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Introduction: Although effective, conventional excisional haemorrhoidectomy (CEH) is associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain but may result in higher recurrence rates. We aimed to compare short- and long-term outcomes of CEH and THD in the present meta-analysis. Methods: A PRISMA-compliant meta-analysis was performed, searching PubMed, Embase, and CENTRAL databases for randomised controlled trials (RCTs) from 1995 to December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time, and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed. Results: A total of 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group. On random-effects analysis, THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03–7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = −14.05 days, 95% CI = −20.38 to −7.72, p < 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19), or LOS (p = 0.22). Results remained similar on subgroup analysis. Conclusions: CEH is associated with lower recurrence but similar complication rates to THD, although patients take longer to return to baseline function postoperatively. [ABSTRACT FROM AUTHOR]

Aim: There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. Methods: The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple‐choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. Results: The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I–IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first‐line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first‐line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second‐line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second‐line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids – with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. Conclusion: Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed. [ABSTRACT FROM AUTHOR]

Objective: To compare mean post-operative pain in stapled haemorrhoidectomy versus open haemorrhoidectomy. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 18-04-2021 to 17-10-2021. Methods: There are 94 patients that fill the concert form that agree in this study. The presenting complaints that included such as bleeding per anus, prolapsed of the mucosal membrane, hardening of stool and itching of rectum that were noted. Complete history was taken and physical examination was done as per rule. There are two groups arranged where patients are divided in this group with a well-mannered numerical method. Patients having the group that labeled as Group A underwent open haemorrhoidectomy that compare with the patients that labelled with as Group B with stapled heamorrhoidectomy. All operations were done by same surgical team. All patients were retained in surgical ward in surgical department of Allied hospital Faisalabad. there are several post-operative therapies were taken for reducing the pain and recommend the analgesic NASIDS in the form of Intravenous rout. In the first post-operative day of treatment I/v Paracetamol were administered for 08 hours. NSAIDS and other pain killers were administered in the form of Diclofenac 50mg for the next five post-operative days. However, these medications were administered in both groups that labeled as Group a and Group B of the patients. Results: Comparison of post-operative pain in both groups shows 2.28+0.45 pain in Group-A and 1.26+0.49 in Group-B, p value is 0.0001. Conclusion: The conclusion that showed post-operative pain is significantly lower in stapled haemorrhoidectomy when compared with open haemorrhoidectomy in 3rd and 4th degree of haemorrhoids. [ABSTRACT FROM AUTHOR]

Background:: Symptomatic haemorrhoids are a quality of life issue. The present study was conducted to assess the quality of life of the patients after stapled hemorrhoidopexy (SH) for haemorrhoids, with the help of WHO quality of life-BREF questionnaire and comparing it with conventional excisional hemorrhoidectomy (CEH). Methods: The study comprised of 40 patients who were diagnosed with grade 2, 3 or 4 internal haemorrhoidal disease after evaluation by examination, rectosigmoidoscopy or other methods and underwent stapled haemorrhoidectomy (SH) procedure. The patients were asked to complete(WHOQOL-BREF questionnaire). Results: We compared the various WHOQOL-BREF parameters before and one month after SH. The important factors responsible for a dramatic improvement in overall perception and physical and psychological domains were relief of the symptoms of haemorrhoids and the minimal postoperative pain. This allowed the patients greater freedom to go through their daily routine and ability to focus better on their work. The score returned to the pre-operative level on the 7th postoperative day and reached a significantly higher level at the end of one month. Conclusion: there was dramatic improvement in the quality of life after stapled hemorrhoidopexy. [ABSTRACT FROM AUTHOR]

Background: Haemorrhoidectomy is the gold standard for definitive treatment of high‐grade symptomatic haemorrhoids but is often associated with substantial pain. This systematic review aims to explore the potential of flavonoids in alleviating the postoperative symptom burden following excisional haemorrhoidectomy. Methods: A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines (PROSPERO CRD42023472711). Randomized controlled trials (RCTs) published PubMed, MEDLINE, Embase, and Scopus from inception to 1st December 2023 were retrieved. The primary outcome investigated was post‐operative pain. Meta‐analysis was performed using Review Manager version 5.4.1. Results: Ten articles with 775 patients were included. The meta‐analysis identified statistically significant decreases in post‐operative pain in favour of the flavonoid groups (Standardized Mean Difference −0.66 [95% confidence intervals (CI) −0.82, −0.52]; P < 0.00001), and bleeding (Odds Ratio 0.13 [95% CI 0.09, 0.19]; P < 0.00001). Conclusion: Flavonoids show promise as a means of reducing pain associated with excisional haemorrhoidectomy. Further research is required to investigate topical routes of administration and standardize regimes. [ABSTRACT FROM AUTHOR]

Given its frequency in the general population and its major impact on the quality of life of patients suffering from it, haemorrhoidal disease is a real subject of public interest. On a daily basis, doctors are faced with patients' questions about the existence of potential triggering factors and, in particular, the role of spicy food in preventing and managing attacks. Despite the paucity of literature and the many complex physiopathology factors involved, this mini-review takes stock of current knowledge on the potential link between haemorrhoidal disease and spices, in an attempt to unravel the myth from the reality of this commonly accepted relationship. [ABSTRACT FROM AUTHOR]

