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Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Phlebotonics are made of plant extracts and synthetic compounds. Although their mechanism of action is not completely clear, they are associated with an increase in venous tone and decreased capillary permeability. The aim of this paper was to assess the efficacy of Diosmin 500mg, Esperidine 90mg, Ruscogenin 100mg in improving symptoms of patients with hemorrhoidal disease. Materials and Methods: This was an observational trial performed at the Department of Universitary General Surgery of L'Aquila from March 2021 to September 2021. Symptoms have been evaluated using scoring system proposed by Giordano et al. Patients have been clinically evaluated by the same surgeon at the time of diagnosis and at the 30th day of treatment. Results: Seventy-one patients were included in the study. In Group A (study group) we reported a decrease in symptomatologic score of 50% with a 30-days follow-up, while we reported a decrease of 27% in Group B (control group). Among patients in Group A, 67% of those with grade IV hemorrhoidal disease have been re-stadiated to grade III after 30 days of treatment. Conclusion: Flavonoids mixture could be a safe and effective mean for conservative management of hemorrhoidal disease. The doses seemed to be satisfactory and the proposed duration of treatment can be considered adequate. [ABSTRACT FROM AUTHOR]

Aim:The aim of our study was to assess the outcome of hemorrhoidal dearterialization, achieved by a dedicated laser energy device.Method:From February 2013 to December 2017, 441 patients with second- or third-degree hemor-rhoids were studied. The primary end point was a reduction in the bleeding rate; secondary end points were; reduction in pain and recurrence of the symptoms which patients complaint. The procedure was carried out as 1-day surgery. A 1,470 nm diode laser device was employed to seal the terminal branch-es of the hemorrhoidal arteries. Follow-up was scheduled at 1 and 4 weeks, 3 and 6 months.Results:Two early postoperative bleeding (2/441) which recquired surgical intervention, Late com-plications were Eight (8/441) thrombosed hemorrhoids that resolved medically and recurrence of the symptoms which patients suffer in 10 patients (10/441). Postoperative pain was recorded by using a 10-point visual analog scale (VAS) on which 0 represents no pain and 10 represents the worst pain imaginable. VAS protocol was followed up after 1 week, 1 month. Mean pain score was 0.65 in postoperative 1 week and decreased gradually. All patients were discharged on the day of surgery.Conclusion:The hemorrhoid laser procedure was effective in improving bleeding and pain symp-toms in patients with Grade II and III hemorrhoids, but prospective randomized controlled studies are needed for evidence based conclusions.

Hemorrhoidal disease (HD) is a common anorectal disorder that affects at least 10 million people in the US, with a peak incidence in individuals between the ages of 45 and 65. This article discusses the signs, symptoms, risk factors, classification, treatment, and nursing interventions for patients with HD. [ABSTRACT FROM AUTHOR]

Several techniques were developed for managing hemorrhoidal disease, but their use in clinical practice and the general management of the condition seems highly variable in Saudi Arabia. To develop consensus recommendations that ensure the best possible diagnosis and treatment of hemorrhoidal disease in Saudi Arabia, the consensus panel consisted of experts in surgery in Saudi Arabia who met from December 2017 to September 2018. The discussions focused on the need: to set up a proctology society in Saudi Arabia to assess the prevalence of hemorrhoidal disease and to regulate the role of health-care professionals (HCPs) in the management of the disease; to initiate guidelines to ensure proper diagnosis (considering symptoms, medical history, and physical/clinical examination) and treatment (topical creams and suppositories should be limited as no strong evidence supports their efficacy); to educate patients on diet and lifestyle modifications using education materials and social media during and after the treatment (regular physical activity, drinking enough fluids, regular meal time with food rich in fibers, and regular bowel habit with non-straining defecation); to refer patients to a general/colorectal surgeon when needed; and to teach junior surgeons the best use of surgical techniques. These recommendations can be a step forward toward a recognized guidance for all HCPs in Saudi Arabia for a better management of hemorrhoidal disease. They will be of a great value for general practitioners, family medicine doctors, junior surgeons, and pharmacists who are the gate keepers and first contact with patients. [ABSTRACT FROM AUTHOR]

Abstract Background Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. Methods We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p

BackgroundExternal hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades.MethodsThis mini-review focuses on the most relevant studies found in literature evaluating conservative and surgical management of EHT. Special conditions such as pregnancy and EHT in elderly patients have been considered.ResultsTraditionally, symptoms duration represents the discriminant in the choice between medical and surgical treatment. Several Coloproctological Societies considered conservative treatment as the first-line approach to EHT and a variety of options have been proposed: wait and see, mixture of flavonoids, mix of lidocaine and nifedipine, botulinum toxin injection and topical application of 0.2% glyceryl trinitrate. Meanwhile, different surgical treatments are recommended when EHT fails to respond to conservative management or when symptoms onset falls within the last 48–72 h: drainage with radial incision, conventional excision, excision under local anesthesia and stapled technique.ConclusionThe management and treatment of EHT is still controversial since no specific guidelines have been published. Both medical and surgical treatment have been proven effective but randomized clinical trials and structured consensus-based guidelines are warranted.

