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PubMed1964

NON-OPERATIVE TREATMENT OF INTERNAL HEMORRHOIDS.

It has been estimated that about one-half of the adult population has internal hemorrhoids. While the majority of these experience relatively few symptoms, a considerable number continue to suffer discomfort because of unwillingness or inability to accept the expense and loss of time necessitated by operation. Ligation by elastic ligatures of certain selected groups of internal hemorrhoids is an alternative procedure which can be done easily by the doctor in his office with minimal distress to the patient. A special instrument devised by Blaisdell and modified by Barron is required. The experience gained in the ligation treatment of 400 patients with internal hemorrhoids is the basis of this report.

Adult↗
PubMed1994

Hemorrhoidal bleeding in chronic spinal cord injury: results of multiple banding.

Most patients with chronic spinal cord injury (SCI) have hemorrhoidal bleeding. 87 banding procedures were performed for bleeding on 62 men with chronic SCI. Multiple bands per session were routinely necessary. Bleeding sites at or distal to the dentate line were also banded. There were no major complications. An outcome questionnaire was completed by 60 subjects (97%). Mean follow-up was one year, minimum one-half year. 73% of patients reported significant reduction in bleeding post-banding, and 20% reported some reduction. A majority of patients felt the procedure was useful or worthwhile overall. Absent sensation allows banding of external hemorrhoids, although symptoms of autonomic hyper-reflexia may occur in patients with lesions at T6 or above. Multiple banding is a safe and effective treatment for hemorrhoidal bleeding in SCI.

Adult↗
PubMed1994

A cavernous hemangioma of the rectum treated as a hemorrhoid for 1 year prior to its diagnosis: report of a case.

We report herein the case of a 28-year-old woman with a rectal cavernous hemangioma in whom recurrent rectal bleeding and marked anemia were interpreted as being caused by her coexisting internal hemorrhoids, resulting in a delay in the correct diagnosis for 1 year. Digital examination revealed a walnut-sized, wide-based, and elastic soft mass, 3 cm proximal from the anal verge, in addition to the internal hemorrhoids. Colonofiberscopy revealed a bluish submucosal lesion with superficial capillary dilatation at the same site. A transanal local resection was performed and the histological diagnosis of the tumor was cavernous hemangioma. The patient has been well without any recurrence of rectal bleeding for 2 years and 6 months since her operation. Thus, although rectal cavernous hemangioma is rare, a lack of awareness of this condition could lead to misdiagnosis as hemorrhoids and subsequent inappropriate therapy.

Adult↗
PubMed1992

Symptomatic hemorrhoids: current incidence and complications of operative therapy.

Hemorrhoidal disease affects more than one million Americans per year. We reviewed the treatment pattern for patients who presented with symptomatic hemorrhoids to our large university-affiliated group practice over a 66-month period. Over 21,000 patients presented to the practice with bleeding, thrombosis, or prolapse. Only 9.3 percent of patients required operative therapy. Conservative therapy was given to 45.2 percent of patients, while rubber band ligation was performed on 44.8 percent of patients. We retrospectively reviewed the complications and length of stay for a subset of patients undergoing operative therapy during the 66-month study period. Postoperative urinary complications (retention or infection) were seen in 20.1 percent of patients. Delayed hemorrhage was seen in 2.4 percent of patients. In-hospital length of stay was 2.5 days, which is approximately two days less than the length of stay found in a similar review of our practice in 1978. We conclude that over 90 percent of symptomatic hemorrhoids can be treated conservatively or with rubber band ligation, and, as surgery is reserved for only the most severe cases, complication rates may not decrease. However, we expect that in-hospital length of stay will continue to decrease over the ensuing years.

Female↗
PubMed1993

Proctoscopic Doppler ultrasound in diagnostics and treatment of bleeding hemorrhoids.

