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Purpose: The aim of this study was to evaluate the real-life clinical and radiological efficacy of darvadstrocel injection into complex perianal fistulas in Crohn’s disease. Secondary endpoints were to assess symptomatic efficacy, outcomes and factors associated with complete combined clinical-radiological response (deep response). Methods: After marketing the product in France, all patients treated consecutively were included. A complete clinical response was defined by a complete closure of all external openings with no discharge on pressure. A partial response was defined by closure of ≥ 50% of external openings with no discharge on pressure. A complete radiological response (MRI), evaluated at least after six months of follow-up, was defined by a completely fibrotic sequela without abscess. Results: Forty-three patients were included (M/F: 22/21, median age 37 [26-45] years). The fistulas of all patients were already drained with seton(s) and were on biologic treatment. After a median follow-up of 383 [359-505] days, 28 (65%) patients showed a clinical response (22 complete and 6 partial). Only 16 (37%) achieved a deep response. The PDAI decreased significantly after treatment: 39 (91%) patients reported symptomatic improvement in terms of discharge, pain, and induration, and 28 (65%) no longer had any perineal symptoms. Only a short history of Crohn’s disease < 3 years was significantly associated with deep response (OD 4.5 [1.0-19.1], p = 0.04). Conclusion: Darvadstrocel injection resulted in a clinical response for two thirds of patients and deep response for one third. A shorter duration of Crohn’s disease was associated with deep response.

Study Aim The aim of the present study was to compare in real life the characteristics of treatment with infliximab according to the presence or absence of anoperineal involvement in Crohn's disease. Methods We performed a single-center, prospective, non-interventional study, on patients with Crohn's disease in remission who had been treated with infliximab for at least 1 year. Patients with poor treatment compliance, on antibiotics, or those with a stoma were excluded. Results We included 52 patients in this study: 34 with anoperineal lesions with or without luminal lesions, and 18 with luminal lesions only. Patients with anoperineal lesions were more likely to have undergone surgery (70.6% versus 38.9%, p = 0.027), had a shorter median time to infliximab treatment initiation (0.5 versus 5.5 years, p = 0.005), a higher mean dose of infliximab (6.6 versus 5.1 mg/kg, p = 0.015), and were more likely to receive combination treatments including infliximab (52.9% versus 11.1%, p = 0.008) than patients with luminal involvement only. Conclusions In our study, infliximab treatment was initiated more quickly, at higher doses, and more in combination therapy for anoperineal Crohn's disease than for luminal damage alone. Additional studies are required to confirm this finding and to assess the tolerance of this treatment throughout patient management.

BACKGROUND The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. METHODS All adult patients treated with SiLaT in our department between June 1, 2018, and August 23, 2019, were included in the study. Success was defined as the closure of cutaneous orifices and the absence of discharge or abscesses. RESULTS We included 29 consecutive patients (22 males) with a median age of 32.5 ± 10.5 years. Eight patients had already undergone prior surgery for pilonidal disease. The procedure was performed under spinal (55%) or general (45%) anesthesia. The mean follow-up was 370.3 days (± 165.8 days). We observed 2 primary failures (6.9%) and 7 recurrences (24.1%). Ultimately, 20 patients were considered to have been cured (69%). The mean time to healing was 25 days (± 8.1 days). No serious complications were reported. Usual activities were resumed within a mean of 4.9 days (± 7.2), and 86% of patients reported being "very satisfied" with the treatment. The body mass index was lower for patients who were cured (24.0 ± 3.6) than for those who experienced treatment failure (27.6 ± 3.4; p = 0.018). The cured patients were less likely to have one or more secondary openings (35.0 versus 88.9%, p = 0.014). CONCLUSIONS Almost 70% of our patients were cured by SiLaT. Complications were rare and mild. The technique appeared to be less effective for overweight patients and those with one or more secondary openings associated with pilonidal pits.

