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Brillantino A, Renzi A, Talento P, Brusciano L, Marano L, Grillo M, Maglio MN, Foroni F, Palumbo A, Sotelo MLS, Vicenzo L, Lanza M, Frezza G, Antropoli M, Gambardella C, Monaco L, Ferrante I, Izzo D, Giordano A, Pinto M, Fantini C, Gasparrini M, Di Visconte MS, Milazzo F, Ferreri G, Braini A, Cocozza U, Pezzatini M, Gianfreda V, Di Leo A, Landolfi V, Favetta U, Agradi S, Marino G, Varriale M, Mongardini M, Pagano CEFA, Contul RB, Gallese N, Ucchino G, D'Ambra M, Rizzato R, Sarzo G, Masci B, Da Pozzo F, Ascanelli S, Liguori P, Pezzolla A, Iacobellis F, Boriani E, Cudazzo E, Babic F, Geremia C, Bussotti A, Cicconi M, Sarno AD, Mongardini FM, Brescia A, Lenisa L, Mistrangelo M, Zuin M, Mozzon M, Chiriatti AP, Bottino V, Ferronetti A, Rispoli C, Carbone L, Calabrò G, Tirrò A, de Vito D, Ioia G, Lamanna GL, Asciore L, Greco E, Bianchi P, D'Oriano G, Stazi A, Antonacci N, Renzo RMD, Poto GE, Ferulano GP, Longo A, Docimo L. The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease. Ann Coloproctol 2024; 40:287-320. [PMID: 39228195 DOI: 10.3393/ac.2023.00871.0124] [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: 12/11/2023] [Accepted: 02/23/2024] [Indexed: 09/05/2024] Open
Abstract
The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.
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Affiliation(s)
| | - Adolfo Renzi
- Esophageal Diseases Center and GERD Unit, Buon Consiglio Hospital, Naples, Italy
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences (Akademia Medycznych i Społecznych Nauk Stosowanych, AMiSNS), Elbląg, Poland
| | - Maurizio Grillo
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | | | - Fabrizio Foroni
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | - Alessio Palumbo
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | | | - Luciano Vicenzo
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | - Michele Lanza
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | - Giovanna Frezza
- Deparment of Surgery, Antonio Cardarelli Hospital, Naples, Italy
| | | | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Monaco
- Department of General Surgery, Villa Esther Clinic, Pineta Grande Hospital, Avellino, Italy
| | - Ilaria Ferrante
- Department of General Surgery, Villa Esther Clinic, Pineta Grande Hospital, Avellino, Italy
| | - Domenico Izzo
- Department of General and Emergency Surgery, AORN dei Colli/C.T.O. Hospital, Naples, Italy
| | - Alfredo Giordano
- Department of General and Emergency Surgery, Hospital of Mercato San Severino, University of Salerno, Salerno, Italy
| | | | - Corrado Fantini
- Department of Surgery, Pellegrini Hospital, ASL Napoli 1, Naples, Italy
| | | | | | - Francesca Milazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Ferreri
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Braini
- Department of General Surgery, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Umberto Cocozza
- Department of General Surgery, S. Maria degli Angeli Hospital, Bari, Italy
| | | | - Valeria Gianfreda
- Unit of Colonproctologic and Pelvic Surgery, M.G. Vannini Hospital, Rome, Italy
| | - Alberto Di Leo
- Department of General and Minimally Invasive Surgery, San Camillo Hospital, Trento, Italy
| | - Vincenzo Landolfi
- Department of General and Specialist Surgery, AORN S.G. Moscati, Avellino, Italy
| | - Umberto Favetta
- Unit of Proctology and Pelvic Surgery, Città di Pavia Clinic, Pavia, Italy
| | | | - Giovanni Marino
- Department of General Surgery, Santa Marta e Santa Venera Hospital of Acireale, Catania, Italy
| | - Massimiliano Varriale
- Department of General and Emergency Surgery, Sandro Pertini Hospital, ASL Roma 2, Rome, Italy
| | | | | | | | - Nando Gallese
- Unit of Proctologic Surgery, Sant'Antonio Clinic, Cagliari, Italy
| | | | - Michele D'Ambra
- Department of General and Oncologic Minimally Invasive Surgery, Federico II University, Naples, Italy
| | - Roberto Rizzato
