A comparative study of rubber band ligation versus BANANA-Clip in grade 1 to 3 internal hemorrhoids

Latest Research Trends on the Management of Hemorrhoids

Hemorrhoids manifest with a range of symptoms and severities, prompting the development of various conservative, interventional, and surgical treatments. Selecting the most suitable treatment for each case is challenging, especially with the continuous evolution of new methods. This review aims to advance hemorrhoid treatment and research by exploring recent developments over the last five years. Conservative approaches have focused on isolating active ingredients from traditional herbal remedies to create new products and understand their mechanisms. In office-based treatments, advanced devices such as modified rubber band ligation and polymer clips with stronger binding forces have been introduced. Polidocanol in foam form has shown promise in sclerotherapy, while infrared coagulation is being replaced by alternative energy-based methods. Additionally, endoscopic office treatments and embolization of hemorrhoidal vessels via angiography are increasingly used as safer options for patients with high surgical risks or bleeding issues. Stapled hemorrhoidopexy has shifted to partial resection instead of complete circular resection, and hemorrhoidal artery ligation techniques have been reported to be effective when combined with stapled hemorrhoidopexy or excisional hemorrhoidectomy in severe cases. Evidence is growing that hemorrhoidal artery ligation remains effective even without Doppler guidance. With ongoing research into various methods, there is a need for scientific comparison and evaluation of their advantages and disadvantages, standardization of indicators and treatment protocols, and cost-effectiveness considerations. Surgeons should offer well-informed options and explanations to patients, based on a comprehensive understanding of available treatments.

Lower pain, less itching, and faster healing after ultrasound scalpel-assisted hemorrhoidectomy using an intimate cleaner containing chlorhexidine, acid hyaluronic acid, and natural anti-inflammatories: a multicenter observational case-control study

PURPOSE

Postoperative pain is a major concern for patients undergoing ultrasound scalpel-assisted hemorrhoidectomy, potentially exacerbated by delayed wound healing. This study aimed to evaluate the impact of an intimate cleansing gel containing chlorhexidine, hyaluronic acid, and other anti-inflammatory agents (Antroclean Fisioderm) on postoperative pain, itching, and wound healing in patients who had undergone this procedure.

METHODS

This multicenter observational case-control study involved a cohort of consecutive adult patients who underwent hemorrhoidectomy using an ultrasound device. The study compared 2 different postoperative wound management strategies over 1 month after surgery: washing with warm water twice per day (control group) versus a 2-minute topical application of intimate cleansing gel (Antroclean Fisioderm) followed by a warm water wash (intervention group).

RESULTS

The median postoperative pain score was significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). The percentage of patients reporting anal itching was also significantly lower in the intervention group than in the control group at each follow-up point (P<0.01). All patients in the intervention group achieved complete wound healing 4 weeks after surgery, compared to 88 (82%) in the control group (P<0.01). No adverse events were reported.

CONCLUSION

The topical application of intimate cleansing gel (Antroclean Fisioderm) twice daily for 1 month following ultrasound scalpel-assisted hemorrhoidectomy appears to be associated with faster healing, reduced pain, decreased itching, and improved quality of life, without any adverse effects. Further larger and prospective randomized trials are recommended to confirm these findings.

Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy

Objective

To investigate the effect of Mayinglong Musk Hemorrhoids Ointment on wound healing and complications after internal hemorrhoid ligation and external hemorrhoidectomy.

Methods

This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). The wound-healing effect, wound-healing time, visual analog scale (VAS), anal function, and complications were compared between the two groups.

Results

The combined group exhibited a significantly higher total effective rate of wound healing when compared with the operation group (p < 0.05). The patients in the combined group experienced remarkably faster wound healing than the operation group (p < 0.05). The visual analog scale (VAS) score of the combined group was significantly lower than that of the operation group (p < 0.05). The combined group obtained superior anal function than the operation group (p < 0.001).

Conclusion

Mayinglong Musk Hemorrhoid Ointment combined with internal hemorrhoid ligation and external hemorrhoidectomy in the treatment of mixed hemorrhoids yields remarkable outcomes. It improves the wound healing outcomes, accelerates wound healing, relieves postoperative pain, enhances anal function, and reduces the occurrence of postoperative complications in the patient.

Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation-a retrospective study

Background

Massive, delayed bleeding (DB) is the most common major complication of Rubber Band Ligation (RBL) for internal hemorrhoids caused by premature band slippage. In this study we modified conventional RBL to prevent early rubber band slippage and evaluated its clinical efficacy and safety.

Methods

Study participants were consecutive patients with grade II or III internal hemorrhoids treated with RBL at Ningbo Medical Center of Lihuili Hospital from January 2019 to December 2020. Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed.

Results

A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL. There was no statistically significant difference between the two groups at baseline. Five cases of postoperative DB have been observed in the conventional RBL group, compared to none in the modified ones, with a significant difference (P < 0.05). Within three months after surgery, 8 cases in the modified RBL group experienced a recurrence rate of 5.4%, whereas 17 patients in the conventional RBL group experienced a recurrence rate of 13.6%. The difference was statistically significant (P < 0.05). The VAS score, edema, and incidence of sensation of prolapse between the two groups were not significantly different at 3 and 7 days after surgery (P < 0.05). There were also no significant differences in HDSS and SHS scores between the two groups after surgery (P > 0.05).

Conclusion

Modified RBL may be associated with a lower rate of complications, especially with lower DB rate in comparison with standard RBL. Further studies in larger samples and different design are necessary to confirm these results.