BackgroundSclerotherapy is defined as the injection of sclerosant agents causing fibrosis and scarring of the surrounding tissue. It is currently employed for the treatment of I-III degree hemorrhoidal disease (HD). The aim of this study is to investigate the use of a new automated device for the injection of 3% polidocanol foam.MethodsThis is an observational study including 50 patients who underwent a sclerotherapy procedure with 3% polidocanol foam for II-degree HD according to Goligher classification. Patients were evaluated through validated scores [Giamundo score, Hemorrhoidal Disease Symptom Score (HDSS), Short Health Scale (SHS-HD) and Vaizey score]. Follow-up was conducted until 3 months from the procedure.ResultsComplete resolution of bleeding was achieved in 72% and 78% of patients, respectively, at 1 week and after 3 months from the procedure. Forty eight percent of patients were symptom free after the last follow-up visit (HDSS = 0). No major surgical complications were reported. Three patients out of 36 successfully treated, recurred, and needed a second sclerotherapy injection, which was successful in 2 of them.ConclusionThese preliminary results of 3% polidocanol foam injection on 50 patients suggest the efficacy and reproducibility of the technique with this new device in the short-term follow-up.

Background: Laser hemorrhoidectomy (LHP) is a minimally invasive procedure with less pain, short operative time and length of stay, and a low recurrent rate. This study aimed to analyze the surgical outcomes of the circumferential stapler hemorrhoidectomy (CSH, Longo operation) by propensity score-matching analysis, including perioperative outcomes and quality of life., Materials and Methods: Between March 2022 and March 2023, 216 patients underwent CSH and 198 LHP in Binh Dan Hospital, Ho Chi Minh City, Vietnam. Potential confounding factors for operative outcomes were adjusted by propensity score-matching analysis. The gender, age, Goligher classification, symptoms, Hemorrhoidal Disease Symptom Score (HDSS), and the number of hemorrhoidal columns were matching variables. After 1:1 propensity score-matching, 115 patients from each group were evaluated for perioperative outcomes and compared for a prospective study., Results: There was no difference in potential preoperative confounders such as gender, hemorrhoid classification, symptoms, and HDSS between the two groups after propensity score-matching. However, there was a difference in age (52 in the Longo group and 43 in the LHP group) and the number of columns (the LHP group had more). Postoperative outcomes such as operative time, blood loss, general complications, and postoperative interventions were less in the LHP group. However, Visual Analog Scale (VAS) (4 vs. 4), length of stay (1 day vs. 1 day), quality of life (both groups improved quality of life after the procedure), and recurrence rate (2 in the Longo group vs. 0 in the LHP group, p=0.5) had no difference between the two groups., Conclusions: Propensity-score matching analysis showed that the LHP procedure was superior to the Longo operation (CSH) in operative time, blood loss, general complications, and postoperative intervention. Other outcomes such as VAS, length of stay, quality of life, and recurrence rate have no difference., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, University of Medicine and Pharmacy, Ho Chi Minh City issued approval IRB-VN01002/IRB00010293/FWA00023448. The Institutional Ethics Committee approved all ethical issues of the study. The study was conducted at Binh Dan Hospital, which is directly under the Ho Chi Minh City Department of Health. The Ho Chi Minh City Department of Health invited a third party, the University of Medicine and Pharmacy, Ho Chi Minh City, to approve ethical issues to ensure objectivity. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hung et al.)

