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Capece SJ, Browning CJ, Barros de Sousa CA, Shaak K, Yoon JY, Sangster W. Hemorrhoidectomy: Does Age Make a Difference? Dis Colon Rectum 2024; 67:820-825. [PMID: 38408874 DOI: 10.1097/dcr.0000000000003085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Grade II and III hemorrhoids often require a multimodal approach that may ultimately culminate in surgical resection. Age and overall medical conditioning around the time of diagnosis can often impact the decision. OBJECTIVE The objective of this study was to evaluate patients with a diagnosis of symptomatic grade II or grade III hemorrhoids and determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention. DESIGN A retrospective cohort study. SETTINGS Group practice at a single institution. PATIENTS Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included. Patients with thrombosed hemorrhoids or surgical contraindications to hemorrhoidectomy were excluded. A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids. INTERVENTION Treatments included hemorrhoidectomy, in-office procedures, and/or medical management. MAIN OUTCOME MEASURES Baseline demographics, treatment choices, and time to hemorrhoidectomy (if applicable) were stratified and analyzed on the basis of hemorrhoid grade (grade II and III) and age groupings that were predetermined by the authors (18-30, 31-50, and 51-75 years). RESULTS Patients with grade III versus grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in the age groups of 18 to 30 and 30 to 50 years were more likely to choose hemorrhoidectomy as the initial treatment management compared to those in the age group of 51 to 75 years (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age. LIMITATIONS Data only looked at age groups and their treatment selection. Personal biases of surgeon and patient may alter results. CONCLUSIONS Our study shows that the younger population tends to seek hemorrhoidectomy first over the older population. See Video Abstract . HEMORROIDECTOMA LA EDAD MARCA LA DIFERENCIA ANTECEDENTES:Las hemorroides de grado II y III a menudo requieren un abordaje multimodal que en última instancia puede culminar en una resección quirúrgica. La edad y el estado médico general en el momento del diagnóstico a menudo pueden afectar la decisión.OBJETIVO:El objetivo de este estudio fue evaluar a pacientes con diagnóstico de hemorroides sintomáticas grado II o grado III y determinar la progresión a hemorroidectomía en función de la edad y el intervalo de tiempo entre el diagnóstico y la intervención quirúrgica.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:Práctica grupal en una sola institución.PACIENTES:Se incluyó a pacientes de 18 a 75 años con hemorroides internas de grado II o III entre 2015 y 2020. Se excluyeron los pacientes con hemorroides trombosadas o contraindicaciones quirúrgicas para hemorroidectomía. Un total de 961 pacientes cumplieron los criterios de inclusión para hemorroides de Grado II (n=442) y III (n=519).INTERVENCIÓN:Los tratamientos incluyeron hemorroidectomía, procedimientos en el consultorio y/o manejo médico.PRINCIPALES MEDIDAS DE RESULTADO:Los datos demográficos iniciales, las opciones de tratamiento y el tiempo hasta la hemorroidectomía (si corresponde) se estratificaron y analizaron según el grado de hemorroides (grado II y III) y los grupos de edad predeterminados por los autores (18-30, 31-50). y 51-75).RESULTADOS:Los pacientes con hemorroides de Grado III versus Grado II tuvieron más probabilidades de elegir la hemorroidectomía como tratamiento inicial (27,6% versus 4,1%). Los pacientes de los grupos de edad de 18 a 30 y de 30 a 50 años tenían más probabilidades de elegir la hemorroidectomía como tratamiento inicial en comparación con los de 51 a 75 años (23,5% y 22% frente a 12,8%). En los pacientes que inicialmente fueron tratados con manejo médico o procedimientos en el consultorio y luego progresaron a hemorroidectomía, no se observaron diferencias significativas en el tiempo hasta la hemorroidectomía según el grado o la edad de las hemorroides.LIMITACIONES:Los datos solo analizan los grupos de edad y su selección de tratamiento. Los sesgos personales del cirujano y del paciente pueden alterar los resultados.CONCLUSIÓN:Nuestro estudio muestra que la población más joven tiende a buscar primero la hemorroidectomía que la población de mayor edad. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Steven J Capece
- Lehigh Valley Health Network, Department of Surgery and Colorectal Surgery, Allentown, Pennsylvania
| | - Charles J Browning
- Lehigh Valley Health Network, Department of Surgery and Colorectal Surgery, Allentown, Pennsylvania
| | - Cesar A Barros de Sousa
- Lehigh Valley Health Network, Department of Surgery and Colorectal Surgery, Allentown, Pennsylvania
| | - Kyle Shaak
- Lehigh Valley Health Network, Network Office of Research and Innovation, Allentown, Pennsylvania
| | - Justin Y Yoon
- Lehigh Valley Health Network, Department of Surgery and Colorectal Surgery, Allentown, Pennsylvania
| | - William Sangster
- Lehigh Valley Health Network, Department of Surgery and Colorectal Surgery, Allentown, Pennsylvania
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Yu M, Shang Y, Han L, Yu X. Bowel Habits, Obesity, Intestinal Microbiota and Their Influence on Hemorrhoidal Disease: a Mendelian Randomization Study. Clin Exp Gastroenterol 2024; 17:157-164. [PMID: 38745764 PMCID: PMC11093121 DOI: 10.2147/ceg.s450807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Hemorrhoids (HEM) are the most common perianal disease, but current observational studies have yielded inconsistent results in investigating the risk factors. Our further exploration of the risk factors will help prevent the disease. Patients and Methods We conducted a two-sample bidirectional Mendelian randomization (MR) analysis using publicly available genome-wide association studies (GWAS) statistics from multiple consortia. The inverse-variance weighted (IVW) method was used for the primary analysis. We applied four complementary methods, including weighted median, weighted mode, MR-Egger regression, and Cochrane's Q value, to detect and correct the effects of horizontal pleiotropy. Results Genetically determined constipation (OR = 0.97, 95% CI: 0.91-1.03, P = 0.28) and diarrhea (OR = 1.00, 95% CI: 0.99-1.01, P = 0.90) did not have a causal effect on HEM but stool frequency (OR = 1.28, 95% CI: 1.05-1.55, P = 0.01), waist-to-hip ratio adjusted for BMI (OR = 1.11, 95% CI: 1.06-1.64, P = 1.59×10-5), and order Burkholderiales (OR = 1.09, 95% CI = 1.04-1.14, p = 1.63×10-4) had a causal effect on. Furthermore, we found a significant causal effect of constipation on HEM in the reverse MR analysis (OR = 1.21, 95% CI: 1.13-1.28, P = 3.72×10-9). The results of MR-Egger regression, Weighted Median, and Weighted Mode methods were consistent with those of the IVW method. Horizontal pleiotropy was unlikely to distort the causal estimates, as indicated by the sensitivity analysis. Conclusion Our MR analysis reveals a causal association between stool frequency and waist-to-hip ratio with HEM, despite variations in results reported by observational studies. Unexpectedly, we found a relationship between the order Burkholderiales in the gut flora and HEM, although the mechanism is unclear.
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Affiliation(s)
- Miaozhi Yu
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Yuan Shang
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Lingling Han
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
| | - Xi Yu
- Department of General Surgery, Xinhua Hospital Affiliated to Dalian University, Dalian, 116011, People’s Republic of China
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Kostev K, Konrad M, Smith L, Krieg S. Hemorrhoids are associated with an increased risk of depression in Germany: A retrospective cohort study in primary care outpatients. J Psychiatr Res 2024; 175:381-385. [PMID: 38772129 DOI: 10.1016/j.jpsychires.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The aim of the present study was to analyze the cumulative incidence of depression diagnosis in patients with hemorrhoids and to evaluate the association between hemorrhoids and subsequent depression diagnosis. METHODS This retrospective cohort study was based on electronic medical records from the Disease Analyzer database (IQVIA) and included 87,264 individuals with hemorrhoids (mean age: 54.2 years; 42% women) and 87,264 propensity score-matched individuals without hemorrhoids in 1284 general practices in Germany between January 2005 and December 2021. Univariable Cox regression analysis was conducted to assess the association between hemorrhoids and depression. RESULTS After up to 10 years of follow-up, 21.4% of patients with hemorrhoids versus 16.3% of the matched cohort (p < 0.001) were diagnosed with depression. There was a significant association between hemorrhoids and a subsequent diagnosis of depression (HR: 1.32; 95% CI: 1.28-1.37), which was confirmed in age- and sex-stratified analyses. The association was stronger with increasing degree of hemorrhoids, from HR: 1.29 (95% CI: 1.15-1.45) for Grade 1 to HR: 1.73 (95% CI: 1.11-2.69) for Grade 4 compared to no hemorrhoids. CONCLUSIONS The present study provides compelling evidence of an association between hemorrhoids and subsequent depression. Addressing the mental health of individuals with hemorrhoids may not only improve their overall well-being but could also lead to better treatment outcomes for the primary condition.
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Affiliation(s)
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, 60486, Frankfurt am Main, Germany
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sarah Krieg
- Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617, Bielefeld, Germany
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Dulskas A, Cerkauskaite D, Nunoo-Mensah J, Fortunato R, Gallo G, El Hussuna A, Lohsiriwat V, Aukstikalnis T, Samalavicius NE. 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. Colorectal Dis 2024. [PMID: 38671592 DOI: 10.1111/codi.17014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/30/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
AIM Haemorrhoidal disease (HD) is one of the most common anal disorders in the adult population. Despite that, treatment options differ among different countries and specialists, even for the same grade of HD. The aim of this study is to evaluate the differences in patient demographics, surgeon preference for the treatment option, outcomes as well as patient satisfaction rate for the procedure using an office-based or surgical approach for the treatment of HD among International Society of University Colon and Rectal Surgeons (ISUCRS) and European Society of Coloproctology (ECSP) fellows. METHOD A panel of the ISUCRS and ECSP members will answer questions that are included in a questionnaire about the treatment of HD. The questionnaire will be distributed electronically to ISUCRS and ECSP fellows included in our database and will remain open from 1 April 2024 to 31 May 2024. CONCLUSION This multicentre, global prospective audit will be delivered by consultant colorectal and general surgeons as well as trainees. The data obtained will lead to a better understanding of the incidence of HD, treatment and diagnostic possibilities. This snapshot audit will be hypothesis generating and inform areas the need future prospective study.
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Affiliation(s)
- Audrius Dulskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Dovile Cerkauskaite
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Joseph Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
- Cleveland Clinic, London, UK
| | - Richard Fortunato
- Department of Colorectal Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | | | - Varut Lohsiriwat
- Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tomas Aukstikalnis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Management of Human Health Activities, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
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Huang Z, Huang J, Leung CK, Zhang CJ, Akinwunmi B, Ming WK. Hemorrhoidal disease and its genetic association with depression, bipolar disorder, anxiety disorders, and schizophrenia: a bidirectional mendelian randomization study. Hum Genomics 2024; 18:27. [PMID: 38509615 PMCID: PMC10956248 DOI: 10.1186/s40246-024-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Hemorrhoids and psychiatric disorders exhibit high prevalence rates and a tendency for relapse in epidemiological studies. Despite this, limited research has explored their correlation, and these studies are often subject to reverse causality and residual confounding. We conducted a Mendelian randomization (MR) analysis to comprehensively investigate the association between several mental illnesses and hemorrhoidal disease. METHODS Genetic associations for four psychiatric disorders and hemorrhoidal disease were obtained from large consortia, the FinnGen study, and the UK Biobank. Genetic variants associated with depression, bipolar disorder, anxiety disorders, schizophrenia, and hemorrhoidal disease at the genome-wide significance level were selected as instrumental variables. Screening for potential confounders in genetic instrumental variables using PhenoScanner V2. Bidirectional MR estimates were employed to assess the effects of four psychiatric disorders on hemorrhoidal disease. RESULTS Our analysis revealed a significant association between genetically predicted depression and the risk of hemorrhoidal disease (IVW, OR=1.20,95% CI=1.09 to 1.33, P <0.001). We found no evidence of associations between bipolar disorder, anxiety disorders, schizophrenia, and hemorrhoidal disease. Inverse MR analysis provided evidence for a significant association between genetically predicted hemorrhoidal disease and depression (IVW, OR=1.07,95% CI=1.04 to 1.11, P <0.001). CONCLUSIONS This study offers MR evidence supporting a bidirectional causal relationship between depression and hemorrhoidal disease.
