Annals of Coloproctology

Guideline

Anorectal benign disease

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease: Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Claudio Gambardella, Luigi Monaco, Ilaria Ferrante, Domenico Izzo, Alfredo Giordano, Michele Pinto, Corrado Fantini, Marcello Gasparrini, Michele Schiano Di Visconte, Francesca Milazzo, Giovanni Ferreri, Andrea Braini, Umberto Cocozza, Massimo Pezzatini, Valeria Gianfreda, Alberto Di Leo, Vincenzo Landolfi, Umberto Favetta, Sergio Agradi, Giovanni Marino, Massimiliano Varriale, Massimo Mongardini, Claudio Eduardo Fernando Antonio Pagano, Riccardo Brachet Contul, Nando Gallese, Giampiero Ucchino, Michele D’Ambra, Roberto Rizzato, Giacomo Sarzo, Bruno Masci, Francesca Da Pozzo, Simona Ascanelli, Patrizia Liguori, Angela Pezzolla, Francesca Iacobellis, Erika Boriani, Eugenio Cudazzo, Francesca Babic, Carmelo Geremia, Alessandro Bussotti, Mario Cicconi, Antonia Di Sarno, Federico Maria Mongardini, Antonio Brescia, Leonardo Lenisa, Massimiliano Mistrangelo, Matteo Zuin, Marta Mozzon, Alessandro Paolo Chiriatti, Vincenzo Bottino, Antonio Ferronetti, Corrado Rispoli, Ludovico Carbone, Giuseppe Calabrò, Antonino Tirrò, Domenico de Vito, Giovanna Ioia, Giovanni Luca Lamanna, Lorenzo Asciore, Ettore Greco, Pierluigi Bianchi, Giuseppe D’Oriano, Alessandro Stazi, Nicola Antonacci, Raffaella Marina Di Renzo, Gianmario Edoardo Poto, Giuseppe Paolo Ferulano, Antonio Longo, Ludovico Docimo; Ann Coloproctol. 2024;40(4):287-320. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2023.00871.0124

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Abstract PDF: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Review

Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis: Ian Jun Yan Wee, Chee Hoe Koo, Isaac Seow-En, Yvonne Ying Ru Ng, Wenjie Lin, Emile John Kwong-Wei Tan; Ann Coloproctol. 2023;39(1):3-10. Published online January 3, 2023; DOI: https://doi.org/10.3393/ac.2022.00598.0085

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Abstract PDF Supplementary Material

Purpose
This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids.
Methods
PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities.
Results
Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], –2.09; 95% confidence interval [CI], –3.44 to –0.75; P=0.002) and postoperative day 7 (MD, –3.94; 95% CI, –6.36 to –1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42–0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12– 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240).
Conclusion
LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

Citations

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Quand et comment traiter des hémorroïdes
Thierry Higuero
La Presse Médicale Formation.2024;[Epub] CrossRef
Spectrum of Diagnoses in Female Patients With Proctologic Symptoms Presenting to the Surgery Unit of a Tertiary Care Center
Sana Sahar, Tamjeed Gul, Muhammad Ihtesham Khan
Cureus.2024;[Epub] CrossRef
Precision and Power: A Comprehensive Review of Exploring the Role of Laser Treatment in Hemorrhoidal Management
Dheeraj Surya, Pankaj Gharde
Cureus.2024;[Epub] CrossRef
Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis
Po-Lung Cheng, Chang-Cyuan Chen, Jian-Syun Chen, Po-Li Wei, Yan-Jiun Huang
Asian Journal of Surgery.2024;[Epub] CrossRef
Laser hemorrhoidoplasty vs. rubber band ligation: a randomized trial comparing 2 mini-invasive treatment for grade II hemorrhoids
Lei Jin, Kaijian Qin, Renjie Wu, Haojie Yang, Can Cui, Zhenyi Wang, Jiong Wu
BMC Surgery.2024;[Epub] CrossRef
Quality of Life of Patients Before and After Hemorrhoid Surgery: A Single-Center Study in Vietnam
Nguyen Thi Thuy Anh, Nguyen Ngoc Huynh Nhu, Tran Ngoc Hong, Pham Thi Ly, Nguyen Thi Hong Huyen, Doan Thi Minh, Ho Tat Bang, Nguyen Trung Tin
Journal of Nursing and Midwifery Sciences.2024;[Epub] CrossRef
Minimally invasive laser technologies in the surgical treatment of hemorrhoidal disease: problems and prospects (literature review)
N. D. Yartseva, L. V. Kornev, E. K. Naumov, G. V. Rodoman, L. A. Laberko
Hirurg (Surgeon).2023; (3): 20. CrossRef
Laser interventions in coloproctology. A plea for standardized treatment protocols
P. C. Ambe
Techniques in Coloproctology.2023; 27(10): 953. CrossRef
Comments on “Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis”
Mohamed Ali Chaouch, Amine Gouader, Bassem Krimi, Hani Oweira
Annals of Coloproctology.2023; 39(5): 442. CrossRef

