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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; 26:1266-1270. [PMID: 38671592 DOI: 10.1111/codi.17014] [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: 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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Porwal A, Gandhi P, Mokashi-Bhalerao N, Borkar N, Khobragade K. Efficacy and Safety of Oral Euphorbia prostrata Tablet and Topical Cream in the Management of Hemorrhoids During Pregnancy: Results From a Prospective Multicenter Study. Cureus 2024; 16:e54152. [PMID: 38496090 PMCID: PMC10940957 DOI: 10.7759/cureus.54152] [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: 01/20/2024] [Indexed: 03/19/2024] Open
Abstract
This is a non-randomized, open-label, prospective single-arm interventional multicentric study conducted between 2021 and 2022 at three different centers situated in Pune, India. It was conducted to evaluate the efficacy and safety of the Sitcom® tablet (Euphorbia prostrata 100 mg) once daily and Sitcom® cream (Euphorbia prostrata 1%w/w) for 14 days in hemorrhoids during pregnancy. The endpoints were to assess hemorrhoidal symptoms relief during the follow-up periods (one, two, four, and eight weeks and 30 days postpartum), relapse of symptoms, improvement in the disease condition at week two and 30 days postpartum, and adverse events. A total of 100 patients (mean age 24.1 years) were included; the majority (71.0%) had mild per-rectal bleeding, 69.0% with mild itching and 46.0% with moderate pain during defecation. The mean score of per-rectal bleeding and pain at defecation showed a significant reduction at each visit (86.6% and 49.3% (two weeks), 95.3% and 59.9% (four weeks), and 100% and 77.6% (eight weeks)). The mean pain score at defecation, itching, exudates, and swelling showed a significant reduction of 77.6%, 96.9%, 100%, and 84.5% at eight weeks (p<0.001). After two weeks and post postpartum follow-up, >90% and 100% good to excellent overall improvement in the disease condition were noted, respectively. No adverse events in the mother or newborn were noted. This pivotal study underscores the potential of a combination therapy with Euphorbia prostrate 100 mg tablet and cream 1% as a potential solution for managing the distressing burden of hemorrhoids in pregnant women. Furthermore, these observations will empower clinicians in the judicious selection of the most suitable course of action for hemorrhoid management during pregnancy.
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Affiliation(s)
| | | | - Nameeta Mokashi-Bhalerao
- Obstetrics, Gynaecology and Reproductive Medicine, Cloudnine Hospital, Pune, IND
- Surgery, Healing Hands Clinic, Pune, IND
| | - Nilesh Borkar
- Medical Affairs, Mankind Pharma Ltd., Navi Mumbai, IND
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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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Huang J, Gui Y, Qin H, Xie Y. Causal association between adiposity and hemorrhoids: a Mendelian randomization study. Front Med (Lausanne) 2023; 10:1229925. [PMID: 37869154 PMCID: PMC10587414 DOI: 10.3389/fmed.2023.1229925] [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: 05/27/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Background Hemorrhoids are a very common anorectal disorder affecting a large number of individuals throughout the world. This study aimed to evaluate the causal effects of four adiposity traits including body mass index (BMI), body fat percentage, waist circumference, and waist-to-hip ratio on hemorrhoids by Mendelian randomization (MR). Methods We used summary statistics of BMI (N = 461,460), body fat percentage (N = 454,633), waist circumference (N = 462,166), waist-to-hip ratio (N = 212,244), and hemorrhoids (N = 337,199) from large-scale genome wide association studies of European ancestry. Univariable and multivariable MR were carried out to infer causality. The MR Steiger directionality test was used to test the causal direction. Results The primary MR analysis using the inverse variance weighted (IVW) method showed that there were positive effects of genetically determined BMI [odds ratio (OR) = 1.005, 95% confidence interval (CI): 1.003-1.008, per standard deviation (SD), p = 7.801 × 10-5], body fat percentage (OR = 1.005, 95% CI: 1.001-1.008, per SD, p = 0.008), waist circumference (OR = 1.008, 95% CI: 1.005-1.011, per SD, p = 1.051 × 10-6), and waist-to-hip ratio (OR = 1.010, 95% CI: 1.003-1.017, per SD, p = 0.003) on hemorrhoids. These findings were robust in multivariable MR adjusting for physical activity. The Steiger directionality test showed evidence against reverse causation. Conclusion Our MR study supports a causal role of adiposity in the development of hemorrhoids. Adiposity prevention may be an important strategy for reducing hemorrhoids risk.
