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

Hemorrhoid disease is very common, affecting greater than one-third of adults. Conservative management and several office-based procedures are useful in the treatment of internal hemorrhoids. Patients with refractory hemorrhoid disease have traditionally been treated with surgical hemorrhoidectomy. Rectal artery embolization has emerged as an alternative to surgical hemorrhoidectomy and has been shown to be safe and effective in case series and clinical trials completed over the past decade. Embolization has significantly less postprocedure pain when compared with surgical hemorrhoidectomy with similar outcomes. Pre- and postprocedure imaging are not routinely performed. Intraprocedural imaging consists of selective catheterization of the superior rectal arteries from the inferior mesenteric artery, and the middle rectal arteries from the internal iliac artery. The inferior rectal artery is seldom embolized due to the supply of the levator ani muscle and skin. To date, intermediate and large particles and fibered and nonfibered coils have been used successfully. [ABSTRACT FROM AUTHOR]

Background: Milligan Morgan hemorrhoidectomy (open hemorrhoidectomy [OH]) once considered the gold standard surgical technique for hemorrhoids is challenged by stapled hemorrhoidopexy (SH) which claims a better postoperative outcome. The purpose of this study was to compare the outcomes of OH and SH in the Indian context. Materials and Methods: This prospective comparative study included 50 consecutive patients who underwent OH (n = 30) and SH (n = 20) from June 2018 to May 2020 at our institute. The primary outcomes were intra-operative time, postoperative pain assessed by the visual analog scoring system, and duration of stay at the hospital. Patients were clinically assessed at 1 week and 3 months postdischarge, and telephonically interviewed at 3 and 6 months for complications and time taken to resume normal activities. Student t test and chi-square test were used to test the statistical significance of the difference in mean of continuous variables and the difference in the proportion of categorical variables respectively. Results: The mean pain score postOH was found to be significantly higher than post-SH, measured after 3 h (3.47 ± 1.16 vs. 1.90 ± 0.968; P < 0.001), 6 h (5.8 ± 1.4 vs. 3.55 ± 0.99; P < 0.001), and 12 h (5.2 ± 1.7 vs. 1.85 ± 1.387; P < 0.001). The duration of hospital stay post-procedure was higher for OH by 24 h on average (3.1 ± 1.08 days vs. 2.10 ± 1.02 days; P < 0.001). The time that is, taken to resume work after OH was significantly higher (28.3 ± 14.5 vs. 10.85 ± 4.082; P < 0.001). Conclusion: SH has lower post-procedure pain, shorter hospitalization, and faster return to work compared to OH. The incidence of complications was comparable between both groups.

Background: Colonoscopy is a critical and frequently used medical procedure that is essential in identifying colonic and rectal cancers on time. It remains the preferred method for visualizing the colonic and rectal mucosae, enabling the detection of conditions like carcinoma, adenoma, and inflammation. Colorectal cancer is the third most common cancer worldwide, and due to its tendency to present late, screening programs that rely on a sensitive tool like colonoscopy are of utmost importance. Objectives: To evaluate the clinical characteristics and colonoscopic findings, including colorectal cancer, among patients referred to the gastro-enterology unit in Al-Imamain Al-Kadhemain Medical City and determine the most common presenting symptoms of colorectal diseases. Patients and Methods: A study was conducted at the GIT unit of Al-Imamain Al-Kadhemain Medical City from November 2022 to March 2023 involving 120 patients who underwent colonoscopy. The study recorded the presenting complaint and colonoscopy results. The mean and standard deviation were used to express continuous variables, while frequency and percentage were used for categorical variables The difference between means was tested using Welch's t-test, and a P-value less than 0.05 was considered statistically significant. Result: The study included a total of 120 participants, with an average age of 46.57 years. The leading indication for colonoscopy was bleeding per rectum (45%), followed by chronic constipation (26.6%) and chronic abdominal pain (21.6%). The most common pathologies observed during colonoscopy were internal hemorrhoid (18.3%), polyposis (15%), and colorectal cancer (13.3%). Conclusion: Rectal bleeding is the primary reason for conducting colonoscopy and is also the most common symptom of colorectal cancer. During colonoscopy, Internal hemorrhoids are frequently observed, which is the most common cause of rectal bleeding. Polyps and colorectal cancer are the next most frequent causes of rectal bleeding.

Background: There is no consensus on the number of ligation bands for varying grades of internal hemorrhoids (IH) in a single session of endoscopic rubber band ligation (ERBL). Aims: The aims of this study were to investigate this issue. Methods: Patients with IH were treated with ERBL. The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL. The secondary endpoints were postoperative complications and recurrence. Results: One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded. The average bands were 3.9 ± 1.1, and grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000). 78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%). The incidence of postoperative complications was not significantly correlated with the grade of hemorrhoids (P = 0.201) and the number of bands (P = 0.886). The median follow-up time was 14.3 ± 7.9 (1.3–30.9) months. The overall recurrence rate was 25.0%, with grade III significantly higher than grade I–II (32.8% vs 14.6%, P = 0.027). For grade III hemorrhoids, the recurrence rate was lower with more than 4 bands of ligation than with less than 4 bands (26.5% vs 53.3%). Conclusions: The average ERBL treatment of IH requires nearly four bands, and grade II hemorrhoids require less banding than grade III hemorrhoids, while the efficacy was better. Increasing the number of bands improves the treatment efficacy for grade III IH, which could be a strategy to reduce the recurrence rate without increasing postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I–III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I–III internal hemorrhoids. Methods: The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I–III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity. Results: Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48–7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15–1.82, p = 0.31). Conclusion: This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I–III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy. [ABSTRACT FROM AUTHOR]