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Affiliation(s)
- Zhiguang Huang
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Jian Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Chun Kai Leung
- Department of Public and International Affairs, City University of Hong Kong, Hong Kong SAR, China
| | - Casper Jp Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Babatunde Akinwunmi
- Maternal-Fetal Medicine Unit, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China.
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Koley M, Vimal VK, Verma AK, Pal SS, Sonkar DK, Vimal S, Singh OP, Ghosh S, Saha S. Efficacy of Individualized Homeopathic Medicines in the Treatment of Hemorrhoids: Double-Blind, Randomized, Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38301138 DOI: 10.1089/jicm.2023.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Objectives: To investigate the efficacy and safety of individualized homeopathic medicines (IHMs) in treating hemorrhoids compared with placebo. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The trial was conducted at the surgery outpatient department of the State National Homoeopathic Medical College and Hospital, Lucknow, Uttar Pradesh, India. Subjects: Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months. Excluded were the patients with grade IV hemorrhoids, anal fissure, and fistula, hypertrophic anal papillae, inflammatory bowel disease, coagulation disorders, rectal malignancies, obstructed portal circulation, patients requiring immediate surgical intervention, and vulnerable samples. Interventions: Patients were randomized to Group 1 (n = 70; IHMs plus concomitant care; verum) and Group 2 (n = 70; placebos plus concomitant care; control). Outcome measures: Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire, and secondary-the EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS); all of them were measured at baseline, and every month, up to 3 months. Results: Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed. The level of significance was set at p < 0.05 two tailed. Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos. Sulfur was the most frequently prescribed medicine. No harm or serious adverse events were reported from either of the groups. Conclusions: IHMs demonstrated superior results over placebo in the short-term treatment of hemorrhoids of grades I-III. The findings are promising, but need to be substantiated by further phase 3 trials. Clinical Trial Registration Number: CTRI/2020/03/024342.
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Affiliation(s)
- Munmun Koley
- East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, Under Department of Health & Family Welfare, Government of West Bengal, India, South 24 Parganas, India
- Department of Organon of Medicine and Homoeopathic Philosophy, State National Homoeopathic Medical College and Hospital, Lucknow, India
| | | | - Arvind Kumar Verma
- Department of AYUSH, Government of Uttar Pradesh, Lucknow, India
- State National Homoeopathic Medical College and Hospital, Lucknow, India
| | - Shiv Shanker Pal
- Department of Organon of Medicine and Homoeopathic Philosophy, State National Homoeopathic Medical College and Hospital, Lucknow, India
| | | | - Smita Vimal
- Department of Materia Medica, State National Homoeopathic Medical College and Hospital, Lucknow, India
| | - Om Prakash Singh
- Department of Materia Medica, State National Homoeopathic Medical College and Hospital, Lucknow, India
| | - Shubhamoy Ghosh
- Department of Pathology & Microbiology, D. N. De Homoeopathic Medical College & Hospital, Government of West Bengal, Kolkata, India
- Department of Pathology & Microbiology, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Government of West Bengal, Howrah, India
| | - Subhranil Saha
- Department of Repertory, D. N. De Homoeopathic Medical College and Hospital, Kolkata, India
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Liu J, Lv L, Qian HH, Sun PL, Zhang D. Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial. Asian J Surg 2024; 47:169-175. [PMID: 37451888 DOI: 10.1016/j.asjsur.2023.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE This study was mainly to compare the safety and long-term clinical efficacy of using intravenous antibiotics in Milligan Morgan hemorrhoidectomy for Grade III to IV Prolapsing Hemorrhoids. METHODS This was a parallel group, 3-arm, randomized clinical trial to evaluate the efficacy of intravenous prophylactic antibiotics. A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled. Patients were randomly assigned to three groups using a computer-generated table. Group A did not receive any prophylactic antibiotic, group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation. RESULTS There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05). Compared with VAS values on the 1st day postoperatively, these values got decreased on the 3rd day and 7th day after surgery (p< 0.05). In addition, there was no significant difference among the first defecation time, wound edema, bleeding, urinary retention after surgery (p> 0.05). There was no significant difference in the outcome comparison between all 3 groups' basal and the 3rd day postoperatively no matter in WBC, NUET% or CRP (p> 0.05). However, compared with basal, the WBC, NUET%,CRP(p< 0.05) of group A and group B on the 3rd day postoperatively got rised, the rate of recurrence of hemorrhoids follow-up for 1 year was 1.4%. CONCLUSIONS Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy.
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Affiliation(s)
- Jiali Liu
- Department of Anorectal Surgery, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Lei Lv
- Department of Anorectal Surgery, Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Hai-Hua Qian
- Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Ping-Liang Sun
- Department of Anorectal Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, 530000, China.
| | - Dan Zhang
- Department of Anorectal Surgery, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
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Amsriza FR, Fakhriani R, Pangki AA. Translation and validation of Indonesian hemorrhoidal disease symptom score (HDSS) and short health scale hemorrhoidal disease (SHSHD). Turk J Surg 2023; 39:336-343. [PMID: 38694532 PMCID: PMC11057928 DOI: 10.47717/turkjsurg.2023.6148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/20/2023] [Indexed: 05/04/2024]
Abstract
Objectives Hemorrhoidal disease, which affects nearly 40% of people, is characterized by pathological alterations and distal displacement of hemorrhoidal tissue. The short health scale (SHSHD) and the hemorrhoidal disease symptom score (HDSS) are two tools that can be utilized to assess the quality of life of hemorrhoidal patients. The present study aims to translate, modify, and validate the HDSS and SHSHD questionnaires in Indonesian. Material and Methods This cross-sectional study assessed the validity and reliability of the HDSS and SHSHD Indonesian adaptation instrument in hemorrhoidal patients from April 15, 2022, and April 1, 2023. Results There were 91 study subjects, 55 males and 36 females. The study showed that the subscale interpretations of the R-values and the full scale scored above 0.25, indicating weak to very strong correlations. These results mean that the HDSS and SHSHD questionnaires are valid for use. Based on the study's results, the R-value of each item, domain, and total score ≥0.8 (p <0.05) indicates that the HDSS and SHSHD instruments are reliable. Conclusion The Indonesian adaptation of the HDSS and SHSHD demonstrates validity and reliability as an assessment tool for measuring the healthrelated quality of life in Indonesian patients diagnosed with hemorrhoidal disease.
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Affiliation(s)
- Fadli Robby Amsriza
- Department of Surgery, Muhammadiyah University of Yogyakarta Faculty of Medicine and Health Sciences, Bantul, Indonesia
| | - Rizka Fakhriani
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Muhammadiyah University of Yogyakarta Faculty of Medicine and Health Sciences, Bantul, Indonesia
| | - Asmaya Aji Pangki
- Department of Surgery, Islam University of Indonesia Faculty of Medicine, Sleman, Indonesia
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Adikusuma W, Firdayani F, Irham LM, Darmawi D, Hamidy MY, Nopitasari BL, Soraya S, Azizah N. Integrated genomic network analysis revealed potential of a druggable target for hemorrhoid treatment. Saudi Pharm J 2023; 31:101831. [PMID: 37965490 PMCID: PMC10641558 DOI: 10.1016/j.jsps.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/14/2023] [Indexed: 11/16/2023] Open
Abstract
Hemorrhoids are a prevalent medical condition that necessitates effective treatment options. The current options for treatment consist of oral medications, topical applications, or surgery, yet a scarcity of highly effective drugs still exists. Genetic markers provide promising avenues for investigating the treatment of hemorrhoids, as they may reveal intricate biological mechanisms and targeted drug therapies, ultimately enhancing more precise treatment tailored to the patient. This study aims to identify new drug candidates for treating hemorrhoids through a meticulous bioinformatics approach and integrated with genomic network analysis. After extracting 21 druggable target genes using DrugBank from 293 genes connected to hemorrhoids, 87 possible drugs were selected. Three of these drugs (ketamine, methylene blue, and fulvestrant) hold potential in addressing issues associated with hemorrhoids and have been supported by clinical or preclinical studies. Eighty-four compounds present new therapeutic possibilities for managing hemorrhoids. We highlight that our findings indicate that NOX1 and NOS3 genes are promising biomarkers, with NOS3 gaining significance owing to its robust systemic functional annotations. Sapropterin, an existing drug, is closely associated with NOS3, providing a clear target for biomarker-driven interventions. This study illustrates the potential of combining genomic network analysis with bioinformatics to repurpose drugs for treating hemorrhoids. Subsequent research will explore the mechanisms for utilizing NOS3 targeting in the treatment of hemorrhoids.
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Affiliation(s)
- Wirawan Adikusuma
- Departement of Pharmacy, University of Muhammadiyah Mataram, Mataram, Indonesia
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), South Tangerang, Indonesia
| | - Firdayani Firdayani
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), South Tangerang, Indonesia
| | | | - Darmawi Darmawi
- Department of Histology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
- Graduate School in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | - Muhammad Yulis Hamidy
- Department of Pharmacology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | | | - Soraya Soraya
- Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
| | - Nurul Azizah
- Master Program in Biomedical Sciences, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
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Drezdzon MK, Peterson CY. Anorectal Emergencies. Surg Clin North Am 2023; 103:1153-1170. [PMID: 37838461 DOI: 10.1016/j.suc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.
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Affiliation(s)
- Melissa K Drezdzon
- Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin
| | - Carrie Y Peterson
- Division of Colorectal Surgery, Medical College of Wisconsin, HCM A6303, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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11
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Wang L, Ni J, Hou C, Wu D, Sun L, Jiang Q, Cai Z, Fan W. Time to change? Present and prospects of hemorrhoidal classification. Front Med (Lausanne) 2023; 10:1252468. [PMID: 37901411 PMCID: PMC10603225 DOI: 10.3389/fmed.2023.1252468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023] Open
Abstract
As a common benign anal condition, the high incidence and recurrence of hemorrhoids pose challenges for both patients and doctors. The classification of hemorrhoids plays a crucial role in assessing, diagnosing, and treating the condition. By using appropriate classification and corresponding treatment strategies, we can achieve higher cure rates and lower recurrence rates of hemorrhoids. Since the introduction of the Miles classification in 1919, various classifications have been developed, which include objective classifications based on anatomical or instrumental assessment and subjective classifications based on symptoms and patient sensations. These classifications aim to accurately evaluate the condition. In this study, we discuss the evaluation values of each classification in terms of their advantages, disadvantages, treatment relevance, reproducibility, practicality, and assessment value. We also analyze the significant and essential factors, principles of use, and components of assessment indicators of hemorrhoidal classification. This study proposes several strategies to address the limitations of current hemorrhoidal assessment methods. All these will provide a reference for the development regarding the assessment and classification of hemorrhoids and clinical diagnosis and management of hemorrhoids.
