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Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo.

Hemorrhoidal disease (HD) is a trophic disorder of the anal canal characterized by recurrent, self-resolving acute episodes. The author reports the results of a double-blind, placebo-controlled trial of the efficacy of Daflon 500 mg in the treatment of acute and chronic symptoms of hemorrhoids. One hundred and twenty outpatients (54 men, 66 women) suffering from an acute episode of HD during the previous two months were included. They received Daflon 500 mg (group D, n = 60) or placebo (group P, n = 60) two tablets daily for two months. The patients were examined at entry (T0) and at two months (T2). At T0, the two groups did not differ in terms of age, sex, weight, height, history of symptoms of HD; 7 patients were excluded from analysis because of treatment failure (group D, n = 2; group P, n = 3), or lost to follow-up (group P, n = 2). In group D, 40% of patients had an attack during the trial with a mean duration of 2.6 days and a mean severity of 1.1 scored on a scale from 1 to 3. These values were significantly different (P < 0.01) from the corresponding values in the P group: 70%, 4.6 days and 1.6 respectively. Each symptom and sign was scored on a scale of severity. The overall symptom score, scored from 0 to 15, decreased from 6.6 (group D) and 6.1 (group P) (NS) to 1.1 and 4.0 respectively (P < 0.01) at the end of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

[Conservative therapy of hemorrhoids].

Conservative therapy of hemorrhoids can be curative at stage I and II of disease; further it rappresent a valid preliminary management for a better result of more aggressive treatments, be they surgical or not. Beside local and general drugs other aspects play an important role in conservative therapy of hemorrhoids: adequate local hygiene, correct diet, education to a physiological evacuation and last but not least stool frequency regulation.

Constipation↗

[Hemorrhoids--etiology, symptoms and therapy].

Hemorrhoids are a very widespread disease causing pain by thrombosis, fear by bleeding and be a burden by weeping and pruritus. The different treatments show the different interpretations of physicians and patients. This paper will give a view of the most common and standardized procedures. Rubber band ligation is the most effective procedure in treating 1st and 2nd grade hemorrhoids. Surgical procedure is best in 2nd and 3rd grade disease. Recurrency is between 0.5 and 5% only. Technical development in surgical practice was leading to less pain in postoperative period by using diathermy, non-traumatic technique and avoiding of tampons. Using these principles hemorrhoidectomy allows a short hospital stay according to the individual needs of the patient. Special care should be given on urinary retention, the most common complication in anorectal surgery.

Anal Canal↗

Preservation of the superior hemorrhoidal artery in resection of the colon and rectum.

As an alternative to anterior resection of the rectum requiring ligature of the inferior mesenteric artery at its origin, it is proposed to carry out this procedure preserving the inferior mesenteric artery and freeing it as far as the origin of the superior hemorrhoidal artery and its division into rectal branches to improve the blood supply to the rectal stump. The results of this new procedure were compared with those of anterior resection. Post-operatively, the blood supply of the rectum was studied by means of angiography. The results of 84 anterior resections for neoplastic disease of the colon were studied. In 56 patients, the inferior mesenteric artery was preserved and in 28 the inferior mesenteric artery was ligated. Postoperative complications due to leakage of the colorectal anastomosis rarely occurred in the first group and were frequent in the latter. In patients in whom the inferior mesenteric artery was preserved, arteriograms showed that vascularization of the preserved rectal stump is supplied essentially by the branches of the superior hemorrhoidal artery.

Angiography↗

Rubber band ligation of hemorrhoids.

While rubber band ligation has found increasing acceptance as a method of dealing with internal hemorrhoids, there is a paucity of literature on the subject. This report gives a detailed, step-by-step approach to this technique.

Hemorrhoids↗

Single-operator hemorrhoid ligator.

A new device for elastic band ligation of hemorrhoids is presented. The three instruments used for this procedure, the anoscope, clamp, and ligator, are combined to allow performance of the procedure by a single operator.

Equipment Design↗

Necrotizing fascitis after injection sclerotherapy for hemorrhoids: report of a case.

A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids is presented. Subsequently developed necrotizing fascitis of the anorectum, perianal region, and scrotum necessitated emergency debridement and defunctioning colostomy. Postoperatively, the patient developed septicemia and renal failure requiring an extended hospital stay. Restoration of bowel continuity was done after three months. A brief review of known complications of this technique was made. It would appear that necrotizing fascitis can be added to this list.

Adult↗

Urgent hemorrhoidectomy for hemorrhoidal crisis.

