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PubMed2005

[Ambulatory treatment of hemorrhoids].

DGHAL (Doppler Guided Hemorrhoid Arterial Ligation) represents a new approach to the treatment of internal hemorrhoids; it entails exact and selective ligation of the arteries supplying the piles (hemorrhoids). The intervention can be performed on ambulatory patients under local anaesthesia. An anoscope is used which incorporates a Doppler head. The superior hemorrhoidal arteries are identified under guidance of the arterial Doppler sound and ligated through a window located just above the Doppler head. The intervention lasts some 30 minutes. Local discomfort can ensue for a few days following surgery. At one month, the time required for the internal haemorrhoids to fade away, the patient is seen again; an external hemorrhoid or residual skintag can then be considered for treatment under local anaesthesia if needed. As of November 2001 until today, more than 350 patients have been treated, and we report here on 150 of them. Long term data (6 months to 2 years) have been collected which includes 85 to 90% patient satisfaction.

Adult↗
PubMed2005

Radiofrequency coagulation: a new option in early grades of bleeding hemorrhoids.

BACKGROUND: The treatment for hemorrhoids has undergone significant changes on introduction of new techniques in the last few years. Radiofrequency coagulation is a new approach for treating grades I and II of hemorrhoids. In this procedure, the hemorrhoidal tissue is coagulated by means of high-frequency radio wave. The author has described his own experience with this new technique. MATERIALS AND METHODS: The procedure was performed using an Ellman radiofrequency generator. Over a period of 18 months, patients with bleeding hemorrhoids were treated with this technique and a 16-month follow-up was carried out to assess relief in bleeding episodes, complications, and recurrence rate. RESULTS: While 13 % of patients had persistent or recurrent bleeding, 2 % of patients needed readmission for secondary hemorrhage. None had reported with any infective complication. The overall ratio of comfort, and patient's satisfaction due to relief of pain and bleeding were quite satisfactory. CONCLUSION: The treatment of bleeding hemorrhoids by using radiofrequency coagulation is technically simple, therapeutically effective and virtually complication-free. The equipment is portable, easy to handle, durable, and needs little maintenance. Long-term follow-up is necessary to justify the reliance on this method (Ref. 49).

Adult↗
PubMed2006

Radiofrequency coagulation: a new option for early grade bleeding hemorrhoids.

BACKGROUND: The treatment of hemorrhoids has undergone significant changes after introduction of new techniques during last years. Radiofrequency coagulation is a new approach for treating grade I and II hemorrhoids. In this procedure, the hemorrhoidal tissue is coagulated by a high frequency radio wave. The author describes his experience using this new technique. MATERIALS AND METHODS: The procedure was performed using an Ellman radiofrequency generator. Over a period of 18 months, patients with bleeding hemorrhoids were treated with this technique and a 16 months follow-up was carried out to assess a relief in bleeding episodes, complications, and recurrence rate. RESULTS: While 13% of patients experienced persistence or recurrence of bleeding, 2% of patients needed readmission for secondary hemorrhage. None has reported an infective complication. Overall ratio of comfort and patient contentment with pain and bleeding was satisfactory. CONCLUSION: The treatment of bleeding hemorrhoids using the radiofrequency coagulation is technically simple, therapeutically effective and virtually complication free. The equipment is portable, easy handling, long lasting, and needs only little maintenance. Long-term follow-up is necessary to justify reliability of this method (Ref. 49).

Adult↗
PubMedDate not supplied

[Non-surgical alternative management of hemorrhoidal disease].

UNLABELLED: Clinical manifestations of hemorrhoidal disease depend on its location (internal or external) and the presence or not of complications. PURPOSE: To describe the results of the three most common alternatives for non-surgical procedures treating internal hemorrhoids: rubber band ligation, esclerotherapy and infrared photocoagulation. MATERIALS AND METHODS: A retrospective, longitudinal and descriptive study from January 1998 to December 2002 was carried out, including variables like age, gender, clinical manifestations and date of initiation, type of non-surgical alternative treatment, complications, management and stage of the illness. RESULTS: In 9,103 charts reviewed this study included 2,701 patients with hemorrhoidal disease, with an annual incidence of 540.20 patients; 1,388 (51.39%) were male and 1,313 (48.62%) were female; ages between 17 and 78 years, 44.10 as a mean age. Rubber band ligation was used in 516 patients (67.45%), esclerotherapy in 177 (23.13%) and infrared photocoagulation in 72 cases (9.41%). CONCLUSIONS: Rubber band ligation is mainly indicated for internal hemorrhoids II degree, the esclerotherapy is indicated in the suppression of acute hemorrhage, but in the long term, this method has the poorest results. Infrared photocoagulation has its best results in internal hemorrhoids I degree because it causes less pain and complications and patients accept it better.