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Affiliation(s)
- Ling Wang
- Chongqing College of Traditional Chinese Medicine, Chongqing, China
- Chongqing Medical University, Chongqing, China
- Department of Proctology, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Jiachun Ni
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Changcheng Hou
- Department of Proctology, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Di Wu
- Chongqing Medical University, Chongqing, China
- Department of Proctology, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Li Sun
- Chongqing Medical University, Chongqing, China
- Department of Proctology, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Qiong Jiang
- Chongqing Medical University, Chongqing, China
| | - Zengjin Cai
- Department of Proctology, Yongchuan Hospital of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Wenbin Fan
- Chongqing College of Traditional Chinese Medicine, Chongqing, China
- Chongqing Medical University, Chongqing, China
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Yalcinkaya A, Yalcinkaya A, Atici SD, Sahin C, Leventoglu S. Local excision versus thrombectomy in thrombosed external hemorrhoids: a multicenter, prospective, observational study. BMC Surg 2023; 23:228. [PMID: 37563701 PMCID: PMC10413608 DOI: 10.1186/s12893-023-02105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Available guidelines describing the procedural treatment of thrombosed external hemorrhoids (TEH) rely solely on expert opinion. We aimed to compare local excision (LE) and thrombectomy (incision) in terms of treatment success, factors affecting success, and outcomes. METHODS This was a multicenter, prospective, observational study conducted in eight centers from September 2020 to September 2021. A total of 96 patients (58 LE, 38 thrombectomy) were included. Risk factors, demographics and clinical characteristics were recorded. Follow-up studies were scheduled for the 1st week, 1st, 3rd and 6th months. Surgical success was assessed at 1 month. Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale (SHS) were applied at baseline and the 6th month. Wexner fecal incontinence score was applied at all follow-up studies. RESULTS Overall mean age was 41.5 ± 12.7 years. At baseline, groups were similar with regard to demographics and disease severity (HDSS) (p > 0.05 for all). Success was relatively higher in the thrombectomy group (86.8%) compared to the LE group (67.2%) (p = 0.054). Constipation and travel history were significantly associated with lower likelihood of LE success. Symptoms during follow-up were similarly distributed in the groups. Both methods yielded significant improvements in HDSS, SHS and Wexner scores; however, SHS scores (6 months) and Wexner scores (all time points) were significantly better in the thrombectomy group. CONCLUSION The in-office thrombectomy procedure may have better short-term outcomes compared to LE in terms of relative success, recurrence and quality of life-despite the fact that success rates were statistically similar with the two interventions. LE may yield particularly worse results in patients with constipation and travel history; thus, thrombectomy appears to be especially advantageous in these patient subsets.
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Affiliation(s)
- Ali Yalcinkaya
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey
- Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Can Sahin
- Department of General Surgery, Ankara Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Sezai Leventoglu
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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Fišere I, Groma V, Svirskis Š, Strautmane E, Gardovskis A. Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients. J Clin Med 2023; 12:5119. [PMID: 37568521 PMCID: PMC10420034 DOI: 10.3390/jcm12155119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Hemorrhoidal disease (HD) is a chronic multifactorial disease. Increased abdominal pressure, along with hyperperfusion, neovascularization, overexpression of inflammatory mediators, and dysbiosis, contributes to the development of HD. The deterioration of the anchoring connective tissue with reduced collagen content and altered collagen ratios, dilatation of blood vessels and thrombosis, muscle injury, and inflammation gradually lead to clinically manifesting prolapse and bleeding from hemorrhoids. The associations of the ABO blood types with a disease have been investigated for the upper gastrointestinal tract only. This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups. Clinical and various morphological methods, combined with extensive bioinformatics, were used. The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids. There were significantly more complaints reported by HD females compared to males (p = 0.0094). The Longo technique appeared mostly used, and there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%). HD males were found to present with significantly more often inflamed rectal mucosa (p < 0.05). Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types. HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165). Furthermore, 0 blood type HD males were significantly more often affected by a disease manifested with tissue hemorrhage compared to the 0 blood type HD females (p = 0.0081). Collectively, the local status of chronically injured anorectal tissue should be considered when applying surgical techniques. Future studies could include patients with HD grades I and II to gain a comprehensive understanding of the disease progression, allowing for a comparison of tissue changes at different disease stages.
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Affiliation(s)
- Inese Fišere
- Department of Doctoral Studies, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
- Surgery Clinic, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Valērija Groma
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia
| | - Šimons Svirskis
- Institute of Microbiology and Virology, Rīga Stradiņš University, Ratsupītes Street 5, LV-1067 Riga, Latvia;
| | - Estere Strautmane
- Medical Faculty, Rīga Stradiņš University, Dzirciema Street 16, LV-1007 Riga, Latvia;
| | - Andris Gardovskis
- Surgery Clinic, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
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Razdar S, Panahi Y, Mohammadi R, Khedmat L, Khedmat H. Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial. BMJ Open Gastroenterol 2023; 10:e001158. [PMID: 37597875 PMCID: PMC10441054 DOI: 10.1136/bmjgast-2023-001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/07/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVE Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance. In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine). DESIGN In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed. RESULTS Post-treatment reduction in haemorrhoid grade was significant in the case group (p=0.02). This ratio was insignificant in the control group (p=0.139). Flavonoid lotion (p<0.05) significantly reduced the signs and symptoms of haemorrhoids more than anti-haemorrhoid ointment. CONCLUSION According to the results, flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patien.
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Affiliation(s)
- Sara Razdar
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Yunes Panahi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ramtin Mohammadi
- Department of Biology, Islamic Azad University Central Tehran Branch, Tehran, Iran (the Islamic Republic of)
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Hossein Khedmat
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Kuiper SZ, Kimman ML, Cooper R, O'Neill H, Watson AJM, Melenhorst J, Breukink SO, Dirksen CD. English translation and cross-cultural validation of the patient-reported outcome measurement-haemorrhoidal impact and satisfaction score (PROM-HISS). Colorectal Dis 2023; 25:1671-1678. [PMID: 37431983 DOI: 10.1111/codi.16650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/28/2023] [Indexed: 07/12/2023]
Abstract
AIM The aim of this study was to translate the Dutch patient-reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS) to English and perform a cross-cultural validation. METHOD The ISPOR good practice guidelines for the cross-cultural validation of PROMs were followed and included two steps: (1) Two forward and two backward translations. The forward translation concerned the translation from the source language (Dutch) to the target language (English), performed by two independent English speakers, one medical doctor and one nonmedical. Subsequently, a discussion about discrepancies in the reconciled version was performed by a stakeholder group. (2) Cognitive interviews were held with patients with haemorrhoidal disease (HD), probing the comprehensibility and comprehensiveness of the PROM-HISS. RESULTS Discrepancies in the reconciled forward translation concerned the terminology of HD symptoms. Furthermore, special attention was paid to the response options, ranging from "not at all", indicating minor symptoms, to "a lot", implying many symptoms. Consensus among the stakeholder group about the final version of the translated PROM-HISS was reached. Interviews were conducted with 10 native English-speaking HD patients (30% female), with a mean age of 44 years (24-83) and primarily diagnosed with grade II HD (80%). The mean time to complete the PROM-HISS was 1 min 43 s. Patients showed a good understanding of the questions and response options, found all items relevant and did not miss important symptoms or topics. CONCLUSION The translated English language PROM-HISS is a valid tool to assess symptoms of HD, its impact on daily activities and patient satisfaction with HD treatment.
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Affiliation(s)
- Sara Zwier Kuiper
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rowena Cooper
- Department of Research, Development and Innovation, Raigmore Hospital, Inverness, UK
| | - Hannah O'Neill
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Angus J M Watson
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
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Al Faifi JJ, AlAradi MM, Alomar NA, AlMuqrin FF, AlKublan RM. Awareness and Acceptance of Digital Rectal Examination for the Clinical Evaluation of Anorectal Conditions Among the Saudi Population: A Cross-Sectional Study. Cureus 2023; 15:e41873. [PMID: 37581127 PMCID: PMC10423588 DOI: 10.7759/cureus.41873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Digital rectal examination (DRE) is an important diagnostic tool used by physicians to resolve several confusing clinical situations. The history and physical examination cannot be complete without performing a DRE. Any patient that presents with abdominal complaints (e.g., diarrhea, constipation, nausea, vomiting, abdominal or rectal pain, bleeding) needs a DRE which is important for detecting warning signs of serious conditions that require further investigation and evaluation such as malignancies. Therefore, our aim was to assess and measure the awareness of the Saudi population regarding the importance and acceptance to perform DRE. METHODS This cross-sectional study was conducted in Riyadh, the capital city of Saudi Arabia, using an online survey between September 2022 and March 2023; the targeted participants were adults between the ages of 18 to 75. RESULTS The study indicated that the general community awareness of DRE is low, with only 59.1% of participants having heard of DRE and 14.6% having undergone the procedure previously. The majority of individuals (60.9%) were willing to undergo DRE if a healthcare provider suggested it. Participants' knowledge of DRE's ability to detect various anorectal diseases varied. While the majority of individuals believed DRE could detect hemorrhoids, just 40.4% believed DRE could help detect colorectal cancer. Chronic constipation or diarrhea, feces-induced stretching, and prolonged sitting were the most oft-cited causes of hemorrhoids. Anemia was the most often reported consequence of hemorrhoids, followed by hypertension and diabetes. CONCLUSION The significance of DRE as a screening tool for the early detection and prevention of anorectal problems, as well as the need for adequate care and treatment of hemorrhoids to prevent complications, are highlighted by these findings. Healthcare practitioners should actively recommend and provide information about DRE and other screening technologies, as well as address their patients' concerns and misconceptions.
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Affiliation(s)
- Jubran J Al Faifi
- General Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Musaab M AlAradi
- General Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Naif A Alomar
- General Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Farah F AlMuqrin
- Medicine and Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Reem M AlKublan
- General Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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van Oostendorp JY, Sluckin TC, Han-Geurts IJM, van Dieren S, Schouten R. Treatment of haemorrhoids: rubber band ligation or sclerotherapy (THROS)? Study protocol for a multicentre, non-inferiority, randomised controlled trial. Trials 2023; 24:374. [PMID: 37270601 DOI: 10.1186/s13063-023-07400-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/22/2023] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Haemorrhoidal disease (HD) is a common condition with significant epidemiologic and economic implications. While it is possible to treat symptomatic grade 1-2 haemorrhoids with rubber band ligation (RBL) or sclerotherapy (SCL), the effectiveness of these treatments compatible with current standards has not yet been investigated with a randomised controlled trial. The hypothesis is that SCL is not inferior to RBL in terms of symptom reduction (patient-related outcome measures (PROMs)), patient experience, complications or recurrence rate. METHODS AND ANALYSIS This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy for symptomatic grade 1-2 haemorrhoids in adults (> 18 years). Patients are preferably randomised between the two treatment arms. However, patients with a strong preference for one of the treatments and refuse randomisation are eligible for the registration arm. Patients either receive 4 cc Aethoxysklerol 3% SCL or 3 × RBL. The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates. Secondary outcome measures are patient experience, number of treatments and days of sick leave from work. Data are collected at 4 different time points. DISCUSSION The THROS trial is the first large multicentre randomised trial to study the difference in effectivity between RBL and SCL for the treatment of grade 1-2 HD. It will provide information as to which treatment method (RBL or SCL) is the most effective, gives fewer complications and is experienced by the patient as the best option. ETHICS AND DISSEMINATION The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers, location AMC (nr. 2020_053). The gathered data and results will be submitted for publication in peer-reviewed journals and spread to coloproctological associations and guidelines. TRIAL REGISTRATION Dutch Trial Register NL8377 . Registered on 12-02-2020.
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Affiliation(s)
- J Y van Oostendorp
- Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
- Proctos Kliniek, Prof. Bronkhorstlaan 10, 3823 MB, Bilthoven, The Netherlands
| | - T C Sluckin
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands
| | - I J M Han-Geurts
- Proctos Kliniek, Prof. Bronkhorstlaan 10, 3823 MB, Bilthoven, The Netherlands
| | - S van Dieren
- Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - R Schouten
- Department of Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, The Netherlands.