Vipul D Yagnik,1 Kaushik Bhattacharya,2 Pankaj Garg,3 Prema Ram Choudhary,4 Mrunal Sadhu,5 Sushil Dawka6 1Department of Surgery, Banas Medical College and Research Institute, Palanpur, GJ, India; 2Department of Surgery, MGM Medical College, Kishanganj, BR, India; 3Department of Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula, HR, India; 4Department of Physiology, Banas Medical College and Research Institute, Palanpur, India; 5Final Year MBBS Student, Pramukhswami Medical College, Karamsad, GJ, India; 6Department of Surgery, SSR Medical College, Belle Rive, MauritiusCorrespondence: Vipul D Yagnik, Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, India, Email vipul.yagnik@gmail.comAbstract: This article explores the potential benefits and challenges of incorporating Patient-Generated Images (PGIs) into the clinical practice for perianal conditions. PGIs refer to photographs (and video) captured by patients themselves of affected areas of their own bodies to illustrate potential pathologies. It facilitates remote patient assessments and swift evaluation for coloproctologist. They potentially reduce the need for in person follow-up particularly after operation if the patient is asymptomatic. However, concerns with PGI include quality of images, risk of misinterpretation, ethical, legal, and practical problems, especially when imaging private or sensitive body regions. Any platform transmitting and storing PGIs should prioritize data protection with advanced encryption. Comprehensive guidelines should be developed by collaboration between healthcare administrators, regulators, and professionals, and a thorough framework formulated to ensure that quality care is delivered always while respecting patient privacy and dignity. It should be considered as complementary to, rather than a replacement for, traditional clinical consultations. However, patient awareness and education regarding the limitations are key to ensuring that this modality is not misinterpreted or misused.Keywords: fistula, haemorrhoids, fissure in ano, telemedicine, patient generated images

Background: Haemorrhoidectomy in Crohn's disease is controversial due to fears over poor wound healing leading to proctectomy. We aim to review the available literature and establish the role of excisional haemorrhoidectomy in Crohn's disease. Methods: A review of the current scientific literature was conducted using Medline, PubMed and the Cochrane Central Registry of Controlled Trials. Clinical trials from 2005 to present, reporting outcomes of excisional haemorrhoidectomy in Crohn's disease, were included. Review articles and case reports were excluded. Results: A cohort of 67 patients across four studies was included in this review. There were no reported cases of proctectomy related to haemorrhoidectomy or poor wound healing. One patient (1.5%) had a non-healing wound post-operatively. Four (6%) cases of post-operative bleeding were identified, two (3%) patients were diagnosed with anal fissures and two (3%) were treated after developing perianal abscess post-procedure. There was one (1.5%) case of urinary retention, and one (1.5%) subject developed an anal stricture. Conclusion: The current available evidence suggests a role for excisional haemorrhoidectomy in Crohn's disease patients with well-controlled symptomatic disease, though further prospective analysis is certainly warranted. The preferred operation (open vs closed) remains unclear. Future recommendations: Further prospective trials are required to investigate the optimal approach to haemorrhoidectomy in Crohn's disease. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhoids is a common issue in the anorectal region and involves venous engorgement in the region. It greatly diminishes the overall quality of life of affected individuals by disrupting their physical and mental health. This descriptive cross-sectional study aimed to ascertain the prevalence of haemorrhoids and the associated risk factors among patients visiting a tertiary care center's surgery department. Methods: A descriptive cross-sectional study was conducted in the Department of Surgery of a tertiary care center from July 2023 to November 2023 after obtaining ethical approval. Convenience sampling method was used. The total sample size included in the study was 385. The data was analyzed in IBM SPSS Statistics software. Point estimate was calculated at 95% confidence interval. Results: Among 385 patients included in the study, haemorrhoids was prevalent in 53 (13.76%, 95% CI: 8.76%-18.76%). Internal haemorrhoids was most prevalent with 30 (56.60%) cases. 22 (41.51%) cases presented with Grade 1 haemorrhoids. The most prevalent symptoms were bleeding in 29 (54.72%) cases, perianal pain in 25 (47.17%) cases, itching in 28 (33.96%) cases and burning sensationin 15 (28.30%) cases. Conclusions: The prevalence of haemorrhoids in our center was found to be higher as compared to similar studies done in Southeast Asian region but similar with studies done in other region.

Abstract Background The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. Methods Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). Results Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p

Background: Surgeons vary in their approach to preventing pain post rubber band ligation (RBL) of haemorrhoids, with pudendal nerve blocks (PNB) being one analgesic strategy. No data exists on how commonly PNBs are used in RBL in Australia, and whether use varies by year and patient and hospital characteristics. Methods: Aggregate data from the National Hospital Morbidity Database was obtained for all admissions for RBL in Australia from 2012 to 2021, with and without a PNB, overall and in relation to sex, age group, hospital remoteness, hospital sector, and year of procedure. Adjusted relative risks (adj. RR) of PNB were estimated using Poisson regression, mutually adjusting for all variables. Results: Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB. The proportion of patients receiving a PNB increased between 2012–2013 and 2020–2021, from 1.62% to 6.63% (adj. RR 3.99, CI 3.64–4.36). Patients most likely to receive a PNB were female (adj. RR 1.10; CI 1.07–1.14) aged 25–34 years (adj. RR 1.13; CI 1.01–1.26); in major‐city (adj. RR 1.25 CI 1.20–1.30) and private hospitals (adj. RR 3.28 CI 3.13–3.45). Conclusion: This is the first published analysis of the use of PNB in RBL. Pudendal nerve block use has increased over time, with substantial variation in practice. Blocks were more than three times as likely to be used in private compared to public hospitals. If evidence supporting PNB use is established, equitable access to the procedure should be pursued. [ABSTRACT FROM AUTHOR]

Background: The anal symptoms occurring during pregnancy and post-partum, mainly related to Haemorrhoidal Disease (HD), have been reported with in a wide range of incidence in the literature. Although in many cases the course of the disease is mild and self-limiting, sometimes it is severe enough to affect quality of life. Methods: Our study has been conducted through a questionnaire administered via social media with the aim of obtaining epidemiologic data on the incidence of the symptoms of HD in an unselected population of pregnant women. In addition, we looked for the presence of those factors notoriously predisposing or associated to HD (constipation, straining on the toilet, low dietary fibres and fluid intake). Results: Out of 133 patients 51% reported symptoms of HD during pregnancy, mainly in the second and third trimester. Constipation, straining on the toilet, low dietary fibres and fluid intake were not significantly related to incidence of HD. Only a previous history of HD was correlated to onset of symptoms of HD in pregnancy and reached a statistical significance (odds ratio = 5.2, p < 0.001). Conclusion: Although with the limitations posed by the nature of our retrospective study via a self-assessment interview, our results suggest that the occurrence of HD in pregnancy seems not sustained by the classical risk factors observed in the general population. At the moment, specific therapeutic measures are lacking and treatment relies on empiric suggestions concerning diet, fluid intake, bowel care, local ointment. Further studies are needed in order to identify a targeted etiologic treatment. [ABSTRACT FROM AUTHOR]

