Hemorrhoidectomy versus rubber band ligation in treatment of second and third degree hemorrhoids: a comparative study

Background: Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used Out patient treatment.Methods: We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. The diagnosis of hemorrhoids is primarily based on the proctoscopic  examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1 year from January 2017 to December 2017. It includes 50 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of Tertiary Care Hospital in Gujarat. These 50 patients were selected randomly and divided into two groups of 25 patients each (hemorrhoidectomy group and RBL group). Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed.Results: Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery.Conclusions: RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.

Clinical observation of stripping resection plus hemorrhoidal artery ligation columnar suture in treatment of mixed hemorrhoids and Maren Soft Capsule in prevention and treatment of constipation after operation / 中草药

Objective: To evaluate the clinical effects of stripping resection plus hemorrhoidal artery ligation columnar suture in treatment of mixed hemorrhoids and Maren Soft Capsule in prevention and treatment of constipation after operation. Methods: Sixty patients were selected as control group A, treated with external dissection and internal ligation, and guided in diet and psychology after operation; sixty patients were selected as control group B, treated with peel resection hemorrhoid artery ligation suture, and guided in diet and psychology after operation; sixty patients were selected as observation group, and the operation method was the same as that of the control group B, but taking Maren Soft Capsule after operation, 2 capsules each time, twice daily. The effects and defecation after operation of patients in the three groups were compared. Results: The recovery rates and postoperative complications of patients in the three groups were compared, and there was no obvious difference between the observation group and the control group B, but there was significant difference in the observation group compared to the control group A (P < 0.05); The defecation after operation in the observation group was better than those in the control groups A and B (P < 0.05). Conclusion: Using stripping resection plus hemorrhoidal artery ligation columnar suture in the treatment of mixed hemorrhoids could achieve good results, with fewer complications after surgery, and it is a good way to treat the mixed hemorrhoids. Maren Soft Capsule could effectively prevent constipation after operation and reduce pain and other symptoms caused by defecation.

Desarterialización hemorroidal transanal. Una nueva alternativa quirúrgica / Transanal hemorrhoidal dearterialization. A new surgical alternative

La desarterialización hemorroidal es una técnica desarrollada en la última década, que consiste en la ligadura de la arteria hemorroidal a través de un proctoscopio que contiene un Doppler, con la subsecuente pexia de la mucosa. Objetivo: Analizar la factibilidad de la generalización de este procedimiento, mencionando sus ventajas y posibles desventajas en la utilización del mismo. Métodos: Se realizó un estudio descriptivo en el cual se incluyeron 41 pacientes (20 masculinos y 21 femeninas) en edades entre 23 y 55 años, con hemorroides II, III sintomáticas y IV sin síntomas de defecación obstruida, intervenidos en el Servicio de Cirugía 2 del Hospital Domingo Luciani y en la Unidad de Colon, Recto y Ano del Centro Clínico Leopoldo Aguerrevere, desde junio de 2012 hasta marzo de 2014. La técnica consiste en la ligadura de las ramas terminales de las arterias hemorroidales en radiales 1, 3, 5, 7,9 y 11. El tiempo promedio del procedimiento fue de 39.26 minutos. El seguimiento de los pacientes se realizó a la semana, a los quince días, al mes y a los 3 meses, valorando satisfacción de la técnica en base a dolor, reducción del prolapso y complicaciones. Resultados: Se logró el seguimiento de 41 pacientes en consulta, el 48.8% con rango de edad entre 31-40 años, 61% con hemorroides III, 27% hemorroides II y el 12% hemorroides IV. Durante el procedimiento quirúrgico se realizaron 6 pexias en el 80.5%. Los plicomas se resecaron en todos los pacientes que lo presentaban. Los síntomas referidos en los primeros 7 días en forma individual o asociado a otro síntoma fueron tenesmo 68.3%, molestia perianal en 39%, dolor moderado en 21.9%, dolor intenso en 14.6%, dolor leve y sangrado en 9.7% y trombosis en 2.4%, igualmente 14.6% no refirieron ninguna sintomatología. Al relacionar la exéresis de los plicomas con el dolor perianal observamos dolor intenso en 15.4% de los pacientes a quienes se le retiraron los plicomas y en el 25% de los pacientes a quien no se le realizó exéresis. El grado de satisfacción de la técnica en el post operatorio inmediato es bueno en 39% y muy bueno en 34%, solo fue malo en 3%. Al aplicar una escala de visualización análoga del dolor se observa una tendencia progresiva en los controles sucesivos en EVA 0-1 19.5% a los 15 días, 78% a los 30 días y 85.3% a los 90 días. En los pacientes sometidos a manometría anorrectal se evidencio un incremento en las presiones de reposo. El 83% se reintegró a sus actividades habituales en promedio a las 3 semanas del postoperatorio. No se presentaron complicaciones mayores, el prolapso de algún paquete hemorroidal se presentó en el 29.4% de los pacientes. Conclusiones: THD es un método seguro, poco invasivo, con buenos resultados para el tratamiento de pacientes, bien seleccionados, con hemorroides II, III y IV. Se deben realizar futuros ensayos controlados comparando con otros procedimientos, para demostrar la ventaja real y definir las indicaciones adecuadas realizando pruebas fisiológicas, además de llevar un control a largo plazo(AU)