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Toyoshima O, Nishizawa T, Yoshida S, Matsuno T, Miyoshi K, Naito E, Shiomi C, Uozumi T, Fujishiro M, Saito Y. Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy. Endosc Int Open 2023; 11:E497-E503. [PMID: 37206696 PMCID: PMC10191731 DOI: 10.1055/a-2062-9443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/23/2023] [Indexed: 05/21/2023] Open
Abstract
Background and study aims Colorectal premalignant polyps and hemorrhoids are important findings in colonoscopy; however, the association between them is unclear. Therefore, we investigated the association between the presence and severity of hemorrhoids and the detection of precancerous colorectal polyps on colonoscopy. Patients and methods This retrospective, single-center, cross-sectional study enrolled patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May 2017 and October 2020. The association between hemorrhoids and other outcomes (patient age, sex, withdrawal time for colonoscopy, expert endoscopist, number of adenomas per colonoscopy, detection rates of adenoma, advanced neoplasia, clinically significant serrated polyp, and sessile serrated lesion) was assessed using a binomial logistic regression model. Results A total of 12,408 patients were enrolled in this study. Hemorrhoids were identified in 1,863 patients. Univariable analysis showed that patients with hemorrhoids were older (61.0 vs. 52.5 years, P < 0.001), had a higher number of adenomas per colonoscopy (1.16 vs. 0.756, P < 0.001) than those without hemorrhoids. Multivariable analyses also demonstrated that hemorrhoids were associated with a higher number of adenomas per colonoscopy (odds ratio [OR]: 1.061; P = 0.002), regardless of patient age, sex, and expert endoscopist. Among patients with hemorrhoids, severe hemorrhoids with a mucosal elevation ≥ 10 mm were associated with a higher number of adenomas per colonoscopy than mild hemorrhoids (OR: 1.112, P = 0.044), regardless of patient age, sex, and expert endoscopist. Conclusions Hemorrhoids, especially severe ones, are associated with a high number of adenomas. Complete colonoscopy should be performed in patients with hemorrhoids.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita, Japan
| | - Shuntaro Yoshida
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Internal medicine, Yoshida Clinic, Fukaya, Japan
| | - Tatsuya Matsuno
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
| | - Kotaro Miyoshi
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Eri Naito
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Shiomi
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Uozumi
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Zhou X, Liu F, Lin C, Chen W, Xu J. Multiple thread ligations versus stapled hemorrhoidopexy on operative outcomes of grade III hemorrhoids: A retrospective cohort study. Front Med (Lausanne) 2023; 10:1156328. [PMID: 37056735 PMCID: PMC10086184 DOI: 10.3389/fmed.2023.1156328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
ObjectControversy remains regarding the safety and efficacy of hemorrhoid ligation and stapled hemorrhoidopexy (SH) in the treatment of hemorrhoids. The study was to explore the operative outcomes of patients underwent multiple thread ligations (MTL) with SH for the management of grade III hemorrhoids.MethodsThis cohort study included patients who underwent MTL (MTL group, 128 cases) or SH (SH group, 141 cases) for grade III hemorrhoids between June 2019 and May 2021. A total of 115 patients in MTL group and 115 patients in SH group were finally included by propensity score matching with a ratio of 1:1. The primary outcome was the recurrence of prolapse within 6 months. Secondary outcomes were operative time, post-operative pain scores, hospital stay, the incidence of complications, Wexner incontinence score, and quality of life of patients with constipation at 6 months post procedure.ResultsMultiple thread ligations and SH resulted in comparable recurrence within 6 months of follow-up, with five and seven cases of recurrence, respectively, (P = 0.352). The two groups had comparable outcomes in terms of post-operative pain, hospital stay, Wexner incontinence scores, and constipation-related quality of life (all P > 0.05). The median operative time was 16 min (15–18 min) in the MTL group versus 25 min (16–33 min) in the SH group (P < 0.01). Univariate analysis showed that the MTL technique had a lower risk of postoperative bleeding than that with the SH technique (P < 0.05).ConclusionThe study indicated that the MTL technique might achieve comparable operative outcomes compared with the SH technique for the management of grade III hemorrhoids, nevertheless, MTL seemed to be associated with less risk of surgical bleeding than SH.
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Affiliation(s)
- Xile Zhou
- *Correspondence: Xile Zhou, ; orcid.org/0000-0001-9042-0700
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Eid M, Bastien A, Shaw R, Goodman DC, Ivatury SJ. Regional Differences in Procedural Care of Hemorrhoid Management in Medicare Patients; Unwarranted Variation in Clinical Practice for a Medical-First Problem. J Surg Res 2023; 283:626-631. [PMID: 36446250 DOI: 10.1016/j.jss.2022.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/07/2022] [Accepted: 10/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hemorrhoid disease is very common problem in the Medicare population. Prior work has shown significant variation in county-level practices of hemorrhoidectomy; however, regional variation of rubber band ligation (RBL) has yet to be assessed. This is important as many different practitioners from different specialties can perform this procedure repeatedly in an office-based setting. We aim to evaluate the variation of RBL and hemorrhoidectomy over a 7-y period. METHODS Using Medicare part B claims data, we identified all beneficiaries >65 y seen for hemorrhoid disease between 2006 and 2013. Current Procedural Terminology (CPT) codes were used to identify all events for hemorrhoidectomy (46083, 46250, 46255, 46257, 46260, and 46261) or RBL (46221) by hospital referral region (HRR). We determined HRR-level rates of hemorrhoidectomy and RBL per 1000 beneficiaries adjusted for age, sex, and race. We calculated annual coefficients of variation (SD × 100/mean) for hemorrhoidectomy and RBL. RESULTS 1.2 to 1.3 million fee-for-service Medicare beneficiaries were seen annually for evaluation of hemorrhoid disease. Mean-adjusted annual rates for hemorrhoidectomy by HRRs varied from 4.34 to 63.03 per 1000 beneficiaries. Mean-adjusted rates of RBL by HRRs varied from 7.06 to 163 per 1000 beneficiaries. Annual procedural coefficients of variation over the study period were 41-48 (high) for hemorrhoidectomy and 69-74 (very high) for RBL. CONCLUSIONS While continued high variation exists for hemorrhoidectomy, there is very high variation for RBL between HRRs in treating hemorrhoid disease among Medicare beneficiaries. There are substantial Medicare expenditures in this high-volume population that are likely unwarranted.
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Affiliation(s)
- Mark Eid
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Outcomes Group, VA Quality Scholars Program, VA Medical Center, White River Junction, Vermont; Geisel School of Medicine, Hanover, New Hampshire
| | | | - Robert Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David C Goodman
- Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - S Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; University of Texas at Austin, Dell School of Medicine, Austin, Texas.
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Neves S, Falcão D, Povo A, Castro-Poças F, Oliveira J, Salgueiro P. 3% polidocanol foam sclerotherapy versus hemorrhoidal artery ligation with recto anal repair in hemorrhoidal disease grades II-III: a randomized, pilot trial. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:115-120. [PMID: 35638762 DOI: 10.17235/reed.2022.8568/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Polidocanol foam sclerotherapy (SP) versus doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR) in the treatment of hemorrhoidal disease (HD) was analyzed. METHODS A prospective, randomized study including patients with HD grades II and III was performed. Participants were randomly assigned (1:1) into SP or HAL-RAR, during a recruitment period between September 2019 and February 2020. Therapeutic success (Sodergren's and bleeding scores) was the primary outcome. Other outcomes evaluated included complications and implication in the professional life. Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session. RESULTS Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24). Most patients achieved therapeutic success (SP 100% vs. HAL-RAR 90.9%, p=0.131). Complete success was higher in the SP group (91.7% vs. 68.2%, p=0.045) and SP patients had less complications (25% vs. 68.2%, p=0.003). HAL-RAR had a greater negative impact on work activity of the patient. CONCLUSION SP was more effective and safer than HAL-RAR. SP patients had less impact on their work activity. Clinical trials identifier NCT04675177.
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Affiliation(s)
- Sara Neves
- Instituto Ciências Biomédicas Abel Salazar
| | - Daniela Falcão
- Gastroenterology, Centro Hospitalar Universitário do Porto, Portugal
| | - Ana Povo
- General Surgery, Centro Hospitalar Universitário do Porto
| | | | | | - Paulo Salgueiro
- Gastroenterology, Centro Hospitalar Universitário do Porto, Portugal
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22
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Rudiman R, Hanafi RV, Evan C, Halim F. The efficacy of topical sucralfate in improving pain and wound healing after haemorrhoidectomy procedure: A systematic review, meta-analysis, and meta-regression of randomised clinical trials. Int Wound J 2023; 20:543-553. [PMID: 35864080 PMCID: PMC9885481 DOI: 10.1111/iwj.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/03/2023] Open
Abstract
Pain and wound after haemorrhoidectomy constantly bothered the patient's convenience. Recurrently, topical sucralfate is used to treat excoriations and burns. It is considered to enhance epidermal growth and tissue granulation, thus, alleviating patients' problems. This study evaluated topical sucralfate's feasibility, safety, and superiority after haemorrhoidectomy. We searched randomised controlled trial (RCT) studies in PubMed, Google Scholar, Europe PMC, and ClinicalTrials.gov until March 29th, 2022. We investigated the influence of topical sucralfate on pain score postoperatively (24 hours, 7 days, and 14 days), pethidine usage, diclofenac usage, and wound healing rate compared to placebo. This study was conducted following the PRISMA guidelines. This study sorted the final six studies with 439 patients underwent haemorrhoidectomy. Topical sucralfate demonstrated significant outcomes on VAS 24 hours post-operative [Std. Mean Difference -1.00 (95% CI -1.70, -0.31), P = .005], VAS 7 days post-operative [Std. Mean Difference -2.29 (95% CI -3.34, -1.25), P < .0001], VAS 14 days post-operative [Std. Mean Difference -1.88 (95% CI -2.74, -1.01), P < .0001], pethidine usage within 24 hours post-operative [Std. Mean Difference -0.62 (95% CI -0.96, -0.27), P = .0004], diclofenac usage 7 days post-operative [Std. Mean Difference -1.76 (95% CI -2.61, -0.92), P < .0001], diclofenac usage 14 days post-operative [Std. Mean Difference -1.64 (95% CI -2.38, -0.91), P < .0001], and wound healing rate at 28-day post-operative [RR 1.45 (95% CI 1.25-1.68), P < .00001]. Topical sucralfate alleviated pain, improved wound healing, and minimised the usage of pethidine and diclofenac compared to placebo.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of MedicineUniversitas Padjadjaran, Hasan Sadikin General HospitalBandungIndonesia
| | | | - Cecilia Evan
- Faculty of MedicineMaranatha Christian UniversityBandungIndonesia
| | - Freda Halim
- Department of General Surgery, Faculty of MedicineUniversitas Pelita HarapanTangerangIndonesia
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Bagla S, Pavidapha A, Lerner J, Kasimcan MO, Piechowiak R, Josovitz K, Marathe A, Isaacson A, Sajan A. Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center. J Vasc Interv Radiol 2023; 34:745-749. [PMID: 36736822 DOI: 10.1016/j.jvir.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. MATERIALS AND METHODS Retrospective analysis of 134 patients who underwent hemorrhoidal artery embolization (HAE) for symptomatic internal hemorrhoids between August 2021 and June 2022 (76 men and 58 women) was performed. The mean age was 54.9 years, with a mean Goligher hemorrhoid grade (HG) of 2.1. Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils. Standard-of-care evaluations were performed at baseline and the 1 month follow-up, which included hemorrhoid-related pain (HRP) (0-10), hemorrhoid symptoms score (HSS) (5-20), quality of life (QoL) (0-4), French bleeding score (FBS) (0-9), and HG (0-4). Clinical success was defined as improvement of symptoms without additional treatment. RESULTS Embolization of at least 1 hemorrhoidal artery was achieved in 133 (99%) of the 134 patients. The mean number of SRA branches embolized per patient was 2.9 ± 1.0. Clinical success was seen in 93% (124 of 134) of patients at the 1-month follow-up, with 10 patients requiring repeat embolization. There were significant improvements in all mean outcomes at 1 month: HSS (11-7.8; P < .01), HRP (4.1-1.3; P < .01), QoL (2.2-0.8; P < .01), FBS (4.4-2.2; P < .01), and HG (2.3-1.2; P < .05). There were no severe adverse events. CONCLUSIONS HAE is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids in the short term.