- Department of General Surgery, Hospital Conegliano - AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giacomo Sarzo
- Department of General Surgery, Sant'Antonio Hospital, University of Padova, Padova, Italy
| | - Bruno Masci
- Department of Surgery, San Carlo di Nancy Hospital, Rome, Italy
| | - Francesca Da Pozzo
- Department of Surgery, Santa Maria dei Battuti Hospital, Pordenone, Italy
| | - Simona Ascanelli
- Department of Surgery, University Hospital of Ferrara, Ferrara, Italy
| | | | | | - Francesca Iacobellis
- Department of General and Emergency Radiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Erika Boriani
- Department of Surgery, University of Parma, Parma, Italy
| | - Eugenio Cudazzo
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Babic
- Department of Surgery, Cattinara Hospital ASUGI, Trieste, Italy
| | - Carmelo Geremia
- Unit of Proctology and Pelvic Surgery, Città di Pavia Clinic, Pavia, Italy
| | | | - Mario Cicconi
- Department of General Surgery, Sant'Omero-Val Vibrata Hospital, Teramo, Italy
| | - Antonia Di Sarno
- Esophageal Diseases Center and GERD Unit, Buon Consiglio Hospital, Naples, Italy
| | - Federico Maria Mongardini
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Brescia
- Department of Oncologic Colorectal Surgery, University Hospital S. Andrea, La Sapienza University, Rome, Italy
| | - Leonardo Lenisa
- Department of Surgery, Surgery Unit, Pelvic Floor Centre, Humanitas San Pio X, Milano, Italy
| | | | - Matteo Zuin
- Unit of General Surgery, Hospital of Cittadella - ULSS 6 Euganea, Padova, Italy
| | - Marta Mozzon
- Unit of General Surgery, S. Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | | | | | | | - Corrado Rispoli
- Unit of General Surgery, AORN dei Colli/Monaldi Hospital, Naples, Italy
| | | | - Giuseppe Calabrò
- Unit of Colonproctology, Euromedica Scientific Institut, Milano, Italy
| | - Antonino Tirrò
- Unit of Surgery, Santa Marta e Santa Venera Hospital - ASP Catania, Catania, Italy
| | - Domenico de Vito
- Unit of Surgery, Sanatrix Clinic, Pineta Grande Hospital, Naples, Italy
| | - Giovanna Ioia
- Department of General and Onologic Surgery, Andrea Tortora Hospital, Pagani, ASL Salerno, Salerno, Italy
| | | | - Lorenzo Asciore
- Department of Surgery, Ave Gratia Plena Hospital, ALS CE, Caserta, Italy
| | - Ettore Greco
- Department of Surgery, P. Colombo Hospital, Rome, Italy
| | | | | | | | - Nicola Antonacci
- Week Surgery and Day Surgery Unit, AUSL Romagna Bufalini Hospital, Cesena, Italy
| | | | | | | | - Antonio Longo
- Department of Surgery, Madonna della Fiducia Clinic, Rome, Italy
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Chen KH, Huang YL, Lin CY, Chen MC, Chiu TY, Chiang FF. Clinical outcomes of laser hemorrhoidoplasty with feeding vessels suture ligation: a retrospective study in a single center. Tech Coloproctol 2024; 28:78. [PMID: 38955875 DOI: 10.1007/s10151-024-02940-4] [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: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally adopted suture ligating the feeding vessels. This study aimed to understand the treatment outcomes and any associated complications. METHODS This study comprised patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy between 1 September 2020, and 31 August 2022. Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected from inpatient records, outpatient follow-ups, and telephone interviews. Initially, we will analyze the distinctions between the laser group and the traditional group, followed by an investigation into complications and satisfaction within the laser surgery subgroup. RESULTS The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy. Regarding pain assessment, the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences. CONCLUSIONS Laser hemorrhoidoplasty with feeding vessels suture ligation has been shown to reduce postoperative pain and appears to be a promising minimally invasive treatment option for symptomatic grade II and III hemorrhoids.