Original Articles

Anorectal benign disease

The importance of compression time in stapled hemorrhoidopexy: is patience a virtue?: Byung Eun Yoo, Wook Ho Kang, Yong Teak Ko, Young Chan Lee, Cheong Ho Lim; Ann Coloproctol. 2024;40(2):176-181. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00556.0079

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Abstract PDF: Purpose
The aim of this study was to evaluate whether longer compression time before firing the stapler reduced the postoperative complications related to staple line formation in stapled hemorrhoidopexy.
Methods
This retrospective case-control study was conducted at a colorectal-anal specialty hospital. Consecutive patients with grades III and IV hemorrhoids who underwent stapled hemorrhoidopexy between January 2016 and November 2019 were included. According to the compression time, patients were assigned to the long compression time group (2 minutes) or the typical compression time group (30 seconds). The primary outcome measure was incidence of staple line complications such as dehiscence, bleeding, and stenosis.
Results
A total of 348 patients treated with stapled hemorrhoidopexy were evaluated. Seventy-three and 275 patients were included in the long compression time group and the typical compression time group, respectively. No significant differences were observed in patient characteristics between the groups. However, additional procedures were performed more frequently in the typical compression time group (78.1% vs. 92.0%, P=0.001). Bleeding occurred more frequently in the typical compression time group (1.4% vs. 8.4%, P=0.030). The rates of dehiscence and stenosis were not significantly different between the groups. Fecal urgency developed more frequently in the typical compression time group (0% vs. 5.1%, P=0.040). In logistic regression analysis, typical compression time (30 seconds) was the only risk factor for bleeding (odds ratio, 8.496; P=0.040).
Conclusion
Longer compression time was associated with a decreased incidence of postoperative bleeding after stapled hemorrhoidopexy.

What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: “no pain, no gain” or “no pain but a gain”?: Jean-Michel Didelot, Benjamin Raux, Romain Didelot, Franz Rudler, Aurelien Mulliez, Anthony Buisson, Armando Abergel, Pierre Blanc; Received May 2, 2022 Accepted June 8, 2022 Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00311.0044 [Epub ahead of print]

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Abstract PDF

Purpose
The purpose of this study was to assess the long-term efficacy of hemorrhoidal radiofrequency thermocoagulation (RFT) on bleeding, prolapse, quality of life (QoL), and recurrence.
Methods
This retrospective, single-center study, with RFT performed using procedure modified via hemorrhoid exteriorization assessed the evolution of hemorrhoidal prolapse rated by Goligher scale; bleeding and discomfort (0–10), feeling of improvement and satisfaction (–5 to +5/5) by analog scales; the impact of hemorrhoids on QoL by HEMO-FISS-QoL score.
Results
From April 2016 to January 2021, 124 patients underwent surgery and 107 were interviewed in September 2021. The average follow-up was 30 months (range, 8–62 months). The mean work stoppage was 3 days, none in 71.0% of the cases. A mean of 4,334 J was applied. No analgesics were required for 66.4% of patients. External hemorrhoidal thrombosis was the only immediate complication in 9 patients, with no long-term reported complication. Bleeding disappeared in 53 out of 102 patients or dropped from 7 to 3 out of 10 (P<0.001). Prolapse reduced from mean grade 3 to 2 (P<0.001), discomfort from 7 to 2 out of 10 (P<0.001). HEMO-FISS-QoL score improved from 22 to 7 out of 100 (P<0.001). Feeling of improvement and overall satisfaction rate were +4/5. Recurrence occurred in 21.5% of patients at 22 months, and 6 required reoperation. Of the patients, 91.6% would choose the same procedure again and 96.3% recommend it.
Conclusion
RFT, although imperfect, leads to a significant improvement in hemorrhoidal symptoms and a lasting increase in QoL with minimal pain and downtime, high acceptance, and low complication and recurrence rates.

Citations

Citations to this article as recorded by

Quand et comment traiter des hémorroïdes
Thierry Higuero
La Presse Médicale Formation.2024; 5(1): 24. CrossRef
The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef

Anorectal benign disease

Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study: Anshini Jain, Chen Lew, Gamze Aksakal, Richard Hiscock, Naseem Mirbagheri; Ann Coloproctol. 2024;40(1):52-61. Published online May 19, 2022; DOI: https://doi.org/10.3393/ac.2022.00164.0023

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Graphical Abstract Abstract PDF

Purpose
Traditional therapeutic approaches to the surgical management of hemorrhoid disease such as hemorrhoidectomies are plagued with severe postoperative pain and protracted recovery. Our pilot study aims to the laser hemorrhoidoplasty (LH) patients with symptomatic hemorrhoid disease that have failed conservative management for the first time in an Australian population.
Methods
Thirty patients were prospectively enrolled to undergo LH. Postoperative pain, time to return to function, and quality of life (QoL) were determined through the Hemorrhoid Disease Symptom Score and Short Health Scale adapted for hemorrhoidal disease and compared to a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon at 3, 6, and 12 months.
Results
The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4. The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001). Similarly, the median days to return to the workplace was significantly lower in the LH group (6 days vs. 13 days, P=0.007). During long-term follow-up (12 months), hemorrhoid symptoms and all QoL measures were significantly improved, especially among those with grade II to III disease.
Conclusion
This pilot study demonstrates low pain scores with this revivified procedure in an Australian population, indicating possible expansion of the therapeutic options available for this common condition. Further head-to-head studies comparing LH to other hemorrhoid therapies are required to further determine the most efficacious therapeutic approach.

