To prevent recurrence, the life style and defecation habits should be changed. Regular monitoring by specialists aids prevention.

The surgical treatment of haemorrhoids has significantly changed by introducing new techniques in the last years. Nowadays, low grade haemorrhoids, grade II and III, are easily and painfree treatable by a minimal invasive, Doppler transducer guided ligation of the haemorrhoidal arteries. In cases of circular protruding haemorrhoids, grade III and IV; the stapled mucosectomy described by Longo is also a new effective treatment. Both procedures can be performed for an outpatient or with short hospital stay and allows patients to return to work earlier compared to conventional techniques. Additionally, due to the new techniques the treatment of haemorrhoids is less painful and has increased patients' satisfaction. Therefore, the traditional haemorrhoidectomy, the Milligan-Morgan or the Ferguson procedure, has become less common and is only performed in a few special indications.

Background: The history of our proposal for a new classification of hemorrhoids is very old: 7 years of scientific debate had a big impact for the study and the definition of hemorrhoids., Methods: Nowadays many things have changed mainly in the field of treatment of hemorrhoids. New medical and surgical tools are available for the modern proctologist., Results: The new classification of the disease seems to fit the necessity of introducing these modern opportunities. Many authors recognize the fundamental role and claim for the routine use of a new classification, named PATE 2000 Sorrento. Nevertheless many problems are on debate. Their resolution needs the cooperation of all the experts in order to choose the best version of the classification., Conclusions: For these reasons the authors analyse all the work carried out till now in order to see what we still need to introduce a new classification of the disease.

The spectrum of procedures for haemorrhoidal disease can deal with all developmental stages if done in a differentiated way. The possibilities, limitations, and risks of the different methods are described. The catalogue stretches from relatively simple operations (Milligan-Morgan, stapler haemorrhoidectomy), which every general surgeon should be able to perform, to extensive anoplastic reconstruction, which is limited to specialists. Although the global risks of the more simple operations make them suitable for outpatient procedures, there are--at least in Germany--severe reservations, as there is the danger of inadequately therapy in more advanced cases, overcharging a lot of patients, lack of cooperation and knowledge about the necessities of early postoperative care by the local practitioners, problems in follow-up in patients living far away, and inadequate payment for the therapeutical costs by the health insurance companies.

Hemorrhoids are a pathophysiological consequence of hyperplasia of the corpus cavernosum recti, and can be classified into three grades of severity. Clinically, they usually manifest in the form of peri-anal bleeding, a diffuse sensation of discomfort, itching and secretion of mucus. The diagnosis is established on the basis of the dinical presentation. Treatment is mainly conservative, but is likely to be successful only in the early stages. Already second degree symptomatic hemorrhoids require definitive treatment. Although peri-anal thrombosis is sometimes a very painful condition, it is usually harmless. If pain is severe, surgical incision is indicated.

The aim of the therapy of piles is to cure the complaints of the patient by reducing the enlarged haemorrhoidal plexus according to the stage (1 degree to 3 degrees) to a nearly physiological size and in case of a prolapse to replace the sensitive anoderma. The basic therapy consists of regulating the bowel function and avoiding straining. A high fibre diet or bulk laxatives may be necessary. If this fails 1 degree haemorrhoids should be treated in the office by sklerotherapy, 2nd or 2nd to 3rd degree haemorrhoids by rubber band ligation from the very beginning. The Haemorrhoidal Artery Ligation (HAL) and the circular mucosectomy with a stapling device can be done as an office procedure too. An anal prolapse of 1 or 2 segments should be treated as outpatient surgery in an "open" technique (Milligan-Morgan), more than 2 segments in a "closed" (Ferguson) or better in a "semi-closed submucosal" technique (Parks) in the hospital. A cicular anoplasty preserves the anoderma and enables its reposition as well as the excision of perianal skin tags and fibromata. This is not an office procedure.

Anorectal disorders are common and more than one half of the population will experience one at some time during their lives. It is important for the clinician to recognize the differences between internal and external hemorrhoids and other anorectal problems such as fissures, abscesses, fistulas, skin tags, and a variety of dermatologic conditions because the treatment is often different. This article will discuss the anatomy, pathophysiology, diagnosis, and treatment of internal and external hemorrhoids.

