Comment on Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218.

Dr. Pata kindly tweeted the publication of the above-mentioned paper [...].

[Surgical Management of Advanced Haemorrhoid Disease - What's the Deal?] / Operative Verfahrenswahl beim fortgeschrittenen Hämorrhoidalleiden ­ worauf kommt es an?

About 2 - 3 million patients suffer from haemorrhoid disease in Germany each year. Advanced haemorrhoid disease is assumed if an operation is planned. In Germany, approximately 50,000 operations per year are performed for haemorrhoids. Individual therapy and surgery are implemented after proctological examination. A wide variety of surgical procedures are available. These techniques will be described and illustrated. Individual comorbidities such as anticoagulation and will be discussed, together with options for teaching these surgical skills - in times of difficult recruitment.

Sacral nerve modulation for fecal incontinence: results of a prospective single-center randomized crossover study.

BACKGROUND: Although sacral nerve modulation has become an important tool for the treatment of fecal incontinence, prospective, randomized data are still rare. OBJECTIVE: To determine the effectiveness of sacral nerve modulation in a prospective randomized crossover study DESIGN: : Prospective randomized crossover study SETTING: : Proctological Office and Department of Surgical Proctology at a private hospital. PATIENTS: A total of 31 consecutive patients (31 women) aged 55 ± 12 years (median ± SD) with fecal incontinence were enrolled between February 2012 and December 2012. INTERVENTIONS: All patients underwent sacral nerve modulation through a staged implantation procedure between 2009-2011. After a median of 26.8 months following implantation, 16 of the 31 patients agreed to be randomized in a crossover design to stimulation ON or OFF, each for a 3-week period. After the two periods (ie, 6 weeks), while still blinded to the stimulator status, the patients chose which stimulation period (first or second) they preferred. The mode of stimulation corresponding to the selected period was then continued for 3 months (final period). MAIN OUTCOME MEASURES: Frequency of bowel movements, frequency of fecal incontinence and urgency episodes, severity scores, preference for ON or OFF. RESULTS: The frequency of fecal incontinence episodes and Cleveland Clinic Incontinence Score (CCIS) were both significantly lower in the ON period than the OFF period (p < 0.005) during the crossover phase of the study. All patients decided to stay in the ON mode for the final period and have continued in the ON mode until now. LIMITATIONS: Small patient numbers. CONCLUSIONS: The significant improvement in fecal incontinence during the ON period, as compared to the OFF period, makes it unlikely that the observed benefits of sacral nerve modulation are due to a placebo effect.

Six years after: complications and long-term results after stapled hemorrhoidopexy with different devices.

PURPOSE: Stapled hemorrhoidopexy (SH) was introduced in 1998. Early in the experience, a standard circular stapler was often used, while later specifically designed staplers for SH were developed. Although the diameter of the circular cutting knife differ significantly, it remains unclear, if the volume of the excised tissue differs and if this has an influence on the long-term results and complications. METHODS: We evaluated in a prospective consecutive database that underwent SH from January 2003 through April 2004. There were three devices used during the study period: end-to-end-anastomosis (EEA) 31, stapler device for haemorrhoids (SDH) and procedure for prolapse and haemorrhoids (PPH). Procedure selection was at the discretion of the surgeon; however, the indications for surgery were similar for all involved surgeons. Demographic and operative characteristics were analysed. Follow-up data were collected continuously over the time, and in May 2010, these patients received a questionnaire. Data were compared by t test and chi-square test, respectively. RESULTS: There were 214 (97 females) evaluable patients. Seventy-three patients were operated with EEA-31, 52 with SDH- and 89 with PPH. The median follow-up was 6.8 years and complete data were available for 131 (61.2%) patients. Demographic characteristics were comparable within the three groups. SDH (6 ml) and PPH (6.5 ml) resected significantly (p < 0.05) more tissue than EEA (5 ml). Early postoperative incontinence rate was significantly higher in the PPH group (6%) as compared to EEA (1%) and SDH (0%). The incidence of other early complications was similar across techniques. The overall complication rates and reoperation rates were similar. Although 41% of the patients had minor anorectal complaints (itching and soiling), incontinence rates were low (2-3%) without any significant differences between the devices. CONCLUSIONS: The results of cohort of SH patients support the conclusion that short- and long-term outcomes are device independent, although each approach is associated with a modest degree of ongoing anorectal symptoms.

[Pain therapy in proctology]. / Schmerztherapie in der Proktologie.

Pain in the anorectal region can be quite considerable. They can be treated effectively however. Before treatment the correct diagnosis is important. In each pain regimen it is important that patients have a normally sized stool (Bristol stool form scale type 4). Diclofenac (3 dd 50 mg) should be routinely used in anorectal pain. If diclofenac does not sufficiently relieve the pain, one should add metamizole or tramadole. Topically relaxing or analgetic agents (glyceryl trinitrate, botulinum toxin A, diltiazem, nifedipin, metronidazole, cincho- or lignocaine) might be used in selected cases. If edema exists topical steroids might have an analgetic effect.