Background: To determine 1‐year postoperative recurrence rates, postoperative pain and complication rates of transanal open haemorrhoidopexy applied also in grade IV haemorrhoids. Methods: Single‐centre retrospective observational study without control group. The primary outcome was recurrence rate after 1 year postoperatively. Secondary outcomes were length of postoperative pain, use of opiates and postoperative complications. The recurrence rate was assessed with the Sodergren haemorrhoid symptom severity score questionnaire. For information on the early postoperative period, a retrospective chart review based on the routine 3‐month clinical follow‐up was done. Results: 135 consecutive patients with haemorrhoids Goligher grades II–IV were operated with transanal open haemorrhoidopexy. 88 patients (65%) consented to participate in the study when approached later via mail. 23% of patients had haemorrhoids Goligher grade IV. 15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse. The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively. 21% of patients reported no postoperative pain, 54% described pain for a duration of up to 1 week and 22% for up to 2 weeks. Two patients reported a longer duration of pain of 3 and 4 weeks, respectively. No complications grade Clavien‐Dindo III or higher were detected. Conclusion: The results of our study indicate that transanal open haemorrhoidopexy has a recurrence rate comparable to traditional haemorrhoidectomy including grade IV haemorrhoids and is associated with less pain and tissue damage. A randomized controlled trial may provide further support for the routine application of this method, but may pose challenges. [ABSTRACT FROM AUTHOR]

Background to the study: Hemorrhoid is a common and unavoidable situation that cuts across all categories, irrespective of class, status, gender, educational attainment, spiritual or religious beliefs, and affiliations. Hemorrhoid is a benign anorectal disease which has affected millions of people across the globe. Aim and objectives: The study investigates the determinants and patterns of treating hemorrhoids (Jedijedi) in Ekiti State, Nigeria. Materials and methods: The study is a survey research study in which a quantitative method was adopted. Multistage sampling was adopted in selecting 492 respondents from the general populace in Ekiti State. A questionnaire was used to collect data and it was analyzed and presented in frequency percentage. Results: Religious beliefs do not determine patients’ choice of medication (49.0%), peer group determines the impact on patients’ choice of medication for Jedijedi treatment (53.3%), 53.0% affirmed that age determines the choice of treating Jedijedi, about 49% attested that gender determines their choice of treatment, and 41.6% confirmed that income determines their choice of hemorrhoid medication. Conclusion: The study concluded that treatment pattern constructs have effects on the treatment of hemorrhoids (Jedijedi). Recommendations: Government and relevant stakeholders should sensitize the public, and also encourage a wide lab test for local herbs.

Background: Haemorrhoids are one of the most common anorectal disorders, affecting almost 25-30% of the population. Aims and objectives: To compare the outcomes of conventional haemorrhoidectomy versus M.I.P.H. Materials and Methods: The present prospective hospital-based observational study will be conducted in the department of general surgery, Indira Gandhi Institute of Medical Sciences (I.G.I.M.S), Patna, Bihar, India. After the approval of the institutional ethical committee, 120 patients of both genders who need surgical intervention for haemorrhoids will be selected. Results: Out of 120 cases of grade III and IV haemorrhoids, 104 were males and 16 were females. The male-to-female ratio was 6.5:1. The mean age of patients was 44.85 ± 14.50 years. The most common presenting complaints of patients were bleeding and haemorrhoidal mass protruding per rectum. 84 patients (70%) had grade-III haemorrhoids. Conclusion: MIPH is associated with a shorter duration of surgery, less postoperative pain, and a shorter hospital stay with minimal postoperative complications as compared with Milligan Morgan (open haemorrhoidectomy). [ABSTRACT FROM AUTHOR]

Introduction Puerperium is defined as the period of about 6 weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition. Perianal problems, including constipation, hemorrhoids, and fissure, are among the most common digestive complications among women in puerperium, observed in about 30 to 50 percent of women. Considering this great prevalence and the paucity of similar research in this aspect in an Indian population, the present study was done to assess the prevalence of perianal problems seen in puerperium and the risk factors associated with it. Methods This was a prospective observational cohort study done over the span of 3 years on 902 puerperal women. A self-structured questionnaire covered detailed history and per-rectal and proctoscopy examination. Patients were followed up telephonically for regression of perianal problems post management. Results The total prevalence of all the perianal problems in puerperium encountered in the present study, out of 902 subjects, was 36.3% (327 subjects). The perianal problems encountered were fissure in 185 patients (20.5%) followed by hemorrhoids in 110 patients (12.2%), perianal episiotomy infections in 25 patients (2.8%), and perineal tears in 7 patients (0.8%). On comparative analysis, positive family history, macrosomia, past history of perianal diseases, and second stage of labour > 50 minutes showed a higher prevalence in the perianal disease group as compared with the healthy group. Out of these, positive family history of perianal diseases (p = 0.015) and past history of perianal diseases (p = 0.016) were statistically significant. The percentage of multipara with hemorrhoids was more when compared to primipara (p = 0.01), patients who had a past history of any perianal disease have a higher chance of hemorrhoids during puerperium (p = 0.00). Patients with constipation in pregnancy have higher chance of hemorrhoids in pregnancy (p = 0.00). Patients who had a past history of any perianal disease had higher chance of fissure during puerperium (p = 0.00). A total of 27.74% of the study subjects with macrosomic babies had fissure in their puerperal period which on comparison with patients with non macrosomic babies was only 19.22%, which was statistically significant (p = 0.02). Conclusion Constipation, hemorrhoids, and anal fissures are the most common perianal problems in postpartum period causing significant reduction in the quality of life of those afflicted with them.