Fifty-six patients who had hemorrhoidal crisis underwent urgent radical hemorrhoidectomy with anoderm-flap repair. There was no significant increase in complications as compared with elective hemorrhoidectomy. One patient (1.8 per cent) had one of his three flaps separate. Anal packing with a central-tubed cotton plaque is of benefit to ensure takes of anoderm flaps and in reducing postoperative hemorrhage.

Adult↗

A randomized trial of photocoagulation or injection sclerotherapy for the treatment of first- and second-degree hemorrhoids.

One hundred thirty-five patients with a diagnosis of hemorrhoids were randomized to receive either photocoagulation (P) (N = 73) or injection sclerotherapy with phenol (I) (N = 62). Each patient was assessed at one, four, and 12-month intervals after treatment. At one, four, and 12 months, there was no clinical difference between the groups; at 12 months, however, the proportion of patients who were symptomatically improved or asymptomatic was 59 percent after photocoagulation compared with 50 percent of those treated by injection (P = 73 percent; I = 50 percent). Seven patients treated by photocoagulation required repeated therapy compared with only one after injection (P less than 0.02). Additional therapy was used in eight patients after photocoagulation, as compared with three after injection. The operation rate for each group, however, was similar. There were no complications of therapy. Photocoagulation is an easy, non-invasive, safe method of treatment, giving results that are comparable to treatment by injection sclerotherapy.

Adult↗

Retroperitoneal abscess following sclerotherapy for hemorrhoids.

A case report of a patient who underwent submucosal injection sclerotherapy for hemorrhoids is presented. Subsequent necrosis of the underlying tissues produced a rectal perforation and retroperitoneal abscess, which necessitated emergency laparotomy and defunctioning colostomy. Healing of the perforation allowed later closure of the stoma. A brief review of the known complications of this technique has been made. It would appear that necrosis and perforation with abscess formation can be added to this list.

Abscess↗

Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding.

Reports have focused attention on a rare but potentially serious complication following rubber band ligation of internal hemorrhoids: pelvic cellulitis with progression to shock and death. This report documents the successful treatment of pelvic cellulitis. The timely use of broad-spectrum antibiotics at an early stage is critical. Emphasis is placed on early recognition and treatment of this potentially fatal complication.

Adult↗

An unusual complication of rubber band ligation of hemorrhoids.

Rubber band ligation of hemorrhoids has had a low incidence of complications until recently, when five deaths resulted from bacterial septicemia or toxemia. The case presented describes a severe soft-tissue infection following banding successfully treated with antibiotics, surgical debridement, and hyperbaric oxygen.

Adult↗

Lateral internal sphincterotomy in the treatment of hemorrhoids. A clinical and manometric study.

Using a microtip pressure transducer, anorectal manometry was performed in 119 patients with symptomatic hemorrhoids. In 96 patients (80.7 percent), a high anal pressure (greater than 125 cm/H2O) was found. These patients were treated by lateral internal sphincterotomy, carried out under local anesthesia. In 23 patients (19.3 percent), a normal or low anal pressure (less than 125 cm/H2O) was found. These patients were treated by band ligation or hemorrhoidectomy. The clinical results after lateral internal sphincterotomy (success rate, 75.3 percent) suggest that this procedure is a good alternative in selected patients.

Adult↗

Hemorrhoids. Measuring the constrictive force of rubber bands.

In ligating hemorrhoids with rubber bands, weaker constrictive force lessens liability to subsequent bleeding but increases that for venous block without complete arterial block. A method applicable in the office is described to assess this force. Thirteen samples of rubber bands tested exhibited very wide differences of this force and also of hysteresis. Some attributes of the desirable rubber band are submitted.

Constriction↗

Hemorrhoidal banding. A warning.

Band ligation of symptomatic internal hemorrhoids is a well-established and accepted outpatient procedure. The purpose of this paper is to alert the medical profession to potential complications and death following this procedure. Each of the four patients described in this report experienced pain and inability to urinate following banding. This report does not condemn banding but, rather, focuses on problems associated with a procedure perceived by many to be risk free.

Adult↗

Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report.

Twenty-five patients with second- or third-degree hemorrhoids were treated on an outpatient basis using a modified form of pile suture of Farag. There were no postoperative complications such as acute urinary retention, hemorrhage, infection, or anal stenosis. After follow-up for 12 to 18 months, the method has relieved bleeding in all patients and anal prolapse in 96 per cent of them. The modified pile suture is useful in a tropical setting where excisional hemorrhoidectomy is a costly operation.

Adult↗