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Affiliation(s)
- Jian Huang
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ying Gui
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongping Qin
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Bhattacharya K, Bhattacharya N, Bhattacharya AS, Yagnik VD, Garg P. Anal Selfie—a New Armamentarium for Colorectal Patients. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
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Gavriilidis P, Askari A, Gavriilidis E, Di Saverio S, Davies RJ, de’Angelis N. Evaluation of the current guidelines for the management of haemorrhoidal disease using the Appraisal of Guidelines Research and Evaluation II instrument. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:265. [PMID: 37082684 PMCID: PMC10113081 DOI: 10.21037/atm-22-4255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/09/2022] [Indexed: 02/18/2023]
Abstract
Background Haemorrhoids are a very common disease and many professional societies have produced guidelines for their treatment. The aim of this study is to appraise the quality of the existing guidelines in the management of haemorrhoids. Methods A systematic search of the literature was conducted in the EMBASE, Google Scholar, Cochrane library, and PubMed databases. The quality of guidelines was independently appraised using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument by five of the authors. Results Six guidelines of varying quality were identified and included in this study. The highest scoring guidelines were the SICCR (Società Italiana di Chirurgia Colorectale, which is Italian Society of Colorectal Surgery), ESCP (European Society of Coloproctology) and ASCRS (American Society of Colon and Rectal Surgeons) guidelines, scoring 86% each overall. There was considerable variability across not just the studies but across the different domains. The highest scoring domains were domain VI: editorial independence (median =95% across all studies) and domain I: Scope & Purpose (85%). The lowest scores were observed in domain V: Applicability (48%) and domain II: Stakeholder Involvement (41%). Only three of the six gained unanimous support for their use, whilst two of the guidelines were unanimously declared not suitable for clinical use. Conclusions With the notable exception of three guidelines (SICCR, ESCP and ASCRS), the general quality of haemorrhoid guidelines is poor. Stakeholder (especially patient) involvement and instructions on how to implement recommendations is lacking from the majority of guidelines. This is an area that requires urgent attention if we are to improve guidelines in haemorrhoid management.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgery, University Hospitals of Coventry and Warwickshire NHS, Coventry, UK
| | - Alan Askari
- Cambridge Oesophagogastric Centre, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Efstratios Gavriilidis
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Salomone Di Saverio
- Department of Surgery, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - R. Justin Davies
- Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Nicola de’Angelis
- Department of Digestive Surgery, University Hospital Henri Mondor (AP-HP), Créteil, France
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7
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Wang G, Wu Y, Cao Y, Zhou R, Tao K, Wang L. Psychological states could affect postsurgical pain after hemorrhoidectomy: A prospective cohort study. Front Surg 2023; 9:1024237. [PMID: 36684369 PMCID: PMC9852767 DOI: 10.3389/fsurg.2022.1024237] [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: 08/21/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Open hemorrhoidectomy is one of the standard procedures for grade IV hemorrhoids. Postsurgical pain is a common problem for patients. We aim to prospectively evaluate potential factors affecting postoperative pain among hemorrhoidectomy patients. Methods An observational study was conducted on 360 patients who had undergone Milligan-Morgan open hemorrhoidectomy. Details of the surgery and baseline information were recorded. Preoperative anxiety and depression were analyzed via the self-rating anxiety scale 20 (SAS-20) and self-rating depression scales 20 (SDS-20), respectively. Postoperative pain score was performed daily after surgery until the patient was discharged. The numerical pain score was evaluated by the visual analogue scale (VAS). The association between preoperative psychological states (anxiety or depression) and postoperative pain was analyzed using a generalized additive mixed model. Results A total of 340 patients eventually provided complete data and were included in our study. The average age was 43.3 ± 14.4 years, and 62.1% of patients were women. In total, 14.9% of patients had presurgical anxiety and 47.1% had presurgical depression. Postsurgical pain reached a peak point 1-2 days after surgery and went down to a very low level around 4-5 days after surgery. More excision of hemorrhoids could lead to more pain experience after surgery. Presurgical depression was associated with postsurgical pain. Patients who had presurgical depression had higher pain scores after surgery (2.3 ± 1.9 vs. 3.3 ± 1.9, p = 0.025). Conclusion Preoperative depression and the amount of excisional hemorrhoids are positively related to postsurgical pain.
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Affiliation(s)
- Geng Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanjue Wu
- Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zhou
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Linfang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Correspondence: Linfang Wang
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8
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Hwang SH. Trends in Treatment for Hemorrhoids, Fistula, and Anal Fissure: Go Along the Current Trends. J Anus Rectum Colon 2022; 6:150-158. [PMID: 35979269 PMCID: PMC9328791 DOI: 10.23922/jarc.2022-012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/27/2022] [Indexed: 12/31/2022] Open
Abstract
Recent trends in benign anal disease treatment are minimizing surgery to preserve normal anorectal anatomical unit and its functions. However, some surgeons still prefer and are confident with the use of conventional solid surgical methods. In this report, we will investigate the recent trends in the treatment for hemorrhoids, fistula, and anal fissure. The practice guidelines of advanced countries, including UK, Italy, France, USA, Japan, and ESCP, are referred to in this review. Opinions suggested in international meetings were also added. In the management of hemorrhoids, surgical treatments and office procedures were recommended according to a patient's status and preference. For the management of complex anal fistula, novel sphincter-preserving surgical techniques are more widely accepted than a sphincter-dividing procedure of immediate repair following fistulectomy. The treatment of anal fissures is well covered in the guidelines of the ASCRS.