An ethnobotanical survey was conducted to identify and document the plants used in the treatment of haemorrhoids in North-Central, Nigeria. A total of three hundred (300) respondents among whom were herb sellers, herbalists, and traditional medicinal practitioners were consulted and interviewed with the help of structured questionnaires to collect data on the plant species from them. Data were represented tables, bar and pie charts and analyzed using descriptive statistics (frequencies and percentages). A total of forty-eight (48) plant species from twenty-seven (27) families were found to be useful in treatment of haemorrhoids in the area under the study. The most prominent among these being members of the family Euphorbiaceae with 4 species, indicating the utmost importance of this family in the cure of haemorrhoids. Followed by families Amaranthaceae, Compositae, Fabaceae and Meliaceae with 3 species each. The plants were identified using botanical, and common names, and the parts of the plant used were also identified. The study revealed that traditional medicinal practices were widely accepted among the people in the study area, probably because they believed in their effectiveness. The plant parts used ranged from root (8.30%), whole plants (8.30%), leaves (43.80%), stem bark (4.24%), bark (10.43%), stem (6.25%) to fruits, young leaves, stem bark leaves, bulb, fruit cub, juice, leaves and juice, shaft of seeds, and bark and leaves at 2.08% each. Further research should be carried out to identify more plant species in the area that can be used to treat haemorrhoids.

Purpose: The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. Method: This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II–III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. Results: A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1–14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a − 5/+ 5 scale). Conclusion: RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. Clinical trial registration and date: Clinical trial NCT04229784 (18/01/2020). [ABSTRACT FROM AUTHOR]

Abstract Extracellular vesicles (EVs) play important roles in many pathophysiologies as cell‐to‐cell communication vehicles. However, the features and potential functions of the EVs in haemorrhoids remain unclear. Therefore, we performed microRNA (miRNA) microarray analysis in EVs derived from haemorrhoid tissue to identify the profile of miRNAs in these EVs and predict their potential functions. We obtained typical EVs from both haemorrhoid and control tissues. Microarray analysis identified 447 miRNAs with significant differential expresssion (DE): 245 upregulated and 202 downregulated. The top three upregulated miRNAs in haemorrhoid EVs (Hae‐EVs), namely miR‐6741‐3p, miR‐6834‐3p and miR‐4254, were detected by RT‐qPCR in both Hae‐EVs and haemorrhoid tissues. Interestingly, we found a different expression pattern in the haemorrhoid tissues from that in Hae‐EVs. The potential target genes of these DE‐miRNAs were predicted by the miRWalk and miRDB databases. Gene ontology (GO) analysis of the target genes showed that the DE‐miRNAs contributed mainly to protein kinase activity, transcriptional activity and ubiquitin‐protein function. KEGG search found that the DE‐miRNAs might regulate the MAPK and Ras signalling pathways. These findings revealed, for the first time, the miRNA profiles in Hae‐EVs and provided potential targets and pathways involved in the pathological process.

Background. Haemorrhoidal disease is a common disorder in the Western World that commonly requires surgical treatment, but original open techniques were associated with significant complications and pain. Haemorrhoidal Arterial Ligation (HAL) has gained popularity for relatively low complication and postoperative pain rates. This review assesses clinical outcomes of this technique in comparison to alternative modern techniques. Methods. The literature was searched on MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. Search terms: dearterialization, artery ligation, mucopexy, recto-anal repair. Inclusion criteria: RCTs, original publications, grade II, III and/or grade IV haemorrhoids, elective procedures. Exclusion criteria: non-English, non-adults, published pre-2016. Results. 14 RCTs were included in the systematic review. HAL performed poorly in terms of recurrence, with a pooled recurrence rate of 10.34% for grade III haemorrhoids. HAL had a similar recurrence rate to Procedure for Prolapse and Haemorrhoids. Pain was comparable between groups. Conclusion. HAL is a safe surgical technique for the treatment of grade II to grade IV haemorrhoids. It still has a relatively low complication rate, and pain scores are comparable to other non-invasive techniques, and superior to open techniques. HAL still performs poorly in terms of recurrence rates. New modified procedures including suture-mucopexy only and tissue-selecting techniques appear to have better therapeutic potential.

IntroductionAround 20% of population in western countries is under anticoagulant treatment. However, there is paucity of evidence about the treatment of HD in patients under anticoagulant/antiplatelet therapy, although both suspension and continuation in the perioperative period may increase the risk of severe complications. The aim of this pilot study was to confirm the feasibility and safety of sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy), an office-based procedure, for the treatment of second-and third-degree HD in patients under anticoagulant/antiplatelet therapy without suspension.Materials and methodsPatients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled between November 2019 and October 2021. Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated.ResultsFifty-one patients were recruited, 23 female (45.1%) and 28 male (54.9%), with an average age of 65 years ± 11.4 SD (range 42–90). Twenty-seven patients (52.9%) had II-degree haemorrhoidal disease, and 24 (47.1%) had grade III-degree. The most frequently taken medications were dual antiplatelet therapy (51%) and new oral anticoagulants (NOACs) (21.6%). The mean follow-up was 23 months. No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported. Postoperative complications were not statistically significantly associated with the number of nodules treated (1, 2, or 3), the disease grade (2nd vs. 3rd) or the specific anticoagulant/antiplatelet regimen. During follow-up, 2 patients (4%) required a new procedure for recurrent bleeding: one an infrared photocoagulation as outpatient, and another a haemorrhoidectomy after 3 months. No cases of intraoperative or postoperative mortality occurred.ConclusionsSclerobanding is a safe and effective technique in treating intermediate-grade haemorrhoidal disease in patients at high risk on anticoagulant/antiplatelet therapy. Sclerobanding is repeatable, usually does not require anaesthesia, and is cost-effective. Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results.