The aim of this study was to evaluate the outcome of hemorrhoidal surgery in patients with inflammatory bowel disease (IBD) undergoing surgery at our center. All adult patients with IBD undergoing hemorrhoidal surgery in our department between November 1, 2013 and July 7, 2020 were included in the study. At the time of surgery, the patients’ IBD was in clinical, biological and endoscopic remission, and none of the patients had specific primary anoperineal lesions. We included 25 patients (48% female) with a mean age 48 years (± 13.1 years). There were 13 cases of CD (52%) and 12 of ulcerative colitis (UC). Pharmacological and instrumental hemorrhoidal treatment had failed in all patients. The CD lesions were exclusively ileal (77%) or ileocolic (23%). The surgical procedures performed for CD were mono-hemorrhoidectomy in three patients (21.4%), tripedicular hemorrhoidectomy in six patients (42.9%), and artery ligations with mucopexy in five patients (35.7%). UC was rectal (16.7%), rectosigmoid (66.7%), or pancolic (16.6%). The surgical procedures performed for UC were a tripedicular hemorrhoidectomy in ten patients (83.3%) and artery ligations with mucopexy in two patients (16.7%). The mean duration of postoperative follow-up was 15.1 months. None of the patients was lost to follow-up. The mean time to wound healing after resection was 71.1 days (± 21 days) for patients with CD and 56.9 days (± 6.7 days) for patients with UC (p = 0.05). Postoperative complications were reported for four patients with CD (28.8%) and two patients with UC (16.7%). There was no suppuration, stenosis, or anal incontinence sequelae. Hemorrhoidal surgery resulted in a non-negligible frequency of complications in our series of IBD patients, especially in those with CD. Caution is, therefore, still necessary in this patient population.

The aim of our study was to evaluate the efficacy of FiLaC® (Fistula Laser Closure) in the treatment of perianal fistulas in patients with Crohn’s disease. All adult patients treated in our department between March 3rd 2016 and November 16th 2018 were included in the study. The fistula was considered healed when the internal and external openings were closed and the patient experienced no pain or leakage (spontaneously or under pressure). We included 20 consecutive patients (10 women) with a mean age of 32 years ± 9.61. The main fistula tracks were intersphincteric (n = 1, 5%), low (n = 3, 15%) or high (n = 14, 70%) transsphincteric, suprasphincteric (n = 1, 5%), or extrasphincteric (n = 1, 5%). Secondary extension (intramural, supralevator, or horseshoe) was found in 6 cases (30%). The average number of previous surgeries was 2.45 ± 1.47. Crohn’s disease extension was ileal in 2 patients (10%), ileocolonic in 8 patients (40%), and colonic in 10 patients (50%). Two patients were lost to follow up and were considered as failures. After a median follow-up period of 7.1 months (range 2–22.5 months), fistula healing was observed in 11 patients (55%). On univariate analysis, only the disease-modifying therapy for Crohn’s disease was a predictive factor of a response to FiLaC® (p = 0.05). The specific analysis of this subgroup showed that FiLaC® was less effective when patients were treated with anti-tumor necrosis factor (TNF) alone with an OR of 13.06 [1.28; 236.66] (p = 0.02). For combination therapy, the results seemed better (5 of 6 healed versus 2 of 9 healed with anti-TNF alone), but the difference was not significant. This pilot study suggests that FiLaC® may play an important role in the management of perianal fistulas in patients with Crohn’s disease.

Resume Introduction L’hidradenome papillifere (HP) est une proliferation adenomateuse de glandes ano-genitales de type mammaire. Ces glandes siegent electivement dans les sillons interlabiaux de la vulve, sur le perinee et sur la marge anale. Quatre-vingt dix pour cent des HP se situent sur la vulve. La localisation anale est moins connue. Objectifs Analyser les caracteristiques cliniques et histologiques des HP de l’anus et les comparer a ceux de la vulve en se fondant sur les donnees de la litterature. Methodes Analyse retrospective monocentrique (service de proctologie medico-chirurgicale du groupe hospitalier Paris Saint-Joseph) des dossiers de patients chez qui le diagnostic d’HP anal a ete pose sur l’analyse anatomopathologique de la piece d’exerese. Resultats Quatorze patientes vues entre 2012 et 2018 ont ete incluses. L’âge moyen etait 48,2 ans (22 a 70). La tumeur, toujours unique, etait le plus souvent asymptomatique et de croissance lente. Elle siegeait toujours a la marge anale. Il s’agissait le plus souvent d’un nodule rond, infracentimetrique, a peine saillant, translucide, mobile. Dans 15 % des cas, la tumeur etait ulceree. Sur le plan histologique, elle avait les caracteristiques habituelles des HP. Une seule recidive est survenue, six ans apres l’exerese. Conclusion Les aspects cliniques et histologiques des HP de l’anus sont superposables a ceux de la vulve, qui sont mieux documentes : petite tumeur arrondie, rose, translucide ou bleutee, mobile, a surface lisse, plus rarement ulceree ou bourgeonnante, le plus souvent asymptomatique. Les HP de notre serie concernaient tous des femmes et se situaient tous sur la marge anale. L’examen anatomopathologique de la piece d’exerese permet de confirmer le diagnostic et d’exclure une tumeur maligne. La frequence des HP anaux est possiblement sous-estimee.

