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PubMed1999

Local injection of bupivacaine after rubber band ligation of hemorrhoids: prospective, randomized study.

PURPOSE: The aim of this study was to determine if local injection of bupivacaine after hemorrhoidal banding causes a decrease in pain and in the incidence of associated symptoms. METHODS: After hemorrhoidal banding, patients were randomly assigned to receive a local injection of bupivacaine with 1:200,000 epinephrine, an injection of normal saline, or no injection, just superior to each band. Pain was graded by the patient and by the study nurse within 30 minutes, and any associated symptoms were recorded. At intervals 6, 24, and 48 hours postbanding, the patient recorded pain, limitation of activities, and analgesic requirements. Associated symptoms while at home were recorded. RESULTS: Of 115 patients studied, 42 received bupivacaine injection, 42 received normal saline injection, and 31 received no injection. In patients receiving bupivacaine compared with no injection, within 30 minutes postbanding there was a significant reduction in pain graded by the patient (P = 0.000002) and by the nurse (P = 0.000005) and a significant reduction in incidence of nausea (P = 0.01) and shaking (P = 0.008). However, in the bupivacaine group compared with the other two groups, at the intervals of 6, 24, and 48 hours postbanding there was no sustained reduction in the severity of pain and no reduction in analgesic requirements or limitation of normal activities. In the week after banding, there was no difference between groups in symptoms of nausea, shaking, lightheadedness, urinary retention, or bleeding. CONCLUSIONS: Bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department but does not show a sustained effect.

Anesthetics, Local↗
PubMed1992

Prospective, randomized trial comparing pain and clinical function after conventional scissors excision/ligation vs. diathermy excision without ligation for symptomatic prolapsed hemorrhoids.

Forty-nine consecutive patients with symptomatic prolapsed hemorrhoids were prospectively randomized for conventional scissors excision with ligation (Group A; n = 16) or diathermy excision without ligation (Group B; n = 33). The median time taken to complete the procedure was 20 minutes (range, 10-40 minutes) and 10 minutes (range, 5-35 minutes) in Groups A and B, respectively (P < 0.05). Length of hospital stay was similar in both groups, with a median of three days and a range of two to five days. The median length of follow-up was 35 weeks (range, 20-50 weeks) and 35 weeks (range, 20-51 weeks) for Groups A and B, respectively. There was no statistical difference in the severity of postoperative pain between the two groups. The use of postoperative oral analgesics was significantly lower in Group B (P < 0.02), but there was no significant difference in the demand for intramuscular or topical analgesics. Diathermy excision of hemorrhoids is significantly faster than scissors excision, there is less bleeding, the vascular pedicles need not be ligated, and there is significant reduction in the requirement for oral analgesics postoperatively without any increase in early or late postoperative complications.

Administration, Oral↗
PubMed1992

Clinical trial of oral diosmin (Daflon) in the treatment of hemorrhoids.

A double-blind, comparative, controlled study on the effectiveness of the addition of oral diosmin (Daflon; Lab. Servier, Orléans, France) and placebo to a conservative regimen of bulk laxative in the treatment of acute symptoms of first-degree and second-degree internal hemorrhoids was undertaken in 100 patients. The diosmin and placebo groups, with 50 patients each, were comparable in age, sex, symptoms, and the severity of the underlying hemorrhoids. During the first four days, the patients received 12 tablets in three divided doses, and then they received two tablets twice daily for another 10 days. Subjective and objective changes were assessed at the 4th and 14th days of treatment. The diosmin group showed statistically significant objective improvement (P < 0.01) without accompanying subjective improvement on the fourth day. However, at day 14, there was no significant difference in either subjective or objective improvement between the two groups. Two cases in the placebo group were taken out of the trial on the fourth day owing to clinical deterioration. No side effect of diosmin was detected in this study.

Acute Disease↗
PubMedDate not supplied

Hemorrhoidal bleeding following transrectal prostatic biopsy. Etiology and management.