Benign perianal conditions commonly present on the acute general surgical take and in the outpatient setting. Accurate diagnosis and appropriate management is not only important in prevention of patient morbidity but also important in differentiation of these conditions from cancers. This article summarizes the presentation and current management of perianal abscess, fistula in ano, haemorrhoids, fissure and pilonidal sinus. [ABSTRACT FROM AUTHOR]

Background Hemorrhoidectomies are considered one of the most commonly performed procedures worldwide. Advances in techniques and technology have emerged new modalities in the management of piles with different grades. Aim The aim of this study is to weigh the advantages and disadvantages of laser hemorrhoidoplasty (LH) versus Stapler hemorrhoidopexy (SH). Methods A prospective randomized trial with 120 patients with symptomatic third degree hemorrhoidal disease who presented with pain and bleeding was undertaken in March 2020 and followed patients for two years in Ain Shams University Hospitals until March 2022. The remaining 60 patients (group B) had SH, while the first 60 patients (group A) got LH. The following factors were evaluated: preoperative complaints (bleeding Per rectum, rectal/perianal pain, mass coming out of anus), operative and postoperative outcomes, operative time, postoperative pain, bleeding, urinary retention, fecal/flatus incontinence, thrombosis of external haemorrhoids, anal/rectal stenosis, wound issues, and recurrence. The visual analog scale (VAS), which is based on a numeric pain rating scale with 0 denoting no pain and 10 denoting severe pain, was used to record postoperative discomfort. Results Operative time and blood loss were significantly better in LH than SH with Operative time 23.04±3.42 min in LH compared with SH 33.72±4.48 min (P < 0.001) and Operative blood loss in LH 5.61±1.06 ml compared with SH 11.67±1.92 ml (P < 0.001). There was less postoperative hospital stay in LH group. Postoperative pain was significantly higher in SH verses LH in the first 12 h (5.83±0.86 in stapler vs 5.02±0.6 in laser in the first 12 h) (P < 0.001). Postoperative VAS score at 24 h and 1 week the VAS score was higher for LH in comparison with SH (3.86±0.48 in laser vs 3.39±0.56 in SH at 24 h), (1.59±0.37 in laser vs 1.01±0.43 at 1 week). As regard Returning to activities SH was significantly better than LH. Regarding early postoperative complications like early Postoperative bleeding and urinary retention we found no statistically significant difference between SH and LH in our study. As regard Late Postoperative complications SH was significantly better regarding recurrence after 2 years with only one case of recorded recurrence verses 7 cases in LH group Also, SH was significantly better regarding postoperative flatus incontinence and late anal stenosis with only one patient of Flatus incontinence and late anal stenosis in SH group verses 6 patients of Flatus incontinence and 4 patients of anal stenosis in LH group. While other late postoperative complications were better in SH Group but were not statistically Significant. Conclusions Both SH and LH are probably equally valuable techniques in modern haemorrhoid surgery. However, SH has an advantage because of lower pain after 24 h better, faster recovery and Return to activities and less postoperative complications so SH is a better technique with overall better outcomes. Results of LH showed be revised, liberal use of LH in third degree hemorrhoidal disease according to patient preference should be regulated. LH should be evaluated in depth in a large-volume studies. [ABSTRACT FROM AUTHOR]

Introduction Management of hemorrhoidal disease had been always a challenge for colorectal surgeons. Recently, the use of diode laser in proctology has emerged as an alternative to conventional surgical treatment. The laser beam causes shrinkage and degeneration that depend on the power and the duration of laser light application. It is also associated with minimal postoperative pain, bleeding, discharge and short hospital stay. Patients and methods This prospective study was carried out on 104 patients with second, third and fourth grades of hemorrhoids in the Gastrointestinal Surgery Unit, General Surgery Department, Tanta University Hospitals, during the study period (18 months, from February 2021 to August 2022). All patients underwent laser hemorrhoidoplasty lasotronix device, bare fibers, wavelength 1470 nm and 8 watts of power. Mucopexy was added in 28 patients with grade 4 hemorrhoids. Results Postoperative pain was evaluated using VAS score, in the first 6 h VAS ranged from 4-9 with mean of 5.81±1.23 SD, after 12 h ranged from 1 to 7 with mean of 4.19±1.70 SD. There was significant relation between the grade of hemorrhoid and postoperative edema (P value was less than 0.001) as all of the 24 patients who developed edema, they were grade 4 hemorrhoids. Also, there was relation between grade 4 hemorrhoid and the development of other postoperative complications but P value was not significant (0.066 in infection and 0.260 in recurrence). There was no incontinence or stenosis in all of the 104 patients and recurrence occurred only in 4 cases (3.8%) and underwent conventional hemorrhoidectomy after six months of follow up. Conclusion Diode laser is a safe minimally invasive procedure for the treatment of second, third and fourth grades of hemorrhoids with less postoperative pain and early return to normal activities but high cost remains the only limitation. [ABSTRACT FROM AUTHOR]

Aim: Laser haemorrhoidoplasty (LHP) is an emerging nonexcisional surgical procedure in which the arteriovenous flow of the haemorrhoidal plexus is interrupted through laser coagulation. The aim of this cohort study was to assess efficacy of LHP in treating symptomatic haemorrhoidal disease through patient satisfaction, remission of symptoms (blood loss, pain, itching, soiling, mucosal prolapse) and recurrence of haemorrhoids. Methods: Patients who underwent treatment for symptomatic haemorrhoids (degrees 1–4) through an LHP procedure between 2015 and 2021 were included in the study. A 1470 nm‐diode laser was used. A total of 200 patients (71% male, average age 51 years) were analysed. Primary outcomes were patient satisfaction and/or complete recovery of symptoms. Secondary outcomes were operating time, complications and recurrence rates. Patient satisfaction, postoperative blood loss, pain and complications were evaluated 6–7 weeks postoperatively. Room turnover time and operating time were documented. Recurrence of haemorrhoids following LHP treatment within 1 year was evaluated. Results: Patient satisfaction regarding LHP treatment was reached in 155 (84,7%) patients. Postoperative blood loss was reported by 44 (24,0%) patients during time of evaluation. Twenty‐four (13,1%) patients reported postoperative pain after 6–7 weeks. Postoperative complications occurred in seven patients (3 anal fissures, 2 perianal abscess, 1 perianal fistula, 1 postoperative anaemia). Room turnover time (patient in to patient out) was 21 min with an average operating time of 7 min. Recurrence of haemorrhoids within 1 year occurred in 50 (27,3%) patients. Conclusions: Laser haemorrhoidoplasty appears to be a promising and effective nonexcisional surgical procedure in the treatment of symptomatic haemorrhoidal disease with high patient satisfaction, acceptable postoperative symptoms, minimal complications and short operating times. [ABSTRACT FROM AUTHOR]