Citations

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Laser hemorrhoidoplasty versus LigaSure™ hemorrhoidectomy versus diathermy hemorrhoidectomy in treatment of grade III and IV Hemorrhoids: A non-randomized prospective trial
Mohammad Ashour Khadr, Walid Galal El Shazly, Mohamed Mazloum Zakria, Ahmed Mohamed Moaz
Surgery Open Digestive Advance.2024; 13: 100129. CrossRef
Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease
Adas Cemil, Kesici Ugur, Genc M. Salih, Karadag Merve, Duman M. Guray, Boluk S. Emine
The American Surgeon™.2024; 90(4): 662. CrossRef
Global International Society of University Colon and Rectal Surgeons in collaboration with European Society of Coloproctology audit on office‐based and surgical treatment of haemorrhoidal disease: Study protocol
Audrius Dulskas, Dovile Cerkauskaite, Joseph Nunoo‐Mensah, Richard Fortunato, Gaetano Gallo, Alaa El Hussuna, Varut Lohsiriwat, Tomas Aukstikalnis, Narimantas E. Samalavicius
Colorectal Disease.2024; 26(6): 1266. CrossRef
The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: An observational cohort study
Nadim H. P. Boerhave, Rutger J. Klicks, Kemal Dogan
Colorectal Disease.2023; 25(6): 1202. CrossRef
Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II–III hemorrhoidal disease: a retrospective analysis
Haluk Tümer, Mevlüt Harun Ağca
ANZ Journal of Surgery.2023; 93(7-8): 1885. CrossRef
Comparison of the efficacy of LigaSure and laser for grade 2-3 hemorrhoids
Ali Kemal Taşkin, Bülent Özçetin
Journal of Clinical Medicine of Kazakhstan.2023; 20(4): 33. CrossRef
Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study
Amir F. Abdelhamid, Mohamed M. Elsheikh, Osama H. Abdraboh
The Egyptian Journal of Surgery.2023; 42(3): 669. CrossRef
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids: Dong Wan Kang, Byoung Soo Kim, Ji Hun Kim, Kyong Rae Kim, Gyong Suk Kang; Ann Coloproctol. 2023;39(1):41-49. Published online December 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00717.0102

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Graphical Abstract Abstract PDF

Purpose
Rubber band ligation (RBL) for grade 1 to 3 internal hemorrhoids is a well-established modality of choice. But RBL is also a kind of surgical treatment; it is not free from complications (e.g., delayed bleeding [DB], rectal stenosis). This study aimed to investigate the results of the comparative treatment of RBL and BANANA-Clip (BC; Endovision).
Methods
Study participants were 632 consecutive patients with grade 1 to 3 internal hemorrhoids attended to Department of Colorectal Surgery at Wellness Hospital between January 2010 and May 2019. We retrospectively reviewed the incidence rate of complications, including DB between RBL and BC.
Results
There were 304 male and 328 female patients, whose ages ranged from 15 to 84 years, with a mean age of 45.7 years. The common symptom and cause of treatment was prolapse (70.1%). The number of ligated sites was 1.49±0.57 in the RBL group and 1.99±0.77 in the BC group. RBL showed a significantly higher incidence of DB (3.5%) compared to BC (0%) (P=0.001). The 1-year success rate was 95.9% in the RBL group and 99.7% in the BC group (P=0.005).
Conclusion
In our study, BC was more reliable in treating grade 1 to 3 internal hemorrhoids with higher success rates and less post-ligation complications, especially DB, compared to RBL.