Outlet obstructive constipation (OOC) is a common type of chronic constipation that is usually caused by internal hemorrhoids (IH) and rectal mucosal prolapse (RMP). Cap-assisted endoscopic sclerotherapy (CAES) was demonstrated to be effective in the treatment of IH and RMP. This study explored the efficacy of CAES in treating OOC associated with IH and RMP. Thirty-one patients (15 males and 16 females) were diagnosed with OOC after colonoscopy and anorectal manometry (AM). CAES was used to treat IH and RMP. The self-rating anxiety scale (SAS), self-rating depression scale (SDS), and Wexner constipation score (WCS) were used to assess patients at baseline and at the end of follow-up. AM tests were performed before and after CAES. The mean age of patients was 56.19 ± 7.969 years, and the follow-up time was 2.875 ± 3.703 months. After CAES treatment, subjective indices, including frequency of bowel movements (p < 0.05), defecation time (p < 0.05), SAS (p < 0.05), SDS (p < 0.05), and WCS (p < 0.05), were significantly improved. AM showed that the anal relaxation rate (p < 0.05), maximum squeeze pressure (p < 0.05), and rectal residual pressure (p < 0.05) were significantly improved. The ratio of Bristol stool form scale typeIII–Vincreased from 12.5 % to 56.25 % (p < 0.05). CAES is effective for treating OOC caused by IH and RMP. The relief of OOC symptoms could improve anxiety and depression symptoms associated with the disease. [ABSTRACT FROM AUTHOR]

Objective　To investigate the efficacy of lauromacrogol foam sclerosant and lauromacrogol injection in patients with internal hemorrhoids. Methods　A total of 94 patients with internal hemorrhoids treated in Kunming Second People’s Hospital from February 2020 to August 2021 were randomly selected and divided into study group and control group by number table method. The control group （n = 47）was treated with lauromacrogol injection，and the study group （ n = 47） was treated with lauromacrogol foam sclerosant. The total effective rate， clinical indicators （total course of treatment，operation cost，dosage of lauromacrogol ），intraoperative bleeding， postoperative pain and complications. Results　The total effective rate of the study group was higher than that of the control group，and the difference was statistically significant （P < 0.05）. The total duration of treatment，operation cost and dosage of lauromacrogol in the study group were lower than those in the control group，and the differences were statistically significant （P < 0.05）. The intraoperative local blood loss and postoperative pain in the study group were lower than those in the control group， and the differences were statistically significant （ P < 0.05） . The incidence of complications in the study group was lower than that in the control group， and the difference was statistically significant （ P < 0.05） . Conclusion　Lauromacrogol foam sclerosant is better than lauromacrogol injection in the treatment of patients with internal hemorrhoids，and can shorten the length of hospital stay，reduce the dosage of lauromacrogol，hospitalization costs，complications，and is worthy of promotion and application. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to prospectively evaluate the efficacy and safety of a new, bare platinum, detachable microcoil as a metallic embolization agent in the treatment of hemorrhoidal disease. Material and Methods: This prospective single-center study evaluated a new, bare platinum, electrical, detachable microcoil (Prestige plus coil (Balt Montmorency France)) for use in vascular embolization in patients with hemorrhoidal disease. Between January 2020 and January 2021, 24 embolization procedures were performed in 21 patients (12 males, 9 females; mean age 44.3 ± 7.3). The inclusion criteria were: (a) participants with grade I, II and III hemorrhoidal disease on the Goligher classification; (b) patients older than 18 years of age with a score of greater than 4 on the French bleeding score (FBS) scale; (c) patients with scores greater than 2 on the scale of discomfort proposed by Tradi and Farfallah. (d) patients who underwent treatment that included the use of the new novel coil (Prestige plus coil (Balt)) as an embolic material. The exclusion criteria were participants who failed to provide informed consent and participants diagnosed with rectal bleeding due to other causes (cancer, fissures or others). Participants with severe renal insufficiency, non-correctable coagulation abnormalities and adverse reactions to the contrast medium not correctable with medication were also excluded. The symptoms, technical aspects, the transarterial approach, clinical and technical success complications and short-term outcomes were assessed. Results: Technical success was obtained in 100% of the cases. Seventeen (80.9%) patients experienced improvements in their hemorrhoidal disease. The VAS and QL scores improved by 4 and 1.5 points (81.2% and 87.5%), respectively, after embolization (pV: 0001). Three (14.2%) patients underwent a second embolization due to rebleeding. One patient (4.7%) underwent surgery. No major complications were observed. Three patients had minor complications. The assessment of subjective post-treatment symptoms and QL surveys showed significant differences from the baseline survey. Likewise, the measurement of the degree of satisfaction using a telephone survey at 12 months revealed a high degree of patient satisfaction over 10 points (mean 8.3 ± 1.1). Conclusions: The present study demonstrates that the use of the new, platinum, detachable, electrical microcoil is safe and well-tolerated in the treatment of hemorrhoidal disease. Key points: Catheter-directed hemorrhoidal dearterialization (CDHD) is the procedure of embolization with embolic agents for the treatment of internal hemorrhoids. CDHD is a simple and safe procedure that is accepted by patients and preserves the anal sphincter; it presents few complications when metal devices or microspheres are used as embolic agents. As the recommended embolization agent in treatments, the Prestige electrical, detachable coil is a safe, easy-to-use and effective arterial embolic device. [ABSTRACT FROM AUTHOR]