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Affiliation(s)
- K-H Chen
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC)
| | - Y-L Huang
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC)
| | - C-Y Lin
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC)
| | - M-C Chen
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC)
| | - T-Y Chiu
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC)
| | - F-F Chiang
- Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407219, Taiwan (ROC).
- Department of Food and Nutrition, Providence University, Taichung, Taiwan.
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Jin L, Qin K, Wu R, Yang H, Cui C, Wang Z, Wu J. Laser hemorrhoidoplasty vs. rubber band ligation: a randomized trial comparing 2 mini-invasive treatment for grade II hemorrhoids. BMC Surg 2024; 24:164. [PMID: 38797851 PMCID: PMC11129420 DOI: 10.1186/s12893-024-02425-z] [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: 07/02/2023] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE As a minimally invasive procedure, laser hemorrhoidoplasty (LHP) can not only relieve the symptoms of hemorrhoids, but also protect the anal cushion structure. This study aimed to investigate the clinical efficacy of LHP in the treatment of grade II hemorrhoids. METHODS A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group) in 2019 from a single center. The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups. RESULTS The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P < 0.01). Both methods can relieve the symptoms of grade II hemorrhoids. There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05). The patients in LHP group took less time to return to normal activities (P < 0.001). CONCLUSIONS As a minimally invasive treatment, LHP is easy and not traumatic and results in mild postoperative pain and few complications. It is an ideal choice for grade II hemorrhoids.
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Affiliation(s)
- Lei Jin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kaijian Qin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Renjie Wu
- Department of Coloproctology, Xiangshan TCM Hospital, Huangpu District, Shanghai, China
| | - Haojie Yang
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Can Cui
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhenyi Wang
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jiong Wu
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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Xu W, Xia G, Dong L, Zhu Y. Effect of lidocaine on postoperative analgesia of endoscopic rubber band ligation combined with injection sclerotherapy for treatment of internal hemorrhoids: A retrospective study (with video). Arab J Gastroenterol 2024; 25:165-169. [PMID: 38403495 DOI: 10.1016/j.ajg.2024.01.007] [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: 12/25/2022] [Revised: 10/28/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic minimally invasive treatment of internal hemorrhoids may cause postoperative pain. The aim of the study is to investigate the analgesic effect of lidocaine plus lauromacrogol on postoperative pain caused by endoscopic rubber band ligation (ERBL) combined with injection sclerotherapy (IS) for internal hemorrhoids treatment. PATIENTS AND METHODS Clinical data of grade Ⅲ internal hemorrhoids patients who underwent ERBL combined with IS in department of Digestive Medicine, Shenzhen Hospital of Southern Medical University, were retrospectively analyzed. According to difference in the composition of sclerosing solution, the patients were divided into control group (lauromacrogol group, 46 patients) and study group (lidocaine plus lauromacrogol group, 20 patients). Postoperative pain (quantized by Visual Analogue Scale, VAS), pain relief time and postoperative adverse reactions were compared. The therapeutic effect was followed up 1 month after operation. RESULTS VAS of postoperative pain was 0.80 ± 0.42 points and pain relief time was 0.90 ± 0.56 days in the study group, while VAS of postoperative pain was 4.11 ± 1.37 points and pain relief time was 2.57 ± 0.83 days in the control group, there was statistical difference between them (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions and follow-up therapeutic effect between the control group and the study group. CONCLUSION Lidocaine plus lauromacrogol is useful for pain alleviation on ERBL combined with IS for internal hemorrhoids treatment because of its convenient procedure, low adverse reaction incidence and good therapeutic effect, which is worthy of promotion.
