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Xiong K, Zhao Q, Li W, Yao T, Su Y, Wang J, Fang H. Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids. Ir J Med Sci 2023; 192:2747-2753. [PMID: 37059872 DOI: 10.1007/s11845-023-03367-w] [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: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND There is no consensus on the number of ligation bands for varying grades of internal hemorrhoids (IH) in a single session of endoscopic rubber band ligation (ERBL). AIMS The aims of this study were to investigate this issue. METHODS Patients with IH were treated with ERBL. The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL. The secondary endpoints were postoperative complications and recurrence. RESULTS One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded. The average bands were 3.9 ± 1.1, and grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000). 78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%). The incidence of postoperative complications was not significantly correlated with the grade of hemorrhoids (P = 0.201) and the number of bands (P = 0.886). The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months. The overall recurrence rate was 25.0%, with grade III significantly higher than grade I-II (32.8% vs 14.6%, P = 0.027). For grade III hemorrhoids, the recurrence rate was lower with more than 4 bands of ligation than with less than 4 bands (26.5% vs 53.3%). CONCLUSIONS The average ERBL treatment of IH requires nearly four bands, and grade II hemorrhoids require less banding than grade III hemorrhoids, while the efficacy was better. Increasing the number of bands improves the treatment efficacy for grade III IH, which could be a strategy to reduce the recurrence rate without increasing postoperative complications.
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Affiliation(s)
- Kangwei Xiong
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
| | - Qian Zhao
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
| | - Wanli Li
- Department of Pharmacology, School of Basic Medical Sciencesof, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Tingting Yao
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
| | - Yuan Su
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China
| | - Jiajia Wang
- Department of Pharmacology, School of Basic Medical Sciencesof, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui Province, China.
| | - Haiming Fang
- Department of Gastroenterology, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China.
- Center of Gut Microbiota, the Second Hospital of Anhui Medical University, No. 678, Furong Road, Hefei, 230601, Anhui Province, China.
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Lie H, Caesarini EF, Purnama AA, Irawan A, Sudirman T, Jeo WS, Budiono BP, Prabowo E, Rivai MI, Sitepu RK. Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis. Lasers Med Sci 2022; 37:3621-3630. [PMID: 36094598 DOI: 10.1007/s10103-022-03643-8] [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: 08/10/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022]
Abstract
Laser hemorrhoidoplasty (LHP) is known as a new minimally invasive and painless procedure for symptomatic hemorrhoids. However, Milligan-Morgan (MM) may offer the best result of long-term cure rates. In this study, we aim to compare the efficacy between LHP and MM for hemorrhoidal disease treatment. Using specific keywords, we comprehensively go through the potential articles on PubMed, Europe PMC, and Google Scholar sources until April 19, 2022. All published studies on LHP and MM hemorrhoidectomy were collected. Statistical analysis was done by using Review Manager 5.4 software. Twelve studies with a total of 1756 patients with hemorrhoid grades II-IV were included for the analysis. Our pooled analysis revealed that LHP was associated with shorter operative time (p < 0.00001), shorter length of hospital stay (p = 0.0005), lower risk of urinary retention (p = 0.005) and anal stenosis (p = 0.0004), and lower VAS 24-h post-operative (p < 0.00001) when compared with MM. However, LHP and MM did not differ in terms of recurrence rate (p = 0.70). LHP was superior to MM procedure in terms of shortening the recovery time and minimizing post-operative complications for patients with hemorrhoidal disease.
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Affiliation(s)
- Hendry Lie
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia.
| | - Evelyn Franca Caesarini
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Antonius Agung Purnama
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Andry Irawan
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Taufik Sudirman
- Department of Surgery, Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
| | - Wifanto Saditya Jeo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bernardus Parish Budiono
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Semarang, Jawa Tengah, Indonesia
| | - Erik Prabowo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Diponegoro University, Semarang, Jawa Tengah, Indonesia
| | - M Iqbal Rivai
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Andalas University, Padang, Sumatera Barat, Indonesia
| | - Ryanto Karobuana Sitepu
- Division of Digestive Surgery, Department of Surgery, Siloam Hospitals Lippo Cikarang, Bekasi, Jawa Barat, Indonesia
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