The aim of our study was to prospectively evaluate the effectiveness of the Fistula Laser Closure (FiLaC®) technique in patients at high risk of anal incontinence and to determine the predictors of success and the impact of the procedure on anal continence. A prospective study was conducted on all patients treated with FiLaC® in our department in May 2016–April 2017, because they were at high risk of anal incontinence after fistulotomy, The fistula was considered healed when the internal and external openings were closed and the patient experienced was no pain or leakage. A total of 69 consecutive patients (34 males) with a median age of 40 years (33–53 years) were included in the study. One patient was lost to follow up. The fistulas were intersphincteric (3%), low (15%) or high (66%) trans-sphincteric, and suprasphincteric (16%). After a median follow-up period of 6.3 months (4.2–9.3), fistula healing was observed in 31 patients (45.6%). In univariate analysis, high trans-sphincteric fistulas (p = 0.007) and age over 50 years (p = 0.034) were significantly associated with healing. In multivariate analysis, only high trans-sphincteric fistulas were a predictive factor of significant success. No new cases of anal incontinence or any worsening in case of pre-existing anal incontinence were observed during follow-up. FiLaC® is particularly effective in cases of high trans-sphincteric fistulas (60% cure). This technique seems to be the most promising sphincter-saving technique available for this indication.

Summary Any gastroenterologist must be trained to properly diagnose anoperineal lesions in patients with Crohn's disease (APLOC). The aim of this study was to establish whether adding pictures would improve teaching effectiveness of the diagnosis of APLOC to French gastroenterology trainees. Method Trainees were asked to answer a first web-based survey consisting of evaluating 12 pictures of APLOC with a closed answer questionnaire. They were then randomized in 2 groups. Group A received an online teaching with typical pictures and APLOC definitions and group B definitions only. Trainees were asked again seven days later to answer a second survey with 12 other pictures of APLOC and 14 experts also answered this survey. Diagnostic scores were expressed in %. The primary endpoint was the comparison of the score of survey 2 between the two groups of trainees. Secondary endpoints were to compare results of survey 2 between trainees of both groups and experts, and assess diagnosis of each lesion. Results Two hundred fourty eight trainees among 465 answered survey 1, and 195 survey 2. The diagnostic score was 71.9% for groups A and B and 74.6% for experts (differences NS). After training diagnosis of ulceration was 72% for group A and 72.9% for group B, fistulae 85.2% versus 85.8%, erythema 44.1% vs. 55.6%, anoperineal scars 67.5% vs. 65.6%, and abscess 100% (differences NS). Conclusion There was no difference between the two teaching methods. Further research should be performed aiming at improving teaching material and quotation baremes.

Le laser FiLaC®, la VAAFT® et la radiofréquence sont les trois traitements chirurgicaux d’épargne sphinctérienne disponibles qui traitent le trajet fistuleux par l’intérieur en le coagulant avec une énergie différente selon la technique choisie. Ils ont l’avantage d’une facilité d’utilisation, d’une morbidité faible et d’un impact quasi nul sur la continence anale. Les résultats préliminaires concernant le FiLaC® et la VAAFT® sont encourageants. Cependant, aucune étude n’a été encore publiée concernant la radiofréquence. Malgré leur coût plus important que les traitements qui ne reposent que sur la technique chirurgicale sans nécessité de matériel spécifique (comme le lambeau d’abaissement et la ligature intersphinctérienne du trajet fistuleux « LIFT »), elles viennent enrichir l’arsenal des traitements d’épargne sphinctérienne, puisque le gold standard n’existe pas encore…

The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for anal ulcerations and anorectal stenosis are suggested. Recommendations have been graded following international recommendations, and when absent professional agreement was established. For each situation, practical algorithms have been drawn.