PURPOSE: Endoscopic Doppler sonography is a relatively new technique in the diagnostics of intestinal hemorrhage. It has been used mainly for bleeding gastroduodenal ulcers, but can also be utilized in the lower digestive tract. METHODS: In the study presented 80 patients with symptomatic hemorrhoids of first degree and previous hemorrhage were randomized in two groups. The 40 patients in Group A were examined by transproctoscopic Doppler ultrasound. After measuring the vessels depth, local injection treatment with 5 percent phenol almond oil followed. The patients in Group B had been given conventional sclerotherapy without the aid of Doppler investigation. The success of treatment was checked using Doppler sonographics six weeks later and the results were statistically compared. RESULTS: In the patients in Group A, the hemorrhoids proved to be totally eliminated in 93 percent vs. 38 percent of the patients in Group B (P, 0.1 percent). CONCLUSIONS: Proctoscopic Doppler ultrasound is useful in the evaluation and sclerotherapy of symptomatic first-degree hemorrhoids.

Adult↗
PubMed1990

A randomized trial comparing direct current therapy and bipolar diathermy in the outpatient treatment of third-degree hemorrhoids.

Fifty patients with third-degree hemorrhoids were randomized to receive outpatient treatment with either bipolar diathermy or direct current therapy. Direct current therapy was used to treat 26 patients and bipolar diathermy was used to treat 24 patients. Twenty patients in each group were successfully treated as judged by resolution of symptoms and shrinkage of hemorrhoidal tissue. Both treatments are effective in the outpatient management of large, prolapsing hemorrhoids. Bipolar diathermy is less time consuming and better tolerated.

Ambulatory Surgical Procedures↗
PubMed2001

Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease.

PURPOSE: A randomized, double-blind, controlled study was conducted to investigate the efficacy of oral calcium dobesilate therapy in treating acute attacks of internal hemorrhoids. METHODS: Twenty-nine well-documented adult patients with first- or second-degree internal hemorrhoids were treated with calcium dobesilate for two weeks, while16 patients received only a high-fiber diet to serve as control. Both symptoms and anoscopic inflammation were scored on a scale from 0 to 2 before (T0) and two weeks after treatment (T2). RESULTS: A success rate of 86.21 percent with cessation of bleeding plus lack of severe anitis anoscopically at two weeks were achieved with calcium dobesilate. The pretreatment symptom score of 2 fell significantly to 0.45 +/- 0.13, and the pretreatment anitis score of 1.69 +/- 0.09 fell to 0.55 +/- 0.12 at T2 (P = 0.0001 for both comparisons). The symptom and anoscopic inflammation scores obtained with calcium dobesilate treatment were also significantly better than those with diet only (P = 0.0017 and P = 0.0013, respectively). CONCLUSION: Together with recommendations about diet and bowel discipline, oral calcium dobesilate treatment provides an efficient, fast, and safe symptomatic relief from acute symptoms of hemorrhoidal disease. This symptomatic healing is associated with a significant improvement in the anoscopically observed inflammation.

Acute Disease↗
PubMed2001

Rubber band ligation for hemorrhoidal disease can be safely performed in select HIV-positive patients.

PURPOSE: Many surgeons have abandoned the use of rubber band ligation for the treatment of hemorrhoids in patients infected with human immunodeficiency virus because of the belief that this procedure could lead to disastrous outcomes. This study was designed to evaluate the safety and efficacy of rubber band ligation in otherwise healthy human immunodeficiency virus-positive patients. METHODS: A retrospective chart review of healthy human immunodeficiency virus-positive patients who underwent rubber band ligation for symptomatic hemorrhoids between April 1993 and May 2000 was conducted. RESULTS: The study group comprised 11 patients. All patients were male, with a median age of 48 (range, 32-64) years. Mean T-cell helper count was 450 (range, 200-1,000) cells/microl. A median of 2 (range, 1-4) rubber band ligations were performed per patient. The median length of follow-up was seven (range, 1-28) months. There were no deaths or complications in any study group patient. Eight patients (73 percent) had excellent results, with complete resolution of symptoms. Two patients (18 percent) had initial improvement but subsequently had hemorrhoidectomy because of recurrent symptoms. Only one patient (9 percent) had no benefit from rubber band ligation and underwent hemorrhoidectomy. CONCLUSION: These data suggest that asymptomatic human immunodeficiency virus-positive patients can be treated safely and effectively with rubber band ligation for symptomatic hemorrhoids.