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Affiliation(s)
- Wen Xu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Guili Xia
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ling Dong
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ying Zhu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China.
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Liu X, Sheng B, Zhang J, Wang J, Yu J, Zhang G, Dai F, Su H, Xu J, Hu W, Li T, Zhu P. Modified whitehead hemorrhoidectomy versus partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids: A retrospective analysis. Heliyon 2024; 10:e28465. [PMID: 38596109 PMCID: PMC11002042 DOI: 10.1016/j.heliyon.2024.e28465] [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: 11/15/2022] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of this procedure for grade IV circular hemorrhoid patients. Methods Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed. Clinical data were extracted from the database at our institution, and long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication. Results A total of 205 patients were included in this study. The mean operative time was 59.2 ± 13.8 min. The average hospital stay was 4.6 ± 1.0 days. For postoperative complications, 66 (32.2%) patients had urinary retention, 10 (4.9%) patients had a sense of incomplete rectal emptying, 5 (2.4%) patients had anal incontinence, and 6 (2.9%) patients had wound infection. For long-term postoperative complications, 3 (1.5%) patients experienced mild to moderate anal stricture, 2 (1%) patients experienced mucosal ectropion, they all had smooth recoveries, and none of them needed secondary surgery. None of these patients had a hemorrhoid recurrence. A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included. There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence. After modified Whitehead hemorrhoidectomy, 3 patients developed anal stenosis, and 2 had mucosal ectropion. Four patients developed anal stricture after partial hemorrhoidectomy, and none had mucosal ectropion. They all had smooth recoveries, and none of them needed a secondary surgery. For the mean duration of surgery, postoperative bleeding, postoperative pain, wound infection, sense of incomplete rectal emptying, anal incontinence, and urinary retention, no statistically significant differences were found between the two groups. Conclusions Compared with partial hemorrhoidectomy, modified whitehead hemorrhoidectomy is an effective and safe surgical procedure and does not significantly increase the risk of anal stenosis and mucosal ectropion for grade IV circular hemorrhoid patients. Prospective randomized controlled trials are needed to verify our results.
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Affiliation(s)
- Xie Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Bo Sheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jianbo Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jijian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jun Yu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Guanggang Zhang
- Department of General Surgery, The People's Hospital of Chongqing City, Chongqing, 400014, China
| | - Fengshun Dai
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Heng Su
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Jingsong Xu
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Wei Hu
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Tong Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Peng Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
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Cemil A, Ugur K, Salih GM, Merve K, Guray DM, Emine BS. Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease. Am Surg 2024; 90:662-671. [PMID: 37846728 DOI: 10.1177/00031348231207301] [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: 10/18/2023]
Abstract
INTRODUCTION The estimated prevalence of hemorrhoidal disease (HD) worldwide ranges from 2.9% to 27.9%. Conservative, medical, non-operative, and surgical therapy approaches are applied in HD treatment. Milligan-Morgan (MM) hemorrhoidectomy which is the most well-known and frequently applied surgical treatment method, and Laser hemorrhoidoplasty (LH) are among the accepted treatment methods in Grade 2-3 HD treatment where medical treatment is insufficient. PURPOSE In this study, the early results of laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy techniques were compared. MATERIAL AND METHODS A randomized clinical trial. The study included ASA 1-3, total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment. Fifty-four patients were allocated to Group L, whereas 31 were allocated to Group M. Age, gender, weight, body mass index, preoperative symptoms, presence of additional disease, use of anticoagulant medication, and length of hospital stay of the patients included in the study were recorded. Rescue analgesic used was recorded. Postoperative VAS score and complications were recorded within 10 days. The total energy numbers applied to all packages were recorded. RESULTS The incidence of minor perioperative hemorrhage was significantly lower in Group L compared to Group M (P = .035). The postoperative 3rd-hour VAS scores were statistically significantly lower in Group L compared to Group (P < .001). At the 3rd hour postoperatively, the need for rescue analgesia was statistically significantly higher in Group M compared to Group L. On the seventh postoperative day, Group M needed considerably more rescue analgesia compared to Group L (P < .001, P = 1.00, P = .035, respectively). The cut-off value of 571 J was calculated in Group L. CONCLUSION We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness, since postoperative pain, which is shown as the most important advantage of LH over conventional hemorrhoidectomy methods in the literature, can be relieved with simple NSA-I rescue analgesia in patients undergoing MM. Trial Registration: 03.06.2021/21-63.