Introduction: The Minimally Invasive Procedure for Haemorrhoids (MIPH), also known as Stapled Haemorrhoidopexy (SH), has gained significant recognition and praise within the surgical community due to its speed and minimal postoperative pain. It was initially believed to have superior postoperative outcomes, resulting in reduced morbidity and mortality rates compared to traditional procedures. However, long-term follow-up data has now revealed previously undocumented sequelae and complications associated with SH. Aim: To share authors’ experience with SH, including patient demographics, operative details, recurrence rates, and postoperative complications, in a tertiary corporate teaching hospital. Materials and Methods: The present retrospective observational study was conducted at the Department of General Surgery and Advanced Laparoscopic Surgery, Dr. LH Hiranandani Hospital, Powai, Mumbai, Maharashtra, India. The study utilised data from the outcomes of SH performed by a single surgeon for Grade II and III haemorrhoids over a 15-year period, from December 2007 to December 2022. Data was extracted from the hospital’s Electronic Medical Records (EMR) and supplemented with information obtained through a telephonic questionnaire. A standard, prevalidated, semi-structured case record proforma was used for data collection. The parameters under study included donut completeness, haemorrhage, faecal urgency, urinary retention, anal stenosis, postoperative pain scores, return to work, and recurrence. Proportions, percentages, and means were calculated and reported for different groups. Results: A total of 245 patients were enrolled in the study. The average pain score at 12 hours postoperatively was 4, which decreased to 2 by day 10. Recurrent disease was observed in 16 patients (6%) at three months and in 24 patients (10%) at six months. Conclusion: The SH demonstrated advantages over conventional open surgery by causing significantly lower postoperative morbidity. However, its recurrence rates were slightly higher.

Background: Various topical applications provide varying pain control outcomes among patients undergoing surgery for anorectal conditions like haemorrhoids, anal fissures, and anal fistulae with varying outcomes. We evaluated the outcomes of a fixed-dose combination of sucralfate, metronidazole, and lidocaine as a local application following anorectal surgery. Methods: This was a prospective, single-arm, single-centre study with 50 patients who underwent anorectal surgery. Coprimary endpoints were 1) proportion of patients with minimal clinically important difference (MCID) defined as 10-point reduction in 100-mm visual analogue scale (VAS) score and 2) mean reduction in anal pain on VAS, from baseline to 3 and 6 weeks after surgery. Proportion of patients with complete wound healing and reduction in symptoms of itching, bleeding, and burning and incidence of adverse events (AEs) and tolerability were also assessed. Results: Of 50 patients, 18.0%, 26.0%, and 56.0% underwent haemorrhoidectomy, fissurectomy, and fistulectomy, respectively. All patients achieved MCID at week 3, which was maintained at 6 weeks. The mean VAS score for anal pain reduced significantly from 68.6 at baseline to weeks 3 and 6, respectively (p Conclusion: The topical FDC was effective, with a good safety and tolerability profile, in patients undergoing surgery for anorectal conditions. Clinical trial registration: CTRI/2020/11/029298.

New Findings: What is the central question of this study?What are the morphological features and microRNA (miRNA) expression features of extracellular vesicles (EVs) from haemorrhoids (Hae‐EVs) and normal tissues? What are the potential functions of the differentially expressed (DE) miRNAs in Hae‐EVs?What is the main finding and its importance?We present, for the first time, the morphological features and miRNA profile of human Hae‐EVs. Four hundred and forty‐seven significant DE‐miRNAs were identified. Gene ontology and pathway analysis of the DE‐miRNAs indicated diverse roles of the Hae‐EVs through different pathways. Our findings provide EV‐based pathological features and the underlying mechanism of haemorrhoids. Extracellular vesicles (EVs) play important roles in many pathophysiologies as cell‐to‐cell communication vehicles. However, the features and potential functions of the EVs in haemorrhoids remain unclear. Therefore, we performed microRNA (miRNA) microarray analysis in EVs derived from haemorrhoid tissue to identify the profile of miRNAs in these EVs and predict their potential functions. We obtained typical EVs from both haemorrhoid and control tissues. Microarray analysis identified 447 miRNAs with significant differential expresssion (DE): 245 upregulated and 202 downregulated. The top three upregulated miRNAs in haemorrhoid EVs (Hae‐EVs), namely miR‐6741‐3p, miR‐6834‐3p and miR‐4254, were detected by RT‐qPCR in both Hae‐EVs and haemorrhoid tissues. Interestingly, we found a different expression pattern in the haemorrhoid tissues from that in Hae‐EVs. The potential target genes of these DE‐miRNAs were predicted by the miRWalk and miRDB databases. Gene ontology (GO) analysis of the target genes showed that the DE‐miRNAs contributed mainly to protein kinase activity, transcriptional activity and ubiquitin‐protein function. KEGG search found that the DE‐miRNAs might regulate the MAPK and Ras signalling pathways. These findings revealed, for the first time, the miRNA profiles in Hae‐EVs and provided potential targets and pathways involved in the pathological process. [ABSTRACT FROM AUTHOR]

Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy . Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids. Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates. [ABSTRACT FROM AUTHOR]

To date, the exact pathophysiology of haemorrhoids is poorly understood. The different philosophies on haemorrhoids aetiology may lead to different approaches of treatment. A pathogenic theory involving a correlation between altered anal canal microflora, local inflammation, and muscular dyssynergia is proposed through an extensive review of the literature. Since the middle of the twentieth century, three main theories exist: (1) the varicose vein theory, (2) the vascular hyperplasia theory, and (3) the concept of a sliding anal lining. These phenomena determine changes in the connective tissue (linked to inflammation), including loss of organization, muscular hypertrophy, fragmentation of the anal subepithelial muscle and the elastin component, and vascular changes, including abnormal venous dilatation and vascular thrombosis. Recent studies have reported a possible involvement of gut microbiota in gut motility alteration. Furthermore, dysbiosis seems to represent the leading cause of bowel mucosa inflammation in any intestinal district. The alteration of the gut microbioma in the anorectal district could be responsible for haemorrhoids and other anorectal disorders. A deeper knowledge of the gut microbiota in anorectal disorders lays the basis for unveiling the roles of these various gut microbiota components in anorectal disorder pathogenesis and being conductive to instructing future therapeutics. The therapeutic strategy of antibiotics, prebiotics, probiotics, and fecal microbiota transplantation will benefit the effective application of precision microbiome manipulation in anorectal disorders. [ABSTRACT FROM AUTHOR]