Citations

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The BANANA-Clip: an innovative solution for hemorrhoidal pile ligation?
Kyung Uk Jung
Annals of Coloproctology.2023; 39(1): 1. CrossRef
Banana Clip: Advancing Hemorrhoid Ligation Beyond Rubber Bands
Navneet Arora, Ranjeet Kumar
Journal of Coloproctology.2023; 43(04): e324. CrossRef
Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy
Sen Lin, Meichun Zang, Zhaoqi Dong
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation—a retrospective study
Jiazi Yu, Jie Zhong, Tao Peng, Liangbin Jin, Leibin Shen, Mian Yang
BMC Surgery.2022;[Epub] 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

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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

Radiofrequency ablation (Rafaelo Procedure) for the treatment of hemorrhoids: a case series in the United Kingdom: Sarah Hassan, Daniel McGrath, Richard Barnes, Simon Middleton; Ann Coloproctol. 2023;39(2):164-167. Published online August 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00276.0039

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6 Citations

Abstract PDF

Purpose
Hemorrhoidal disease remains a common condition that can have a significant effect on a patient’s quality of life. Various methods have been introduced over the years; however, their overall success rates remain low. Although the traditional Milligan Morgan technique is effective, the associated pain level prevents it from being an attractive form of treatment. This study was devised to assess the safety and efficacy associated with a novel minimally invasive approach, radiofrequency ablation (RFA).
Methods
Forty-two patients underwent RFA at a single center, by 1 of 2 surgeons. This was performed under local anesthetic and sedation. Outcomes including postoperative pain levels, recurrence rates, and patient satisfaction scores were recorded and analyzed using medians and interquartile ranges
Results
The median postoperative pain score was 2.5/10 (interquartile range [IQR], 0–4.5) and the overall patient satisfaction score was 9 out of 10 (IQR, 6.5–10). Recurrence rates (6–12 months following the procedure) were low at 12% and all patients reported milder symptoms at recurrence. There were no serious adverse complications
Conclusion
The results from this case series supports other limited data in concluding that RFA is a safe and effective method in the treatment of hemorrhoids and patients report a high level of satisfaction following

Citations

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Radiofrequency Ablation for Internal Hemorrhoids: A Case Series
Kean leong Koay, Nabil Mohammad Azmi, Soma Chandrakanthan, Nurafdzillah Abdul Rahman, Diana Melissa Dualim
Cureus.2024;[Epub] CrossRef
Protocol for the ORION trial (RadiO fRequency ablatION for haemorrhoids): a randomised controlled trial
C. Girling, M. J. Lee, D. Vimalchandran, D. J. Jayne, S. Stancliffe, A. Wailoo, M. Bradburn, D. Hind, M. Bursnall, L. K. Robinson, S. R. Brown
Techniques in Coloproctology.2023; 27(2): 117. CrossRef
The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis
Prokopis Christodoulou, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, George Tzovaras
Techniques in Coloproctology.2023; 27(2): 103. CrossRef
Radiofrequency thermocoagulation of haemorrhoids: learning curve of a novel approach
Valentin Butnari, Ahmer Mansuri, Sandeep Kaul, Veeranna Shatkar, Richard Boulton
Journal of Surgical Case Reports.2023;[Epub] CrossRef
French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease
A. Laurain, D. Bouchard, J.-M. Rouillon, P. Petit, A. Liddo, B. Vinson Bonnet, A. Venara, J.-M. Didelot, G. Bonnaud, A. Senéjoux, T. Higuero, P. Delasalle, A.-L. Tarrerias, F. Devulder, A. Castinel, C. Thomas, H. Pillant Le Moult, C. Favreau-Weltzer, L. A
Techniques in Coloproctology.2023; 27(10): 873. CrossRef
Early and midterm results of radiofrequency ablation (Rafaelo® procedure) for third-degree haemorrhoids: a prospective, two-centre study
S. Tolksdorf, D. Tübergen, C. Vivaldi, M. Pisek, F. Klug, M. Kemmerling, H. Schäfer
Techniques in Coloproctology.2022; 26(6): 479. CrossRef

Long-term outcomes of high-volume stapled hemorroidopexy to treat symptomatic hemorrhoidal disease: Alessandro Sturiale, Raad Dowais, Bernardina Fabiani, Claudia Menconi, Felipe Celedon Porzio, Virginia Coli, Gabriele Naldini; Ann Coloproctol. 2023;39(1):11-16. Published online July 29, 2021; DOI: https://doi.org/10.3393/ac.2020.00227.0032

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Abstract PDF

Purpose
The study aimed to assess the long-term results of the stapled hemorrhoidopexy (SH) using high-volume devices equipped with innovative technology, evaluating recurrence rate, complications rate, and patients’ satisfaction.
Methods
All the patients who underwent SH using high-volume devices (TST Starr plus, Touchstone International Medical Science Corp., Ltd.) for II to IV symptomatic hemorrhoidal disease from November 2012 to December 2014 were enrolled. Between December 2019 and January 2020, all of them were phone called to come to undergo a proctological reevaluation and asked to fill some questionnaires about hemorrhoidal prolapse recurrence, symptoms recurrence, and surgery satisfaction.
Results
Fifty-nine patients with a mean age of 47 years completely answered the questionnaires. Twenty-two of them accepted to come to undergo a proctological reevaluation while 27 preferred to answer only by phone due to their referred wellbeing. The median follow-up was 70.5 months (range, 60–84 months). The recurrence rate was 5.1% with a mean satisfaction level after surgery was 9.1 (range, 0–10) and 84.7% of patients whose satisfaction scored ≥8. The mean value of Cleveland Global Quality of Life assessment was 0.79 (range, 0.71–0.93). There were no cases of new onset of impaired anal continence after surgery.
Conclusion
The new generation high-volume devices to perform SH resulted to be safe and effective for II to IV degree hemorrhoidal prolapse leading to a lower long-term recurrence rate with an evident reduction of postoperative complications in comparison with the low-volume SH.