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

Abstract Background Rectovaginal fistula (RVF) following aluminum potassium sulfate hydrate-tannic acid (ALTA) injection therapy for hemorrhoids is a rare complication. We report the first case of RVF after ALTA injection therapy successfully treated by gluteal-fold flap. Case presentation A 49-year-old female suffered from a fever and rectal ulcer after undergoing internal hemorrhoid treatment with a submucosal ALTA injection at a previous clinic. One week after ALTA therapy, she noted obvious passage of flatus and stool through the vagina, and was diagnosed with RVF by anoscope at another clinic. She was referred to our hospital 3 weeks after ALTA therapy. Sigmoid colostomy was performed for fecal diversion as a preliminary step for fistula repair. However, the fistula was scarred and the defect between the rectum and vagina did not improve at all. Ten months after ALTA therapy, we performed fistula repair by gluteal-fold flap. Seven months later, sigmoid-colostomy reversal was performed. The patient has experienced no RVF in the 3 years since sigmoid-colostomy reversal. Conclusions The gluteal-fold flap strategy is a useful option for severe RVF management.

In the study, we comment on the article by Qu et al . Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings., Competing Interests: Conflict-of-interest statement: We have nothing to disclose for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

We have read the article by Qu et al with great interest, as it presents an integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade II-III internal hemorrhoids. The authors conducted a prospective, multicenter, randomized study to evaluate the long-term symptomatic and endoscopic efficacy of this combined intervention. In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflicts of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Hemorrhoids are swollen veins of the hemorrhoidal plexus that are normally present in the anal canal. Clinically detectable if the supporting connective tissue is compromised. In this study, we focused on the effectiveness and importance of colonoscopy for studying the prevalence of internal hemorrhoids. Objective: The study aimed to evaluate the prevalence of internal hemorrhoids in patients undergoing colonoscopy for different indications. Patients and Methods: This cross-sectional study was conducted in the Elective Gastrointestinal Endoscopy Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University. The study was conducted through the period from March 2021 to Augustus 2021, and including 300 consecutive Egyptian patients who underwent a flexible colonoscopy for different reasons. Results: In the present study, we revealed that hemorrhoids increasing with aging. The diagnostic results were internal hemorrhoids (38.3%), colonic ulcers (11%), inflammatory lesions (7.3%) and mass (7%), diverticular disease (6%), polyps (5.7%), and vascular malformations (1.3%). The complaints of the patients were lower GI bleeding (41.7%). Chronic diarrhea (17.7%), abdominal pain (14.7%), and chronic constipation (13.3%) in the subsequent levels. Also, chronic anemia (6.7%), follow-up colon polyp (5.3%), one patient had weight loss (0.3%) and one patient had anal pain (0.3%). Conclusions: We can conclude a wide prevalence of internal hemorrhoids in patients who underwent colonoscopy for various reasons. Besides, retroflexed colonoscopy can contribute to the study of the prevalence of internal hemorrhoids because it can diagnose even asymptomatic hemorrhoids. In addition, colonoscopy was found to be extremely safe and no complication was detected. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoid is a common anorectal lesion. Goligher’s system classified the internal hemorrhoids into (4) grades, however, it did not provide any information about the severity of the disease. There is limited data about the role of the colonoscopy in the diagnosis and evaluate the severity of the internal hemorrhoids. Objective: The study to compare the difference between both colonoscopy and standard Goligher’s grading in their relation to the symptoms and complications in the same patient and to prove which grading system is better for the diagnosis of internal hemorrhoids. Patients and Methods: This cross-sectional study was done in the elective gastrointestinal endoscopy unit, Internal Medicine Department, Faculty of Medicine, Zagazig University from March 2021 to Augustus 2021, and including 300 consecutive Egyptian patients who underwent a flexible colonoscopy were enrolled in this study for different reasons. Results A significant increase in the proportion of patients who had grade IV colonoscopy classification with an increase in the size and presents of RCS, also there is a significant increase in the proportion of patients who had RCS with increasing the size of internal hemorrhoids, (P<0.05). The chronic anemia, lower GI bleeding, are the most independent risk factors for the development of internal hemorrhoids in patients undergoing colonoscopy grading, (P < 0.001). Conclusions: The use of retroflexed colonoscopy is accurate and effective in diagnosing and evaluating internal hemorrhoids. The colonoscopy grading is more accurate in describing the relationship between the degree of hemorrhoids and complaints than Goligher's grading. [ABSTRACT FROM AUTHOR]