La patologia emorroidaria e la principale causa di visita in proctologia. Quando diventano complicate, le emorroidi esterne causano trombosi e le emorroidi interne sono responsabili di sanguinamenti e/o di prolasso. I principali trattamenti strumentali sono la fotocoagulazione a infrarossi e la legatura elastica. Chirurgicamente, l’emorroidectomia e piu efficace a lungo termine, ma espone a sequele piu lunghe e piu dolorose. L’intervento di Longo o la legatura sotto controllo Doppler con o senza mucopessi hanno indicazioni piu limitate e un tasso di fallimento e di recidiva piu importante. La ragade anale e la seconda causa principale di consultazione in proctologia. La diagnosi e spesso clinicamente evidente. Il trattamento medico, in particolar modo con la regolarizzazione del transito, e la prima linea solitamente raccomandata. Tuttavia, la chirurgia e il trattamento a lungo termine piu efficace. Si basa su due principi che possono essere associati: ridurre il tono dello sfintere ed eseguire l’escissione della ragade anale. La sfinterotomia laterale interna e la tecnica standard nella letteratura internazionale, ma espone al rischio di incontinenza irreversibile. In Francia, e, quindi, preferita la fissurectomia, che, tuttavia, e piu a rischio di recidiva. La fistola anale e la piu frequente delle suppurazioni anoperineali. Il trattamento della fistola anale e sempre chirurgico. Solo la gestione dell’ascesso e urgente. Gli obiettivi sono di drenare la suppurazione, di evitare la recidiva e di preservare l’apparato dello sfintere. La fistulotomia e la tecnica piu efficace, ma espone a rischi di incontinenza, in determinate situazioni. Le tecniche di risparmio sfinterico si sviluppano per preservare la continenza, ma sono all’origine di un alto tasso di insuccesso. La malattia di Crohn, il seno pilonidale e la malattia di Verneuil sono responsabili della maggior parte delle altre suppurazioni perineali.

Anal fissure. Anal fissure is a painful proctological disease that most often affects young patients equally in both sexes. It significantly worsens the quality of life and requires rapid care. The anal fissure is most often located in the posterior anal commissure and frequently surmounted by a skin tag which can hide it and wrongly carry the diagnosis of hemorrhoids. Differential diagnoses such as carcinoma, Crohn's disease, sexually transmitted infection, etc. should be mentioned in case of atypical presentation. Its pathophysiology remains controversial, but in most cases, it results from the trauma of the passage of hard stools on an hypertonic anus. Medical treatment can cure just over half of patients. Surgery is reserved for failures of medical treatment and hyperalgesic fissure. In France, fissurectomy is the most commonly performed procedure while on the other side of the Channel or the Atlantic, lateral internal sphincterotomy is considered as the reference technique.Fissure anale. La fissure anale est une pathologie proctologique douloureuse qui atteint le plus souvent le sujet jeune de manière équivalente dans les deux sexes. Elle altère significativement la qualité de vie et nécessite une prise en charge rapide. La fissure est le plus souvent située au niveau de la commissure anale postérieure et fréquemment surmontée par un capuchon mariscal qui peut la cacher et faire porter à tort le diagnostic de pathologie hémorroïdaire. Des diagnostics différentiels comme un carcinome, une maladie de Crohn, une infection sexuellement transmise, etc., doivent être évoqués en cas de présentation atypique. La physiopathologie reste un sujet de controverse mais elle résulte dans la grande majorité des cas de la conjonction du traumatisme du passage de selles dures et d’une contracture sphinctérienne avec hypertonie anale de repos. Le traitement médical permet de guérir un peu plus de la moitié des patients. La chirurgie est réservée aux échecs du traitement médical et aux fissures hyperalgiques. En France, la fissurectomie est le geste le plus pratiqué alors que de l’autre côté de la Manche ou de l’Atlantique, la sphinctérotomie latérale interne est considérée comme la technique de référence.

L’incontinence anale (IA) du post-partum est un sujet d’actualite du fait de sa prevalence elevee et de son impact social important. Sa prise en charge est complexe en raison d’un mecanisme multifactoriel impliquant le plus souvent une neuropathie pudendale et des modifications tissulaires mais egalement des dechirures sphincteriennes dont l’impact n’est pas negligeable a long terme. Plus des trois quarts des patientes symptomatiques recuperent dans les six mois du post-partum en raison de l’amelioration spontanee des lesions nerveuses et tissulaires. Concernant les patientes avec dechirure sphincterienne obstetricale, une reparation est a preconiser bien que ses effets positifs se degradent a long terme. La regularisation du transit, eventuellement completee par une reeducation anale, est l’approche initiale de l’IA du post-partum et ameliore bon nombre de patientes. La neuromodulation sacree est reservee aux echecs du traitement medical, voire meme en lieu et place de la reparation sphincterienne et donne des resultats interessants a court et a long terme aussi bien sur l’IA que sur une incontinence urinaire eventuellement associee. L’approche preventive de l’IA du post-partum est primordiale et vise a depister les patientes a risque, bien que les indications de la cesarienne programmee « protectrice » fassent encore l’objet de debat.