Adult↗
PubMed2001

Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine.

PURPOSE: This study was performed according to a prospective, randomized, open design. The aim was to test the efficacy of local application of nifedipine ointment in healing acute thrombosed external hemorrhoids. METHODS: Ninety-eight patients who gave their informed consent were recruited; they received clinical examination and anoscopy. A questionnaire to evaluate symptoms, pain, and concurrent use of analgesics was administered. Patients treated with nifedipine (n = 50) used topical 0.3 percent nifedipine and 1.5 percent lidocaine ointment every 12 hours for two weeks. The control group, consisting of 48 patients, received topical 1.5 percent lidocaine ointment during therapy. RESULTS: Results obtained were as follows: complete relief of pain in 43 patients (86 percent) of the nifedipine-treated group as opposed to 24 patients (50 percent) of the control group after 7 days of therapy (P < 0.01); oral analgesics were used by 4 patients (8 percent) in the nifedipine-treated group as opposed to 26 patients (54.1 percent) of the control group after 7 days of therapy (P < 0.01); and resolution of acute thrombosed external hemorrhoids was achieved after 14 days of therapy in 46 patients (92 percent) of the nifedipine-treated group, as opposed to 22 patients (45.8 percent) of the control group (P < 0.01). We did not observe any systemic side effect in patients treated with nifedipine. CONCLUSIONS: Our study clearly demonstrates that the use of topical nifedipine, which at present is for treatment of cardiovascular disorders, is a reliable new option in the conservative treatment of thrombosed external hemorrhoids.

Acute Disease↗
PubMed2000

Micronized purified flavonidic fraction compared favorably with rubber band ligation and fiber alone in the management of bleeding hemorrhoids: randomized controlled trial.

PURPOSE: The aim of this study was to assess the role of micronized purified flavonidic fraction in the management of bleeding nonprolapsed hemorrhoids. METHODS: Patients were randomly assigned to receive ispaghula husk alone, rubber band ligation plus ispaghula husk, or micronized purified flavonidic fraction plus ispaghula husk. Other colorectal diseases were excluded by colonoscopy. Blinded observers noted the time for bleeding to stop completely, recurrences, and treatment complications. RESULTS: A total of 162 patients were randomly assigned with no significant differences in the age and gender distributions among the groups. Hemorrhoidal bleeding was relieved most expediently in the micronized purified flavonidic fraction plus ispaghula husk group (ispaghula husk alone n = 66, mean (standard error of the mean) 10.6 (2.3) days; rubber band ligation plus ispaghula husk n = 57, 5.6 (1.1) days; micronized purified flavonidic fraction plus ispaghula husk n = 39, 3.9 (1.2) days; P = 0.03). However, there were no significant differences in the recurrences at six months of follow-up (ispaghula husk alone n = 8 (12 percent); rubber band ligation plus ispaghula husk n = 12 (21 percent); micronized purified flavonidic fraction plus ispaghula husk n = 2 (5.1 percent); P = 0.075). No complications or side-effects were noted. CONCLUSIONS: micronized purified flavonidic fraction used with fiber supplements rapidly and safely relieved bleeding from nonprolapsed hemorrhoids.

Adult↗
PubMed1989

The laser treatment of hemorrhoids: results of a study on 1816 patients.

Laser is an effective, simple and harmless clinical procedure used for the treatment of hemorrhoids, as an alternative to medical therapy or surgery. In this report, we describe our experience of applying carbon dioxide laser to hemorrhoids in a total 1816 consecutive patients. The results lead us to conclude that the laser treatment of hemorrhoids is effective in pain alleviation from the first session and that patients so treated have a much more comfortable postoperative course.

Female↗
PubMed1989

Hemorrhoidal ligation. A review of efficacy.