Background: Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain., Aim: To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL., Methods: This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range., Results: One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]., Conclusion: Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure., Competing Interests: Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Rectovaginal fistula (RVF) following aluminum potassium sulfate hydrate-tannic acid (ALTA) injection therapy for hemorrhoids is a rare complication. We report the first case of RVF after ALTA injection therapy successfully treated by gluteal-fold flap. Case presentation: A 49-year-old female suffered from a fever and rectal ulcer after undergoing internal hemorrhoid treatment with a submucosal ALTA injection at a previous clinic. One week after ALTA therapy, she noted obvious passage of flatus and stool through the vagina, and was diagnosed with RVF by anoscope at another clinic. She was referred to our hospital 3 weeks after ALTA therapy. Sigmoid colostomy was performed for fecal diversion as a preliminary step for fistula repair. However, the fistula was scarred and the defect between the rectum and vagina did not improve at all. Ten months after ALTA therapy, we performed fistula repair by gluteal-fold flap. Seven months later, sigmoid-colostomy reversal was performed. The patient has experienced no RVF in the 3 years since sigmoid-colostomy reversal. Conclusions: The gluteal-fold flap strategy is a useful option for severe RVF management. [ABSTRACT FROM AUTHOR]

Résumé: Les techniques mini-invasives en chirurgie hémorroïdaire, apparues durant les deux dernières décennies, sont en plein essor. Elles représentent une alternative intéressante à l'hémorroïdectomie tripédiculaire classique car elles ne nécessitent pas de soins locaux, sont réalisées en ambulatoire, elles sont moins ou pas douloureuses et elles permettent une reprise d'activité plus rapide. Le traitement mini-invasif hémorroïdaire par laser est à la mode. Deux techniques utilisant ce type d'énergie sont disponibles : l'hémorroïdoplastie laser (LHP) et la HeLP (Hemorroidal Laser Procedure). L'hémorroïdoplastie laser, technique pratiquée en France, a montré des résultats satisfaisants dans les études publiées. Elle consiste à détruire le tissu hémorroïdaire et les branches terminales sous-muqueuses de l'artère hémorroïdaire supérieure par coagulation à l'aide d'une fibre laser introduite via une incision cutanée marginale. Les suites sont simples et les résultats à court et moyen terme sont bons sur la régression des symptômes (saignements, douleurs, démangeaisons) et la réduction du prolapsus hémorroïdaire. Elle représente une nouvelle option dans le traitement chirurgical de la maladie hémorroïdaire interne avec prolapsus minime à modéré. Sa place par rapport aux autres techniques mini-invasives reste encore à évaluer. La HeLP, non réalisée en France, détruit avec une fibre laser par voie transanale, après repérage au Doppler, les branches terminales de l'artère hémorroïdaire supérieure. Minimally invasive hemorrhoid surgery, which have appeared the last two decades, are in full development. They are an attractive alternative to conventional hemorrhoidectomy because they do not require local care, they are performed on outpatient, their postoperative courses are less painful and less longer. Minimally invasive hemorrhoidal laser treatment is popular. Two techniques using this type of energy are available: Laser hemorrhoidoplasty (LHP) and HeLP (Hemorrhoidal Laser Procedure). Laser hemorrhoidoplasty, performed in France, has shown satisfactory results in published studies. The shrinkage of internal hemorrhoidal tissue and the terminal branches of the superior hemorrhoidal artery are achieved by a specific laser device through a skin incision. Its postoperative courses are simple and their short-term results are good in terms of improvement of symtoms (bleeding, pain, itching) and reduction of hemorrhoidal disease grade. It represents a new option in the treatment of symptomatic second to third grade hemorrhoids with minimal internal mucosal prolapse. Its position, compared to other minimally invasive procedures, needs to be evaluated. HeLP, not performed in France, using a diode laser coupled with Doppler into the anal canal for photocoagulation of the distal branches of hemorrhoidal arteries. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the second most diagnosed cancer and the second leading cause of cancer-related deaths in the United States. Rectal cancers, specifically, are the second most common cancer of the large intestine. Although once perceived as a disease of the elderly, the incidence of early-onset CRC (EO-CRC), classified as occurring in individuals less than 50 years old, has been paradoxically increasing. Although the incidence of rectal cancers has increased, the digital rectal exam (DRE) continues to be an underutilized physical exam maneuver when a patient presents with red-flag symptoms. Here, we present a case of a 38-year-old male from West Virginia who was referred to general surgery for complaints of rectal bleeding attributed to internal hemorrhoids. After undergoing a colonoscopy, the patient was found to have a rectal mass consistent with adenocarcinoma. We describe the importance of identifying red-flag signs to keep colorectal malignancy in the differential diagnosis in a young patient and highlight the importance of performing rectal exams to identify rectal cancers early to expedite treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ramanathan et al.)