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Affiliation(s)
- Adas Cemil
- Department of General Surgery, Health Science University, Sultan II. Abdulhamid Han, Training and Reseach Hospital, Istanbul, Türkiye
| | - Kesici Ugur
- Department of General Surgery, Health Science University, Prof. Dr. Cemil Tascioglu, Training, and Research Hospital, Istanbul, Türkiye
| | - Genc M Salih
- Department of General Surgery, Health Science University, Sultan II. Abdulhamid Han, Training and Reseach Hospital, Istanbul, Türkiye
| | - Karadag Merve
- Department of General Surgery, Health Science University, Sultan II. Abdulhamid Han, Training and Reseach Hospital, Istanbul, Türkiye
| | - Duman M Guray
- Department of General Surgery, Health Science University, Prof. Dr. Cemil Tascioglu, Training, and Research Hospital, Istanbul, Türkiye
| | - Boluk S Emine
- Department of General Surgery, Health Science University, Sultan II. Abdulhamid Han, Training and Reseach Hospital, Istanbul, Türkiye
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Jain A, Lew C, Aksakal G, Hiscock R, Mirbagheri N. Laser hemorrhoidoplasty in the treatment of symptomatic hemorrhoids: a pilot Australian study. Ann Coloproctol 2024; 40:52-61. [PMID: 35584917 PMCID: PMC10915529 DOI: 10.3393/ac.2022.00164.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/02/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Traditional therapeutic approaches to the surgical management of hemorrhoid disease such as hemorrhoidectomies are plagued with severe postoperative pain and protracted recovery. Our pilot study aims to the laser hemorrhoidoplasty (LH) patients with symptomatic hemorrhoid disease that have failed conservative management for the first time in an Australian population. METHODS Thirty patients were prospectively enrolled to undergo LH. Postoperative pain, time to return to function, and quality of life (QoL) were determined through the Hemorrhoid Disease Symptom Score and Short Health Scale adapted for hemorrhoidal disease and compared to a historical group of 43 patients who underwent a Milligan-Morgan hemorrhoidectomy by the same surgeon at 3, 6, and 12 months. RESULTS The LH group had significantly lower mean predicted pain scores on days 1 and 2 and lower defecation pain scores and lower opioid analgesia use on days 1, 2, 3, and 4. The median time to return to normal function was significantly lower in the LH group (2 days vs. 9 days, P<0.001). Similarly, the median days to return to the workplace was significantly lower in the LH group (6 days vs. 13 days, P=0.007). During long-term follow-up (12 months), hemorrhoid symptoms and all QoL measures were significantly improved, especially among those with grade II to III disease. CONCLUSION This pilot study demonstrates low pain scores with this revivified procedure in an Australian population, indicating possible expansion of the therapeutic options available for this common condition. Further head-to-head studies comparing LH to other hemorrhoid therapies are required to further determine the most efficacious therapeutic approach.