Background: The Laser Haemorrhoidoplasty (LHP) procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of this study was to assess the safety of laser haemorrhoidoplasty and to study long term recurrence rates and other complications. Methods: In this retrospective, single-centre study, 250 consecutive symptomatic patients of internal haemorrhoids of grade I-IV underwent laser haemorrhidoplasty. The procedure was done using 15 W,1470 Nm diode laser machine (Lasotronix). All the preoperative and postoperative variables were analyzed, with special emphasis on post-procedural pain, complications and recurrence rate. Follow-up was scheduled at 4th,7th and 30thday and then at 3, 6 and 12 months, and once a year thereafter. Complications were recorded. Results: There were 250 patients ( 134 male and 116 female; mean age: 43.72 18.34 years, range 16-85 years). Short-term follow-up was achieved for all patients. Patient satisfaction in terms of pain at rest and post-defaecation pain was 100%. Twenty eight patients (11.2 %) had complications.10 patients (4%) had postoperative bleeding,3 patients (1.2 %) had infection,1 patient (0.4 %) developed a fistula-in-ano,1 patient (0.4 %) developed a thrombosed haemorrhoid,1 patient (0.4 %) had prolapsed haemorrhoid,5 patients (2 %) had incomplete regression,1 patient (0.4 %) had fissure in ano. Ulceration occurred in 1 patient (0.4 %) and 2 patients (0.8 %) developed recurrence. No anal stenosis or faecal incontinence occurred in any of the patients. Conclusion: This study shows that LHP gave 100% patient satisfaction in terms of post-procedure pain at rest and post-defaecation pain. With standardisation, LHP is a safe procedure with good short term and long term results with minimal recurrence rate.

Purpose: The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. Methods: This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. RBL was offered as first-line treatment in this group. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale).Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. Results: A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (p < 0.001). The main improvement was found in the first month and it was maintained until the sixth month. A high degree of satisfaction with the procedure was reported by 76% of patients. The overall success rate of banding was 89%. A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%). Conclusion: Rubber band ligation, as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment, leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients. [ABSTRACT FROM AUTHOR]

Background: Haemorrhoids are common and can significantly impact the personal and working lives of individuals. Those with more severe symptoms and those not responding to conservative management may require surgery. Current surgical techniques are associated with a degree of postoperative discomfort which may delay return to normal activity. Recurrence is lower in more radical procedures but resulting pain is higher. Radiofrequency ablation (RFA) is a new technique that is gaining popularity and has several hypothesised benefits, including reduced pain and recurrence. However, available evidence is limited. A recent overview from the National Institute for Health and Clinical Excellence recommended more research, in the form of randomised controlled trials, be carried out before further investment is made by national health services. Our aim is to assess whether RFA is at least as good in terms of recurrence as existing surgical interventions, but superior in terms of pain, for patients with symptomatic grade II and III haemorrhoids. Methods: The RadiO fRequency ablatION for haemorrhoids (ORION) trial will be a pragmatic multicentre patient/assessor-blind parallel group-controlled trial with economic evaluation. The target sample size is 376 participants (188 per arm) and is based on two co-primary endpoints: (i) a non-inferiority design for recurrence and (ii) superiority design for pain at seven days. Participants with grade II or III haemorrhoids will be recruited in 16 National Health Service hospitals and randomised (1:1) to either RFA or surgeon's choice of surgery. Conclusions: Results will inform future practice for the treatment of grade II–III haemorrhoids and provide evidence for national health services on future investments in RFA. Trial registration: ISRCTN14474552. [ABSTRACT FROM AUTHOR]

Aim: To evaluate 30‐day complications and 1‐year mortality for older adults undergoing haemorrhoid surgery. Method: This retrospective cohort study evaluated older adults (age 66+) undergoing haemorrhoid surgery using Medicare claims and the minimum data set (MDS). Long‐stay nursing home residents were identified, and propensity score matched to community‐dwelling older adults. Generalized estimating equation models were created to determine the adjusted relative risk of 30‐day complications, length of stay (LOS), and 1‐year mortality. Among nursing home residents, functional and cognitive status were evaluated using the MDS‐activities of daily living (ADL) score and the Brief Instrument of Mental Status. Faecal continence status was evaluated among a subset of nursing home residents. Results: A total of 3664 subjects underwent haemorrhoid surgery and were included in the analyses. Nursing home residents were at significantly higher risk for 30‐day complications (52.3% vs. 32.9%, aRR 1.6 [95% CI: 1.5–1.7], p < 0.001), and 1‐year mortality (24.9% vs. 16.1%, aRR 1.6 [95% CI: 1.3–1.8], p < 0.001). Functional and mental status showed an inflection point of decline around the time of the procedure, which did not recover to the baseline trajectory in the following year. Additionally, a subset of nursing home residents demonstrated worsening faecal incontinence. Conclusion: This study demonstrated high rates of 30‐day complications and 1‐year mortality among all older adults (yet significantly worse among nursing home residents). Ultimately, primary care providers and surgeons should carefully weigh the potential harms of haemorrhoid surgery in older adults living in a nursing home. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhoid is a common surgical condition occurring in 4.4% of adults with a peak prevalence between 45 and 65 years of age. A haemorrhoidectomy is the standard treatment for patients with grade III or IV internal haemorrhoids. Recently Harmonic scalpel has been used for haemorrhoidectomies, since it reduces operative bleeding. The present study was conducted to analyse and compare outcomes of haemorrhoidectomies performed with an ultrasonic scalpel and monopolar electric cautery. Material and Methods: The present study was carried out at a tertiary care centre over a period of two year from October 2017 to October 2019. A total of 60 patients, with history suggestive of haemorrhoids were screened and those diagnosed with grade III or grade IV haemorrhoids were enrolled in the study. The patients were randomised to either Group A (haemorrhoidectomy using electrocautery) or Group B (haemorrhoidectomy using Harmonic scalpel). Milligan-Morgan open hemorrhoidectomy using electrocautry and harmonic scalpel were performed as per the group. Observations: The most common age group to be involved was 31-40, 23 patients (38.3%). Males were affected more than females, with a male to female ratio of 7.6:1. The primary presenting symptom was painless bleeding per rectum in 44 patients (73%) and prolapse was seen in 33 patients (55%). 29 patients (48.3%) had grade III and 31 patients (51.7%) had grade IV haemorrhoids. Post-operative bleeding was significantly less in harmonic scalpel haemorrhoidectomy [ 3(10%), 8(26.7%), p =0.04]. Post-operative pain was significantly greater in the conventional electrocautery group as compared to the harmonic scalpel group on post-operative days 1,5 and14. Conclusion: It can be concluded that Scalpel approach have reduced pain in immediate post-operative period and at 24 hours with fewer analgesics required. We strongly advocate the use of Harmonic Scalpel devices for haemorrhoidectomy when and where possible, especially for high grade. [ABSTRACT FROM AUTHOR]

