Annals of Coloproctology

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Anorectal physiology & pelvic floor disorder

Efficacy and safety of anal encirclement combining the Leeds-Keio artificial ligament with injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of rectal prolapse: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2023;39(3):210-215. Published online November 12, 2021; DOI: https://doi.org/10.3393/ac.2021.00731.0104

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152 Download
3 Web of Science
5 Citations

Purpose
Perineal procedures are an important surgical option for frail and high-risk patients with rectal prolapse. This study aimed to evaluate the efficacy and safety of combined therapy using injection sclerotherapy, with aluminum potassium sulfate and tannic acid (ALTA), and the Thiersch procedure, using the Leeds-Keio ligament (ALTA-Thiersch).
Methods
This study included 106 consecutive patients (mean age, 81.2 years) who underwent ALTA-Thiersch for rectal prolapse. The procedure was performed under caudal epidural anesthesia. ALTA was injected into the submucosa from the tip of the prolapsed rectum down to the dentate line, circumferentially, at 20 to 40 locations. The ligament tape was placed outside the external sphincter muscle and at an approximate depth of 2 cm into the middle anal canal.
Results
Of 106 patients, rectal prolapse was cured shortly after surgery in 105 patients. An additional tape was inserted in 1 patient who had persistent prolapse. Postoperative complications were observed in 27 patients (25.5%). Fecal impaction occurred in 12 patients; however, since it was temporary, no tape removal was required. Of the 12 cases in which the tape was infected or exposed, 11 required tape removal. There were 18 cases of recurrence at a mean follow-up of 22.1 months. Cumulative recurrence rates at 3 and 5 years were 21.3% and 38.6%, respectively.
Conclusion
ALTA-Thiersch is a simple and safe procedure for rectal prolapse, having reasonable outcomes. The use of the Leeds-Keio ligament for anal encircling can help compensate for the disadvantages of the Thiersch operation.

Citations

Citations to this article as recorded by

Outcomes of the Gant-Miwa-Thiersch Procedure Using the Leeds-Keio Mesh for Rectal Prolapse
Naoto Nishigori, Yoshiyuki Sasaki, Shinsaku Obara
Journal of the Anus, Rectum and Colon.2025; 9(2): 252. CrossRef
Gant-Miwa-Thiersch Procedure for Rectal Prolapse - Use of the Leeds-Keio Mesh
Naoto Nishigori, Yoshiyuki Sasaki, Shinsaku Obara
Nihon Daicho Komonbyo Gakkai Zasshi.2025; 78(10): 398. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Benign proctology,Postoperative outcome & ERAS,Surgical technique

Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids: Shunya Takada, Akira Tsunoda, Tomoko Takahashi, Hiroshi Kusanagi; Ann Coloproctol. 2022;38(4):290-296. Published online November 2, 2021; DOI: https://doi.org/10.3393/ac.2020.00920.0131

5,991 View
168 Download
1 Web of Science
1 Citations

Abstract PDF

Purpose
Aluminum potassium sulfate and tannic acid (ALTA; Zion, Mitsubishi Pharma Corp.) is an effective sclerosing agent for internal hemorrhoids. ALTA therapy with a rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study compared the early postoperative outcomes of AM surgery with Doppler-guided transanal hemorrhoidal dearterialization and mucopexy (DM) in patients with third-degree hemorrhoids.
Methods
AM surgery was performed on 32 patients with grade III hemorrhoids and was compared with a cohort of 22 patients who underwent DM surgery in a previous randomized controlled trial.
Results
The pain scores during defecation were significantly lower in the AM patients beginning 4 days after surgery. The total use of analgesics 2 weeks postoperatively was significantly lower in the AM patients than in the DM patients (3.5 tablets [range 1.6–5.5] vs. 7.6 tablets [range 3.3–11.9], P=0.04). The length of operation, blood loss, and incidence of postoperative complications were significantly lower in the AM patients than in the DM patients. During 12 months follow-up, recurrence of prolapse occurred in 1 patient who underwent AM surgery.
Conclusion
AM surgery is effective, with lower complication rates and postoperative analgesic requirements, and is a less invasive treatment for patients with grade III hemorrhoids compared to DM surgery.

Citations

Citations to this article as recorded by

Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids
A. Tsunoda, H. Kusanagi
Techniques in Coloproctology.2023; 27(12): 1335. CrossRef

Benign proctology,Surgical technique

Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2022;38(6):403-408. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00248.0035

7,948 View
168 Download
3 Web of Science
4 Citations

Graphical Abstract Abstract PDF

Purpose
Perianal injection of bulking agents is an attractive treatment option for patients with mild to moderate fecal incontinence (FI). Various bulking agents have been used for injection therapy, but the optimal injection materials and methods are yet to be standardized. This study aimed to evaluate the effects of injection therapy using aluminum potassium sulfate and tannic acid (ALTA) in the management of FI.
Methods
This study included consecutive patients who underwent ALTA injection therapy for FI at our institution. The procedure was performed with the patient in the jackknife position, under caudal epidural anesthesia. The procedure consisted of a 4-step injection to the 3 main cushions and a multipoint injection to the remaining submucosa of the anal canal.
Results
Seventy-seven patients (mean age, 76 years) were enrolled in the study. The mean Cleveland Clinic incontinence score of 11.9 ± 4.1 at baseline significantly improved to 7.3 ± 5.2 at 3 months following treatment. The mean maximal resting pressure also increased significantly 3 months after the intervention. Postoperative complications were observed in 3 patients (3.9%), and all events were mild. The mean duration of postoperative follow-up was 17.5 months. The cumulative recurrence-free rate at 3 years was 72.4%.
Conclusion
ALTA injection for FI is safe, easy to perform, and provides reasonable mid-term outcomes. Moreover, concomitant anorectal diseases that may be contraindicated by other injectable bulking agents could be treated simultaneously. Therefore, ALTA injection is a promising alternative in the absence of other injectable agents.