The generally accepted classification of hemorrhoids presents some rather wide gaps which may either be due to expressions of intrinsic limits or recent moves of the Colonproctology field. The authors of this paper would like to present their proposal for a new classification that considers the results of the National Multicentric Study that was performed in collaboration with nineteen centres and a total of 1,494 patients. In addition, a comparative study was conducted on the two forms of classification. Nineteen patients (1.28%) were considered unclassifiable with the new classification system while 49 were (3.29%) with the presently used one. These results were found significant with the MacNemar Chi-Square test. The description of type 2 and 3 in the new classification system was found useful in 69% of 2nd degree, 77% of 3rd degree and 28% of 4th degree using the present system. Acute events (type 5,6 and 7) proposed with the new classification were found in the present system with several different rates. We have also included the data taken from a national and international survey we conducted on the usefulness of the new classification that provoked intense debate within two of the most important national institutes. The result was the elaboration of a design on the new classification.

Purpose: The aim of this study was to determine the efficacy of infrared photocoagulation in the treatment of grades I and II of hemorrhoidal disease., Material and Methods: 60 patients with hemorrhoidal disease grades I and II were included, each one with transanal bleeding as the only symptom, without any other ano-rectal pathology. They were 30 male and 30 female patients, with 39.9 years as median age. Each had 1 to 4 photocoagulation sessions, according to the results obtained in each one., Technic: Each application was 1.5 seconds duration, once every two weeks, in diamond or rainbow shape; 1 to 4 sessions were required. Follow up was 24 months., Results: Good results were obtained in 66.6% since the second application, and in 93.4% at the end of the study; 4 (6.6%) patients were failures and had to be operated on., Conclusion: Treatment of hemorrhoidal disease grades I and II with infrared photocoagulation is an excellent alternative; it is painless, suitable as an outpatient procedure and its cost is low.

During an eight-year period 887 patients with symptoms of hemorrhoids were treated at the Department of Surgery and Outpatient Care of the Vaszary Kolos County Hospital, Esztergom. 178 patients with first degree hemorrhoids received only conservative treatment. Rubber band ligation (RBL) which can be performed on outpatients was applied in 324 patients with first, second and third degree hemorrhoids. Thrombosed external hemorrhoids were treated by excision in 215 patients. Hemorrhoidectomy (H) was mainly carried out in 91 cases for treatment of circular 3rd and 4th degree nodules involving complications. More than 80 per cent of the patients receiving rubber band ligation and hemorrhoidectomy were followed up. 65% of the RBL group and 85% of the H group were symptom free, while 76% of the RBL group and 91% of the H group showed great improvement after the treatment. Personal results, complications, and review of the literature are discussed in detail.

Haemorrhoids are common, but careful clinical assessment is necessary to ensure that more significant bowel disease is not overlooked. Most patients with haemorrhoids can be managed non-surgically in an office setting, but conventional haemorrhoidectomy is the best option for patients with large symptomatic haemorrhoids.

Hemorrhoidal disease is the most common pathophysiologic abnormality in the anus in the western civilized world. Sixty years after publication of the method in The Lancet, hemorrhoidectomy according to Milligan and Morgan and modifications of their methods are still considered the standard procedure in cases of advanced hemorrhoidal disease. During the last 5 years, 107 patients underwent hemorrhoidectomy in the Department of Surgery at the University of Cologne. In most of these patients, the operation followed Milligan and Morgan's method. There were 69 males and 38 females with a mean age of 47.9 years. Mean length of hospital stay was 4.5 days. We saw one case of postoperative bleeding that required operative review. The patients' risk profile (age, concomitant diseases, ASA classification) did not influence the length of the hospital stay. Operative hemorrhoidectomy according to Milligan and Morgan allows a short stay in hospital according to the individual needs of the patient, with a high degree of safety concerning possible postoperative complications.

The many treatments for haemorrhoids highlight a lack of consensus. Differences in patients' and surgeons' priority make objective evaluation of haemorrhoid treatment difficult; different types of haemorrhoids are being treated in patients from different socio-economic backgrounds by surgeons of varying expertise from within different cultural settings. In this article we have reviewed the results of common treatments for haemorrhoids and give an outline of our operative technique when performing haemorrhoidectomy.

Rectal pain and/or bleeding are common complaints among the general population. Hemorrhoids are the most common etiology for these complaints, but the family physician should always be alert to the possibility of other pathologic explanations, such as fissure, abscess, fistula, condyloma or cancer. Feelings of embarrassment or apprehension about surgery may make patients reluctant to discuss anorectal symptoms with their physician. A variety of outpatient methods is available to treat internal hemorrhoids. Rubber band ligation is widely used in the treatment of all grades of internal hemorrhoids. Infrared coagulation uses high-intensity light to treat grade I, grade II and some grade III internal hemorrhoids. Bipolar electrocoagulation is useful in all cases, while low-voltage direct current is useful in cases of more advanced hemorrhoids. Proper anal hygiene and correction of chronic constipation or diarrhea are essential to prevent recurrence of hemorrhoids.