Three cases of rectal bleeding within a series of 120 transrectal prostatic biopsies are reported. The precipitating factor was the presence of hemorrhoids which were unsuspected prior to prostatic biopsy. Rectal bleeding in these patients was arrested by ballon tamponade with a 24 French Foley catheter. In situ monitoring of the rectal Foley catheter was discontinued when no further rectal bleeding was ascertained. There were no complications due to this simple, safe, and effective technique. When hemorrhoids are suspected, preliminary proctoscopy aids and alerts surgeons to choose alternative routes to the prostatic bed.

Aged↗
PubMedDate not supplied

Rubber band ligation of three primary hemorrhoids in a single session. A safe and effective procedure.

Rubber band ligation was used in 221 patients with first or second-degree hemorrhoids. All three primary hemorrhoids were ligated at a single out-patient session without anesthesia. Nineteen patients were lost to follow up. For the 202 patients under review, the follow up period ranged from three to 39 months with a mean of 18.4 months and median of 17 months. Excellent or good results were obtained in 183 patients (90.6 per cent). Moderate to severe pain was noticed by 58 patients (28.7 per cent). Further banding was required in 28 patients (13.9 per cent) and hemorrhoidectomy in six patients (3 per cent). The overall complication rate resulting from the treatment procedure was 3.5 per cent.

Adolescent↗
PubMed1987

Severe complication of rubber band ligation of internal hemorrhoids.

In light of recent reports describing severe and even fatal complications, the authors would like to report good results in two patients with massive edema and one with localized necrosis following rubber band ligation of internal hemorrhoids, which were recognized early and treated aggressively. The potential for severe complications emphasizes the need for determining other causes of rectal symptoms before ligation of hemorrhoids is undertaken.

Adult↗
PubMedDate not supplied

The outpatient management of acute hemorrhoidal disease.

A procedure for the outpatient management of acute hemorrhoidal disease is presented. Treatment, using local anesthesia with hyaluronidase, is directed to (1) relieve pain, (2) decrease edema, (3) treat appropriately the internal hemorrhoidal disease, and (4) treat the external thrombosis if present. Adequate treatment of the acute disease will, in a significant proportion of patients, avoid further surgical intervention. Eperience with results of this modality of treatment in patients is presented.

Acute Disease↗
PubMed1996

[Surgical therapy of advanced hemorrhoidal disease--is an ambulatory surgery intervention possible?].

Hemorrhoidal disease is the most common pathophysiologic abnormality in the anus in the western civilized world. Sixty years after publication of the method in The Lancet, hemorrhoidectomy according to Milligan and Morgan and modifications of their methods are still considered the standard procedure in cases of advanced hemorrhoidal disease. During the last 5 years, 107 patients underwent hemorrhoidectomy in the Department of Surgery at the University of Cologne. In most of these patients, the operation followed Milligan and Morgan's method. There were 69 males and 38 females with a mean age of 47.9 years. Mean length of hospital stay was 4.5 days. We saw one case of postoperative bleeding that required operative review. The patients' risk profile (age, concomitant diseases, ASA classification) did not influence the length of the hospital stay. Operative hemorrhoidectomy according to Milligan and Morgan allows a short stay in hospital according to the individual needs of the patient, with a high degree of safety concerning possible postoperative complications.

Adult↗
PubMed2006

[Therapy of hemorrhoidal disease].

Hemorrhoidal disease is one of the most frequent disorders in western countries. The aim of individual therapy is freedom from symptoms achieved by normalisation of anatomy and physiology. Treatment is orientated to the stage of disease: haemorrhoids 1 are treated conservatively. In addition to high-fibre diet, sclerotherapy is used. Haemorrhoids 2 prolapse during defecation and return spontaneously. First-line treatment is rubber band ligation. Haemorrhoids 3 that prolapse during defecation have to be digitally reduced, and the majority need surgery. For segmental disorders, haemorrhoidectomy according to Milligan-Morgan or Ferguson is recommended. In circular disease, Stapler hemorrhoidopexy is now the procedure of choice. Using a therapeutic regime according to the hemorrhoidal disease classification offers high healing rates and low rates of complications and recurrence.