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Affiliation(s)
| | | | - Jade Lerner
- St. George's University, Great River, New York
| | | | | | | | | | | | - Abin Sajan
- Department of Radiology (A.S.), Columbia University Irving Medical Center, New York, New York
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Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, Rimbu M, Ghenea A, Savulescu F, Godoroja D, Botea F. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. World J Clin Cases 2023; 11:366-384. [PMID: 36686344 PMCID: PMC9850966 DOI: 10.12998/wjcc.v11.i2.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise.
AIM To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities.
METHODS We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons.
RESULTS Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients.
CONCLUSION Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.
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Affiliation(s)
- Cosmin Moldovan
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Elena Rusu
- Department of Preclinic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
| | - Daniel Cochior
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
- Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
| | - Madalina Elena Toba
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Horia Mocanu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Ear, Nose and Throat, Ilfov County Clinical Emergency Hospital, Bucharest 022104, Romania
| | - Razvan Adam
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
| | - Mirela Rimbu
- Medical Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
| | - Adrian Ghenea
- Department of Coloproctology, MedLife SA Băneasa Hyperclinic, Bucharest 013693, Romania
| | - Florin Savulescu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Carol Davila Central Military Emergency University Hospital, Bucharest 010242, Romania
| | - Daniela Godoroja
- Department of Anesthesia, Ponderas Academic Hospital, Bucharest 014142, Romania
| | - Florin Botea
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Fundeni Clinical Institute, Bucharest 022328, Romania
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25
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Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study. J Clin Med 2023; 12:jcm12010391. [PMID: 36615189 PMCID: PMC9821446 DOI: 10.3390/jcm12010391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to assess the short- and long-term safety and efficacy of the sutured haemorrhoidopexy (SH) in patients with haemorrhoidal disease (HD). METHODS A retrospective study was performed, assessing the following treatment characteristics: number of sutures needed; operation time; perioperative complications; postoperative pain; hospital stay. The short- and long-term postoperative complications, HD recurrence and data on current HD symptoms were assessed according to the Core Outcome Set for HD. RESULTS Between January 2009 and December 2021, 149 patients with HD underwent a SH. One-hundred and forty-five patients were included, with a mean age of 61 years (±12.8), of which 70 were women (48.3%). Patients were predominantly diagnosed with grade III (37.2%) HD and the median follow-up was nine years (5-11). Perioperative complications occurred in four cases (2.8%). In two patients (1.4%), short-term postoperative complications were reported, and in seven patients (6.2%), long-term complications were reported. The cumulative efficacy in terms of freedom of recurrence was 88.3% (95% CI, 83.1-93.5) at six months, 80.0% (95% CI, 73.5-86.5) at one year, and 67.7% (95% CI, 59.7-75.7) at five years. CONCLUSIONS Sutured haemorrhoidopexy is a safe treatment for patients with HD and can be proposed as a minimally invasive surgical treatment if basic and outpatient procedures fail.
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26
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Torrinha G, Gonçalves T, Sousa M, Högemann G, Goulart A, Carvalho AF, Leão P. The effects of laser procedure in symptomatic patients with haemorrhoids: A systematic review. Front Surg 2022; 9:1050515. [PMID: 36578968 PMCID: PMC9791955 DOI: 10.3389/fsurg.2022.1050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/10/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Haemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review. Methods EMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids. Results Ten clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias. Conclusion The laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.
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Affiliation(s)
- Gonçalo Torrinha
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal,Correspondence: Gonçalo Torrinha
| | - Tatiana Gonçalves
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal
| | - Maria Sousa
- General Surgery Department, Hospital Privado de Braga, Grupo Trofa Saúde, Braga, Portugal
| | - Gerrit Högemann
- General Surgery Department, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - André Goulart
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal,General Surgery Department, Hospital Privado de Braga, Grupo Trofa Saúde, Braga, Portugal,ICVS/3B's – PT – Surgical Science Department, Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Pedro Leão
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal,General Surgery Department, Hospital Privado de Braga, Grupo Trofa Saúde, Braga, Portugal,ICVS/3B's – PT – Surgical Science Department, Government Associate Laboratory, Braga/Guimarães, Portugal
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27
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Prevalent Technique and Results of Hemorrhoidal Embolization. J Clin Med 2022; 11:jcm11226631. [PMID: 36431108 PMCID: PMC9698593 DOI: 10.3390/jcm11226631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Hemorrhoids are blood cushions located in the anus and lower rectum, acknowledged as a common cause of bleeding, which can reduce quality of life. The development of minimally invasive techniques such as endovascular embolization of superior rectal artery, "Emborrhoid technique", is an effective treatment, with no pain or ischemic complications, and allows quick patient recovery. Our purpose is to describe the general technique and discuss the results of the current literature.
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28
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Morrison BG, Morris TC, Phillips CW, Kato H. Internal Hemorrhoids: A Source of Massive Obscure Lower Gastrointestinal Bleeding in Cirrhosis. Cureus 2022; 14:e28138. [PMID: 36158440 PMCID: PMC9491678 DOI: 10.7759/cureus.28138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/05/2022] Open
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29
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Kuiper SZ, Kimman ML, Van Tol RR, Waardenburg SF, Van Kuijk SMJ, Dirksen CD, Breukink SO. Patient reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS): Development, reliability and construct validity. Colorectal Dis 2022; 24:992-999. [PMID: 35119715 PMCID: PMC9544465 DOI: 10.1111/codi.16079] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 12/29/2022]
Abstract
AIM Haemorrhoidal disease (HD) is a frequently occurring disorder with a significant negative impact on a patient's quality of life. Here, we describe the development and validation of the Dutch patient reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS). METHODS The development of the PROM-HISS followed recommended guidelines. Face and content validity, structural properties, reliability and construct validity were evaluated in a HD population. Reliability was tested by assessing the test-retest reliability, defined by the intraclass correlation coefficient (ICC), and internal consistency measured with Cronbach's alpha. Construct validity was evaluated using confirmatory factor analysis (CFA) and hypotheses testing. RESULTS The PROM-HISS consists of three domains: (1) HD symptoms (blood loss; pain; prolapse; soiling; itching), (2) impact of symptoms on daily activities, and (3) satisfaction with treatment. The PROM-HISS showed good face and content validity. The PROM-HISS was completed by 102 patients (65% male), with a mean age of 58 years (23-81 years). The ICCs of the different items in the domain HD symptoms ranged between 0.56 and 0.79 and were interpreted as good. The Cronbach's alpha value was 0.80 and considered satisfactory. The CFA provided further evidence for construct validity with a good model fit. A high score on the symptoms of HD correlated with a high impact of HD on daily activities (Pearson's r = 0.632, p < 0.01) and a low degree of satisfaction (Pearson's r = 0.378, p < 0.01). CONCLUSION The PROM-HISS is a reliable and valid instrument to evaluate symptoms of HD, impact on daily activities and satisfaction with treatment.
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Affiliation(s)
- Sara Z. Kuiper
- Department of SurgerySchool of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Merel L. Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Robin R. Van Tol
- Department of SurgeryDiakonessenhuis Medical CentreUtrechtThe Netherlands
| | - Sophie F. Waardenburg
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI)Maastricht University Medical CentreMaastrichtThe Netherlands,Department of Anaesthesiology and Pain MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sander M. J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Carmen D. Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Stéphanie O. Breukink
- Department of SurgerySchool of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands,Department of SurgerySchool for Oncology and Developmental Biology (GROW)Maastricht UniversityMaastrichtThe Netherlands,Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
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Salgueiro P, Garrido M, Santos RG, Pedroto I, Castro-Poças FM. Polidocanol Foam Sclerotherapy Versus Rubber Band Ligation in Hemorrhoidal Disease Grades I/II/III: Randomized Trial. Dis Colon Rectum 2022; 65:e718-e727. [PMID: 34840294 DOI: 10.1097/dcr.0000000000002117] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rubber band ligation and sclerotherapy are considered the office-based procedures of choice in hemorrhoidal disease. However, there are no studies comparing rubber band ligation and polidocanol foam sclerotherapy. OBJECTIVE We aimed to evaluate the efficacy and safety of polidocanol foam sclerotherapy compared with rubber band ligation. DESIGN This study was a randomized open-label study with 1-year follow-up. SETTINGS The study was conducted in the colorectal unit of a tertiary hospital. PATIENTS One hundred twenty patients with hemorrhoidal disease grades I to III were included. INTERVENTIONS Patients were stratified by hemorrhoidal disease grade and randomly assigned (1:1) to treatment with either rubber band ligation (n = 60) or polidocanol foam sclerotherapy (n = 60). MAIN OUTCOME MEASURES Efficacy outcomes included therapeutic success and recurrence. Safety outcomes included the occurrence of complications related to the procedures. RESULTS Therapeutic success was not significantly different between the groups (polidocanol foam sclerotherapy 93.3% vs rubber band ligation 85.0%, p = 0.14). However, complete success rate was higher in the polidocanol foam sclerotherapy group (88.3% vs 66.7%, p = 0.009) with fewer office-based sessions (mean ± SD: 1.32 ± 0.60 vs 1.62 ± 0.76, p = 0.02). Recurrence rates were lower in the polidocanol foam sclerotherapy group (16.1% vs 41.2%, p = 0.004). Most recurrences were mild (83.3%). Complications were more frequent in the rubber band ligation group (30.0% vs 10.0%, p = 0.01) and were mostly minor (91.7%). No severe complications were observed in either group. LIMITATIONS This study was performed in a single center, and both patients and investigators were not blinded to the treatment group. CONCLUSIONS Both procedures are effective in the treatment of hemorrhoidal disease grades I to III. Polidocanol foam sclerotherapy was more effective than rubber band ligation when considering complete success. Patients in the polidocanol foam sclerotherapy group needed fewer treatment sessions, had lower recurrence rates, and were less likely to have complications. See Video Abstract at http://links.lww.com/DCR/B816. REGISTRATION https//www.clinicaltrials.gov; Identifier: NCT04091763. ESCLEROTERAPIA CON ESPUMA DE POLIDOCANOL VERSUS LIGADURA CON BANDA DE GOMA EN LOS GRADOS I / II / III DE ENFERMEDAD HEMORROIDAL ENSAYO ALEATORIZADO ANTECEDENTES:La ligadura con banda elástica y la escleroterapia se consideran los procedimientos de elección en el consultorio para la enfermedad hemorroidal. Sin embargo, no hay estudios que comparen la ligadura con bandas elastica y la escleroterapia con espuma de polidocanol.OBJETIVO:Nuestro objetivo fue evaluar la eficacia y seguridad de la escleroterapia con espuma de polidocanol en comparación con la ligadura con bandas elastica.DISEÑO:Estudio aleatorizado randomizado, abierto, con seguimiento de 1 año.AJUSTES:El estudio se realizó en una unidad colorrectal de un hospital terciario.PACIENTES:Se incluyeron 120 pacientes con enfermedad hemorroidal grados I a III.INTERVENCIONES:Los pacientes fueron estratificados por grado de enfermedad hemorroidal y asignados al azar (1: 1) al tratamiento con ligadura con banda elastica (n = 60) o escleroterapia con espuma de polidocanol (n = 60).PRINCIPALES MEDIDAS DE RESULTADO:Los resultados de eficacia incluyeron el éxito terapéutico y la recurrencia. Los resultados de seguridad incluyeron la aparición de complicaciones relacionadas con los procedimientos.RESULTADOS:El éxito terapéutico no fue significativamente diferente entre los grupos (escleroterapia con espuma de polidocanol 93,3% vs ligadura con banda de goma 85,0%, p = 0,14). Sin embargo, la tasa de éxito completo fue mayor en el grupo de escleroterapia con espuma de polidocanol (88,3% vs 66,7%, p = 0,009), con menos sesiones en el consultorio (media ± desviación estándar: 1,32 ± 0,60 vs 1,62 ± 0,76, p = 0,02). Las tasas de recurrencia fueron más bajas en el grupo de escleroterapia con espuma de polidocanol (16,1% vs 41,2%, p = 0,004). La mayoría de las recurrencias fueron leves (83,3%). Las complicaciones fueron más frecuentes en el grupo de ligadura con bandas elastica (30,0% vs 10,0%, p = 0,01) y fueron en su mayoría menores (91,7%). No se observaron complicaciones graves en ninguno de los grupos.LIMITACIONES:Este estudio se realizó en un solo centro y ni los pacientes ni los investigadores estaban cegados al grupo de tratamiento.CONCLUSIONES:Ambos procedimientos son efectivos en el tratamiento de la enfermedad hemorroidal grados I a III. La escleroterapia con espuma de polidocanol fue más eficaz que la ligadura con banda de goma cuando se consideró el éxito completo. Los pacientes del grupo de escleroterapia con espuma de polidocanol necesitaron menos sesiones de tratamiento, tuvieron tasas de recurrencia más bajas y menos probabilidades de tener complicaciones. Consulte Video Resumen en http://links.lww.com/DCR/B816. (Traducción-Dr Yolanda Colorado)ClinicalTrials.gov, número NCT04091763.