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Affiliation(s)
- Sung Hwan Hwang
- Busan Hangun Hospital & Busan Hangun Hospital Bumcheon Campus
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Brown S, Girling C, Thapa Magar H, Chaudry A, Bhatti B, Sayers A, Hind D. Guidelines, guidelines and more guidelines for haemorrhoid treatment: A review to sort the wheat from the chaff. Colorectal Dis 2022; 24:764-772. [PMID: 35119707 PMCID: PMC9310584 DOI: 10.1111/codi.16078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 01/15/2023]
Abstract
AIM Guidelines benefit patients and clinicians by distilling evidence into easy-to-read recommendations. The literature around the management of haemorrhoids is immense and guidelines are invaluable to improve treatment integrity and patient outcomes. We identified current haemorrhoid guidelines and assessed them for quality and consistency. METHODS A systematic search of the literature from January 2011 to October 2021 was carried out. Guidelines identified were assessed for quality using the AGREE II instrument and for consistency in terms of tabulated treatment recommendations. RESULTS During this period nine guidelines were identified worldwide. The general quality was poor with only one guideline considered of high enough quality for use. In general, expert selection criteria for guideline development groups were vaguely defined. There were inconsistencies in the interpretation of the published evidence leading to variation in treatment recommendations. DISCUSSION Fewer, higher quality guidelines, with more consistent results, are needed. Particular attention should be given to defining the selection of experts involved.
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Affiliation(s)
- Steven Brown
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Carla Girling
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Adeeb Chaudry
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Brian Bhatti
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Adele Sayers
- NHS Foundation TrustSheffield Teaching HospitalSheffieldUK
| | - Daniel Hind
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Godeberge P, Sheikh P, Lohsiriwat V, Jalife A, Shelygin Y. Micronized purified flavonoid fraction in the treatment of hemorrhoidal disease. J Comp Eff Res 2021; 10:801-813. [PMID: 33928786 DOI: 10.2217/cer-2021-0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Hemorrhoidal disease (HD) is common in adults. Treatment is largely conservative, although more invasive procedures may be required. Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used, but a recent and comprehensive review of supporting evidence is lacking. In acute HD, MPFF can reduce HD symptoms such as bleeding, pain, anal discomfort, anal discharge and pruritus. In patients undergoing surgery, postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia. MPFF treatment is appropriate and effective both as a first-line conservative treatment and as a postoperative adjunct treatment. MPFF reduces the duration of hospital stay following surgery, facilitating a return to normal activity and improving quality of life. MPFF may also prevent HD recurrence.
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Affiliation(s)
| | - Parvez Sheikh
- Department of Colorectal Surgery, Saifee Hospital, Mumbai, India
| | - Varut Lohsiriwat
- Division of Surgery, Department of Colorectal Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Abel Jalife
- Center of Medical Specialties & Investigation of Mexico, Mexico City General Hospital Surgery, Mexico City, Mexico
| | - Yury Shelygin
- State Scientific Center of Coloproctology, Ministry of Health of Russian Federation, Moscow, Russia
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Sheikh P, Mital K, Maheshwari U, Prabakaran J, Sharda P, Dumbre R. Clinical Presentation of Hemorrhoids and its Correlation with Chronic Venous Disease in India: a Subgroup Analysis of the International CHORUS Survey. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Khan MA, Chowdri NA, Parray FQ, Wani RA, Mehraj A, Baba A, Laway M. “PNR-Bleed” classification and Hemorrhoid Severity Score—a novel attempt at classifying the hemorrhoids. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractHemorrhoids are the most common anorectal disorders with a prevalence of 39% in general population. Hemorrhoids are generally classified on the basis of their location and degree of prolapse. Goligher’s classification does not describe the number of hemorrhoidal columns involved and does not give much consideration to the amount of blood loss. To describe the hemorrhoidal disease more vividly, we devised the “PNR-Bleed” (or PNR-Booking) classification system. We tried to classify the hemorrhoids based on the four main characteristics of the hemorrhoidal disease i.e. the degree of hemorrhoidal Prolapse (P), Number (N) of the primary hemorrhoidal columns involved, Relation (R) of the hemorrhoidal tissue to dentate line and the amount of Bleeding (B) from it. All the four components in this classification system are graded into five grades ranging from 1 to 5. The peculiarity of this new classification system is that it allows more detailed documentation of the hemorrhoids in a particular patient and conveys more explicit meaning and information about the hemorrhoids for future references. Based on this ‘PNR-Bleed’ classification, we are introducing another concept of scoring the severity of hemorrhoids and referred it as the Hemorrhoid Severity Score (HSS). Hemorrhoid Severity Score (HSS) is the total score obtained by the sum of the numerical grades of all four characteristics of hemorrhoids in “PNR-Bleed” classification. This new “PNR-Bleed” system of classifying the hemorrhoids and calculation of HSS seems to be more comprehensive, detailed, more objective and easily reproducible.