Anus Neoplasms↗
PubMed2006

Prospective randomized clinical trial comparing two different circular staplers for mucosectomy in the treatment of hemorrhoids.

BACKGROUND: The main objections against circular stapled mucosectomy have been anal pain and rectal bleeding during the surgical procedure or in the immediate postoperative follow-up. To avoid these consequences, a new stapler (PPH33-03) has been developed. The aim of this trial was to compare the intraoperative and short-term postoperative morbidity of stapled mucosectomy with PPH33-01 versus PPH33-03 in the treatment of hemorrhoids. METHODS: We conducted a prospective randomized clinical trial comparing hemorrhoidectomy with PPH33-01 (group 1, n=30) versus PPH33-03 (group 2, n=30) for grade III-IV symptomatic hemorrhoids. For the follow-up, the patients underwent examination and proctoscopy at 4 weeks, 3 months, and 6 months. We recorded anal pain (linear analog scale from 0 to 10), intraoperative hemorrhage, postoperative bleeding, and continence (Wexner Continence Grading Scale). RESULTS: Demographic and clinical features showed no differences between the two groups. More patients required suture ligation to stop anastomotic bleeding at surgery when the PPH33-01 stapler was used (15 versus 4, P<0.05). Rectal bleeding during the first postoperative 4 weeks was similar (P>0.05). The postoperative pain scores during the first week were similar (P>0.05). Patients with pain on defecation were fewer in the PPH-03 group (15 versus 2, P<0.05). Six patients from group 1 and none from group 2 (P<0.05) had granulomas along the line of staples at the sites of the reinforcing stitches; the granulomas were associated with postoperative anal discomfort and rectal bleeding. One patient in group 1 complained of persistent pain that resolved within 3 months. Of all the intraoperative or preoperative variables analyzed, only the presence of granuloma was associated with postoperative bleeding and anal discomfort. We have not found any recurrence or incontinence during the 6-month follow-up. CONCLUSIONS: Intraoperative bleeding along the stapled line and tenesmus or discomfort during defecation were less frequent after circular stapled mucosectomy with PPH33-03. Therefore, circular stapled mucosectomy with PPH33-03 decreases the risk of immediate complications and thus allows implantation with more safety as a day surgery procedure.

Female↗
PubMed2003

Circumferential mucosectomy with stapled proctopexy is a safe, effective outpatient alternative for the treatment of symptomatic prolapsing hemorrhoids in the elderly.

BACKGROUND: Circumferential mucosectomy with stapled proctopexy (CMSP) was first introduced in 1993 as a less painful and highly effective alternative to traditional operative hemorrhoidectomy. Although CMSP has many advantages over traditional hemorrhoidectomy, some authorities and insurers continue to regard it as an inpatient procedure and others have been slow to adopt this progressive technique. This study documents the safe and effective outpatient nature of this procedure. METHODS: From December 2001 through August 2002, 33 patients with mucosal prolapse and prolapsing internal hemorrhoids were treated using circumferential mucosectomy with stapled proctopexy as outpatients at an ambulatory surgery center. Fourteen (42%) patients were treated using local anesthesia with intravenous sedation, 18 (55%) chose spinal anesthesia, and general anesthesia was used in one patient. Patients were evaluated postoperatively by telephone at 1 and 2 weeks, and seen in clinic at 4 weeks. RESULTS: One patient (3%) required an emergency department visit for minor postoperative bleeding. None of our elderly patients required emergency department evaluation and none reported significant complications. Four patients (13%) required urinary catheter placement prior to discharge from the surgery center due to urinary retention. One patient (3%) developed an uncomplicated urinary tract infection, which resolved with antibiotic treatment. Two patients were seen earlier than 4 weeks at the surgeon's request; one was immunocompromised from chemotherapy for metastatic carcinoid, and one reported persistent pain during initial telephone follow-up. No complications were identified in either patient, and no additional complications have been noted to date. CONCLUSIONS: CMSP is a safe, effective, time-efficient procedure for patients with mucosal prolapse and prolapsing hemorrhoids that can be performed safely in the ambulatory surgery center setting. Age is not a limiting factor in selecting patients for this safe outpatient procedure.