Objective: To compare the efficacy of injections Sclerotherapy (IST) and rubber band ligation (RBL) for the treatment of 2nd degree haemorrhoids in terms of improvement in symptoms severity score (SS score) in OPD patients. Study Design: Randomized controlled trial. Place and Duration of Study: It was conducted in surgical OPD of CMH Kohat, from 15th October 2010 to 10th April 2011 Material and Methods: A total of 116 patients with symptomatic 2nd degree haemorrhoids were randomly divided into two groups, RBL and IST (58 patients each) respectively and a baseline symptoms severity score was noted for each patient. Patients in RBL group were treated with RBL while in IST group were treated with IST. The outcome measures were relief of symptoms and improvement in SS score. Results: In RBL group, baseline SS score was 4.67 ± 2.01 which reduced to final mean SS score of 1.34 ± 0.96 whereas in IST group the baseline SS score was of 4.31 ± 2.13 which reduced to a final mean SS score of 1.6 ± 0.97. 44 (75.95%) patients had complete recovery and control of bleeding in RBL group; whereas in IST group 32 (55.1%) of the patients had this response by the end of two weeks. Conclusion: Rubber band ligation was found to have better patient outcomes as compared to injections sclerotherapy in treatment of 2nd degree hemorrhoids. [ABSTRACT FROM AUTHOR]

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

A 45 years female presented with a complain of something coming out through her anus since one year, which comes on straining and reduces only after manual intervention. She had also, a history of constipation with occasional blood and mucus discharge in the stool. On examination, she was found to have full thickness rectal prolapse, which comes out on straining and reduces only after pushing it manually. With a diagnosis of complete rectal prolapse grade III, she underwent abdominal suture rectopexy and now she is doing well after six months of follow-up. One of the very close differential diagnosis of complete rectal prolapse is prolapsed internal hemorrhoid. Both can present with similar symptoms with similar clinical grading, but management is completely different. Diagnosis of both these conditions is critical and mostly based on clinical findings. The differentiating point between a rectal prolapse and internal hemorrhoid lies in the orientation of the mucosal folds. Rectal prolase usually has circular folds (A,B) where as internal hemorrhoids have radial folds (C). This is because, hemorrhoids are collections of submucosal, fibrovascular, arterio-venous sinusoids mostly seen in the left lateral, right anterolateral and right posterolateral region of anal canal. While rectal prolapse is the intussusception of whole circumference of the rectal wall through the anal canal which presents with circular folds of rectal mucosa. This image presents a classic case of complete rectal prolapse with an image of a prolapsed internal hemorrhoid to understand the differentiating points of these two very common clinical conditions.

A 66-year-old male patient came to the anorectal clinic, Outpatient department, AVT Institute for Advanced Research, Coimbatore, Tamil Nadu, with complaints of prolapsing pile mass during defecation and bleeding while passing stool. The case was diagnosed as "Raktarsha" - 11 & 7 ′o′ clock position II degree internal hemorrhoids, deeply situated, projecting one and caused by pitta and rakta; with bleeding tendency. Kshara karma (application of caustic alkaline paste) intervention was done in this case to internal hemorrhoids under local anesthesia. The pile mass and per rectal bleeding resolved in 8 days and the patient was relieved from all symptoms within 21 days. No complications were reported after the procedure. The patient was followed up regularly from 2004 onward till date and proctoscopic examination did not reveal any evidence of recurrence of the hemorrhoids.

Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy is increasingly popular for treating internal hemorrhoids. This injectable compound incites inflammation to dampen hemorrhoidal blood flow and inflict secondary fibrosis. Herein, we detail the implications of ALTA treatment for laparoscopic low anterior resection of rectal cancer. A 72-year-old man receiving ALTA sclerotherapy for internal hemorrhoids thereafter required laparoscopic low anterior resection for newly discovered early rectal cancer. Observed changes of anal canal resembled those of radiochemotherapy and proved problematic. There was mural thickening and sclerosis at the planned resection site. To ensure proper removal, the bowel was compressed and stapled slowly. A two-shot resection took place (without straining), anastomosis was performed, and a covering stoma was constructed. Recovery was uneventful, allowing discharge on postoperative Day 10. The ileostomy was closed at a later time. Although little information is available on long-term rectal pathology after ALTA therapy, existing data suggest that sclerosis persists well beyond injection timeframes. Hence, caution is required in dissecting and debriding sclerotic remnants. We have identified only four earlier reports in this setting, the present case providing added perspective. Colonoscopy is highly advisable prior to ALTA therapy. A thorough work-up before rectal surgery is also essential, documenting any past treatments for anorectal disease, especially ALTA. • Rectal surgery after ALTA therapy requires caution due to mural thickening. • ALTA-induced tissue fibrosis is sustained for at least 5 years. • Careful preoperative histories of prior anorectal treatments are essential. • Colonoscopy is strongly recommended prior to treatment of anorectal disease. [ABSTRACT FROM AUTHOR]

An estimated 50% of the population over age 50 years have experienced hemorrhoidal symptoms at some point in their lives. Improved surgical techniques for internal hemorrhoids can reduce postoperative pain and facilitate a quicker recovery. [ABSTRACT FROM AUTHOR]