Background: Coexistence of dilating venous diseases in different vascular territories has raised the idea that they have similar vascular wall abnormality in their evolutionary process. Accordingly, we aimed to evaluate venous leg symptoms in patients with hemorrhoidal disease (HD) by means of VEINES-Sym questionnaire. Materials and methods: The study involved 249 consecutive patients who underwent colonoscopy and met the inclusion criteria. Presence and grading of HD were made according to Goligher's classification. All patients were examined for the existing of varicose vein and classified in respect of CEAP classification. All participants were requested to answer the VEINES-Sym questionnaire. Results: There was not statistically significant differences between the patients without HD (grade 0 or I) and with HD (Grade II or III) in respect to clinical characteristics except female predominance in hemorrhoid group (p = 0.07). Scores of heavy legs, swelling, burning sensation, restless leg, throbbing, tingling, and total VEINES score were significantly lower (ie: worse) in hemorrhoid group. Logistic regression analysis revealed that female gender and total VEINES score were independently associated with HD (OR: 2.03, 95% CI: 1.17-3.52, p = 0.01; OR: 0.96, 95% CI: 0.92-0.99, p = 0.02, respectively). Among all venous leg symptoms, severity of heavy legs, night cramps, swelling and aching were significantly correlated with the grades of HD. Conclusion: We have shown significant association between the HD and venous leg symptoms reflected by total VEINES score and significant correlation between the HD grade and venous leg symptoms severity including heavy legs, swelling, night cramps and aching legs. [ABSTRACT FROM AUTHOR]

Purpose. Hemorrhoidal disease (HD) is a widespread condition severely influencing patients' quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. Methods. Patients affected by III–IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium–long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. Results. We enrolled 433 patients (277 SLAP1 and 156 SLAP2). Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. Conclusions. The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoidal disease most commonly manifests itself with chronic rectal bleeding and, in its most severe and refractory forms, may lead to chronic anaemia with the need for recurrent blood transfusions. The main pathogenetic mechanism involved seems to be arterial hyperflux in the terminal branches that supply the hemorrhoidal plexus. It is based on this principle, that embolization of the superior rectal artery (emborrhoid technique) has recently re-emerged, with very promising results that support its feasibility, treatment efficacy, and safety. Case presentation: We report a case of a patient with both recurrent hemorrhoidal bleeding and portal hypertension with rectal varices, who underwent SRA embolization as a salvage therapy, with significant clinical improvement and no immediate or short-term complications. Conclusions: We believe that the positive results from our case raise the possibility that the emborrhoid technique could be effective and safe even in patients with portal hypertension, and that it would be clinically relevant to investigate this hypothesis on larger samples with a longer follow-up. [ABSTRACT FROM AUTHOR]

Background and Aim: Several evidences have shown how, in hemorrhoidal disease, phlebotonic flavonoid agents such as quercetin reduce capillary permeability by increasing vascular walls resistance, how rutin and vitamin C have antioxidant properties, and that Centella asiatica has reparative properties towards the connective tissue. A retrospective study was designed in order to evaluate the efficacy and safety of a compound consisting of micronized flavonoids in combination with vitamin C and extracts of C. asiatica , Vaccinium myrtillus , and Vitis vinifera for grade II and III hemorrhoidal disease. Patients and Methods: Data of 49 patients, over 18, who were following a free diet regimen, not on therapy with other anti-hemorrhoid agents, treated with a compound consisting of 450 mg of micronized diosmin, 300 mg of C. asiatica , 270 mg of micronized hesperidin, 200 mg of V. vinifera , 160 mg of vitamin C, 160 mg of V. myrtillus , 140 mg of micronized quercetin, and 130 mg of micronized rutin (1 sachet or 2 tablets a day) for 7 days were collected. Hemorrhoid grade according to Goligher's scale together with anorectal symptoms (edema, prolapse, itching, thrombosis, burning, pain, tenesmus, and bleeding) both before treatment (T0) and after 7 days of therapy (T7) were collected. Primary outcomes were the reduction of at least one degree of hemorrhoids according to Goligher's scale assessed by proctological examination and compound safety. The secondary outcome was the reduction of anorectal symptoms assessed by questionnaires administered to patients. Results: Forty-four patients (89.8%) presented a reduction in hemorrhoidal grade of at least one grade (p < 0.001). No adverse events with the use of the compound were noted. A significant reduction was observed in all anorectal symptoms evaluated (p < 0.05). No predictors of response to the compound were identified among the clinical and demographic variables collected. Conclusion: The compound analyzed was effective and safe for patients with grade II and III hemorrhoidal disease according to Goligher's scale. [ABSTRACT FROM AUTHOR]

