A morphometric analysis of pathological alterations in hemorrhoidal disease versus normal controls: a controlled trial

Objective: Until today, the true pathophysiology of hemorrhoidal disease (HD) has not yet been unraveled. More and more evidence guides us towards the hypothesis that reduced connective tissue stability is associated with a higher incidence of hemorrhoids. The present study aimed to compare the quantity and quality of collagen, and vessel morphometrics, in patients with symptomatic HD compared with normal controls. Methods: Twenty-two samples of grade III and grade IV HD tissue from patients undergoing a hemorrhoidectomy between January 2004 and June 2015 were included in the study group. Samples of 15 individuals without symptomatic HD who donated their body to science and died a natural death served as controls. The quantity and quality of anal collagen, and anal vessel morphometrics were objectified. The quality of collagen was subdivided in young (immature) and old (mature) collagen. Results: Patients with HD had an increased percentage of total anal collagen (62.1 ± 13.8 versus 18.7 ± 14.5%; p = 0.0001), a decreased percentage of young collagen (0.00009 ± 0.00008 versus 0.0008 ± 0.0008%; p = 0.001), and a smaller surface area of the anal vessels (795.1 ± 1215.9 micrometre2 versus 1219.0 ± 1976.1; p = 0.003) compared with controls. The percentage of old collagen did not differ between the control and study groups (0.588 ± 0.286% versus 0.389 ± 0.242%; p = 0.06). Conclusion: The outcomes of the present study suggest that alterations in anal collagen composition may play a role in the formation of hemorrhoids. (AU)

Anti-hemorrhoidal activity of Lian-Zhi-San, a traditional Chinese medicine, in an experimental hemorrhoidal model in rats / 中西医结合学报

OBJECTIVE@#Hemorrhoidal disease (HD) is the most common proctological disease, with an estimated prevalence rate of 4.4%, and a peak in individuals between 45 and 65 years of age. This study was done to evaluate whether Lian-Zhi-San (LZS), a clinically used anti-hemorrhoidal ointment could alleviate the inflammatory injury, with its associated changes of inflammatory cytokines and morphology of anorectal tissues, in an experimental model of HD in rats.@*METHODS@#HD was induced by croton oil preparation (COP) applied to the anorectal region. Rats were then treated with cotton swabs soaked in LZS ointment, water or white vaseline, twice a day for 7 d. At the end of the experiment, HD was evaluated by measuring hemorrhoidal and biochemical parameters along with histopathological observations.@*RESULTS@#In this study, COP induced a significant increase in the macroscopic severity score, anorectal coefficient and Evans blue extravasation, compared to normal rats. Additionally, it greatly enhanced the expression and secretion levels of some important inflammation-related cytokines along with marked histological damage, compared to normal rats. Rats treated with LZS ointment experienced significantly ameliorated Evans blue extravasation (P < 0.05), decreased macroscopic severity score (0.86 ± 0.14 vs. 1.65 ± 0.16) and the anorectal coefficient (P < 0.01); its use also attenuated tissue damage and inhibited the expression and secretion levels of inflammation-related cytokines (interleukin-1β, interleukin-6 and tumor necrosis factor-α).@*CONCLUSION@#This study validates a preliminary understanding of the use of LZS ointment to treat inflammatory factors and tissue damage in an experimental model of HD in rats.

Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study

Abstract Background: Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. Methods: We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. Results: Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation ( p = 0.067) and constipation ( p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2, p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose ( p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. Conclusion: We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.(AU)

Nueva técnica quirúrgica para el tratamiento de la enfermedad hemorroidal / Anew surgical technique for treatment of hemorrhoidal disease

INTRODUCCIÓN. Sobre la base de un nuevo concepto de enfermedad hemorroidal se diseñó una nueva técnica para el tratamiento quirúrgico de ésta. El objetivo fue disminuir la morbilidad del tratamiento quirúrgico de la enfermedad. MÉTODOS. Se realizó un análisis prospectivo no aleatorizado con pacientes atendidos entre abril de 2006 y junio de 2008. Fueron incluidos pacientes con enfermedad hemorroidal de grado III y IV. Se describe la técnica quirúrgica. Después de la cirugía, se siguió la evolución de todos los pacientes por más de 10 meses. RESULTADOS. Fueron operados 44 pacientes, 30 pacientes (69 por ciento) en régimen ambulatorio. Solo 6 pacientes (14 por ciento) refirieron dolor posoperatorio. Las complicaciones no fueron mayores que las reportadas con las técnicas de hemorroidectomía. Se reportó un 93,4 por ciento de eficiencia. CONCLUSIONES. La morbilidad posoperatoria fue mucho mejor en comparación con los resultados reportados con técnicas de hemorroidectomía. La técnica propuesta proporciona una nueva opción para mejorar la morbilidad posoperatoria del tratamiento quirúrgico en pacientes con enfermedad hemorroidal. Se hace necesario realizar estudios aleatorizados comparativos con las técnicas de hemorroidectomía(AU)