Citations

Citations to this article as recorded by

Effective non-surgical treatment of hemorrhoids with sclerosing foam and novel injection device
Juan Cabrera Garrido, Gonzalo López González
Gastroenterology & Endoscopy.2024; 2(4): 176. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Review

Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids: Seok Won Lim; J Korean Soc Coloproctol. 2012;28(2):73-77. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.73

46,783 View
83 Download
14 Citations

Abstract PDF

A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment.

Citations

Citations to this article as recorded by

Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis
Vasiliki Manaki, Vangelis Bontinis, Alkis Bontinis, Argirios Giannopoulos, Ioannis Kontes, Angeliki Chorti, Kiriakos Ktenidis
Acta Chirurgica Belgica.2024; 124(4): 253. CrossRef
Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Akane Ito, Kenji Watanabe, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki, Yusuke Saitoh, Masanori Murakami
Journal of the Anus, Rectum and Colon.2024; 8(4): 331. CrossRef
ANTI-HEMORRHOIDAL ACTIVITY OF AYURVEDIC CREAM IN RATS
Anil T. Pawar, Chinmay D. Deshmukh, Digambar K. Jadhav, Ranganath R. Kulkarni
INDIAN DRUGS.2023; 60(01): 84. CrossRef
Injection of aluminum potassium sulfate and tannic acid in the treatment of fecal incontinence: a single-center observational study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki
Annals of Coloproctology.2022; 38(6): 403. CrossRef
Sklerosierungstherapie
Alex Furtwängler
coloproctology.2020; 42(1): 14. CrossRef
Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids
Yuichi Tomiki, Jun Aoki, Shunsuke Motegi, Rina Takahashi, Toshiaki Hagiwara, Yu Okazawa, Kosuke Mizukoshi, Masaya Kawai, Shinya Munakata, Shun Ishiyama, Kiichi Sugimoto, Kazuhiro Sakamoto
Clinical Endoscopy.2019; 52(6): 581. CrossRef
Taste of phytocompounds: A better predictor for ethnopharmacological activities of medicinal plants than the phytochemical class?
Dorin Dragos, Marilena Gilca
Journal of Ethnopharmacology.2018; 220: 129. CrossRef
Changes in anorectal physiology following injection sclerotherapy using aluminum potassium sulfate and tannic acid versus transanal repair in patients with symptomatic rectocele; a retrospective cohort study
Joo Hyung Kim, Yong Pyo Lee, Kwang Wook Suh
BMC Surgery.2018;[Epub] CrossRef
Extraoral Taste Receptor Discovery: New Light on Ayurvedic Pharmacology
Marilena Gilca, Dorin Dragos, Marco Leonti
Evidence-Based Complementary and Alternative Medicine.2017;[Epub] CrossRef
Liver injury after aluminum potassium sulfate and tannic acid treatment of hemorrhoids
Kenichi Yoshikawa, Reimi Kawashima, Yuki Hirose, Keiko Shibata, Takafumi Akasu, Noriko Hagiwara, Takeharu Yokota, Nami Imai, Akira Iwaku, Go Kobayashi, Hirohiko Kobayashi, Akiyoshi Kinoshita, Nao Fushiya, Hiroyuki Kijima, Kazuhiko Koike, Masayuki Saruta
World Journal of Gastroenterology.2017; 23(27): 5034. CrossRef
Treatment of Internal Hemorrhoids by Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid
Yuichi Tomiki, Seigo Ono, Jun Aoki, Rina Takahashi, Shun Ishiyama, Kiichi Sugimoto, Yukihiro Yaginuma, Yutaka Kojima, Michitoshi Goto, Atsushi Okuzawa, Kazuhiro Sakamoto
Diagnostic and Therapeutic Endoscopy.2015; 2015: 1. CrossRef
Aluminum Potassium Sulfate and Tannic Acid - A New Option for the Treatment of Grade 3 Hemorrhoids
Yong Hee Hwang
Annals of Coloproctology.2015; 31(3): 83. CrossRef
Comparison of Injection Sclerotherapy Between 5% Phenol in Almond Oil and Aluminum Potassium Sulfate and Tannic Acid for Grade 3 Hemorrhoids
Takaaki Yano, Kenji Yano
Annals of Coloproctology.2015; 31(3): 103. CrossRef
Distal Hemorrhoidectomy With ALTA Injection: A New Method for Hemorrhoid Surgery
Tatsuya Abe, Yoshikazu Hachiro, Yoshiaki Ebisawa, Houhei Hishiyama, Masao Kunimoto
International Surgery.2014; 99(3): 295. CrossRef

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