Purpose: Hemorrhoidectomy remains the gold standard treatment for grade III–IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery, post-operative pain has been a limitation to the widespread inclusion of this condition in day surgery programs. The aims of the study were to analyze and compare the post-operative pain of conventional open hemorrhoidectomy, considered the reference technique, against other surgical procedures such as closed hemorrhoidectomy, open hemorrhoidectomy using bipolar or ultrasonic sealant, hemorrhoidopexy, or HAL-RAR, when performed exclusively as outpatients. Methods: A systematic review and meta-analysis was conducted according to PRISMA methodology. All prospective and randomized studies of patients operated on for hemorrhoids in day surgery and specifying the value of post-operative pain, using a validated scale, were included. Conventional meta-analyses and a random-effects network meta-analysis were carried out. Results: Twenty-nine studies were included (3309 patients). None of the procedures described severe pain in the post-operative period. Hemorrhoidopexy was the least painful. Conventional open hemorrhoidectomy was the most painful on the first and seventh post-operative days. Pain was reduced after closed hemorrhoidectomy technique and when bipolar or harmonic scalpel was used. Furthermore, transfixive ligation of the hemorrhoidal pedicle was associated with increased post-operative pain. Conclusion: Hemorrhoidal surgery is feasible in day surgery units and post-operative pain can be adequately managed in an outpatient setting. Hemorrhoidopexy was the least painful; however, data should be carefully evaluated by the high rate of long-term recurrence described in literature. Closed hemorrhoidectomy, performed with bipolar or ultrasonic sealing, avoiding transfixive ligation of the hemorrhoidal pedicle, may improve post-operative pain control. Trial registration: CRD42020185160 [ABSTRACT FROM AUTHOR]

Background and Aim: Several evidences have shown how, in hemorrhoidal disease, phlebotonic flavonoid agents such as quercetin reduce capillary permeability by increasing vascular walls resistance, how rutin and vitamin C have antioxidant properties, and that Centella asiatica has reparative properties towards the connective tissue. A retrospective study was designed in order to evaluate the efficacy and safety of a compound consisting of micronized flavonoids in combination with vitamin C and extracts of C. asiatica, Vaccinium myrtillus, and Vitis vinifera for grade II and III hemorrhoidal disease.Patients and Methods: Data of 49 patients, over 18, who were following a free diet regimen, not on therapy with other anti-hemorrhoid agents, treated with a compound consisting of 450 mg of micronized diosmin, 300 mg of C. asiatica, 270 mg of micronized hesperidin, 200 mg of V. vinifera, 160 mg of vitamin C, 160 mg of V. myrtillus, 140 mg of micronized quercetin, and 130 mg of micronized rutin (1 sachet or 2 tablets a day) for 7 days were collected. Hemorrhoid grade according to Goligher’s scale together with anorectal symptoms (edema, prolapse, itching, thrombosis, burning, pain, tenesmus, and bleeding) both before treatment (T0) and after 7 days of therapy (T7) were collected. Primary outcomes were the reduction of at least one degree of hemorrhoids according to Goligher’s scale assessed by proctological examination and compound safety. The secondary outcome was the reduction of anorectal symptoms assessed by questionnaires administered to patients.Results: Forty-four patients (89.8%) presented a reduction in hemorrhoidal grade of at least one grade (p < 0.001). No adverse events with the use of the compound were noted. A significant reduction was observed in all anorectal symptoms evaluated (p < 0.05). No predictors of response to the compound were identified among the clinical and demographic variables collected.Conclusion: The compound analyzed was effective and safe for patients with grade II and III hemorrhoidal disease according to Goligher’s scale.

Purpose: A wide variety of methods has been proposed for treating hemorrhoidal disease. The aim of the study is to assess the safety and effectiveness of hemorrhoidal artery ligation with rectoanal repair (HAL-RAR). Methods: Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease. Demographics, degree of disease, hospital stay, postoperative pain, complications, and recurrence were recorded. Patients were followed up at postoperative days 1 and 8 and at 1, 6, and 12 months. Results: A total of 105 patients (60 men, 45 women) underwent HAL-RAR. Median age was 49 (range, 20–86) years. Two patients with hemorrhoidal thrombosis underwent emergent excision of the hemorrhoid. Median length of hospital stay was 2 (range, 1–13) days. Patients reported median visual analog scale pain score 3 (range, 1–5) on the 1st postoperative day. At 1 month, no patient reported pain, 84.76% of patients confirmed complete resolution of symptoms, while complication rate was 7.61%: 2 patients presented urinary retention, 3 dyschezia, 2 bleeding, and 1 hemorrhoidal necrosis. At 6 months, 2 patients presented mild symptoms and 7 recurrence. At 12 months, 92.4% of patients experienced complete resolution of symptoms, 2 patients intermittent bleeding, and 2 recurrence. Overall recurrence and re-intervention rate were 8.57% rate and 10.5%, respectively. Conclusion: HAL-RAR is a safe and effective minimal invasive operative technique related to a high percentage of success, low complication, and recurrence rates. Long-term follow-up is lacking and would better establish the results of this technique. Trial registration: Trial registration number NCT04778124 Date of registration 26/02/2021 "retrospectively registered" [ABSTRACT FROM AUTHOR]