Citations

Citations to this article as recorded by

The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease
Antonio Brillantino, Adolfo Renzi, Pasquale Talento, Luigi Brusciano, Luigi Marano, Maurizio Grillo, Mauro Natale Maglio, Fabrizio Foroni, Alessio Palumbo, Maria Laura Sandoval Sotelo, Luciano Vicenzo, Michele Lanza, Giovanna Frezza, Massimo Antropoli, Cl
Annals of Coloproctology.2024; 40(4): 287. CrossRef
Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients
Inese Fišere, Valērija Groma, Šimons Svirskis, Estere Strautmane, Andris Gardovskis
Journal of Clinical Medicine.2023; 12(15): 5119. CrossRef
Stapled Transanal Rectal Resection (Starr) in the Treatment of Obstructed Defecation: A Systematic Review
Lorenzo Ripamonti, Angelo Guttadauro, Giulia Lo Bianco, Maria Rennis, Matteo Maternini, Gerardo Cioffi, Marco Chiarelli, Matilde De Simone, Ugo Cioffi, Francesco Gabrielli
Frontiers in Surgery.2022;[Epub] CrossRef
Indications, Feasibility, and Safety of TST STARR Plus Stapler for Degree III Hemorrhoids: A Retrospective Study of 125 Hemorrhoids Patients
Jun Wei, Xufeng Ding, Jie Jiang, Lijiang Ji, Hua Huang
Frontiers in Surgery.2022;[Epub] CrossRef

Benign proctology,Surgical technique

Hemorrhoidectomy versus rubber band ligation in grade III hemorrhoidal disease: a large retrospective cohort study with long-term follow-up: Lisette Dekker, Michiel T.J. Bak, Willem A. Bemelman, Richelle J.F. Felt-Bersma, Ingrid J.M. Han-Geurts; Ann Coloproctol. 2022;38(2):146-152. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.01011.0144

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Abstract PDF

Purpose
Standard therapy for grade III hemorrhoids is rubber band ligation (RBL) and hemorrhoidectomy. The long-term clinical and patient-reported outcomes of these treatments in a tertiary referral center for proctology were evaluated.
Methods
A retrospective analysis was performed in all patients with grade III hemorrhoids who were treated between January 2013 and August 2018. Medical history, symptoms, reinterventions, complications, and patient-reported outcome measurements (PROM) were retrieved from individual electronic patient files, which were prospectively entered as standard questionnaires in our clinic.
Results
Overall, 327 patients (163 males) were treated by either RBL (n=182) or hemorrhoidectomy (n=145). The median follow-up was 44 months. The severity of symptoms and patient preference led to the treatment of choice. The most commonly experienced symptoms were prolapse (83.2%) and blood loss (69.7%). Hemorrhoidectomy was effective in 95.9% of the cases as a single procedure, while a single RBL procedure was only effective in 51.6%. In the RBL group, 34.6% received a second RBL session. Complications were not significantly different, 11 (7.6%) after hemorrhoidectomy versus 6 (3.3%) after RBL. However, 4 fistulas developed after hemorrhoidectomy and none after RBL (P<0.05). The pre-procedure PROM score was higher in the hemorrhoidectomy group whereas the post-procedure PROM score did not significantly differ between the groups.
Conclusion
Treatment of grade III hemorrhoids usually requires more than one session RBL whereas 1-time hemorrhoidectomy suffices. Complications were more common after hemorrhoidectomy. The patient-related outcome did not differ between procedures.

Citations

Citations to this article as recorded by

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review
Cosmin Moldovan, Elena Rusu, Daniel Cochior, Madalina Elena Toba, Horia Mocanu, Razvan Adam, Mirela Rimbu, Adrian Ghenea, Florin Savulescu, Daniela Godoroja, Florin Botea
World Journal of Clinical Cases.2023; 11(2): 366. CrossRef

Benign proctology

Proposal for a New Score: Hemorrhoidal Bleeding Score: Nadia Fathallah, Hélène Beaussier, Gilles Chatellier, Jean Meyer, Marc Sapoval, Nadia Moussa, Vincent de Parades; Ann Coloproctol. 2021;37(5):311-317. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.19