Adult↗
PubMed2003

Radiofrequency ablation and plication of hemorrhoids.

BACKGROUND: Radiofrequency ablation is emerging as a new therapeutic method in various fields of medicine. This study describes procedure of radiofrequency ablation followed by plication of hemorrhoidal mass in advanced grades of hemorrhoids. METHODS: This non-controlled, prospective study included 300 patients (211 men) treated at Fine Morning Hospital, Laxminagar, Nagpur, India, between July 1999 and December 2000. Patients were followed over a median period of 18 months (range, 15-20 months). RESULTS: The hospital stay was less than 24 hours for all patients. After 1 week, most of the patients had symptoms like bleeding and pain. At 4 weeks, 21% complained of pruritus, but none had prolapse, incontinence or anal stenosis. At the last follow-up, 96% had relief from bleeding, while 8% of patients had developed external skin tags and 6% had asymptomatic recurrence revealed by anoscopy. CONCLUSIONS: For advanced degree of piles with prolapse as the main symptom, plication of the pile mass along with radiofrequency ablation may be used as an alternative to the various types of hemorrhoidectomies. With this treatment, hospital stay is minimized, postoperative pain in low, recurrence is low and return to work is faster.

Adult↗
PubMed2004

Prospective, randomized trial comparing diathermy excision and diathermy coagulation for symptomatic, prolapsed hemorrhoids.

PURPOSE: This study was designed to compare diathermy excision and diathermy coagulation in the treatment of symptomatic prolapsed piles. METHODS: Forty-five consecutive patients were randomly assigned to diathermy excision hemorrhoidectomy (Group A, n = 25) and diathermy coagulation (Group B, n = 20) under general anesthesia. RESULTS: The median duration of surgery was ten minutes for both groups. There was no statistical difference in the severity of postoperative pain at rest between the two groups, but Group A patients felt less pain during defecation on the third postoperative day (median, 5 (interquartile range, 3-7) vs. 8 (4-9); P = 0.04) and on the sixth postoperative day (median, 5 (interquartile range, 2-6) vs. 9 (5-10); P = 0.02). There was, however, no statistical difference in postoperative oral analgesics use and patients' satisfaction scores between the two groups. Complication rates were similar except that diathermy coagulation tended to leave some residual skin components of external hemorrhoid especially in very large prolapsed piles. Group A patients resumed work earlier (mean, 12 (range, 4-20) vs. 17 (11-21) days); however, this was not statistically significant ( P = 0.1). CONCLUSIONS: Diathermy coagulation of hemorrhoids is a simple technique and may be considered in suitable cases.

Adult↗
PubMed2002

Local infiltration with ropivacaine improves immediate postoperative pain control after hemorrhoidal surgery.

PURPOSE: This study was conducted to assess the efficacy of infiltration with a new local anesthetic (ropivacaine) to control pain after hemorrhoidal surgery. METHODS: Thirty-four patients who underwent hemorrhoidectomy were included in a double-blind, randomized study to assess the analgesic effect of a perianal infiltration with 40 ml of 0.75 percent ropivacaine compared with isotonic saline infiltration. Postoperatively, pain was assessed on a visual analog scale, and intravenous morphine consumption was measured with patient-controlled administration. RESULTS: In the ropivacaine group, patients had lower visual analog scale scores at 1, 3, and 6 hours after infiltration and required fewer cumulative doses of morphine (patient-controlled administration) at 3, 6, and 12 hours. Side effects were comparable in the two groups. CONCLUSION: Local infiltration with ropivacaine improves pain control and patient comfort in the immediate postoperative course of hemorrhoidal surgery.