Résumé: La proctologie est un motif de consultation fréquent en gastro-entérologie rapporté jusque dans 20 % des cas. Il l'est également en médecine générale avec un diagnostic parfois erroné par défaut d'examen clinique ou de connaissance. Les principales affections sont la maladie hémorroïdaire, la fissure anale, les suppurations et les infections sexuellement transmissibles. Les plaintes se résument à une douleur, une tuméfaction, un prurit, un saignement. À partir de ces éléments qu'il va falloir préciser lors de l'interrogatoire, un diagnostic sera évoqué et le plus souvent confirmé par l'examen physique. Plus rarement, des examens complémentaires seront nécessaires. Il faut prendre le temps d'écouter, de revenir sur des antécédents importants comme une chirurgie anale, un accouchement traumatique, une maladie inflammatoire chronique de l'intestin. Un trouble du transit, l'ancienneté des troubles, leur caractère récurrent, la rapidité d'apparition, les traitements tentés doivent être précisés. Il faut savoir regarder dans de bonnes conditions, en genu pectoral ou décubitus latéral gauche, avec un éclairage de qualité suffisamment puissant, un lubrifiant à l'eau, un anesthésique de contact (type lidocaïne chlorhydrate gel à 2 % ou pramocaïne chlorhydrate, gel à 1 %) et des anuscopes de taille différente. Ces cas cliniques sont là pour rappeler l'importance de la séméiologie dans la prise en charge des patients qui consultent en proctologie. Proctology is frequent in gastroenterology consultation, reported up to 20% of cases. It is also frequent in general practice with sometimes an erroneous diagnosis because of a lack of knowledge or physical examination. The most frequent diagnoses are hemorrhoidal disease, anal fissure, anal infections and sexually transmitted infections. The symptoms are pain, a tumefaction, itching and bleeding. From these elements which will have to be specified during the interview, a diagnosis will be evoked and most often confirmed by the physical examination. More rarely, complementary procedures will be necessary. It is important to take time to listen, to review important points as anal surgery, obstetric injuries, inflammatory bowel disease. A transit disorder, the age of the symptoms, their recurrent characteristic, the date of the beginning, treatments tried, must be specified. It is important to examine in good conditions, in knees to chest or left lateral side position, with a sufficient powerful quality lighting, a water-based lubricant, a local anesthetic (for example, lidocaine hydrochloride 2% jelly or pramoxine hydrochloride 1% jelly) and different sizes of proctoscope. The following clinical cases are there to remind you how much the semiology is important in the management of proctological diseases. [ABSTRACT FROM AUTHOR]

Copyright of Praktické Lékárenství is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Infective endocarditis with Enterococcus spp. is common in patients with digestive tract diseases. Such patients should be monitored periodically through clinical examination and colonoscopy, to detect the recurrence of seemingly cured disease. There are currently no studies on the incidence of infective endocarditis in patients with hemorrhoidal disease. Case report: The case of a 48-year-old man is addressed, known with type 2 diabetes mellitus, with a seemingly cured hemorrhoidal disease, who developed infective endocarditis of the mitral and aortic valve, complicated by ischemic stroke as the first symptom. After six weeks of antibiotic treatment, an almost complete echocardiographic resolution of the vegetation was achieved, such that surgical intervention was postponed. Conclusion: Performing a colonoscopy in all Enterococcus spp. infective endocarditis patients, regardless of the presumed source of infection, could be helpful in diagnosing colorectal disease and avoiding a new bacteraemia episode - and eventually infective endocarditis - by the same or a different microorganism. The presented case emphasizes the importance of periodic monitoring of the digestive tract for hemorrhoidal disease in patients with a high risk of recurrence - due to high risk of bacteraemia and systemic complications. Moreover, it is worth noting that in certain cases, efficient antibiotic treatment on its own can achieve an outstanding result for patients with large vegetations, presenting with an embolic episode, and thus postpone (indefinitely) a surgical intervention. [ABSTRACT FROM AUTHOR]

Hemorrhoidal disease (HD) is a frequent health problem with considerable repercussions on patients’ quality of life. However, much of the clinical practice related to HD is based on knowledge without scientific evidence and supported largely by empirical experience of the physician who deals with this pathology. As in other countries, the goal of this consensus is to establish statements supported by solid scientific evidence and whose purpose will be to standardize and guide the diagnosis and management of HD both in the general population and in some particular groups of patients.