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Affiliation(s)
- Anshini Jain
- Department of Surgery, Epworth HealthCare, Melbourne, VIC, Australia
- Department of Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Chen Lew
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Gamze Aksakal
- Department of Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Richard Hiscock
- Department of Surgery, Epworth HealthCare, Melbourne, VIC, Australia
| | - Naseem Mirbagheri
- Department of Surgery, Epworth HealthCare, Melbourne, VIC, Australia
- Department of Surgery, Eastern Health, Melbourne, VIC, Australia
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Kavraal Ş, Avcıoğlu BÜ, Hoşafcı MC, Akkuyu FZ, İnci G, Ortaç B, Seymen AA. Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser. POLISH JOURNAL OF SURGERY 2024; 96:1-6. [PMID: 38965992 DOI: 10.5604/01.3001.0054.4819] [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: 07/06/2024]
Abstract
<b>Indroduction:</b> Hemorrhoids often cause pain, and achieving painless outcomes through surgery is challenging. Hemorrhoidal Laser Ablation, a method for treating severe hemorrhoids, has limited documentation in clinical trials.</br> <br><b>Aim:</b> This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation in symptomatic grade II, III, and IV internal hemorrhoids and evaluate the efficacy and safety of this relatively recent technique.</br> <br><b>Material and methods:</b> The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation at three different medical centers in 2017-2022. Patients were treated with a 1470 nm diode laser. Data were collected on clinical and perioperative characteristics and outcomes.</br> <br><b>Results:</b> No evidence of intraoperative complications occurred. There was no rectal tenesmus or alteration of defecation habits. Early mild postoperative symptoms were observed for an average of one week after the operation. The plateau of symptom resolution and downgrading of hemorrhoid size reached approximately six months post-procedure. The short- -term recurrence rate was 0.8% within roughly a month after the laser surgery, while the long-term recurrence rate was 5% over up to five years of follow-up. The overall satisfaction rate was 95% with symptomatic relief.</br> <br><b>Conclusions:</b> Hemorrhoidal Laser Ablation is a painless outpatient technique that does not require general anesthesia. It is an easy-to-perform, convenient, safe, and efficient modality in reducing symptoms and complications of grades II, III, and IV internal hemorrhoids. Hemorrhoidal Laser Ablation limits postoperative discomfort and allows the patient to return to daily routines quickly.</br>.
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Affiliation(s)
- Şehrazat Kavraal
- Research and Development Department, Vamet Medikal Corporate Research Inc., Ankara, Turkey
| | | | - Mert Can Hoşafcı
- Research and Development Department, Vamet Medikal Corporate Research Inc., Ankara, Turkey
| | - Fatma Zehra Akkuyu
- Research and Development Department, Vamet Medikal Corporate Research Inc., Ankara, Turkey
| | - Gizem İnci
- Research and Development Department, Vamet Medikal Corporate Research Inc., Ankara, Turkey
| | - Bülend Ortaç
- Bilkent University, UNAM-National Nanotechnology Research Center and Institute of Materials Science and Nanotechnology, Ankara, Turkey
| | - Ali Aytaç Seymen
- Research and Development Department, Vamet Medikal Corporate Research Inc., Ankara, Turkey, Bilkent University, UNAM-National Nanotechnology Research Center and Institute of Materials Science and Nanotechnology, Ankara, Turkey, E-A Teknoloji LLC, Ankara, Turkey
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Solari S, Martellucci J, Annicchiarico A, Scheiterle M, Bergamini C, Prosperi P. Laser technology in proctological diseases: is it really the wave of the future? Updates Surg 2023; 75:1759-1772. [PMID: 37438655 DOI: 10.1007/s13304-023-01578-5] [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: 12/05/2022] [Accepted: 06/25/2023] [Indexed: 07/14/2023]
Abstract
Different types of lasers have been applied for various proctological conditions. We discuss about published articles regarding the application of lasers, with concern about evidence-based use of these techniques and technologies. We performed a literature search about laser treatments for proctological conditions. 55 studies were included for the final revision. Meta-analysis of data was not performed because of heterogeneity of study designs and outcome measures. A scoping review was performed. Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive. Studies are heterogeneous in design, endpoints, postoperative assessment, length of follow-up and outcome measures. Only 3 RCTs are available and only three studies evaluate long-term outcomes. FiLaC (fistula laser closure) was initially described in 2011 for the treatment of anal fistula. In the published studies the reported healing rates vary between 20 and 82%, and the ideal indication is yet to be defined. Studies with long-term follow-up are lacking. SiLaT (sinus laser treatment) applied the technology used for FiLaC to the treatment of pilonidal sinus disease. This technique had less perioperative pain and shorter hospital stay, but a lower primary healing rate when compared to traditional techniques. Available data is very limited, and no randomized trials are published to date. Laser assisted techniques are a viable, minimally invasive, but expensive option for the treatment of several proctological conditions. Further researches are needed to assess if patients could benefit of their use, and for what indication.