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Affiliation(s)
- Paulo Salgueiro
- Department of Gastroenterology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Mónica Garrido
- Department of Gastroenterology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ruben G Santos
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Pedroto
- Department of Gastroenterology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Fernando M Castro-Poças
- Department of Gastroenterology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Nagaratnam JM, Manning A, Hughes L, Abi El Cheik T, Tiesenga F. Intero-External Hemorrhoids Complicated by Ischio-Anal Infection Coexisting with Tubo-Ovarian Abscesses: A Case for Early Surgical Intervention. Cureus 2022; 14:e26117. [PMID: 35875278 PMCID: PMC9298958 DOI: 10.7759/cureus.26117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
Abstract
Hemorrhoids are abnormal collections of engorged blood vessels and tissue within the anal canal or surrounding the anus. Management consists of conservative treatment or a hemorrhoidectomy, dependent on disease severity, duration, and physician discretion. Reported is a case of a 44-year-old, African American female initially treated conservatively for intero-external hemorrhoids, that later abscessed into the ischio-anal fossa and was further complicated by an infection of the deep pelvic space. This report explores conservative and surgical management of hemorrhoids, and offers recommendations for symptom management, and reducing disease progression and complications.
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Nguyenhuy M, Xu Y, Kok HK, Maingard J, Joglekar S, Jhamb A, Brooks M, Asadi H. Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2022; 45:1351-1361. [PMID: 35551442 DOI: 10.1007/s00270-022-03154-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life. Rectal artery embolisation (RAE) is a recently described technique for the management of HD, however, its clinical efficacy and safety are unclear at present. The objective of this systematic review and meta-analysis is to evaluate the clinical outcomes following RAE. METHODS The PubMed, MEDLINE and EMBASE databases were searched for studies specifying the management of haemorrhoids with RAE from January 2000 to October 2021. Primary outcomes were: French bleeding score (FBS), Visual analogue scale (VAS) for pain, general quality of life (QoL) score, and the Goligher prolapse score (GPS). Secondary outcomes were technical success, clinical success, postoperative complications, and technical outcomes. A random-effects meta-analysis was conducted. Study heterogeneity was evaluated, and sensitivity analysis was performed. RESULTS Thirteen eligible studies were identified including 381 patients. Rectal artery embolisation was associated with improvements in the FBS (mean difference [MD] 2.66; 95% confidence interval [CI] 2.10-3.23), VAS (MD 1.92; 95% CI 1.58-2.27) and QoL (MD 1.41; 95% CI 1.20-3.80), although the grade of internal haemerrhoids increased with uncertain clinical significance (MD 0.30; 95% CI 0.23-0.36). Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%). Procedural duration and radiation exposure were heterogeneous. No major complications occurred. CONCLUSION RAE demonstrates early clinical efficacy with low rates of peri-procedural complications or morbidity. RAE is a promising addition to the treatment options available for HD and warrants ongoing research.
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Affiliation(s)
| | - Yifan Xu
- Peninsula Health, Frankston, VIC, 3199, Australia
| | - Hong Kuan Kok
- Interventional Radiology Service, Northern Health Radiology, Epping, VIC, 3076, Australia
| | - Julian Maingard
- Department of Interventional Radiology, Monash Health, Clayton, VIC, 3168, Australia
| | - Shantanu Joglekar
- Department of General Surgery, Eastern Health, Box Hill, VIC, 3128, Australia
| | - Ashu Jhamb
- Department of Interventional Radiology, St Vincent's Melbourne, Fitzroy, VIC, 3065, Australia
| | - Mark Brooks
- Department of Interventional Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Hamed Asadi
- Department of Interventional Radiology, Monash Health, Clayton, VIC, 3168, Australia
- Department of Interventional Radiology, Austin Health, Heidelberg, VIC, Australia
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Zhang C, Zhang W, Xu J. Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids. Medicine (Baltimore) 2022; 101:e29100. [PMID: 35356944 PMCID: PMC10684234 DOI: 10.1097/md.0000000000029100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT To investigate the clinical effect and outcome of traditional hemorrhoidectomy and procedures for prolapse and hemorrhoid (PPH) for the treatment of grades III and IV hemorrhoids.We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital. A total of 585 patients underwent PPH, and 418 patients underwent hemorrhoidectomy. The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.No significant difference between the 2 treatment groups regarding patient demographics. All patients underwent more than 12months of postoperative follow-up. No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.Our data suggest that PPH is useful and safe for grades III and IV hemorrhoids. It can reduce postoperative and surgery-related complications. However, this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.
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Affiliation(s)
- Chaojie Zhang
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
| | - Weiping Zhang
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
| | - Jian Xu
Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.
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Salgueiro P, Ramos MI, Castro-Poças F, Libânio D. Office-Based Procedures in the Management of Hemorrhoidal Disease: Rubber Band Ligation versus Sclerotherapy - Systematic Review and Meta-Analysis. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022; 29:409-419. [PMID: 36545183 PMCID: PMC9761374 DOI: 10.1159/000522171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 12/24/2022]
Abstract
Introduction The most frequently used office-based procedures in hemorrhoidal disease (HD) are rubber band ligation (RBL) and sclerotherapy. Few studies have been published comparing the various types of instrumental therapy. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of sclerotherapy and RBL. Methods Three online databases were searched. Efficacy (control of symptoms, prolapse, bleeding and pain, patients' satisfaction, and disease recurrence) and safety (complications, such as pain and bleeding) were the assessed outcomes. Pooled relative risks (RR) were computed for each outcome using a random-effects model, and heterogeneity was assessed by Cochran's Q test and I2. Results Six RCTs and three cohort studies were included. Control of prolapse and bleeding was significantly higher with RBL (93.1% RBL vs. 66.4% sclerotherapy, RR 1.34, 95% CI 1.12-1.60 and 89.1% RBL vs. 78.7% SCL, RR 1.17, 95% CI 1.02-1.34, respectively). Both techniques had similar results in terms of pain relief, overall control of symptoms, and risk of recurrence at 3 months. Although patient satisfaction was significantly higher with RBL (77.8% RBL vs. 46.7% sclerotherapy, RR 1.59, 95% CI 1.01-2.50), post-procedural pain was significantly higher with this technique (24% RBL vs. 14% sclerotherapy, RR 1.74, 95% CI 1.32-2.28). There was no significant difference regarding post-procedure bleeding (11.1% RBL vs. 8.7% sclerotherapy, RR 1.29, 95% CI 0.86-1.94). In the subgroup analysis, according to the HD grade, post-procedure pain was higher with RBL only in HD grade II (vs. HD grade I-III). Conclusions RBL performs better than sclerotherapy in controlling HD symptoms, specifically prolapse and bleeding, although post-procedural pain is a frequent complication. Recurrence is similar with both procedures. While waiting for the publication of results with sclerotherapy with new sclerosants, RBL remains the office-based treatment of choice in HD.
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Affiliation(s)
- Paulo Salgueiro
- Gastroenterology Department of Centro Hospitalar Universitário do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal,*Paulo Salgueiro,
| | - Maria Inês Ramos
- Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Fernando Castro-Poças
- Gastroenterology Department of Centro Hospitalar Universitário do Porto, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Gastroenterology Department of Portuguese Oncology Institute of Porto, Porto, Portugal,MEDCIDS − Faculty of Medicine, University of Porto, Porto, Portugal
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Lunsford TN, Atia MA, Kagbo-Kue S, Harris LA. A Pain in the Butt: Hemorrhoids, Fissures, Fistulas, and Other Anorectal Syndromes. Gastroenterol Clin North Am 2022; 51:123-144. [PMID: 35135658 DOI: 10.1016/j.gtc.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Painful and bothersome anorectal syndromes can be a diagnostic and therapeutic challenge for clinicians because structural and functional abnormalities may often coexist and require a multidisciplinary approach to management. Although it is often difficult to attribute all of a patient's anorectal symptoms to a singular disorder with definitive intervention and cure, improving quality of life, treating coexistent conditions such as functional constipation and/or defecation disorders, addressing psychological comorbidities if present, and confirming there is no evidence of inflammatory or malignant conditions are top priorities.
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Affiliation(s)
- Tisha N Lunsford
- Division of Gastroenterology & Hepatology, Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
| | - Mary A Atia
- Arizona Digestive Health, 5823 W. Eugie Ave, Suite A, Glendale, AZ 85304, USA
| | - Suaka Kagbo-Kue
- Division of Gastroenterology & Hepatology, Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA
| | - Lucinda A Harris
- Division of Gastroenterology & Hepatology, Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ 85259, USA.
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Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study. Tech Coloproctol 2022; 26:615-625. [PMID: 35217937 PMCID: PMC8879173 DOI: 10.1007/s10151-022-02600-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023]
Abstract
Background The management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD. Methods This prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I–III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded. Results We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate. Conclusions Patients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD. Supplementary Information The online version contains supplementary material available at 10.1007/s10151-022-02600-5.
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El-Kelani MZ, Kerdahi R, Raghib S, Shawkat MA, Abdelnazer N, Mudawi I, Mahmoud M, Abi Hussein W, Tawfik M, Wahdan W. Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia. Hosp Pract (1995) 2022; 50:104-109. [PMID: 35188048 DOI: 10.1080/21548331.2022.2042150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several techniques were developed for managing hemorrhoidal disease, but their use in clinical practice and the general management of the condition, seems highly variable in Saudi Arabia. CONSENSUS PANEL To develop consensus recommendations that ensure the best possible diagnosis and treatment of hemorrhoidal disease in Saudi Arabia, the consensus panel consisted of experts in surgery in Saudi Arabia who met from December 2017 to September 2018. CONSENSUS FINDINGS The discussions focused on the need: to set up a proctology society in Saudi Arabia to assess the prevalence of hemorrhoidal disease and to regulate the role of healthcare professionals (HCPs) in the management of the disease; to initiate guidelines to ensure proper diagnosis (considering symptoms, medical history and physical/clinical examination) and treatment (topical creams and suppositories should be limited as no strong evidence supports their efficacy); to educate patients on diet and lifestyle modifications using education materials and social media during and after the treatment (regular physical activity, drinking enough fluids, regular meal time with food rich in fibers, and regular bowel habit with non-straining defecation); to refer patients to a general/colorectal surgeon when needed; and to teach junior surgeons the best use of surgical techniques. CONCLUSION These recommendations can be a step forward towards a recognized guidance for all HCPs in Saudi Arabia for a better management of hemorrhoidal disease. They will be of a great value for general practitioners, family medicine doctors, junior surgeons and pharmacists who are the gate keepers and first contact with patients.