Hemorrhoid dearterialisation is a technique developed in the last decade, consisting of ligation of hemorrhoidal artery through a proctoscope which contains a Doppler, with the subsequent mucosal pexy. Objective: To analyze the feasibility of the generalization of this procedure, mentioning its advantages and possible disadvantages in the use of the same. Methods: We conducted a descriptive study which included 41 patients (20 male and 21 female) ages between 23 and 55 years, with II, symptomatic III and IV haemorrhoids without symptoms of obstructed defecation, operated in the service of Surgery 2 of the Hospital Domingo Luciani and Unit of Colon, Rectum and Anus at the Centro Clínico Leopoldo Aguerrevere, from June 2012 to March 2014. The technique involves the ligation of terminal branches of the hemorrhoidal arteries in radial 1, 3, 5, 7.9 and 11. The average time of the procedure was 39.26 minutes. The follow-up of the patients was carried out a week, fifteen days, a month and three months, assessing satisfaction of the technique based on pain, reduction of prolapse and complications. Results: Were follow-up 41 patients in consultation, the 48.8% with age range between 31-40 years, 61% with hemorrhoids III, 27% hemorrhoid II and 12% hemorrhoid IV. During the surgical procedure were 6 pexy the 80.5%. The plicomas be resected in all patients presenting with it. The symptoms referred to in the first 7 days individually or associated to other symptoms were tenesmus 68.3%, 39%, moderate in 21.9 pain perianal discomfort %, severe pain in 14.6%, bleeding and mild pain in 9.7% and thrombosis in 2.4%, also 14.6% not reported any symptoms. To relate the resection of plicomas with perianal pain it was observed severe pain in 15.4% of the patients resected to 25% of patients not resected. Immediate postoperative satisfaction was good at 39 % and very good at 34 %, it was just bad at 3 %. To apply a scale of analog display of pain there is a progressive tendency in the successive controls at 0-1 19.5% at 15 days, 30 days 78% and 85.3% at 90 days. In patients undergoing anorectal manometry were demonstrated an increase in resting pressures. 83% returned to their usual activities on average at 3 weeks of the postoperative period. There were no major complications, some package hemorrhoidal prolapse was presented at the 29.4% of the patients. Conclusions: THD is a safe method, minimally invasive, with good results in the treatment of well selected patients with hemorrhoids II, III and IV. Future controlled trials comparing with other procedures, to demonstrate the real advantage and define appropriate physiological indications, as well as to control long-term studies should be performed(AU)

Early Experience of Treatment for Symptomatic Hemorrhoids with Doppler Guided Hemorrhoidal Artery Ligation and Recto-anal Repair

PURPOSE: Despite all developments in recent years, the choice of an adequate treatment for hemorrhoids remains a problem. Hemorrhoidal artery ligation and recto-anal repair (HAL-RAR) is a nonexcisional surgical technique for the treatment of hemorrhoids, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the hemorrhoidal plexus. The aim of this study was to present the early experience of treating hemorrhoids with HAL-RAR. METHODS: Between December 2008 and November 2009, 70 consecutive patients with symptomatic hemorrhoids were treated with HAL-RAR. The patients underwent sonographic identification and suture ligation of 4 to 8 terminal branches of the superior rectal artery above the dentate line. RESULTS: There were 33 males and 37 females (mean age, 49.72+/-14.1 years). The mean operative time was 43.8 minutes (25~80 min). Most patients (=61, 87%) were without any complaint upon follow-up at 1 week. Nine patients presented with early complication: isolated pain in 1, anemia in 1, isolated bleeding in 1, voiding difficulty (over 1 day) in 2 and tenesmus (over 2 weeks) in 4. CONCLUSION: Based on our results we may conclude that HAL-RAR is a minimally invasive, safe and effective method and may offer an important alternative for the treatment of hemorrhoids. It may offer minimally postoperative pain, and early return of patients to their normal activities.

Early Experience of Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (DG-HAL & RAR) for the Treatment of Symptomatic Hemorrhoids

PURPOSE: This study is to introduce our preliminary experience of the Doppler-guided hemorrhoidal artery ligation and Rectoanal repair (DG-HAL & RAR) as a new treatment for symptomatic or prolapsed hemorrhoids. METHODS: A Doppler probe incorporated proctoscope was inserted under the lithotomy position and the location of the hemorrhoidal artery was identified. The identified artery was ligated as a 'figure of eight' method with an absorbable suture into the submucosa. Then the prolapsed hemorrhoidal pile was lifted at the rectal mucosa by continuous suture to 5 mm above the dentate line and tied. The procedure was repeated at the 1, 3, 5, 7, 9, and 11 o'clock positions. We evaluated post-operative hospital stay, degree of pain, time to return to work, and recurrence. RESULTS: The patient's mean age was 50.2+/-15 years old and the mean follow-up time was 415+/-75 days. The constitution of the type of internal hemorrhoids was as follows: Grade II: 13, Grade III: 16, and Grade IV: 5. The mean operation time was 35 minutes and post-operative hospital stay was 1.4 days. The mean time it took to return to work was 1.8 days. There were no severe pains requiring injection of analgesics or other severe complications. So far, 2 patients have had recurrence of symptoms. CONCLUSION: The DG-HAL & RAR is a safe and less painful procedure. The DG-HAL & RAR is an effective alternative for the treatment of symptomatic or prolapsed hemorrhoids.

Submucosal Hemorrhoidal Artery Ligation Technique and Shortening Suture Technique for a Hemorrhoidectomy

There are many techniques for performing a hemorrhoidectomy. The author introduces the submucosal hemorrhoidal artery ligation technique and the shortening suture technique. In the author's expericence, the submucosal hemorrhoidal artery ligation technique reduces not only the secondary bleeding rate but also the hemorrhoid recurrence rate after a hemorrhoidectomy. The shortening suture technique reduces the postoperative anal stricture rate by folding skin into the anal canal and prevents a skin tag after a hemorrhoidectomy.