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Affiliation(s)
- Stefano Solari
- Emergency Surgery, Careggi University Hospital, Florence, Italy.
- Department of Medical Science, University of Ferrara, Ferrara, Italy.
| | | | - Alfredo Annicchiarico
- Emergency Surgery, Careggi University Hospital, Florence, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Carlo Bergamini
- Emergency Surgery, Careggi University Hospital, Florence, Italy
| | - Paolo Prosperi
- Emergency Surgery, Careggi University Hospital, Florence, Italy
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Durgun C, Yiğit E. Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis. Cureus 2023; 15:e43119. [PMID: 37692631 PMCID: PMC10483433 DOI: 10.7759/cureus.43119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background and objective Minimally invasive techniques in the surgical treatment of hemorrhoids have been gaining in popularity. Laser hemorrhoidoplasty (LHP) and LigaSure™ (LigH; Medtronic, Dublin, Ireland) hemorrhoidectomy methods are the most recent innovative methods that are increasingly used. In this study, we aimed to compare the effectiveness of these two innovative techniques. Methods The data of patients who underwent LHP or LigH for grade III hemorrhoidal disease at our clinic between January 2022 and June 2023 were retrospectively analyzed. Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded. Results A total of 100 patients were included in the study. Of these, 48 patients had LHP surgery and 52 had LigH surgery. The demographic characteristics of both groups were similar. The mean operation time was statistically significantly shorter in the LHP group (p<0.001). The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001). The median time to return to daily activity was 2.3 (range: one to three) days in the LHP group and 4.6 (range: 3-11) days in the LigH group (p<0.001). Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001). Conclusion Based on our findings, LHP is an effective procedure for the surgical treatment of hemorrhoidal disease as it is associated with less morbidity, less pain, early return to work, and acceptable recurrence rates.
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Affiliation(s)
- Cemalettin Durgun
- General Surgery, Üsküdar University Faculty of Medicine, Istanbul, TUR
- General Surgery, Memorial Dicle Hospital, Diyarbakır, TUR
| | - Ebral Yiğit
- General Surgery, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
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Tümer H, Ağca MH. Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II-III hemorrhoidal disease: a retrospective analysis. ANZ J Surg 2023; 93:1885-1889. [PMID: 37312422 DOI: 10.1111/ans.18568] [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: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hemorrhoidal disease is a common ailment that presents a challenge in terms of standard treatment methods. Although surgical hemorrhoidectomy is often considered the gold standard, new surgical techniques have emerged, such as laser hemorrhoidoplasty and LigaSure hemorrhoidectomy, to address postoperative pain, bleeding, and extended return-to-work times. This study aims to compare the outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in patients with grade II-III hemorrhoidal disease. METHODS A retrospective analysis was conducted on a cohort of patients who underwent laser hemorrhoidoplasty or LigaSure hemorrhoidectomy. Data were collected on postoperative pain, complications, recurrence rates, and return-to-work times. The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS). RESULTS Patients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%). Return to work and normal activities time after laser hemorrhoidoplasty was shorter than after LigaSure hemorrhoidectomy. CONCLUSION Laser hemorrhoidoplasty is a minimally invasive technique that can be safely applied in suitable grade II-III patients, offering lower postoperative pain rates, fewer complications, and shorter return to work and normal activity times compared to LigaSure hemorrhoidectomy. However, recurrence rates are still higher for laser hemorrhoidoplasty. Future studies should explore the potential of combining laser hemorrhoidoplasty with other surgical treatments.