Purpose: Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for internal hemorrhoids. However, it is contraindicated for patients with chronic renal failure on dialysis, because the aluminum in ALTA can cause aluminum encephalopathy when it is not excreted effectively. We conducted this study to measure the serum aluminum concentrations and observe for symptoms relating to aluminum encephalopathy in dialysis patients after ALTA therapy. Methods: Ten dialysis patients underwent ALTA therapy for hemorrhoids. We measured their serum aluminum concentrations and observed them for possible symptoms of aluminum encephalopathy. Results: The total injection volume of ALTA solution was 31 mL (24-37). The median serum aluminum concentration before ALTA therapy was 9 μg/L, which increased to 741, 377, and 103 μg/L, respectively, 1 h, 1 day, and 1 week after ALTA therapy. These levels decreased rapidly, to 33 μg/L by 1 month and 11 μg/L by 3 months after ALTA therapy. No patient suffered symptoms related to aluminum encephalopathy. Conclusions: Although the aluminum concentrations increased temporarily after ALTA therapy, dialysis patients with levels below 150 μg/L by 1 week and thereafter are considered to be at low risk of the development of aluminum encephalopathy. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of An's Shaobei Injection (安氏芍倍注射液) with Xiaozhiling Injection (消痔灵注射液) in patients with internal hemorrhoids of grade I-III. Methods: This cohort study included 1,520 internal hemorrhoids patients with grade I-III who were scheduled for liquid injection treatment from July 2003 to July 2009. The cohort included patients who underwent either An's Shaobei Injection treatment (the treatment group, 760 cases) or Xiaozhiling Injection treatment (the control group, 760 cases). All patients were followed up regularly for 3 years; the observing indices included anal function recovery and clinical response after operation. Results: Among the 1,520 patients, 1,508 (99.2%) completed the 3-year follow-up. The efficacy rate was 97.5% in the treatment group, significantly higher than the control group (91.8%, P<0.01). The recurrence rate in the treatment group was 0.5%, significantly lower than that of the control group (1.3%, P<0.01). In addition, perianal callosity occurred in 8 cases (1.1%) and anorectal stricture in 26 cases (3.5%) after operation in the control group. There was no perianal callosity and anorectal stricture in the treatment group. Conclusion: The treatment with An's Shaobei Injection demonstrated superior clinical effect to Xiaozhiling Injection with fewer adverse effects. [ABSTRACT FROM AUTHOR]

Background: Several minimally invasive technologies are available to treat common soft tissue lesions including symptomatic hemorrhoids. The use of energy to deliver heat and coagulate target lesions is commonly practiced. This study compares the histologic effects produced on intestinal tissues by two energy-based systems which employ different approaches of heat delivery. Methods: Two heat delivery systems were evaluated in vivo in a single porcine subject: infrared coagulator and bipolar tissue ligator utilizing constant tissue compression and temperature guidance. Eighteen treatment sites divided into three groups of six were assessed. Treatment site temperature was measured and the effects of thermal treatment in the mucosa, submucosa, submucosal vessels, and muscularis layer were scored. Lateral thermal spread beyond the energy application site was also assessed. Results: Treatment site temperatures were much lower in the bipolar ligator group than in the infrared coagulator group. The mucosal and submucosal tissue changes observed in tissues treated with infrared energy and bipolar energy at 55°C were similar. Both the mucosal and submucosal tissue changes with bipolar energy at 50°C were significantly less. Conclusion: Both devices achieved similar histologic results. However, the unique design of the bipolar ligator, which allows consistent capture, constant compression, and temperature monitoring of target tissue, accomplished the desired histologic changes with less muscular damage at much lower temperatures than the infrared coagulator. The use of bipolar ligation could offer clinical advantages such as reduced patient pain and a minimized chance of heat-related collateral tissue damage. [ABSTRACT FROM AUTHOR]

Purpose: Aluminum potassium sulfate and tannic acid (ALTA) induce noninvasive sclerosis and the involution of hemorrhoids by initiating an inflammatory reaction. We assessed the mid-term outcome after ALTA sclerotherapy for symptomatic hemorrhoids. Methods: Between May 2006 and July 2009, 1210 patients with grade III or IV hemorrhoids underwent surgery at Kunimoto Hospital. Our treatment strategy for internal hemorrhoids is first establishing whether ALTA therapy is possible for the type of hemorrhoid, and then performing either ALTA therapy or alternatively, ligation and excision (LE) for those types unsuitable for ALTA therapy. Results: A total of 448 patients were treated with ALTA therapy alone (Group A), 706 patients were treated with a combination of ALTA and LE therapy (Group B), and 56 patients were treated with LE alone (Group C). The overall recurrence rates were 3.6% (16/448) and 0.3% (2/706) in Groups A and B, respectively. There was no recurrence in Group C. Rectal ulcers developed at the injection site in four (0.9%) patients from Group A, but they healed within a few months with conservative therapy. Conclusion: ALTA sclerotherapy is a simple and safe treatment for symptomatic hemorrhoids, with few complications. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 63-year-old male who was referred for colonoscopy for cancer in diminutive rectal polyp with internal hemorrhoids which was detected by rectal retroflexion. His colonoscopic examination revealed that lesions are above the anorectal junction with atypical features and identified internal hemorrhoids during colonoscopy. Transanal excision was used to remove the cancer with defect closure via a flap without hemorrhage.