Background There is no consensus on screening strategy of high-grade intraepithelial neoplasia (HGAIN). Guidelines range from clinical examination with digital anorectal examination followed by standard anoscopy (SA), to anal cytology (Pap)+/− HPV genotyping. We compared screening strategy yields based on Pap, SA, and HPV-16 genotyping alone or in combination in HIV-MSM. Methods Pap, SA, and HPV-16 genotyping were performed in all HIV-MSM attending a first anal cancer screening consultation in Paris, France. High-resolution anoscopy, the gold standard to detect HGAIN, was performed in the case of HPV-16 positivity or abnormal cytology. Yield was defined as the number of patients with HGAIN relative to the total number of patients screened. Results On 212 patients, the complete strategy (SA + Pap + HPV genotyping) yield (12.7%) was significantly higher than that of SA (3.3%, p

Background: Doppler-guided haemorrhoidal artery ligation with mucopexy is a minimal-invasive surgical technique. It is both effective and less painful than conventional haemorrhoidectomy. Methods: We gathered records on all patients operated on between November 2012 and June 2014. Pre- and postoperative scores were calculated during consultation and then by phone. Unsuccessful surgical treatment was defined by persistent haemorrhoid symptoms within three months following the procedure and relapse defined by recurrent symptoms after the third postoperative month. Results: During the period analysed, 70 patients underwent consecutive surgical procedures for haemorrhoid prolapse (52%), bleeding (29%), or both (17%). Hospitalisation was outpatient or overnight for 87% of patients. There were no complications in 92.7% of cases. The average period away from work was 11 days (± 6.5). The time between the procedure and last postoperative consultation, followed by telephone contact, was respectively 2.7 months (± 5.8) and 16.5 months (± 4.9). At the time of the postoperative telephone call, the Thaha et al. score decreased by 5.6 (p

Les techniques chirurgicales mini-invasives de la maladie hemorroidaire sont en plein developpement et suscitent un engouement sans precedent. Elles offrent des suites postoperatoires moins douloureuses, moins contraignantes et moins longues que l’hemorroidectomie tripediculaire. Ces techniques sont l’anopexie de Longo, les ligatures sous controle doppler avec mucopexie, l’hemorroidoplastie au laser et la radiofrequence. Le but de cette fiche est de presenter l’hemorroidoplastie au laser.

Les abces anoperineaux sont un motif de consultation urgent frequent. Les examens complementaires sont exceptionnellement utiles et l’examen clinique seul permet le plus souvent de poser le diagnostic positif. En urgence, l’incision de l’abces est le geste essentiel visant a soulager la douleur du malade et limiter la diffusion de l’infection. En revanche, les antibiotiques n’ont pas de place, du moins seuls, pour traiter ce type de suppuration. Ils ne sont indiques, apres incision, que dans certaines situations particulieres chez des patients fragiles ou en cas de cellulite. La prescription antalgique d’anti-inflammatoire non steroidien est contre-indiquee en raison du sur-risque de cellulite necrosante. La prise en charge chirurgicale urgente, au bloc operatoire, sous anesthesie generale, n’a de place que chez un patient non soulage par l’incision simple, qu’en cas d’abces profond inaccessible ou de cellulite. Apres incision, et au mieux dans la semaine qui suit, le patient est adresse pour une consultation specialisee de proctologie afin de decider de la prise en charge therapeutique etiologique qui reste dominee par les fistules cryptoglandulaires.

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations.

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 14 juin 2018

To compare safety and clinical outcomes of embolization of the superior rectal arteries in patients with hemorrhoidal bleeding using particles and coils versus coils only. We retrospectively reviewed data for patients undergoing embolization for chronic hemorrhoidal bleeding from January 2014 to April 2017. Embolization was performed with coils alone or with particles and coils. Clinical scores (Paris bleeding severity score, Goligher classification and quality of life score) were obtained, and embolization was performed with microparticles (300–500 μm) followed by fibered pushable coils. Clinical success was defined as an improvement of > 2 points in the Paris bleeding severity score, without complications. Outcomes were compared between the two groups in a matched-pairs analysis (1:1 scenario), with patients embolized with particles and coils as the study group and patients embolized with coils alone as the control. We treated 45 consecutive patients. After matched-pairs analysis, the final study population was 38 patients (19 study group and 19 controls). Clinical success did not differ significantly between the two populations: 63% for control group and 68% for the study group (p = 0.790). The median change in clinical score was − 3 [− 6; − 1] for the control group and − 3 [− 4; − 1] for the study group (p = 0.187). Grade 1 complications were reported in 15% of patients, with no major complications. Embolization was feasible, with a technical success of 100% and no major complications. Clinical success was obtained in 66% in patients with no difference when using combined embolization with particles and coils versus coils only.