Hemorrhoidal disease has been known since ancient times and remains one of the most common human diseases. This review presents the results of tribenoside and lidocaine combinations used in the conservative therapy of hemorrhoids, which give grounds to recommend combination therapy with tribenoside and lidocaine in the form of rectal cream and rectal suppositories as an effective and safe method of local treatment of hemorrhoids and moderate severity in different categories of patients, allowing to achieve rapid clinical improvement.

Constipation, a low fiber diet, a high Body Mass Index, pregnancy, and a sedentary lifestyle are often assumed to increase the risk of hemorrhoidal disease (HD). However, evidence regarding these factors is controversial. This mini-review aims to examine and critically analyze the association between main risk factors and the prevalence of HD, focusing both on the patient's clinical history and on a tailored treatment. Moreover, some practical suggestions about lifestyle and conservative approaches are given to help clinicians in the management of patients with HD and to obtain the best results from therapy.

Purpose: We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD). Methods: The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL. Results: A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19 years; mean BMI 24 ± 3 kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4 h postoperatively. Four patients (5.3%) suffered tenesmus for about 1 week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1 day postoperatively, then at 1 week, 1 month and 1 year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65). Conclusion: Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12 mm and running a long mucopexy suture line. [ABSTRACT FROM AUTHOR]

To determine the frequency of symptoms (bleeding, pain, rectal swelling, itching, soiling, constipation) in subjects consulting for hemorrhoidal disease and assess the possible concomitance between hemorrhoids and chronic venous disease (CVD). CHORUS is a multinational cross-sectional survey carried out in seven countries. Consecutive patients consulting for hemorrhoidal disease were screened to confirm the presence of chronic venous disease. Data collected exclusively from India is analyzed here. Of the 2511 eligible patients, 63.8% were male and the mean age was 43.3 ± 12.2 years. Overall, 95.7% patients had physician-confirmed hemorrhoidal disease. Bleeding, swelling, prolapse, and fecal incontinence were significantly associated with the presence of hemorrhoidal disease (p < 0.0001). About one third of patients (37.5%) had reported simultaneous occurrence of hemorrhoidal disease and CVD and the occurrence of hemorrhoidal disease was significantly correlated with the presence of CVD (p = 0.004). Moreover, 70.4% patients with CVD had recurrent hemorrhoidal disease (p < 0.0001). Venoactive drug was the most commonly (95.7% cases) prescribed treatment; micronized purified flavonoid fraction was the most widely used (86.2%) venoactive drug. More than one third individuals with hemorrhoidal disease in our study had CVD, which highlights the importance of investigating signs of CVD in patient with hemorrhoids during daily clinical practice which could help better understand the disease and optimize the management. [ABSTRACT FROM AUTHOR]

Background: We conducted a systematic review to assess the safety and efficacy of Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for the treatment of hemorrhoidal disease., Methods: Our study was conducted in accordance with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020. Primary endpoints included overall recurrence and type of recurrence while secondary endpoints included postoperative complications, reintervention, presence of rectal ulcer, rectal stricture, defecation abnormalities and perianal abscess. Α regression analysis, where the percentage of patients with grade II, III and IV hemorrhoidal disease was used as a covariate, was also performed., Results: Twelve studies with 4249 patients met all the inclusion criteria and were eventually included. The crude and pooled estimates of the overall recurrence and complications by the end of follow-up were 10% (95% CI, 6.52%-14.08%) and 5.20% (95% CI, 2.59%-8.52%), respectively. Regression analysis displayed no correlation between recurrence and the grade of hemorrhoid disease II, β= -0.0012 (95% CI, -0.0074 to 0.0049) ( p  = .64), grade III β= -0.0006 (95% CI, -0.0056 to 0.0045) ( p  = .79) and grade IV β = 0.0025 (95% CI, -0.0075 to 0.0124). However, a trend suggestive of increased recurrence was observed in patient populations with a higher proportion of grade IV disease., Conclusion: ALTA sclerotherapy may be a safe and viable alternative for patients with hemorrhoidal disease. Long-term follow-up and high-quality randomized controlled trials will help define the place of ALTA sclerotherapy in the armamentarium of treatment of hemorrhoids.