Background and Aim: Rigid proctoscopy, the gold standard for detecting hemorrhoids, has become a neglected procedure in the era of flexible endoscopy. Evaluation of hemorrhoids is often done with the retroflexed fiberoptic colonoscope. The aim of this study was to evaluate the technique of videoanoscopy in comparison with retroflexion of colonoscope in the rectum to detect hemorrhoids and to correlate objective findings of hemorrhoids and their relation to bleeding. Methods: In total, 544 patients were screened and 358 patients were evaluated by the technique of videoanoscopy and retroflexion of colonoscope in the rectum. The video images of both the procedures were independently analyzed by two observers for the presence or absence of hemorrhoids. The videoanoscopy images were also analyzed for number of columns of hemorrhoids, size and presence of red-color sign. Results: Videoanoscopy detected hemorrhoids in a significantly higher number of subjects when compared with retroflexion of colonoscope in the rectum by both observers ( P < 0.05). The average kappa value was 0.637 and 0.779 for retroflexed colonoscopy and videoanoscopy, respectively. Red-color sign was present in 80.5% of patients with bleeding compared with only 30.3% in the non-bleeding group. The majority (71%) of patients in the bleeding group had larger hemorrhoids. Red-color sign and size of hemorrhoidal columns correlated with bleeding ( P < 0.05). Conclusion: Videoanoscopy is a simple technique with increased sensitivity to detect hemorrhoids compared with intrarectal retroflexion of colonoscope and yields valuable objective information about the presence and condition of hemorrhoids. It should be performed as an extension of standard colonoscopy. [ABSTRACT FROM AUTHOR]

This study was designed to evaluate the safety and efficacy of combining outpatient colonoscopy with simultaneous three-quadrant hemorrhoidal ligation in patients with symptomatic internal hemorrhoidal disease. A four-year analysis of patients undergoing combined colonoscopy and synchronous three-quadrant hemorrhoidal ligation was performed. Indications for the procedure were patients with symptomatic internal hemorrhoids who had failed conservative management and who also required colonoscopy. Conventional colonoscopy was performed under moderate sedation, immediately followed by synchronous three-quadrant hemorrhoidal ligation, using a TriView™ anoscope and Short-Shot™ hemorrhoidal ligator. Patients undergoing this procedure were entered in a computer database, and outcomes were tracked. Patients requiring repeat ligation, surgical intervention, or readmission within 30 days were identified and further analyzed. Five hundred patients underwent colonoscopy with simultaneous three-quadrant internal hemorrhoid ligation during the study period. Four hundred sixty-seven patients (93.4 percent) had complete resolution of their symptoms and required no further treatment. Thirty-three patients (6.6 percent) required repeat ligation, and 11 (2.2 percent) required completion surgical hemorrhoidectomy for persistent symptoms. Fifty-two patients (10.4 percent) required incidental biopsy/polypectomy during the colonoscopy. Two incidental colon carcinomas were identified, and ligation was deferred. No patients required admission for bleeding after the procedure. There were no cases of pelvic sepsis, and no patients required emergent surgical intervention. Combining colonoscopy with three-quadrant hemorrhoidal ligation is a safe and effective method of treating symptomatic internal hemorrhoids. The procedure is convenient for both physician and patient and makes more efficient use of time and resources. [ABSTRACT FROM AUTHOR]

Background: In 1995, Morinaga reported a new technique for the treatment of hemorrhoids, hemorrhoidal artery ligation (HAL), which uses a specially designed proctoscope coupled with a Doppler transducer for identification and ligation of hemorrhoidal arteries. Methods: Because the arteries carrying the blood inflow are ligated, internal pressure of the plexus hemorrhoidalis is decreased. Results: We report the results of the first 308 patients (189 male and 119 female; median age 50.1 years) who have been treated at our department since 2002 and followed-up for a median period of 18 months. Eighty-nine patients had grade II, 192 patients had grade III, and 27 patients had grade IV hemorrhoids. The acute symptoms of hemorrhoids were treated immediately by performing HAL. Conclusions: Our study showed that HAL is painless, effective, and has a low rate of complications. It can be applied in an outpatient setting and is an good alternative to all other hemorrhoid treatment methods. [ABSTRACT FROM AUTHOR]

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

PURPOSE: Rubber band ligation therapy for symptomatic hemorrhoidal disease has been used for many years and is a well-accepted treatment modality, but information on longterm outcome is limited. Our goals were to determine safety and long-term efficacy of this treatment. METHODS: A retrospective chart review of patients undergoing rubber band ligatures for symptomatic internal hemorrhoids in a single practice was conducted. Information on presenting symptoms, number of bands applied, response to therapy, complications encountered, length of follow-up, interval to recurrent symptoms when applicable, and subsequent therapy were documented. Supplemental information was obtained from telephone follow-up. Outcome was categorized as success or failure, in which success was defined as: permanent relief of symptoms for follow-up period; marked improvement in symptomatology with rare manifestation of bleeding (≤1/month); symptom relief for a limited period of time (≥100 days), and failure was defined as: modest improvement (decreased but not relief of symptoms); or no improvement in symptoms. RESULTS: A total of 805 patients underwent 2,114 rubber band ligatures. Most common presenting symptoms were bleeding in 731 patients (90.8 percent) and prolapsing in 382 patients (47.5 percent). The median number of bands placed was two (range, 1–17). The median time between bandings was 4.7 (range, 1.1–35.6) weeks. Median follow-up time was 1,204 (range, 14–9,571) days. Excluding 104 patients lost to follow-up (never returned after initial treatment), success was obtained in 70.5 percent (494/701) and failure in 29.5 percent (207/701) of patients. Success rates were similar for all degrees of hemorrhoids. Hemorrhoidal disease requiring the placement of four or more bands was associated with a trend in higher failure rates and greater need for subsequent hemorrhoidectomy. Complications per treatment series included bleeding (2.8 percent), thrombosed external hemorrhoids (1.5 percent), and bacteremia (0.09 percent). Higher bleeding rates were encountered with the use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin. Time to recurrence was less with subsequent treatment courses. Treatment of recurrent symptoms with rubber band ligation resulted in success rates of 73.6, 61.4, and 65 percent for first, second, and third recurrences respectively. This resulted in a cumulative success rate of 80.2 percent for this method of treatment. CONCLUSIONS: Rubber band ligatures are safe and effective therapy for symptomatic internal hemorrhoids. It can be used to treat all degrees of hemorrhoids with similar effectiveness. The likelihood of success is lower if more than four bands are needed to eliminate symptoms. The use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin is associated with higher bleeding rates. Rubber band ligatures for recurrence of symptoms is effective; however, time to recurrence is less with subsequent treatments. [ABSTRACT FROM AUTHOR]