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Affiliation(s)
| | - Nisar A. Chowdri
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
| | - Fazl Q. Parray
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
| | - Rauf A. Wani
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
| | - Asif Mehraj
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
| | - Arshad Baba
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
| | - Mushtaq Laway
- Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Department of Colorectal Surgery, Srinagar, India
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Abstract
Hemorrhoids are one of the most common diseases of the anorectal region. Previously, treatment for hemorrhoids included conservative treatment, outpatient treatment, and surgical treatment. The development of flexible reversible endoscopes has provided precise controllability and imaging, enabling further improvement and development of various endoscopic techniques to treat hemorrhoids. This article discusses several of these endoscopic techniques: rubber band ligation, sclerotherapy, and electrocoagulation. The development, efficacy, and advantages of these treatments are summarized and evaluated. It is expected that going forward, endoscopic technology will be further applied in clinical practice and may become the first-line method for the treatment of hemorrhoids.
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14
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Liu Z, Song X, Ye F. Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01959-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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15
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Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg 2019; 11:117-121. [PMID: 31057696 PMCID: PMC6478596 DOI: 10.4240/wjgs.v11.i3.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 02/06/2023] Open
Abstract
Classification and guidelines of hemorrhoidal disease are based on the subdivision in Grades of prolapse followed by any aspect related to both the treatment and its technique. When taking the proposals for classification and guidelines issued by prolific scientific societies into consideration, it is evident that strong contradictions and interpretative limits emerge in finding the best treatment to be adopted. After a critical examination of these limitations, a methodological proposal is shared to achieve a new classification, which plays a part in forming a new guideline for hemorrhoidal disease, identifying its evolution, dynamism of the prolapse, symptomatology, enteropathogenesis and gender characteristics.
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Affiliation(s)
- Michele Rubbini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara 44121, Italy
| | - Simona Ascanelli
- Department of Surgery, Azienda Ospedaliero-Universitaria Sant’anna, Ferrara, Ferrara 44121, Italy
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Lee MJ, Morgan J, Watson AJM, Jones GL, Brown SR. A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials. Tech Coloproctol 2019; 23:33-41. [PMID: 30725242 PMCID: PMC6394714 DOI: 10.1007/s10151-019-01936-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.
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Affiliation(s)
- M J Lee
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK
| | - J Morgan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J M Watson
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
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17
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Bashankaev BN, Wexner SD, Arkharov AV. [Common sense of diosmin administration in combined treatment of hemorrhoids]. Khirurgiia (Mosk) 2018:83-89. [PMID: 30199057 DOI: 10.17116/hirurgia201808283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flavonoids are herbal medicines and widely used for chronic venous diseases and hemorrhoids. Flavonoid diosmin in both micronized and non-micronized form is a part of various drugs. According to literature data, flavonoids are able to reduce venous stasis, suppress local inflammation, improve venous tone and lymphatic outflow. It should be noted that biological models of in vivo trials have certain limitations while available data of different researches are contradictory. However, flavonoids were recommended for hemorrhoids in view of meta-analysis of 14 trials comparing flavonoids (diosmin, micronized purified flavonoid fraction and rutosides) with placebo in 1514 patients with hemorrhoids and Cochrane review of 24 randomized controlled trials (2,334 participants). These drugs should be administered as a part of complex therapy. At the same time, there is no conclusive evidence to prefer only one of these medicines. There are also no data confirming the benefits of daily dosage of 3000 mg per day of micronized fraction of flavonoids compared with 1800 mg of purified diosmin per day for treatment of acute hemorrhoids.
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Affiliation(s)
- B N Bashankaev
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia; GMS Clinic and Hospitals, Moscow, Russia
| | - S D Wexner
- Colorectal Surgery Department of the Cleveland Clinic Florida, Weston, USA
| | - A V Arkharov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, GMS Clinic and Hospitals, Moscow, Russia, Colorectal Surgery Department of the Cleveland Clinic Florida, Weston, USA
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18
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Garg P. Hemorrhoid Treatment Needs a Relook: More Room for Conservative Management Even in Advanced Grades of Hemorrhoids. Indian J Surg 2017; 79:578-579. [PMID: 29217916 DOI: 10.1007/s12262-017-1664-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pankaj Garg
- Indus Super Specialty Hospital, Mohali, Punjab India
- 1042, Sector-15, Panchkula, Haryana 134113 India
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