Hemorrhoidal disease is a widespread proctologic clinical entity. Even if surgical excision is an effective treatment, it only represents the standard procedure for patients with high-grade hemorrhoids. Considering that most cases are grade I or II hemorrhoids, oral or topical therapies are widely used despite, currently, there are no satisfactory options for these kinds of treatments. The pathology involves the degeneration of the supporting tissue of the anal cushions, causing venous dilation, blood stagnation, formation of edematous venous plexus covered by mucosa and inflammation. An effective treatment must, therefore, be multi-targeted and capable of acting on all the pathological mechanisms simultaneously. During the 8th National Congress of the Italian Association of Colorectal Surgery (SICCR), some clinical evidence of hemorrhoidal disease has been discussed along with new opportunities in oral and topical treatment options. Among these, the effectiveness and the safety of two innovative products, a sublingual nanoemulsion and a liquid bandage, has been reported. [ABSTRACT FROM AUTHOR]

Hemorrhoidal disease (HD) treatment still remains controversial. In fact, despite many surgical progresses, postoperative pain, and discomfort remain the major weaknesses. Laser hemorrhoidoplasty (LHP) is a minimal invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser. The aim of the current study is to analyze the feasibility and efficacy of LHP in patients with II–III degrees hemorrhoids. Consecutive patients with II–III degree hemorrhoids were enrolled in the study and underwent an LHP treatment using a 1470-nm diode laser. Operative time, postoperative pain and complications, resolution of symptoms, and length of return to daily activity were prospectively evaluated. Recurrence of prolapsed hemorrhoid or symptoms at a minimum follow-up of 6 months was evaluated. Fifty patients (28 males and 22 females) were enrolled in the study. No significant intraoperative complications occurred. Postoperative pain score (at 12, 18, and 24 h postoperatively), evaluated through visual analogue scale, was extremely low (mean value 2). No postoperative spontaneous bleeding occurred. The 100% of our population came back to daily activity 2 days after surgery. At a mean follow-up period of 8.6 months, we reported a recurrence rate of 0%. LHP demonstrated a large efficacy in selected patients. The greatest strength points were low postoperative pain, the presence of slightly significant peri-anal wounds, no special anal hygienic measures and low surgical time. Thus, resulting in a negligible postoperative discomfort, LHP could be considered a painless and minimal invasive technique in the treatment of HD. [ABSTRACT FROM AUTHOR]

Introduction: Hemorrhoidal disease (HD) is a common and recurrent problem for many adults worldwide. Venoactive drugs, such as micronized purified flavonoid fraction (MPFF; Daflon®), have been used to treat HD and their clinical benefits have been demonstrated in previous meta-analyses of clinical trials. The aim of this study was to evaluate the efficacy of MPFF across the broader spectrum of signs and symptoms following treatment of patients with HD.Methods: We performed a systematic review of the literature to identify randomized clinical trials in which MPFF treatment was compared to placebo or no treatment for acute HD or for relief of symptoms after patients had undergone medical management or a surgical procedure to remove hemorrhoids. The main endpoints investigated were bleeding, pain, pruritus, discharge or leakage, and overall improvement. There was no limit on treatment duration.Results: From 351 unique records retrieved, 11 studies reported in 13 articles were included. On the basis of findings from qualitative analysis, MPFF was reported in most studies to be beneficial in treating bleeding, pain, pruritus, anal discharge/leakage, and tenesmus, and in overall improvement. Quantitative meta-analysis of four studies indicated that MPFF treatment provided significant benefits for bleeding (odds ratio [OR] 0.082, 95% confidence interval [CI] 0.027-0.250; P < 0.001), discharge/leakage (OR 0.12, 95% CI 0.04-0.42; P < 0.001), and overall improvement according to patients (OR 5.25, 95% CI 2.58-10.68; P < 0.001) and investigators (OR 5.51, 95% CI 2.76-11.0; P < 0.001). MPFF also tended to decrease pain (OR 0.11, 95% CI 0.01-1.11; P = 0.06).Conclusion: Taken together, these results suggest that MPFF treatment can improve the most important signs and symptoms of HD. [ABSTRACT FROM AUTHOR]

Background and Aim: The CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research) was conducted to provide data on patients presenting with hemorrhoidal disease (HD) in clinical practice and to explore the frequency with which it coexists with chronic venous disease (CVD) and shared risk factors. Methods: This international, noninterventional study enrolled adult patients attending a consultation for hemorrhoidal complaints. The questionnaire completed by physicians established the subjects' demographic and lifestyle characteristics and collected information on HD grade and symptoms and signs of CVD. Results: A total of 5617 patients were analyzed. Symptoms commonly reported were bleeding (71.8%), pain (67.4%), swelling (55.0%), itching (44.1%), and prolapse (36.2%). Multivariate analysis revealed the variables with the strongest association with HD severity were older age, higher CVD CEAP (Clinical manifestations, Etiologic factors, Anatomic distribution of disease, and underlying Pathophysiology) class, constipation, and male gender (all P < 0.0001). Elevated BMI was a risk factor for HD recurrence. Among women, number of births had a significant association with both HD grade and recurrence. The presence of CVD, reported in approximately half the patients (51.2%), was strongly associated with advanced grade of HD (P < 0.0001). Treatments most commonly prescribed were venoactive drugs (94.3%), dietary fiber (71.4%), topical treatment (70.3%), analgesics (26.3%), and surgery (23.5%). Conclusions: CHORUS provides a snap shot of current profiles, risk factors, and treatments of patients with HD across the globe. The coexistence of HD and CVD in more than half the study population highlights the importance of examining for CVD among patients with a hemorrhoid diagnosis, particularly when shared risk factors are present. [ABSTRACT FROM AUTHOR]