Adult↗
PubMed1992

Symptomatic hemorrhoids and anorectal varices in children with portal hypertension.

There have been few reports of the anorectal problems encountered in children with portal hypertension. We report the incidence of anorectal symptoms in a retrospective study of 189 children treated by injection sclerotherapy for esophageal varices secondary to portal hypertension. Anorectal symptoms, proctoscopic findings and treatment have been recorded in this group. The incidence of symptomatic hemorrhoids and rectal varices was 4.2%. Hemorrhoids are rare in children and the increased incidence can be assumed to be secondary to portal hypertension. Treatment is advised only for symptomatic patients and injection sclerotherapy is satisfactory for the majority.

Child↗
PubMed1991

Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases.

The investigators report the clinical and pathologic features of 19 cases of intraepithelial neoplasia occurring in the anal canal mucosa of routinely excised hemorrhoidal tissue, a condition that has been infrequently described. The patients were 12 women and seven men having an age range of 21 to 74 years (mean, 48 years). Two patients had coexistent anogenital condylomata acuminata. Leukoplakia of the hemorrhoidal surface was noted in two patients. Intraepithelial neoplasia arose in the transition zone of the anal canal of 11 cases, in the squamous zone of three cases, and in both sites of five cases. All were high-grade intraepithelial neoplasms; one was classified moderate to severe dysplasia, 17 exhibited severe dysplasia/carcinoma in situ, and one contained microinvasive carcinoma. Both keratinizing and cloacogenic type neoplasms were observed. Associated koilocytotic atypia was identified in 16 cases (84%). In situ hybridization for human papillomavirus (HPV) messenger RNA demonstrated HPV RNA sequences in seven of nine neoplasms (78%) studied by that technique (five HPV type 16, one HPV type 18, and one coinfection with HPV types 6 and 18). Eighteen patients had no clinically evident recurrent or progressive disease at mean follow-up of 6.6 years. Residual/recurrent intraepithelial neoplasia was noted in one patient at 1, 2, 5, and 49 months posthemorrhoidectomy. Our data indicate that incidentally discovered high-grade intraepithelial neoplasia present in hemorroidal tissue is a clinically nonaggressive lesion frequently associated with HPV infection. Hemorrhoidectomy alone is curative in most cases.

Adult↗
PubMed1999

[Treatment of hemorrhoids with the Longo technique. Preliminary results of a prospective study on 94 cases].

AIM OF STUDY: The aim of this multicenter prospective study was to report the early results of Longo procedure for the surgical treatment of hemorrhoids disease. PATIENTS AND METHOD: From April 1998 to July 1998, 94 patients (60 men and 34 women with a mean age of 47 years) were treated according to Longo procedure for a mucosal prolapse (12 grade II, 63 grade III, and 19 grade IV). All patients were evaluated at 2 and 6 postoperative months. The technique consisted in the reduction of mucosal and hemorrhoidal prolapses with a circular suturing device. RESULTS: Postoperative morbidity rate was 6.3% (n = 6). A rectal bleeding occurred within 12 hours after surgery in five patients. The mean postoperative length of hospital stay was 36 hours (range: 24-72 hours). The only antalgic prescribed was paracetamol. Local care was not necessary in any patient. After 6 months, 89 patients (94.7%) were very satisfied, three patients (3.2%) were satisfied (rectal sub-mucosal abscess in one case, functional troubles in two cases) and two patients (2.1%) were not satisfied (persistence of mucosal prolapse). CONCLUSION: These preliminary results are satisfactory but need to be confirmed by a prospective randomized trial, comparing Milligan Morgan procedure and Longo procedure.

Digestive System Surgical Procedures↗