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Abstract PDF

Purpose
We conducted a prospective study to evaluate a new hemorrhoidal bleeding score (HBS).
Methods
All consecutive patients who had consulted between May 1, 2016 and June 30, 2017 for bleeding hemorrhoidal disease were prospectively assessed at a proctological department. The study was conducted in 2 stages. The first stage assessed the validity of the score on a prospective patient cohort. A second stage assessed the interobserver reproducibility of the score on another prospective cohort.
Results
One hundred consecutive patients were studied (57 males; mean age, 49.70 years). A positive association between HBS and surgery indication was found (P<0.001). A cut-off value of the score of 5 (≤5 vs. >5) separated patients from surgical to medical-instrumental treatment with a sensitivity and specificity of 75.00% and 81.25%, respectively. In the multivariate analysis, only HBS was significantly associated with the operative decision (odds ratio, 12.22). Prolapse was no longer significantly associated with the surgical indication. After a mean follow-up after treatment of 7 months, HBS improved statistically significantly (P<0.0001). For the reproducibility of the score, an additional 30 consecutive patients (13 males; mean age, 53.14 years) were enrolled with an excellent agreement between 2 proctologists (kappa=0.983).
Conclusion
HBS is sensitive, specific, and reproducible. It can assess the severity of hemorrhoidal bleeding. It can discriminate between the most severe surgery-indicated patients and does so in a more efficient way than the Goligher prolapse score. It also allows quantifying the extent of change in hemorrhoidal bleeding after treatment.

Citations

Citations to this article as recorded by

Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management
Nadia Fathallah, Amine Alam, Anne L. Rentien, Giorgio La Greca, Joshua Co, Elise Pommaret, Amélie Barré, Stéphane Kegne, Hélène Beaussier, Lucas Spindler, Vincent de Parades
Journal of Visceral Surgery.2024; 161(3): 161. CrossRef
Pathologie hémorroïdaire : étude épidémiologique et analyse des facteurs de risque de chirurgie
Nadia Fathallah, Amine Alam, Anne-Laure Rentien, Giorgio La Greca, Joshua Co, Elise Pommaret, Amélie Barré, Stéphane Kegne, Hélène Beaussier, Lucas Spindler, Vincent de Parades
Journal de Chirurgie Viscérale.2024; 161(3): 177. CrossRef
Imaging for Hemorrhoidal Disease: Navigating Rectal Artery Embolization from Planning to Follow-up
Jonathan Lindquist, James Hart, Katherine Marchak, Eduardo Bent Robinson, Premal Trivedi
Seminars in Interventional Radiology.2024; 41(03): 263. CrossRef
The efficacy of Aescin combined with MPFF for early control of bleeding from acute hemorrhoids, A randomized controlled trial
Suwan Sanmee, Witcha Vipudhamorn, Pawit Sutharat, Ekkarin Supatrakul
Asian Journal of Surgery.2024;[Epub] CrossRef
Emborrhoid technique performed on a patient with portal hypertension and chronic hemorrhoidal bleeding as a salvage therapy
Filipa Alves e Sousa, Pedro Marinho Lopes, Inês Bolais Mónica, Ana Catarina Carvalho, Pedro Sousa
CVIR Endovascular.2022;[Epub] CrossRef
Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease
Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Vincent Vidal, Farouk Tradi
Seminars in Interventional Radiology.2022; 39(02): 194. CrossRef
Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques
Julien Panneau, Diane Mege, Mathieu Di Biseglie, Julie Duclos, Paul Habert, Axel Bartoli, Vincent Vidal, Farouk Tradi
RadioGraphics.2022; 42(6): 1829. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
Hemorrhoid embolization: A review of current evidences
Reza Talaie, Pooya Torkian, Arash Dooghaie Moghadam, Farouk Tradi, Vincent Vidal, Marc Sapoval, Jafar Golzarian
Diagnostic and Interventional Imaging.2021;[Epub] CrossRef

Benign proctology,Postoperative outcome & ERAS

Is There a Relationship Between Stool Consistency and Pain at First Defecation After Limited Half Hemorrhoidectomy? A Pilot Study: Takaaki Yano; Ann Coloproctol. 2021;37(5):306-310. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.10

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2 Citations

Abstract PDF

Purpose
While the first defecation pain is a problem following hemorrhoidectomy, it is unknown whether the stool consistency has an influence on pain. This pilot study aimed to investigate whether the intensity of defecation pain varied according to stool consistency.
Methods
This prospective cohort study evaluated patients who underwent hemorrhoidectomy in combination with injection sclerotherapy for grade III or IV hemorrhoids. The pain intensity and stool form during the first postoperative defecation were self-recorded by the patients using a visual analogue scale (score of 0–10) and Bristol Stool Form Scale, respectively. The patients were classified into 3 groups according to stool consistency, and the intensity of defecation pain was compared among the groups using analysis of variance.
Results
A total of 61 patients were eligible for this study and were classified into the hard stool (n=15), normal stool (n=21), and soft stool groups (n=25). No significant intergroup differences were identified in the intensity of pain at defecation (P=0.29).
Conclusion
This pilot study demonstrated that there were no clear differences in pain intensity during the first defecation after surgery among the 3 groups with different levels of stool consistency.