Correct definition of haemorrhoidal disease allows the estimation of the incidence and the therapeutic choices. The term "haemorrhoidal disease" should be used specifically for symptoms secondary to abnormalities of the intern haemorrhoidal plexus. The classification of severity is useful but difficult to apply to individual cases. The aetiopathogenesis remains unclear. Many arguments are in favour of a progressive degeneration of the fibromuscular structure of the internal haemorrhoidal plexus responsible for his prolapse in the anal canal. Most patients suffering from haemorrhoids are relieved by simple dietary advice. Moderate prolapsing haemorrhoids are significantly improved by rubber band ligation. Surgical haemorrhoidectomy remains the procedure of choice in patients with advanced prolapsing haemorrhoids.

This study discusses the management of hemorrhoids by rubber band ligation. It reviews 233 rubber band ligation procedures in 148 patients with symptomatic hemorrhoids performed over a 5-year period. 72% of the patients underwent a single rubber band ligation, 22% a double band ligation and 6% a triple band ligation in one session without anesthesia. A follow-up of 18 +/- 5 months was carried out. Only three patients required hospitalization for complications. One patient was admitted for bleeding and recovered with clot evacuation, bed rest and blood transfusion. Two patients developed a band related abscess that resolved with drainage. Twenty patients (13.5%) reported pain associated with the procedure. Four patients needed subsequent surgical hemorrhoidectomy. Long-term results were good in 81.2% of the patients. This report agrees with previously published series showing the efficacy and cost containment of hemorrhoidal ligation.

It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient.

Traditional and current concepts, anatomical and physiological mechanisms, causes, classification, clinical manifestations, diagnostic approach, and current therapy of hemorrhoidal disease are reviewed in this article. It is encouraged to use the term hemorrhoidal disease instead of the misused one hemorrhoids.

Hemorrhoids is the most common disease in coloproctology, and rectoromanoscopy is a valuable tool of diagnosis. Of a total of 1614 patients examined at the proctologic consulting room of the Department of Gastroenterology at the Medical Academy in Sofia, hemorrhoids had 609 (37.8 per cent). External were 2 per cent of the hemorrhoids, internal 81.1 per cent and external + internal 15.9 per cent. Characteristic finding in internal hemorrhoids were the swelling in the anal canal, localized along 3, 7 and 11 hours of the clock dial in knee-elbow position of the patient. Endoscopic symptoms of hemorrhoid malignization were ulceration, thickening and infiltration of the mucosa at the bottom of the erosion. Hemorrhoids were frequently associated with accompanying diseases (52.6 per cent) which aggravated the patients complaints. They may occasionally be the cause of symptomatic hemorrhoids.

Although hemorrhoids are considered a minor medical problem, they may cause considerable discomfort and anxiety. Fortunately, treatment is often simple and surgery is rarely necessary. In this practical article, Dr Cocchiara describes internal and external hemorrhoids, a classification system, and treatment choices based on the degree of involvement.

The treatment of piles should aim to reduce the abundant hemorrhoidal tissue in accordance with the stage (1. degree-3. degrees). In all cases an attempt should be made to regulate bowel function while avoiding straining. A high fibre diet is advised or a bulk laxative may be necessary. Advice on anal hygiene is given. If this treatment fails, infrared coagulation or injection sclerotherapy is indicated. Second or second to third degree hemorrhoids should be treated with rubber band ligation from the very beginning. In view of their possible complications, both methods should be used only by trained and experienced physicians.

Pain, bleeding, protrusion, soilage, itching, and burning are anorectal complaints associated with hemorrhoidal disease. Although hemorrhoidectomy remains the treatment of choice for grade 3 and 4 hemorrhoids, symptoms can be controlled short of hemorrhoidectomy, the alternative methods being effective in lesser degrees of involvement, such as grades 1, 2, and 3. Cryosurgery and dilation are fading alternatives; laser is becoming more widely used, but results have not been fully evaluated. Sclerotherapy, rubber band ligation, and infrared coagulation are also effective alternatives for patients who demand nonsurgical therapy.