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Affiliation(s)
| | - Raouf Kerdahi
- Department of General, Laproscopic and Paediatric Surgeon, Olaya Medical Center (OMC), Riyadh, Saudi Arabia
| | - Samir Raghib
- Department of Surgery, United Doctors Hospital, Jeddah, Saudi Arabia
| | | | - Naser Abdelnazer
- Department of General Surgery, Dallah Hospital, Riyadh, Saudi Arabia
| | - Ishag Mudawi
- Department of General Surgery, King Fahd Armed Force, Jeddah, Saudi Arabia
| | - Magdy Mahmoud
- Department of General Surgery, King Khaled National Guard, Jeddah, Saudi Arabia
| | - Wassim Abi Hussein
- Department of General and Laparoscopic Surgery, Al Ahsa Hospital, Dammam, Saudi Arabia
| | - Mohamed Tawfik
- Department of Surgery, Erfan Hospital, Jeddah, Saudi Arabia
| | - Waleed Wahdan
- Department of General Surgery, Riyadh National Hospital, Riyadh, Saudi Arabia
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Kusumawati I, Rullyansyah S, Rizka AF, Hestianah EP, Matsunami K. Histomorphometric study of ethanolic extract of Graptophyllum pictum (L.) Griff. leaves on croton oil-induced hemorrhoid mice: A Javanese traditional anti-hemorrhoid herb. JOURNAL OF ETHNOPHARMACOLOGY 2022; 284:114765. [PMID: 34688799 DOI: 10.1016/j.jep.2021.114765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 09/09/2021] [Accepted: 10/19/2021] [Indexed: 05/15/2023]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Graptophyllum pictum (L.) Griff., known as "handeuleum" in West Java and "Daun Ungu" in Indonesia, is traditionally used to cure hemorrhoids. AIM OF THE STUDY The purpose of this study is to prove its effectiveness scientifically using anorectal histological parameters in Croton oil-induced hemorrhoid mice. MATERIALS AND METHODS In vivo tests were performed by observing histomorphologic changes in mice anorectal tissue induced by croton oil. In addition, in vitro assay was performed for evaluating antioxidant activity, astringency property, and hemostasis-associated activity. The antioxidant activity was measured using a DPPH radical scavenging assay. The total flavonoid and phenolic contents were also determined spectrophotometrically. RESULTS The in vivo assay showed that the oral-topical combination use of the ethanolic extract of G. pictum leaves demonstrated significant improvement on the croton oil-induced anorectal damage better than the single application by oral or topical application. CONCLUSION These results showed that G. pictum has potent anti hemorrhoid activity, especially for the combinational use of oral and topical administration.
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Affiliation(s)
- Idha Kusumawati
- Department of Pharmaceutical Science, Faculty of Pharmacy, Airlangga University, Nanizar Zaman Joenoes Building, Jl. Mulyorejo, Surabaya, 60155, East Java, Indonesia; Natural Product Drug Discovery and Development Research Group, Faculty of Pharmacy, Airlangga University, Nanizar Zaman Joenoes Building, Jl. Mulyorejo, Surabaya, 60155, East Java, Indonesia.
| | - Subhan Rullyansyah
- Department of Pharmaceutical Science, Faculty of Pharmacy, Airlangga University, Nanizar Zaman Joenoes Building, Jl. Mulyorejo, Surabaya, 60155, East Java, Indonesia.
| | - Aisyah Farah Rizka
- Department of Pharmaceutical Science, Faculty of Pharmacy, Airlangga University, Nanizar Zaman Joenoes Building, Jl. Mulyorejo, Surabaya, 60155, East Java, Indonesia.
| | - Eka Pramyrtha Hestianah
- Veterinary Anatomy Department, Faculty of Veterinary, Airlangga University, Jl. Mulyorejo, Surabaya, 60155, East Java, Indonesia.
| | - Katsuyoshi Matsunami
- Department of Pharmacognosy, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
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Chaush S, Husain N, Khalid M, Doni M, Khan MQ, Hussain MM. The efficacy of alum sitz baths followed by topical gall ointment in hemorrhoids—a single-arm clinical trial. ADVANCES IN TRADITIONAL MEDICINE 2022. [PMCID: PMC8819210 DOI: 10.1007/s13596-022-00634-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemorrhoidal disease is one of the most common gastrointestinal ailments affecting life quality of the patients. Unani classical literature is replete with anti-hemorrhoidal drugs, but scientific evidence is lacking. Therefore, Safūf Zāj (powdered alum) and Marham-e-Māzū (gall ointment) having potent anti-hemorrhoidal actions were selected to evaluate their efficacy in hemorrhoids. This clinical trial was conducted on 30 participants with hemorrhoids, aged > 18 years. All the participants received Safūf Zāj for sitz baths and Marham-e-Māzū to be applied twice daily for 2 weeks. Primary outcome measures were: change in pain intensity, anal itching, and defecate discomfort assessed on 100 mm VAS scale and per-rectal bleeding assessed on 4-point scale. Secondary outcome measures were: change in the size of the external hemorrhoidal mass assessed on 5-point scale, grade of internal hemorrhoid assessed by Goligher classification and quality of life (QoL) assessed on SF-12 questionnaire. The per-protocol analysis was done on 30 participants and statistically significant improvement was seen in primary and secondary outcome measures. Moreover, both the mental and psychological components of QoL were improved. The study inferred that therapeutic approach of Safūf Zāj and Marham-e-Mazu is safe and efficacious in hemorrhoids. Future studies with well-designed RCTs are highly recommended.
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Affiliation(s)
- Salma Chaush
- Department of ’Ilaj bi’l Tadbir, Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
| | - Nazim Husain
- Department of Medicine (Unani), Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
| | - Mohd Khalid
- Department of Medicine (Unani), Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
| | - Meenu Doni
- Department of Medicine (Unani), Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
| | - Mohd Qudrathullah Khan
- Department of Medicine (Unani), Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
| | - Md Majid Hussain
- Department of Medicine (Unani), Luqman Unani Medical College Hospital and Research Center, Bijapur, Karnataka 586101 India
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Kuiper SZ, Tol RRV, Lataster A, Cleutjens JP, Melenhorst J, Dijk PV, van Kuijk SM, Breukink SO. A Morphometric Analysis of Pathological Alterations in Hemorrhoidal Disease Versus Normal Controls: A Controlled Trial. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0041-1742257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
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.
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Affiliation(s)
- Sara Z. Kuiper
- Department of Surgery, School of Nutrition and Translation Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Robin R. van Tol
- Department of Surgery, Diakonessenhuis Medical Centre, Utrecht, The Netherlands
| | - Arno Lataster
- Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands
| | - Jack P.M. Cleutjens
- Department of Pathology, Maastricht University Medical Centre and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul van Dijk
- Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stéphanie O. Breukink
- Department of Surgery, School of Nutrition and Translation Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands
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41
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Levy L, Smiley A, Latifi R. Independent Predictors of In-Hospital Mortality in Elderly and Non-elderly Adult Patients Undergoing Emergency Admission for Hemorrhoids. Am Surg 2022; 88:936-942. [DOI: 10.1177/00031348211060420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The study explored determinants of mortality of admitted emergently patients with the primary diagnosis of hemorrhoids, during the years 2005-2014. Methods Demographics, clinical data, and outcomes were obtained from the National Inpatient Sample, 2005-2014, in elderly (65+ years) and non-elderly adult patients (18-64 years) with hemorrhoids who underwent emergency admission. Multivariable logistic regression model with backward elimination was used to identify predictors of mortality. Results 25 808 adult and 26 978 elderly patients were included. Female patients consisted of 42.5% and 59.3% in adult and elderly, respectively. 42 (.2%) adults died, of which 50% were female and 125 (.5%) elderly patients died, of which 60% were female. Mean (SD) age of the adult patients was 47.8 (11) years and in elderly patients was 78.7 (8) years. 82.2% and 85.7% had internal hemorrhoids in adult and elderly patients, respectively. 9326 (36.1%) adult and 7282 (27%) elderly patients underwent an operation. In the final multivariable logistic regression model for adult patients with operation, delayed operation and invasive diagnostic procedures increased the odds of mortality, whereas in elderly patients, delayed operation and frailty index were the risk factors of mortality. In both adults and elderly with no operation, increased hospital length of stay (HLOS) significantly increased the odds of mortality, and undergoing an invasive diagnostic procedure significantly decreased the odds of mortality. Conclusion In all operated patients, increased time to operation and undergoing an invasive diagnostic procedure were the risk factors for mortality. On the other hand, in non-operated emergency hemorrhoids patients, increased age and increased HLOS were the risk factors for mortality while undergoing an invasive diagnostic procedure decreased the odds of mortality.
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Affiliation(s)
- Lior Levy
- Department of Surgery, School of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Abbas Smiley
- Department of Surgery, School of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, School of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Porwal A, Kundu GC, Bhagwat G, Butti R. Herbal medicine AnoSpray suppresses proinflammatory cytokines COX-2 and RANTES in the management of hemorrhoids, acute anal fissures and perineal wounds. Exp Ther Med 2021; 23:86. [PMID: 34938368 PMCID: PMC8688930 DOI: 10.3892/etm.2021.11009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/30/2021] [Indexed: 12/03/2022] Open
Abstract
Hemorrhoids, anal fistula and fissure are common anorectal complications. Anorectal diseases are associated with severe pain, inflammation, swelling, itching and bleeding. These diseases may be managed with different medical treatments or surgical procedures, depending on their severity. Surgical procedures, however, are highly invasive and are associated with higher costs and the possibility of recurrence. In addition, surgical removal of fistula-in-ano leads to the formation of perineal wounds. Therefore, developing therapeutic interventions that are effective in alleviating inflammation and pain are desirable for the effective management of anorectal diseases. Herbal compounds have previously been indicated to suppress inflammation and pain in different pathological conditions. The aim of the present study was to examine the effects elicited by a polyherbal formulation, AnoSpray®, on the migration of inflammatory cells and on the expression of inflammatory cytokines in anorectal diseases. The effect of AnoSpray on cell viability and migration was studied using MTT and wound-migration assays, respectively. Furthermore, the effects of AnoSpray on the expression of the inflammatory cytokines regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF, as well as on cyclooxygenase-2 (COX)-2, were investigated using western blot analysis. The expression of RANTES and COX-2 in human hemorrhoid specimens was also analyzed to corroborate the in vitro findings. The results obtained revealed that AnoSpray did not exhibit any cytotoxic effects; however, it did lead to a significant suppression in the migration of RAW 264.7 and BJ cells. Furthermore, the results suggested that AnoSpray suppressed the expression of the inflammatory cytokines RANTES and VEGF, and also the expression of COX-2. In addition, RANTES and COX-2 were significantly downregulated in the clinical specimens of AnoSpray-treated hemorrhoids compared with the controls. Taken together, the results of the present study suggested that AnoSpray may be a potential therapeutic agent in the treatment of bleeding hemorrhoids, anal fissures and perineal wounds.