Citations

Citations to this article as recorded by

Pain at the First Post-hemorrhoidectomy Defecation Is Associated with Stool Form
Takaaki Yano, Daijiro Kabata, Seiichi Kimura
Journal of the Anus, Rectum and Colon.2022; 6(3): 168. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef

Benign proctology

A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice: Carlos Walter Sobrado Júnior, Carlos de Almeida Obregon, Afonso Henrique da Silva e Sousa Júnior, Lucas Faraco Sobrado, Sérgio Carlos Nahas, Ivan Cecconello; Ann Coloproctol. 2020;36(4):249-255. Published online June 1, 2020; DOI: https://doi.org/10.3393/ac.2020.02.06

7,344 View
383 Download
11 Web of Science
12 Citations

Abstract PDF

Purpose
Present an updated classification for symptomatic hemorrhoids, which not only guides the treatment of internal hemorrhoids but also the treatment of external components. In addition, this new classification includes new treatment alternatives created over the last few years.
Methods
Throughout the past 7 years, the authors developed a method to classify patients with symptomatic hemorrhoids. This study, besides presenting this classification proposal, also retrospectively analyzed 149 consecutive patients treated between March 2011 and November 2013 and aimed to evaluate the association between the management adopted with Goligher classification and our proposed BPRST classification.
Results
Both classifications had a statistically significant association with the adopted management strategies. However, the BPRST classification tended to have fewer management discrepancies when each stage of disease was individually analyzed.
Conclusion
Although there is much disagreement about how the classification of hemorrhoidal disease should be updated, it is accepted that some kind of revision is needed. The BPRST method showed a strong association with the management that should be adopted for each stage of the disease. Further studies are needed for its validation, but the current results are encouraging.

Citations

Citations to this article as recorded by

Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review
Gaetano Gallo, Arcangelo Picciariello, Antonella Tufano, Giuseppe Camporese
Updates in Surgery.2024; 76(2): 423. CrossRef
The role of flavonoids in the pharmacological treatment of haemorrhoids
SS Singh, MA Strydom, M Balmith, C Megaw, MJ Nell
South African General Practitioner.2024; 5(1): 36. CrossRef
Timing and Modality of Hemorrhoidal Prolapse Impact on Patients’ Quality of Life
Carlo Ratto, Angelo Parello, Angelo Alessandro Marra, Paola Campennì, Veronica De Simone, Francesco Litta
Journal of Clinical Medicine.2024; 13(13): 3946. CrossRef
Topical Lidocaine or Lidocaine/Diltiazem Ointment Following Rubber Band Ligation of Hemorrhoids: A Prospective Three-Armed Randomized Controlled Trial
Allan M.F. Kwok, Stephen R. Smith, Jie Zhao, Rosemary Carroll, Lucy Leigh, Brian Draganic
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Time to change? Present and prospects of hemorrhoidal classification
Ling Wang, Jiachun Ni, Changcheng Hou, Di Wu, Li Sun, Qiong Jiang, Zengjin Cai, Wenbin Fan
Frontiers in Medicine.2023;[Epub] CrossRef
Risk factors for hemorrhoidal disease among healthy young and middle-aged Korean adults
Yun Soo Hong, Kyung Uk Jung, Sanjay Rampal, Di Zhao, Eliseo Guallar, Seungho Ryu, Yoosoo Chang, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun, Chong Il Sohn, Hocheol Shin, Juhee Cho
Scientific Reports.2022;[Epub] CrossRef
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard
Varen Zhi Zheng Tan, Ern-wei Peck, Sharmini S. Sivarajah, Winson J. Tan, Leonard M. L. Ho, Jia-Lin Ng, Cheryl Chong, Darius Aw, Franky Mainza, Fung-Joon Foo, Frederick H. Koh
International Journal of Colorectal Disease.2022; 37(8): 1759. CrossRef
Treatment of Hemorrhoid in Unusual Condition-Pregnancy
Hyo Seon Ryu
The Ewha Medical Journal.2022;[Epub] CrossRef
Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study
Dimitrios Symeonidis, Michail Spyridakis, Dimitrios Zacharoulis, George Tzovaras, Athina A. Samara, Alexandros Valaroutsos, Alexandros Diamantis, Konstantinos Tepetes
BMC Surgery.2022;[Epub] CrossRef
Management of Stage 3 Haemorrhoids with Homoeopathy – A case report
Jyothi Vijaykumar, Dhanya Deepak Bhat
Journal of Integrated Standardized Homoeopathy.2022; 5: 107. CrossRef
The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment
Carlos Walter Sobrado, Carlos de Almeida Obregon, Lucas Faraco Sobrado, Lucas Morales Bassi, José Américo Bacchi Hora, Afonso Henrique Silva e Sousa Júnior, Sergio Carlos Nahas, Ivan Cecconello
Annals of Medicine and Surgery.2021; 61: 97. CrossRef
Evaluation Of Anti-inflammatory Mediated Anti-hemorrhoidal Activity of Lawsonia inermis on Croton Oil Induced Hemorrhoidal Rats
Sai Krishna Nallajerla, Suhasin Ganta
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry.2021; 21(1): 62. CrossRef