Adolescent↗
PubMedDate not supplied

Hemorrhoids: associated pathologic conditions in a family practice population.

BACKGROUND: Hemorrhoidal disease is an affliction that in referral populations coexists with other significant anorectal diseases. Published texts recommend aggressive procedures to diagnose associated pathologic conditions and as an aid for planning the extirpation of these diseases. Procrastination in management is said to be characteristic of both patient and primary care physician. The purpose of this study was to ascertain whether patients with hemorrhoids in the general population are truly at high risk for significant anorectal disease. METHODS: Charts of 173 patients with hemorrhoids from a nonselected population were reviewed for treatment management, associated anorectal disease, and sequelae. RESULTS: A small subpopulation of persons aged more than 55 years was identified who may be at higher risk for colon polyps. Anoscopy, barium enema, fecal occult blood testing, and complete blood counts had very low yields. These findings differ significantly from data collected on highly selected populations that suggest hemorrhoids rarely exist alone. CONCLUSIONS: It appears that family physicians have not been cavalier in their attitudes toward and management of this common ailment. Clinical investigation of hemorrhoids should be initiated based on clinical impression from evaluating symptoms and signs combined with age-specific screening recommendations.

Adult↗
PubMed1989

A personal experience in comparing three nonoperative techniques for treating internal hemorrhoids.

Infrared photocoagulation therapy was used on a total of 302 patients. Approximately 20% of the patients experienced minor bleeding; however, two required surgery, and 30% of the patients experienced discomfort during a 14-day period following the procedure. Good results were obtained in patients with first- and second-degree hemorrhoids. Heater probe coagulation therapy was conducted in a total of 264 patients. Good results were achieved in 90% of patients with first- and second-degree hemorrhoids, minor pain and bleeding occurred in approximately 10% of these patients, and one patient with third-degree hemorrhoids who was treated with this technique failed to respond and required surgery. Ultroid d.c. current therapy was utilized in 192 patients, and follow-up results were good in 95% of these cases. Minor bleeding occurred in four patients. It is concluded that all three techniques, performed on an outpatient basis with little or no sedation, are effective modalities for first- and second-degree hemorrhoids, but that Ultroid d.c. current therapy is associated with less discomfort and fewer complications and that Ultroid therapy may yield good results in some patients with third- or even fourth-degree hemorrhoids.

Hemorrhoids↗
PubMed1989

Direct current electrotherapy of internal hemorrhoids: an effective, safe, and painless outpatient approach.

Hemorrhoid disease is one of the most frequently occurring, disabling conditions of man. We report the results of 120 patients with symptomatic internal and mixed hemorrhoid disease treated with direct current (d.c.) via a dual-tipped disposable needle probe (negative electrode). Evaluation and treatment utilized an operative anoscope which visualized one-eighth of the anal canal. Five hundred ninety segments revealed hemorrhoid disease (grade 1 = 114, 2 = 222, 3 = 178, 4 = 76). One or more segments (highest grade) were treated per office visit. Symptoms, frequency, and mean number of treatment applications per patient for complete symptom resolution were: bleeding, 85%, 4.0; protrusion, 58%, 3.9; pain, 52%, 3.6; and pruritus, 49%, 3.9. Ablation of hemorrhoid disease grade was directly correlated with milliampere current and time of application. No major complications occurred. All patients were successfully treated and remained symptom-free at a mean duration of follow-up of 23 months. Direct current electrotherapy is an effective, painless, and safe outpatient treatment approach to all grades of internal and mixed hemorrhoid disease.

Adult↗
PubMedDate not supplied

[Hemorrhoids. Etiopathogenesis and therapeutic inferences].

Etiopathoganeic and physiopathological conceptions of hemorrhoidal illness underline the importance of the mechanical factor in hemorrhoidal prolapse, arteriovenous shunts of sections of circulatory blockage, in surface mucous in hemorrhoidal bleeding; the role of shunts in mid-channel mucous, in neuro-vegetative dependence in the regulation of pressure and flow; the clinical factor manifest in the appearance of hemorrhoidal disorders, muscular straining, notably in constipation, genital phases, and stress-linked disorders. The therapeutic possibilities determined by these factors are clear: the advantage of a medical treatment that will link the correction of transit disorders, alimentary regularity, decongestive action of the venotropes, the value of instrumental ambulatory therapy such as sclerotherapy, elastic dressings, controlled freezing in the cases of proctorrhagia and limited prolapse. It is quite clear that the most radical treatment of hemorrhoids is surgery, as long as it is complete, and high up, which can be achieved by the techniques that treat separate clusters, with or without sphincterectomy.