Two hundred forty-one patients undergoing hemorrhoidal rubber band ligation over a five-year period were reviewed to focus on complications. Three patients (1.2 percent) were hospitalized. Two, on oral anticoagulants, recovered from bleeding complications. One patient developed a band-related abscess that resolved with drainage. Twenty patients (8.3 percent) reported pain associated with the procedure. Three patients went on to subsequent surgical hemorrhoidectomy. There were no deaths in the series. This report agrees with previously published series highlighting the efficacy and cost containment of hemorrhoidal ligation. Continued reliance on this approach to hemorrhoidal disease is justified.

Abscess↗
PubMedDate not supplied

Infrared coagulation: a new treatment for hemorrhoids.

Many methods, which have effectively reduced the number of patients requiring hospital admission, have been described for the outpatient treatment of hemorrhoids. However, complications have been reported, and the methods are often associated with unpleasant side effects. In 1977 Neiger et al. described a new method that used infrared coagulation, which produced minimal side effects. The authors have conducted a prospective, randomized trial to evaluate infrared coagulation compared with more traditional methods of treatment. The authors' results show that it may be more effective than injection sclerotherapy in treating non-prolapsing hemorrhoids and that it compares favorably with rubber band ligation in most prolapsing hemorrhoids. No complications occurred, and significantly fewer patients experienced pain after infrared coagulation (P = less than 0.001).

Ambulatory Care↗
PubMed2004

[Hemorrhoids. Differential diagnosis and therapy].

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

Administration, Rectal↗
PubMed2006

Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse. A randomized controlled trial.

PURPOSE: A remarkable incidence of failures after stapled axopexy (SA) for hemorrhoids has been recently reported by several papers, with an incomplete resection of the prolapsed tissue, due to the limited volume of the stapler casing as possible cause. The stapled transanal rectal resection (STARR) was demonstrated to successfully cure the association of rectal prolapse and rectocele by using two staplers. The aim of this randomized study was to evaluate the incidence of residual disease after SA and STARR in patients affected by prolapsed hemorrhoids associated with rectal prolapse. METHODS: Sixty-eight patients were selected on the basis of validated constipation and continence scorings, clinical examination, colonoscopy, anorectal manometry, and defecography and randomized: 34 underwent a SA and 34 a STARR operation. The operated patients were followed-up with clinical examination, visual analog scale for postoperative pain, a satisfaction index, and defecography. RESULTS: At a mean follow-up of 8.1+/-2.0 and 7.9+/-1.8 months for the SA and STARR groups, respectively, the incidence of residual disease was significantly higher in the first group (29.4 vs 5.9 in the STARR group, p=0.007), while a significantly lower incidence of residual skin-tags was found after STARR (23.5% vs 58.8 after SA, p=0.03). All patients with residual disease showed prolapsed tissue over half the length of the anal dilator at the time of the operation. Operative time and incidence of transient fecal urgency were significantly higher in the STARR group (with p=0.001 and 0.08, respectively), while SA was followed by a significantly higher incidence of poor results at the overall patient satisfaction index (p=0.04). No significant differences were found in hospital stay, operative complications, postoperative pain, time to return to normal activity, continence, and constipation scores. All the defecographic parameters significantly improved after STARR, while SA was followed only by a trend to a reduction of rectal prolapse. CONCLUSIONS: STARR provides a more complete resection of the prolapsed tissue than SA in patients with association of prolapsed hemorrhoids and rectal prolapse with equal morbidity and significantly lower incidence of residual disease and skin-tags. The anal dilator can be used for selecting the surgical technique.

Anal Canal↗
PubMed2006

Randomized comparison between stapled hemorrhoidopexy and Ferguson hemorrhoidectomy for grade III hemorrhoids in Taiwan: a prospective study.