Role of a Micronized Purified Flavonoid Fraction as an Adjuvant Treatment to Rubber Band Ligation for the Treatment of Patients With Hemorrhoidal Disease: A Longitudinal Cohort Study: Ana Célia Caetano, Catarina Cunha, Bruno Arroja, Dalila Costa, Carla Rolanda; Ann Coloproctol. 2019;35(6):306-312. Published online December 31, 2019; DOI: https://doi.org/10.3393/ac.2018.09.18

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3 Web of Science
5 Citations

Abstract PDF

Purpose
Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.
Methods
Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.
Results
Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).
Conclusion
A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.

Citations

Citations to this article as recorded by

The role of flavonoids in the pharmacological treatment of haemorrhoids
SS Singh, MA Strydom, M Balmith, C Megaw, MJ Nell
South African General Practitioner.2024; 5(1): 36. CrossRef
The influence of supportive therapy with a six-component myophlebotropic preparation on the reduction of symptoms in patients with symptoms of hemorrhoidal disease
Anna Kwiatkowska, Maciej Borejsza-Wysocki, Michał Głyda, Anna Maria Pietrzak, Marek Szczepkowski, Andrzej Organ, Tomasz Banasiewicz
Polish Journal of Surgery.2024; 96(3): 1. CrossRef
Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study
Chun-Ying Qu, Fei-Yu Zhang, Wen Wang, Feng-Yu Gao, Wu-Lian Lin, Hao Zhang, Guang-Yu Chen, Yi Zhang, Ming-Ming Li, Zheng-Hong Li, Mei-Hong Cai, Lei-Ming Xu, Feng Shen
World Journal of Gastroenterology.2024; 30(27): 3326. CrossRef
Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial
Sara Razdar, Yunes Panahi, Ramtin Mohammadi, Leila Khedmat, Hossein Khedmat
BMJ Open Gastroenterology.2023; 10(1): e001158. CrossRef
Phlebotonics for conservative treatment of haemorrhoids: when, to whom, how?
D. D. Shlyk, I. A. Tulina, P. V. Tsarkov
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2023; 20(1): 148. CrossRef

Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids: Hyeonseok Jeong, Sunghwan Hwang, Kil O Ryu, Jiyong Lim, Hyun Tae Kim, Hye Mi Yu, Jihoon Yoon, Ju-Young Lee, Hyoung Rae Kim, Young Gil Choi; Ann Coloproctol. 2017;33(1):28-34. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.28

8,044 View
125 Download
10 Web of Science
10 Citations

Abstract PDF

Purpose

Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH.

Methods

We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler.

Results

Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur.

Conclusion

PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.

Citations

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Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience
Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Ta-Wei Pu
World Journal of Gastrointestinal Surgery.2024; 16(9): 2787. CrossRef
Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids
Chenchen Yuan, Chongjun Zhou, Rong Xue, Xiaofeng Jin, Chun Jin, Chenguo Zheng
Frontiers in Surgery.2022;[Epub] CrossRef
Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids
Liu Tao, Jun Wei, Xu-Feng Ding, Li-Jiang Ji
World Journal of Clinical Cases.2022; 10(18): 6060. CrossRef
Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm
Georgi Popivanov, Piergiorgio Fedeli, Roberto Cirocchi, Massimo Lancia, Domenico Mascagni, Michela Giustozzi, Ivan Teodosiev, Kirien Kjossev, Marina Konaktchieva
Medicina.2020; 56(6): 269. CrossRef
The Effort to Reduce Vasovagal Reaction and Abdominal Pain During Stapled Hemorrhoidopexy
Hyeonseok Jeong
Annals of Coloproctology.2020; 36(5): 291. CrossRef
Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial
Hong-Cheng Lin, Qiu-Lan He, Wan-Jin Shao, Xin-Lin Chen, Hui Peng, Shang-Kui Xie, Xiao-Xue Wang, Dong-Lin Ren
Diseases of the Colon & Rectum.2019; 62(2): 223. CrossRef
Transanale Hämorrhoiden-Dearterialisation vs. selektive Stapler-Hämorrhoidopexie
R. Proßt
coloproctology.2018; 40(1): 47. CrossRef
Hemorrhoids
Danny O. Jacobs
Current Opinion in Gastroenterology.2018; 34(1): 46. CrossRef
Partial Stapled Hemorrhoidopexy Versus Circular Stapled Hemorrhoidopexy
Jin Sub Kim
Annals of Coloproctology.2017; 33(1): 7. CrossRef
A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique
A. L. H. Leung, T. P. P. Cheung, K. Tung, Y. P. Tsang, H. Cheung, C. W. Lau, C. N. Tang
Techniques in Coloproctology.2017; 21(9): 737. CrossRef

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