Cryosurgery↗
PubMed1994

[Hemorrhoidal diseases].

Main symptoms associated with hemorrhoids are anal bleeding, pruritus as well as weeping and superficial wounds of the rima ani and, finally, hemorrhoidal prolapse. The reason for the symptoms described is a relative anal incontinence due to hemorrhoidal knots prolapsing into the anal channel. There is evidence of an increased sphincteric pressure following increase of intraluminal pressure in colon and rectum in patients whose volumes of stool are too little because of small amounts of dietary fiber or regular use of laxatives. The stop of venous blood flow leads to a constant swelling of the vascular bed in the anal channel, which herniates during defection with variable intensity. Almost half of the patients suffering from hemorrhoids of grade 1 or grade 2 are treated successfully and conservatively (regulation of bowel habits by intake of large quantities of dietary fiber, change of life style and training of sphincter ani). Although injection therapy is used mostly, ligation of the prolapsing knots is the most physiological form of treatment: in retaining the vascular bed, the patient is able to keep complete continence. The consequent use of the former mentioned modes of treatment gives a 95% success rate in patients suffering from hemorrhoids. Only 5% need surgical intervention.

Fecal Incontinence↗
PubMedDate not supplied

[Complications of the surgical treatment of hemorrhoids and its therapy].

Hemorrhoidal disease is a common problem in a proctological ambulatory. Surgery is the best therapy for fourth degree hemorrhoids and the complication rate is 10-20%: postoperative urinary retention etiology is unknown but it may be caused by dysfunction of bladder muscles in response to pain and by an excessive perioperative somministration of fluids; delayed hemorrhage (i.e., 7-10 days postoperative) needs an inpatient care and the treatment ranges from bedside and packing to hemorrhoid pedicle suture ligation in the operating room. Anal stenosis is most commonly a result of a prior improper hemorrhoidectomy: it may be mild, moderate or severe; V-Y and C-anoplasty are the best therapy, also for ectropion. Rubber band Ligation and Sclerotherapy are the most common treatment of internal hemorrhoids: external hemorrhoid trombosis and delayed hemorrage are frequent complications.

Anal Canal↗
PubMed1993

Doppler sonographic diagnostics and treatment control of symptomatic first-degree hemorrhoids. Preliminary report and results.

Endoscopic Doppler sonography is a relatively new technique in the diagnostics of intestinal hemorrhage. It has been used mainly for gastroduodenal ulcer bleeding, but is also utilized in the lower digestive tract. For the first time, the effectiveness of Doppler ultrasound was studied in hemorrhoidal disease. In the trial presented, 60 patients with symptomatic first-degree hemorrhoids and previous bleeding were randomized in two groups. Thirty patients of group A were examined by transproctoscopic Doppler sonography. After measuring the vessel's depth, local sclerosing treatment with 6 ml of 5% phenol almond oil was carried out. In the 30 patients of group B, the same amount of the solution was injected without the aid of Doppler investigation. The success of treatment was checked Doppler sonographically six weeks later and the results were compared statistically. In the patients of the Doppler group, the hemorrhoids proved to be totally eliminated in 87% versus only 37% in the patients of the non-Doppler group (P < 0.1). Proctoscopic Doppler ultrasound is useful in the evaluation and sclerotherapy of bleeding hemorrhoids.

Adult↗
PubMed1994

Multiple hemorrhoidal bandings in a single session.

PURPOSE: The aim of our study was to evaluate the risks of multiple hemorrhoidal bandings in a single session. METHODS: We retrospectively examined all of the patients who had hemorrhoidal bandings from July 1989 to August 1992. RESULTS: Patients with multiple hemorrhoidal banding in a single session when compared with patients with single banding had greater discomfort and pain (29 percent vs. 4.5 percent), but this discomfort was usually manageable with oral analgesia of limited duration. There were also more vasovagal symptoms (5.2 percent vs. 0 percent), local swelling and edema (2.6 percent vs. 0 percent), and urinary hesitancy and frequency (12.3 percent vs. 0 percent) in the multiple-banded patients. No major complication such as massive delayed bleeding and perineal or pelvic sepsis was noted. CONCLUSION: Most patients tolerated multiple hemorrhoidal banding in a single session with acceptably low complications. Multiple banding in a single session is a safe and cost-effective alternative.

Adult↗
PubMed1993

Surgery for symptomatic hemorrhoids and anal fissures in Crohn's disease.