Management of anorectal bleeding. Anorectal bleeding is a common reason for consultation in general medical practice. The ano-rectal origin is suspected on the characteristics of the bleeding which is often scant and bright red color. Medical history and clinical examination alone are often sufficient to make a diagnosis, since the main causes are hemorrhoids and anal fissure. On the other hand, the estimated risk of anorectal tumours in patients with ano-rectal bleeding has been reported in about 10%. Colonoscopy is therefore necessary at the slightest diagnostic doubt and, anyway, in all patients aged over 45 years.Conduite à tenir devant un saignement anorectal. Les saignements anorectaux sont un motif de consultation fréquent en médecine générale. L’origine anorectale est suspectée sur les caractéristiques du saignement, qui est habituellement de faible abondance et de couleur rouge vif. L’interrogatoire et l’examen clinique seuls suffisent le plus souvent à poser un diagnostic étiologique, puisque les causes sont dominées par la pathologie hémorroïdaire et la fissure anale. D’un autre côté, la pathologie tumorale anorectale, hantise aussi bien des patients que des médecins, en est la cause dans environ 10 %. La coloscopie reste donc indiquée au moindre doute diagnostique et, de principe, chez tous les patients âgés de plus de 45 ans.

The French National Society of Coloproctology established national recommendations for the treatment of anoperineal lesions associated with Crohn's disease. Treatment strategies for acute abscesses, active fistulas (active denovo and still active under treatment), fistulas in remission, and rectovaginal fistulas are suggested. Recommendations have been graded following the international recommendations, and when absent, professional agreement has been established. For each situation, practical algorithms have been drawn.

Les techniques mini-invasives en chirurgie hemorroidaire, apparues durant les deux dernieres decennies, sont en plein essor. En effet, elles representent une alternative interessante a l’hemorroidectomie tripediculaire classique car, en l’absence de plaie externe, elles ne necessitent pas de soins locaux, elles sont moins ou pas douloureuses et elles permettent une reprise d’activite plus rapide. Les techniques les mieux evaluees sont l’anopexie de Longo et les ligatures sous controle Doppler ± mucopexie. Elles ont des resultats globalement similaires aussi bien en termes d’efficacite sur les symptomes hemorroidaires qu’en termes de suites postoperatoires. L’engouement actuel pour les ligatures sous controle Doppler ± mucopexie s’explique possiblement par des complications graves rapportees apres l’anopexie et considerees comme inacceptables pour une pathologie fonctionnelle benigne. D’autres techniques comme l’hemorroidoplastie au laser et la HeLP®, plus recentes, sont en cours de diffusion, avec des resultats preliminaires seduisants, mais qui necessiteront d’etre confirmes par des etudes plus robustes. Ces techniques mini-invasives ont cependant l’inconvenient d’indications plus restreintes et d’un taux d’echecs et de recidives plus important que l’hemorroidectomie tripediculaire. L’indication operatoire doit donc etre posee en concertation avec le patient afin de trouver le compromis optimal entre les contraintes postoperatoires immediates et le resultat therapeutique.

Coordonnateur : Thierry Higuero Auteurs : Laurent Abramowitz L, Helene Pillant-Le Moult; Philippe Hemery, Ghislain Staumont; Thierry Higuero, Francois Pigot, Agnes Senejoux, Jean-Luc Suduca, Cecile Laclotte Duhoux, Alain Castinel, Nadia Fathallah, Beatrice Vinson-Bonnet, Laurent Siproudhis. Groupe de lecture : Laurent Abramowitz, Paul Bendfredj, Dominique Bouchard, Carole Cordonnier, Hubert Dereux, Paul Dieterling, Jean-Luc Faucheron, Philippe Godeberge, Michel Gompel, Thierry Higuero, Pierre Moreau, Francois Mion, Francois Pigot, Elise Pommaret, Agnes Senejoux, Laurent Siproudhis, Denis Soudan, Marc Souffran, Ghislain Staumont, Jean Jacques Tassou, Christian, Thomas, Beatrice Vinson-Bonnet et autres membres anonymes de la SNFCP.