INTRODUCTION. Oral metronidazole has been previously demonstrated to decrease postoperative pain after open diathermy hemorrhoidectomy. The current study investigates the efficacy of topical metronidazole (10 percent) in reducing postoperative pain and promoting wound healing after Harmonic Scalpel® hemorrhoidectomy. METHODS. A prospective, randomized trial was conducted to compare posthemorrhoidectomy pain and wound healing with use of topical metronidazole (10 percent) vs. placebo carrier, applied to the surgical site. Surgical indications included grade 3 or 4 internal or external hemorrhoidal disease, with or without a fissure-in-ano. Pain was assessed using a visual analog score (VAS) preoperatively and on postoperative days 1, 2, 7, 14, and 28. Twenty-four-hour narcotic use (hydrocodone 10 mg) was recorded on postoperative days 1, 2, 7, 14, and 28. Digital photographs of the surgical site were taken at 14 days postoperatively. The photographs were independently ranked by three blinded observers according to a) postoperative edema, b) primary vs. secondary healing, and c) overall wound healing. RESULTS. Twenty patients were randomized in a prospective manner, ten to the topical 10 percent metronidazole group and ten to the placebo carrier group. Patients in the topical metronidazole group experienced significantly less postoperative pain at day 7 (VAS ± SEM, 3.4 ± 0.4 vs. 6.3 ± 0.5; P = 0.002) and day 14 (1.0 ± 0.4 vs. 3.2 ± 0.7, P = 0.02). There was no statistical difference in narcotic analgesic requirements between groups. In the metronidazole group, postoperative edema was ranked significantly lower (mean score, 3.0 vs. 7.0, P < 0.01) and overall wound healing ranked significantly better (4.0 vs. 7.0, P = 0.03) than in controls. CONCLUSION. Topical 10 percent metronidazole significantly reduces posthemorrhoidectomy discomfort at days 7 and 14 postoperatively. Postoperative edema is reduced and overall healing is improved, compared with that of carrier controls. [ABSTRACT FROM AUTHOR]

PURPOSE: A modified anoscope was developed, with lateral apertures at the left lateral, right anterior, and right posterior quadrants, to enable synchronous exposure and ligation of all three internal hemorrhoids. Results were compared with those for conventional multiple ligation. METHODS: Postligation pain, complications, and outcomes were compared between synchronous ligation with the new anoscope (synchronous group) and three-quadrant ligation with a conventional anoscope with similar overall dimensions (conventional group). RESULTS: Twenty-five patients were prospectively randomized to each group. Postligation pain and analgesic requirements were recorded up to 28 days, and postligation complications and outcomes were evaluated for a minimum of 6 months. Narcotic requirements were lower in the synchronous group, but this difference did not achieve statistical significance (P > 0.05, Student’s t-test). Secondary hemorrhage occurred in 1 patient (4 percent) in the conventional group but resolved spontaneously. The synchronous group experienced significantly less pain during the ligation procedure and for 2 days afterward (P < 0.01, Wilcoxon’s test). External hemorrhoidal thrombosis developed in 4 percent of the synchronous group and 12 percent of conventionally treated patients, all of whom responded to conservative treatment. Repeat ligation was required less often in the synchronous group (16 percent) than with conventional ligation (28 percent). Surgery (completion hemorrhoidectomy for external thrombosis) was necessary in one patient (4 percent) in each group. Anal stenosis developed in one patient in the synchronous group. CONCLUSION: The new anoscope provides improved exposure of all three internal hemorrhoids and permits optimal placement of the rubber bands; this may account for the decreased postligation pain and lower repeat ligation rates. Synchronous hemorrhoidal ligation is a less painful method of multiple hemorrhoidal ligation and may improve outcomes compared with conventional multiple ligation. [ABSTRACT FROM AUTHOR]

Anorectal bleeding is the second most common site of lower gastrointestinal bleeding. Colonoscopy remains the gold standard test to localize sources of lower gastrointestinal bleeding, but it can miss left-sided colon pathologies such as diverticula, rectal varices, and internal hemorrhoids. We report an unusual case of a male cirrhotic patient with massive hemorrhoidal bleeding which went undiagnosed despite multiple imaging and endoscopic evaluations. He underwent urgent sigmoidoscopy that identified grade III internal hemorrhoids and sclerotherapy which resolved the hematochezia. Decompensated cirrhosis complicates patient candidacy for surgical hemorrhoidectomy, but sclerotherapy is a viable option even for high-risk patients. Urgent sigmoidoscopy during active bleeding should be considered if hemorrhoidal bleeding is suspected but inconclusive by colonoscopy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Morrison et al.)