INTRODUCTION: On the base of a new concept of hemorrhoidal disease we designed a new technique for its surgical treatment. The aim of present paper was to decrease the surgical treatment morbidity of this disease. METHODS: A non-randomized prospective analysis of patients seen between April, 2006 and June, 2008. The patients with grade III and IV hemorrhoidal disease were included. We describe the surgical technique. After surgery the course of all patients for more than 10 months was followed. RESULTS: Forty four patients were operated on and 30 patients (69 percent) under ambulatory regime. Only 6 patients (14 percent) had postoperative pain. Complications weren't greater than the reported ones using the hemorrhoidectomy. There was a 93,4 percent of efficiency. CONCLUSIONS: Postoperative morbidity was much better compared with the results reported using the hemorrhoidectomy techniques. The technique proposed offers a new option to improve the postoperative morbidity of surgical treatment in patients with hemorrhoidal disease. It is necessary carrying out of comparative studies with hemorrhoidectomy techniques(AU)

Como o coloproctologista brasileiro vê a doença hemorroidária: análise de dados colhidos de questionário dirigido aos especialistas filiados à sociedade brasileira de coloproctologia / How Brazilian coloproctologists see hemorrhoidal diseases: analysis of data collected from a questionnaire answered by specialists members of the Brazilian society od coloproctology

A análise das 52 respostas dadas pelos 77 especialistas ao questionário permite as seguintes conclusões: EPIDEMIOLOGIA: A média temporária de exercício profissional foi 18,6 anos; os 77 especialistas atenderam ± 1.097.860 pacientes, tendo diagnosticado DH em ± 393.763 (35,86 por cento), tendo operado ± 102.400 pacientes (± 26 por cento). A média aproximada de incidência de DH por gênero foi de 42 por cento em homens e 58 por cento em mulheres, e de hemorroidectomia de 43 por cento em homens e 57 por cento em mulheres, sendo as incidências de DH por faixas etárias: até 20 anos, 7 por cento; de 21 a 40 anos, 40 por cento; de 41 a 60 anos, 40 por cento; e acima de 60 anos,13 por cento. TRATAMENTO CLÍNICO E NÃO INTERVENCIONISTA: o tratamento clínico foi dispensado a ± 291.363, e ± 81,5 por cento foram tratados com cuidados higiêno-dietéticos, pomadas e cremes. O tratamento intervencionista não cirúrgico de escolha foi a LE (94,0 por cento dos especialistas), mais indicada em DH interna grau II (85,2 por cento), com preferência de abordagem de um mamilo por sessão (74,1 por cento), e preferência pela não realização de plicomectomia (67,1 por cento), sendo os graus de satisfação ótimos e bons de 91 por cento. A LE foi feita em ± 48.273 pacientes (12,50 por cento), tendo a maioria (42 médicos; 53,95 por cento) negado complicações, destacando-se, dentre os que admitiram complicações, 69 casos de hemorragia que levaram à revisão (0,142 por cento de 48.273 LE). HEMORROIDECTOMIA: a média anual foi de ± 80,34 cirurgias, totalizando 102.400, sendo a principal indicação cirúrgica a intensidade de sintomas independentemente do grau da DH (64,47 por cento), com preferência pela técnica aberta de Milligan-Morgan (65,79 por cento) seguida pela fechada de Ferguson (21,05 por cento). A preferência anestésica absoluta foi pelos bloqueios raqueano (52,63 por cento) e peridural (26,32 por cento), os posicionamentos preferidos foram em canivete (44,73 por cento)...

Analysis of a questionnaire with 52 questions about hemorrhoidal disease (HD) answered by 77 Brazilian specialists allowed the following conclusions: EPIDEMIOLOGY: The meantime of medical practice was 18.6 years; the 77 specialists attended ± 1,097.860 patients, HD being diagnosed in ± 393,763 (35.86 percent), and ± 102,400 patients (± 26 percent) undergoing surgical treatment. The approximate incidence by gender of HD was 42 percent in men and 58 percent in women, and the incidence of surgery 43 percent in males and 57 percent in females. The incidences of HD according to age were: 7 percent under 20 years, 40 percent between 21 and40 years, 40 percent between 41 and 60 years and 13 percent above 60 years of age. CLINICAL AND NON SURGICAL TREATMENT: clinical approach for HD was carried out in ± 291.363 patients. The non surgical treatment of choice was rubber band ligation (94,0 percent of the specialists), mainly for second grade internal hemorrhoids (85.2 percent), being the most common procedure the approach of a single ligation by each session (74.1 percent), without plicomectomy (67.1 percent). Satisfaction grade reached 91.0 percent (good and optimal). Rubber band ligation was used in ± 48,273 patients (12.50 percent), no complication being reported by most of the specialists (42 specialists, 53.95 percent), being hemorrhage the most common complication (69 cases, 0.142 percent of 48,273 ligations). HEMORRHOIDECTOMY: 102,400 hemorrhoidectomies were performed by the 77 specialists, being the intensity of anal symptoms the main indication for surgery despite of the grade of the HD (64.47 percent). Open hemorrhoidectomy (Milligan-Morgan) was the most used technique (65.79 percent) followed by closed hemorrhoidectomy (Ferguson) (21.05 percent). The most used anesthesia were spinal blocks, being 52.63 percent of raquianesthesia and 26.32 percent of peridural anesthesia. Knife position was the number one in preference (44.73 percent)...

Proctosigmoidoscopy - a statistical study of 1000 consecutive examinations

1) 1000 consecutive proctosigmoidoscopies were statistically studied2) Hemorrhoidal disease is very common - much more common than all other anorectal diseases put together, in this series. Discounting hemorrhoids, there are but few pyogenic infections and diseases involving the anorectum among Filipinos3) The incidence of neoplastic disease, whether benign or malign is low compared to foreign statistics.