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Aim: Comparison the application and effectiveness of hemorrhoidal artery ligation (HAL) and rubber band ligation (RBL) techniques in the treatment of grade II and III hemorrhoidal disease. Method: HAL was performed in 50 patients between December 2006 and May 2007 and RBL was performed in 96 patients between August 2011 and October 2014. A total of 146 patients with grade II-III hemorrhoidal disease were included in this retrospective study. Surgery duration, performed ligations, pain on postoperative day 7 visual analog scale, complications, and ratio of symptom-free patients at 6 months were statistically analyzed for both procedures. Results: Patients who underwent HAL returned to work earlier and had less pain on postoperative day 7 than those who underwent RBL; in addition, the RBL procedure was statistically more cost-effective and had shorter surgery times. There was no statistical difference between the HAL and RBL groups in proportion of patients who were symptom-free at postoperative 6 months (94% and 96.6%, respectively). Conclusion: The RBL and HAL procedures are both effective and have low complication, and can be used safely together or separately in the treatment of grade II-III hemorrhoidal disease.

Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication. The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE. These guidelines are inclusive and not prescriptive. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C. [ABSTRACT FROM AUTHOR]

Background: Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5 years) for patients with hemorrhoidal disease. Methods: A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009–April 2013. Patients were followed clinically for 1 month and with a questionnaire until 5 years after surgery or until they underwent a second surgery for recurrent hemorrhoids. Results: Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2 days (median = 2 days; range = 1–8 days). No major complications were described. There were no deaths. At 5 years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36 months (median 27.4 months). The majority (61.4%) of patients were satisfied with the procedure. Conclusions: Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation. [ABSTRACT FROM AUTHOR]

Introduction. HIV infection is one of the pandemics of the twentieth and twenty-first centuries. In Mexico, according to the National Institute of Statistics and Geography (INEGI), a total of 286,700 cases have been recorded in the period from 1983 to 2018. Anorectal pathology is one of the major causes of morbidity in this population and the main cause of surgical intervention. Information on the prevalence of these entities in the Mexican population is scarce, so the objective of this study was to describe the prevalence of anorectal pathologies in individuals with HIV / AIDS who attend the Coloproctology Service of the Hospital Civil de Guadalajara Fray Antonio Alcalde. Methods. This was a retrospective study carried out in the Coloproctology service of the Hospital Civil de Guadalajara Fray Antonio Alcalde, which included individuals with HIV / AIDS infection treated in the outpatient clinic who had a diagnosis of benign anorectal pathology, during the period from January 1st, 2015 to April 30, 2019. Different variables such as sex, age, T-CD4 + lymphocyte count, HIV viral load, time of evolution of the HIV infection diagnosis, history of anoreceptive intercourse, type of sexual practice, number of sexual partners, use of treatment were analyzed. antiretroviral, clinical features of anorectal pathology and type of treatment used. Statistical analysis was performed with the IBM SPSS Statistics version 24 software. Results. There were 381 evaluations for benign anorectal pathology in individuals with HIV infection. The majority of individuals (n = 350, 91.9%) were male and the average age was 37.7 years. 57.5% (n = 219), were men who reported having sex with men; while 81.4% said they had anoreceptive intercourses. The majority (72.2%) were under ART and 24% were in AIDS. The most frequent pathology was condylomatous disease followed by hemorrhoidal disease and anal fissure. Only 12.8% had more than one anorectal pathology and 7.9% had recurrences. Discussion. In individuals living with HIV infection treated at our institution, the most frequent anorectal pathology was anal condylomatous disease. The risk factors for presenting this entity were similar to those previously described. With the change in epidemiology and life expectancy of those living with HIV, the prevalence of benign anorectal pathology has changed so that this work lays the foundations for future research in which risk factors for development other than infection are identified as well as prospective monitoring and quality of life assessments. [ABSTRACT FROM AUTHOR]