Background. Haemorrhoidal disease is a common disorder in the Western World that commonly requires surgical treatment, but original open techniques were associated with significant complications and pain. Haemorrhoidal Arterial Ligation (HAL) has gained popularity for relatively low complication and postoperative pain rates. This review assesses clinical outcomes of this technique in comparison to alternative modern techniques. Methods. The literature was searched on MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. Search terms: dearterialization, artery ligation, mucopexy, recto-anal repair. Inclusion criteria: RCTs, original publications, grade II, III and/or grade IV haemorrhoids, elective procedures. Exclusion criteria: non-English, non-adults, published pre-2016. Results. 14 RCTs were included in the systematic review. HAL performed poorly in terms of recurrence, with a pooled recurrence rate of 10.34% for grade III haemorrhoids. HAL had a similar recurrence rate to Procedure for Prolapse and Haemorrhoids. Pain was comparable between groups. Conclusion. HAL is a safe surgical technique for the treatment of grade II to grade IV haemorrhoids. It still has a relatively low complication rate, and pain scores are comparable to other non-invasive techniques, and superior to open techniques. HAL still performs poorly in terms of recurrence rates. New modified procedures including suture-mucopexy only and tissue-selecting techniques appear to have better therapeutic potential. [ABSTRACT FROM AUTHOR]

Aim of the Study: To determine the different etiologies, clinical evaluation, and need for blood transfusion in lower gastrointestinal bleeding patients admitted at a tertiary care institution of eastern Odisha. Materials and Methods: A total of 988 cases were included in the study which consisted of824 retrospective cases and 164 prospective casesin the Gastroenterology Department, S.C.B. Medical College and Hospital, Cuttack, Odisha. Information was compiled by analysing the case sheets of retrospective cases. Prospective patients were managed as per departmental protocol and details of all investigations and treatments done were documented. Results: Patients aged >40 years were the most commonly affected constituting 56% (533/988) of studied population. Males constituted 70.5% (697/988) and females 29.5% (291/988). Mean age of males was 43.23±10.65 years compared to females (42.79±16.53years). Hemorrhoids was found to be the most common pathologyin colonoscopy and was seen in 30.8% (n =305) patients. Anorectal growth was found in 15.3% casesand colonic growth in 9.7%.Inflammatorylesions were seen in14% (139/988) of patients. Colonic polyp was found in 4.8% of patients compared to rectal polyp in 3.9%. Mean haemoglobin level of males was 10.64±3.79 g/dl compared to females (10.83±3.69 g/dl). Only7.8% (77/988) patients required blood transfusion as their haemoglobin level dropped to <7gm/dl. Conclusion: Hemorrhoids was the most frequent diagnosis of lower gastrointestinal bleeding followed by anorectal growth. Colonoscopy was the first and most frequent investigation used for the evaluation of lower gastrointestinal bleed. Only few patients required blood transfusion. [ABSTRACT FROM AUTHOR]

Background: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients., Methods: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution., Results: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported., Conclusion: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.

Introduction: Haemorrhoids is a very common condition in patients presenting to surgery Outpatient Department (OPD) with complaints of bleeding per rectum. Injection Foam Sclerotherapy has been established as a safe, simple and effective non surgical modality in treatment of symptomatic grade 1 and 2 haemorrhoids. Aim: To evaluate the effectiveness of foam sclerotherapy as a treatment modality in patients suffering with symptomatic Grade I and II Haemorrhoidal diseases. Materials and Methods: This prospective interventional study was conducted in General Surgery department of FH Medical College and Hospital, Agra, Uttar Pradesh, India between April 2021 to September 2021. A total of 42 patients with complaints of bleeding per rectum, and who were diagnosed as a case of Grade I or II internal haemorrhoids were included. 3% Polidocanol was used as the sclerosing agent for sclerotherapy. Effectiveness of sclerotherapy was evaluated, parameters assessed were bleeding per rectum, pain and pruritis with regular follow-ups of the patients at specific intervals. Results: Among 42 patients 29 (69.05%) patients had grade I haemorrhoids while 13 (30.95%) presented as a case of grade II haemorrhoidal disease. Among the patients with grade I haemorrhoids, 82.76% (24/29) were treated successfully after a single session of foam sclerotherapy while 53.85% (7/13) of the patients with grade II haemorrhoids were symptomatically relieved after a single session. The success rate after 2nd session of sclerotherapy was 100% (29/29) in patients diagnosed as a case of grade I haemorrhoids comparing it to 69.23% (9/13) in those with grade II haemorrhoids. The overall cure rate for either grade of haemorrhoid after three sessions of therapy was 95.24% (40/42). Conclusion: This study reflects that 3% polidocanol when used as a sclerosant agent was found to be cheap, safe and effective, and first line treatment modality in grade I and II haemorrhoids that can be done on outpatient basis with minimal complication.

PurposeHaemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review.MethodsEMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids.ResultsTen clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias.ConclusionThe laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.