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Affiliation(s)
- Ashwin Porwal
- Healing Hands Clinic, Pune, Maharashtra 411001, India
| | - Gopal C Kundu
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India.,School of Biotechnology and Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Institute of Eminence, Bhubaneswar, Odisha 751024, India
| | - Gajanan Bhagwat
- R&D Center, Healing Hands & Herbs Pvt. Ltd., Pune, Maharashtra 411002, India
| | - Ramesh Butti
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India.,R&D Center, Healing Hands & Herbs Pvt. Ltd., Pune, Maharashtra 411002, India
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43
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Association between haemorrhoids and Graves’ disease: a retrospective cohort study using data from Taiwan’s Longitudinal Health Insurance Database. BMJ Open 2021. [PMCID: PMC8718419 DOI: 10.1136/bmjopen-2021-053442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the relationship between haemorrhoids and Graves’ disease (GD). Setting Using the nationwide data from Taiwan’s Longitudinal Health Insurance Database. Participants We conducted a retrospective study, stratified patients by International Classification of Diseases, Ninth Revision, Clinical Modification disease code and compared the incidence rate of GD between patients with and without haemorrhoids. The study period was from 2000 to 2010, with exclusion of patients with diagnosed haemorrhoids before 2000 or after 2009, and we analysed the HR of GD in the univariable and multivariable models as well as the cumulative incidence curves of GD by using Kaplan-Meier curves. Result This study included 13 165 and 52 660 patients with and without haemorrhoids, respectively. The mean follow-up duration was approximately 6 years. The incidence rate of GD was 1.57 and 1.13 per 1000 person-years in patients with and without haemorrhoids, respectively. The area under the cumulative incidence curve of GD in patients with haemorrhoids was higher than that of patients without haemorrhoids. The risk of GD increased by 1.39 times (95% CI 1.13 to 1.71) in patients with haemorrhoids compared with patients without haemorrhoids. In the subgroup analysis, women with haemorrhoids had a higher risk of GD (adjusted HR 1.44; 95% CI 1.13 to 1.83). Patients with haemorrhoids aged 30–39 years were more likely to develop GD (adjusted HR 1.73; 95% CI 1.18 to 2.55). Conclusion The findings of this study indicate that patients with haemorrhoids may have an increased risk of GD compared with other potential confounding factors.
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Kuiper SZ, Kimman ML, Rørvik HD, Olaison G, Breukink SO. Making Use of Patient-Reported Outcome Measures for Haemorrhoidal Disease in Clinical Practice: A Perspective. Front Surg 2021; 8:728532. [PMID: 34513917 PMCID: PMC8424037 DOI: 10.3389/fsurg.2021.728532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/26/2021] [Indexed: 11/14/2022] Open
Abstract
Haemorrhoidal disease (HD) affects millions of people around the world and for most it is a recurring problem. Increasingly, clinicians broaden their focus on the patient's experiences with haemorrhoidal symptoms, including their impact on daily life. The patient's experience can be assessed using a patient-reported outcome measure (PROM). A PROM facilitates a deeper understanding of the disease-burden and allows a clinician to obtain information directly from the patients about their experiences with the ailment. Over the last years, PROMs have shown their additional role to traditional outcomes for several diseases and have earned their place in the daily consultation room. In order to improve and personalize the treatment of HD, we endorse the use of validated PROMs in clinical care.
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Affiliation(s)
- Sara Z Kuiper
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands
| | - Merel L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Håvard D Rørvik
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Stephanie O Breukink
- Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Surgery, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, Netherlands
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45
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Preparation and In Vivo Evaluation of a Lidocaine Self-Nanoemulsifying Ointment with Glycerol Monostearate for Local Delivery. Pharmaceutics 2021; 13:pharmaceutics13091468. [PMID: 34575544 PMCID: PMC8464853 DOI: 10.3390/pharmaceutics13091468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Lidocaine, a commonly used local anesthetic, has recently been developed into a number of ointment products to treat hemorrhoids. This study examined its efficient delivery to the dermis through the pharmaceutical improvement of hemorrhoid treatment ointments. We attempted to increase the amount of skin deposition of lidocaine by forming a nanoemulsion through the self-nanoemulsifying effect that occurs when glycerol monostearate (GMS) is saturated with water. Using Raman mapping, the depth of penetration of lidocaine was visualized and confirmed, and the local anesthetic effect was evaluated via an in vivo tail-flick test. Evaluation of the physicochemical properties confirmed that lidocaine was amorphous and evenly dispersed in the ointment. The in vitro dissolution test confirmed that the nanoemulsifying effect of GMS accelerated the release of the drug from the ointment. At a specific concentration of GMS, lidocaine penetrated deeper into the dermis; the in vitro permeation test showed similar results. When compared with reference product A in the tail-flick test, the L5 and L6 compounds containing GMS had a significantly higher anesthetic effect. Altogether, the self-nanoemulsifying effect of GMS accelerated the release of lidocaine from the ointment. The compound with 5% GMS, the lowest concentration that saturated the dermis, was deemed most appropriate.
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Talaie R, Torkian P, Moghadam AD, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: A review of current evidences. Diagn Interv Imaging 2021; 103:3-11. [PMID: 34456172 DOI: 10.1016/j.diii.2021.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Hemorrhoids are local vascular structure dilations in the lower rectum, associated with morbidity and reduced quality of life. Endovascular coil or particle embolization of the superior rectal arteries, known as Emborrhoid technique, is a minimally invasive, image-guided therapy that targets the hemorrhoidal plexus and reduces hemorrhage. The purpose of this review was to analyze the results of published studies to determine the efficacy, clinical outcomes, and morbidities associated with the endovascular occlusion of hemorrhoidal arteries for the treatment of internal hemorrhoids. Current evidences suggest that hemorrhoids treated by Emborrhoid technique using microcoils, embolic particles or a combination is safe with no reported serious complications. Hemorrhoid embolization can preserve the anal tone without direct anorectal trauma and maintain the hemorrhoidal tissue in place requiring minimal local wound care on an outpatient basis. However, due to the paucity of high-quality trials, further research is warranted to evaluate its long-term outcomes, compare its efficacy with other treatment modalities, and fully assess its role in the treatment of hemorrhoid.
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Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
| | - Arash Dooghaie Moghadam
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, 13005 Marseille, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, 55455 Minneapolis, USA
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Porwal A, Kundu GC, Bhagwat G, Butti R. Polyherbal formulation Anoac‑H suppresses the expression of RANTES and VEGF for the management of bleeding hemorrhoids and fistula. Mol Med Rep 2021; 24:736. [PMID: 34414451 PMCID: PMC8404094 DOI: 10.3892/mmr.2021.12376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/21/2021] [Indexed: 11/06/2022] Open
Abstract
Hemorrhoids and fistula are considered the most common anorectal conditions in the general population. These conditions affect the quality of a patient's life by causing pain and bleeding during defecation or even in the resting state. Lower grades of hemorrhoids may be controlled by traditional measures. However, surgery is an effective treatment option in recurrent-lower and higher-grade hemorrhoids. Surgical procedures are associated with various complications, including pain and delayed wound healing. Recurrence of hemorrhoids is also a major concern in the post-operative period. An anal fistula is the connection between the anus and the skin and causes severe pain, swelling, as well as blood and pus discharge. Fistula has serious social and economic consequences. Hence, it is important to understand the pathophysiology and molecular pathology of hemorrhoids and fistula, to identify the molecular targets and to develop pharmacological-interventions. In a previous study by our group, the polyherbal formulation Anoac-H was developed for the treatment of different stages of hemorrhoids and fistula, and it was demonstrated that Anoac-H is an effective formulation for treating hemorrhoids. However, the molecular mode of action of Anoac-H on hemorrhoids and fistula had remained elusive. In the present study, it was determined that this formulation reduces the migration of mesenchymal (fibroblasts) and immune (RAW 264.7) cells without affecting their viability. It was also observed that Anoac-H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages. Inflammation and elevated expression of RANTES and VEGF were observed in hemorrhoids and fistula. However, inflammation, as well as the expression of RANTES and VEGF, were significantly reduced in treated human hemorrhoid and fistula tissues as compared to untreated ones, confirming the in vitro results.
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Affiliation(s)
- Ashwin Porwal
- Healing Hands Clinic, Pune, Maharashtra 411001, India
| | - Gopal C Kundu
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India
| | - Gajanan Bhagwat
- Healing Hands & Herbs (R&D Center), Pune, Maharashtra 411002, India
| | - Ramesh Butti
- Laboratory of Tumor Biology, Angiogenesis and Nanomedicine Research, National Centre for Cell Science, Pune, Maharashtra 411007, India
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Kothari TH, Bittner K, Kothari S, Kaul V. Prospective evaluation of the hemorrhoid energy treatment for the management of bleeding internal hemorrhoids. World J Gastrointest Endosc 2021; 13:329-335. [PMID: 34512880 PMCID: PMC8394182 DOI: 10.4253/wjge.v13.i8.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/07/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The hemorrhoid energy treatment (HET) system is a non-surgical bipolar electrotherapy device, which has previously demonstrated efficacy in the management of bleeding Grade I and II internal hemorrhoids; however, data is limited.
AIM To prospectively assess the safety and efficacy of the HET device.
METHODS This was an IRB-approved prospective study of 73 patients with Grade I or II internal hemorrhoids who underwent HET from March 2016 to June 2019. Patient factors and procedural data were obtained. A post-procedure questionnaire was administered by telephone to all patients at 1-wk and 3-mo following HET to assess for improvement and/or resolution of rectal bleeding and adherence to a stool softener regimen. A chart review was performed to observe recurrent symptoms and durability of response. Statistical analyses were performed using SPSS software (IBM; SPSS Version 25.0).
RESULTS Seventy-three patients underwent HET during the study period. Mean post-HET follow-up was 1.89 years. Complete resolution of bleeding was reported in 65% at 1 wk (n = 48), with improvement in bleeding in 97.2% (n = 71) of patients. At 3-mo, resolution and/or improvement in bleeding was reported in 90% (n = 64) of patients. No procedure-related pain or adverse events were reported.
CONCLUSION HET is well tolerated, safe and highly effective in the majority of our patients presenting with Grade I and II symptomatic internal hemorrhoids.
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Affiliation(s)
- Truptesh H Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Krystle Bittner
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Shivangi Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
| | - Vivek Kaul
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
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Colorectal Cancer Risk in Patients with Hemorrhoids: A 10-Year Population-Based Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168655. [PMID: 34444406 PMCID: PMC8394877 DOI: 10.3390/ijerph18168655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan’s National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78–2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48–3.28) and 1.79 (95% CI = 1.06–3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.
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Amjad W, Haider R, Malik A, Qureshi W. Insights into the management of anorectal disease in the coronavirus 2019 disease era. Therap Adv Gastroenterol 2021; 14:17562848211028117. [PMID: 34290826 PMCID: PMC8274100 DOI: 10.1177/17562848211028117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/08/2021] [Indexed: 02/04/2023] Open
Abstract
Coronavirus 2019 disease (COVID-19) has created major impacts on public health. The virus has plagued a large population requiring hospitalization and resource utilization. Knowledge about the COVID-19 virus continues to grow. It can commonly present with gastrointestinal symptoms; initially, this was considered an atypical presentation, which led to delays in care. The pandemic has posed serious threats to the care of anorectal diseases. Urgent surgeries have been delayed, and the care of cancer patients and cancer screenings disrupted. This had added to patient discomfort and the adverse outcomes on healthcare will continue into the future. The better availability of personal protective equipment to providers and standard checklist protocols in operating rooms can help minimize healthcare-related spread of the virus. Telehealth, outpatient procedures, and biochemical tumor marker tests can help with mitigation of anorectal-disease-related problems. There is limited literature about the clinical management of anorectal diseases during the pandemic. We performed a detailed literature review to guide clinicians around management options for anorectal disease patients. We also highlighted the health challenges seen during the pandemic.
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Affiliation(s)
- Waseem Amjad
- Internal Medicine, Albany Medical Center, Albany, NY, USA
| | - Rabbia Haider
- Internal Medicine, Nishter Medical University, Multan, Punjab, Pakistan
| | - Adnan Malik
- Internal Medicine, Loyola University School of Medicine, Chicago, IL, USA
| | - Waqas Qureshi
- Section of Cardiology in Division of Internal Medicine, University of Massachusetts School of Medicine, Worcester, MA 01655, USA
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