PURPOSE: Short-term and mid-term outcomes of stapled hemorrhoidopexy (SH) were compared with those for Ferguson hemorrhoidectomy (FH) for treating hemorrhoids. MATERIALS AND METHODS: Patients with prolapsed hemorrhoids were randomized into two groups treated with SH (N = 300) and FH (N = 296) at Chang Gung Memorial Hospital at Chiayi in Taiwan between January 2002 and December 2004. The outcomes of the procedures were evaluated postoperatively (short-term, i.e., intra-/postoperative conditions, hospital stay, pain intensity scoring, time off work, and procedure-related morbidity) and over a follow-up period of minimum 18 months (mid-term, i.e., relapse of prolapse and/or bleeding, anal stricture, anal sepsis, and the acceptability of the procedures to the patients). RESULTS: SH was superior to FH in operative time, intraoperative blood loss, postoperative pain intensity, and return to work. Based on telephone interviews over the follow-up period, most patients who received SH appreciated the procedure better than those with FH. CONCLUSIONS: This study confirms that SH generates less postoperative suffering, less time off work, and more complete resolution of primary symptoms associated with hemorrhoids in the mid-term follow-up than FH.

Adult↗
PubMed2004

Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model.

BACKGROUND: The procedure for prolapsing hemorrhoids (PPH) is a new surgical method for the treatment of symptomatic hemorrhoids. In cases of recurrent prolapse, the performance of a second PPH may result in a ring of mucosa and submucosa between the two circular staple lines. In this study, we used a porcine model to assess whether PPH can be safely performed twice. METHODS: Five adult pigs underwent two PPH procedures in one session, leaving a ring of approximately 1 cm of mucosa between the two staple lines. One month later, the pigs were examined under anesthesia. The anal canal was assessed using the following four methods: (a) clinical examination, (b) evaluation of mucosal blood perfusion at different levels of the anal canal via a laser Doppler flow detector, (c) measurement of concentrations of hydroxyproline and collagen to check for fibrosis, and (d) histopathological examination. RESULTS: At the completion of the study period, all five pigs showed no clinical evidence of anorectal dysfunction. On examination under anesthesia 1 month after surgery, there was no evidence of anal stenosis in any of the pigs. The mean mucosal blood flow between the two staple lines did not differ significantly from the flow measured proximally and distally (394 vs 363 and 339 flow units, respectively; p = NS). The collagen levels, based on hydroxyproline concentration, were 81 mcg/mg between the staple lines, compared to 82 and 79 proximally and distally, respectively ( p = NS). There was no significant difference in degree of fibrosis, as assessed histopathologically, between specimens taken from the ring between the staple lines and specimens taken from the area external to the staple lines. CONCLUSIONS: The results of this porcine model suggest that a second synchronous PPH is feasible. A controlled experience involving human subjects is required to determine the safety and usefulness of this technique in cases of metachronous application for recurrent or residual hemorrhoids.

Animals↗
PubMed2005

Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature.

PURPOSE: The aim of this prospective study was to compare the results of stapled hemorrhoidopexy with those of conventional diathermy excision for controlling symptoms in patients with fourth-degree hemorrhoids. METHODS: Thirty-one patients with symptomatic, prolapsed irreducible piles were randomized to either stapled hemorrhoidopexy (n = 15) or diathermy excision (n = 16). The primary outcome measure was the control of hemorrhoidal symptoms one year after operation. RESULTS: The two procedures were comparable in terms of pain relief and disappearance of bleeding. Recurrent prolapse starting from the fourth month after operation was confirmed in 8 of 15 patients in the stapled group and in none in the diathermy excision group: two-tailed Fisher's exact test P = 0.002, RR 0.33, 95 percent confidence interval 0.19-0.59). Five of these patients responded well to a later conventional diathermy hemorrhoidectomy. Persistence of itching was reported in six patients in the stapled group and in one of the diathermy excision group (P = 0.03). On the other hand, six patients in the stapled group and none in the diathermy excision group experienced tenesmus (P = 0.007). CONCLUSIONS: Stapled hemorrhoidopexy was not effective as a definitive cure for the symptoms of prolapse and itching in patients with fourth-degree hemorrhoids. Moreover, stapled hemorrhoidopexy induced the appearance of a new symptom, tenesmus, in 40 percent of the patients. Therefore conventional diathermy hemorrhoidectomy should continue to be recommended in patients with symptomatic, prolapsed, irreducible piles.

Adult↗