This study was undertaken to determine the outcome of surgery for symptomatic hemorrhoids and anal fissures in patients with known Crohn's disease. Seventeen patients underwent surgery for symptomatic hemorrhoids. Fifteen of these 17 patients' wounds healed without complication. Twenty-five patients underwent 27 operations for anal fissures. Twenty-two of these patients had uncomplicated wound healing by two months. Long-term follow-up, which was at a mean of 11.5 years in the hemorrhoid patients and 7.5 years in the fissure patients, revealed that only three patients required proctectomy, none as a direct result of surgery. Patients with severe symptoms secondary to anal fissures and hemorrhoids, who are known to have Crohn's disease and who cannot be controlled with conservative medical management, may undergo surgery on a highly selective basis when the disease is in the quiescent state. Proctectomy is not an inevitable outcome.

Adolescent↗
PubMed1991

Temporal changes in the occurrence of hemorrhoids in the United States and England.

Although numerous etiologic risk factors have been proposed, the pathogenesis of hemorrhoids remains unknown. The present investigation assesses the temporal distribution of hemorrhoids as depicted by physician visits, hospital discharges, and surgical procedures to provide further insight into potential etiologic risk factors. The analysis was based on five data sources: from the United States, the National Disease and Therapeutic Index (NDTI), the National Hospital Discharge Survey (NHDS), and the Commission on Professional Hospital Activities (CPHA); from England and Wales, the Morbidity Statistics from General Practice (MSGP) and the Hospital In-patient Enquiry (HIPE). Results demonstrated a consistent decline in all data sources from the United States. The decrease occurred in males and females similarly and was most striking in those aged 45-64 years. Physician visits and hospital discharges for hemorrhoids in England and Wales likewise declined although the decrease was not as dramatic. The consistency of the temporal distributions among the two countries, as well as among the different sources, suggests that the observed decline may, in fact, reflect an overall decrease in the occurrence of hemorrhoidal disease.

Adolescent↗
PubMedDate not supplied

Sclerotherapy of internal hemorrhoids using newly devised transparent disposable anorectoscope.

We devised a transparent anorectoscope for internal hemorrhoidal sclerotherapy. Using this scope the grade of hemorrhoids of the patients can be evaluated accurately through the transparent wall of the scope, and the device facilitates easier and safer sclerotherapy under clear direct vision, compared to the conventional free-hand-style treatment. We conclude that sclerotherapy using this anorectoscope represents a minimally invasive treatment for low-grade internal hemorrhoids and is recommendable for outpatient therapy of internal hemorrhoids.

Disposable Equipment↗
PubMed1988

Hemorrhoidectomy in the patient with multiple or circumferential hemorrhoids.

A technique is presented that allows complete removal of hemorrhoids even when large hemorrhoids exist between the classic three major hemorrhoidal locations. Since the anorectal mucosa overlying these "interval" hemorrhoids is preserved, there is no increased tendency for stricture formation to occur.

Hemorrhoids↗
PubMedDate not supplied

In defense of cryotherapy for hemorrhoids. A modified method.

The rationale of nonoperative hemorrhoid treatment, whether injection, ligation, or cryotherapy, consists of correction of prolapse and bleeding by the creation of submucosal fibrosis. Cryotherapy of hemorrhoids is most effective and has the least side effects when directed at the internal hemorrhoids only, at a high level, and in stages, each application being for a period of one minute only. A plan of treatment selection is presented, based on the stage of the hemorrhoids. The results of 528 treatment procedures are reported.

Adolescent↗
PubMed1989

Anal manometric studies in hemorrhoids and anal fissures.

Manometric study with the use of continuous water perfusion system was performed on 50 patients with Grade III or IV hemorrhoids and for 29 patients with chronic anal fissure. Another 36 patients who had no anorectal symptoms or pathology were chosen as the control group. The maximal basal pressures for the controls, hemorrhoids, and chronic anal fissures were 71.2 +/- 24.9, 85.3 +/- 27.7, and 87.4 +/- 38.8 mmHg, respectively; the maximal contraction pressures for the controls, hemorrhoids, and fissures were 132.9 +/- 44.9, 158.8 +/- 58.0, and 162.1 +/- 64.5 mmHg, respectively; the lengths of the functional sphincter of the three groups were 3.7 +/- 0.5, 3.8 +/- 0.8, and 3.9 +/- 0.6 cm, respectively. The maximal basal pressures and maximal contraction pressures of the hemorrhoid and fissure patients were significantly greater than those of the control group (t test, P value less than 0.05); whereas the functional sphincter lengths of the three groups showed no significant difference.

Adolescent↗