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Affiliation(s)
- Haluk Tümer
- Department of General Surgery, Seyhan State Hospital, Adana, Turkey
| | - Mevlüt Harun Ağca
- Department of General Surgery, Medicalpark Hospital, Antalya, Turkey
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Gambardella C, Brusciano L, Brillantino A, Parisi S, Lucido FS, Del Genio G, Tolone S, Allaria A, Di Saverio S, Pizza F, Sturiale A, Docimo L. Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend. Langenbecks Arch Surg 2023; 408:140. [PMID: 37020091 PMCID: PMC10076349 DOI: 10.1007/s00423-023-02879-4] [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: 07/25/2022] [Accepted: 03/31/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Hemorrhoidal disease (HD) is a common condition, and several surgical techniques have been proposed to date without being able to achieve definitive consensus on their use and indications. Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure for HD treatment determining the shrinkage of the hemorrhoidal piles by diode laser limiting the postoperative discomfort and pain. The aim of the current study was to evaluate the postoperative outcomes of HD patients undergoing LHP vs conventional Milligan-Morgan hemorrhoidectomy (MM). METHOD Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity of grade III symptomatic HD patients undergoing LHP vs MM were retrospectively evaluated. The patients were followed-up for recurrence of prolapsed hemorrhoid or symptoms. RESULT From January 2018 to December 2019, 93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment using a 1470-nm diode laser. No significant intraoperative complications occurred in both groups. Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management. After 25 ± 8 months follow-up, the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05) with a similar Rorvik score (7.8 ± 2.6 in LHP group vs 7.6 ± 1.9 in MM group, p = 0.12). CONCLUSION LHP demonstrated high efficacy in selected HD patients guaranteeing lower postoperative pain, easier wound care, higher rate of symptoms resolution, and greater patient appreciation compared to MM, even though it had a higher recurrence rate. Larger comparative studies are needed to address this issue.
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Affiliation(s)
- Claudio Gambardella
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy.
| | - Luigi Brusciano
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Antonio Brillantino
- Department of Emergency Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, Naples, Italy
| | - Simona Parisi
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Gianmattia Del Genio
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Salvatore Tolone
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Alfredo Allaria
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
| | - Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OQQ, UK
| | - Francesco Pizza
- Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy
| | - Alessandro Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
| | - Ludovico Docimo
- Division of General, Oncological, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", via Luigi Pansini n° 5, 80131, Naples, Italy
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Ram E, Kayzer M, Zager Y, Anteby R, Nachmany I, Carter D, Meyer R, Horesh N. Laser hemorrhoidoplasty for II-IV grade hemorrhoids: should we treat them the same? Updates Surg 2023; 75:635-642. [PMID: 36881287 DOI: 10.1007/s13304-023-01480-0] [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: 06/25/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023]
Abstract
Laser Hemorrhoidoplasty (LHP) is a novel therapeutic option for hemorrhoids. In this study, we aimed to evaluate the post-operative outcomes of patients undergoing LHP surgery based on hemorrhoid grade. A retrospective analysis of a prospective database of all patients who underwent LHP surgery between September 2018 and October 2021 was performed. Patients' demographics, clinical perioperative data, and post-operative outcomes were recorded and analyzed. One hundred and sixty two patients that underwent laser hemorrhoidoplasty (LHP) were included. Median operative time was 18 min (range 8-38). Median total energy applied was 850 Joule (450-1242). Complete remission of symptoms following surgery was reported by 134 patients (82.7%), while 21 patients (13%) reported partial symptomatic relief. Nineteen patients (11.7%) presented with post-operative complications, and 11 patients (6.75%) were re-admitted following surgery. Post-operative complication rate was significantly higher in patients with grade 4 hemorrhoids compared to grades 3 or 2, due to a higher rate of post-operative bleeding (31.6% vs. 6.5% and 6.7%, respectively; p = 0.004). Furthermore, post-operative readmission rate (26.3% vs. 5.4% and 6.2%; p = 0.01) and reoperation rate were also significantly higher in grade IV hemorrhoids (21.1% vs. 2.2% and 0%; p = 0.001). Multivariate analysis found that grade IV hemorrhoids had a significantly higher risk for post-operative bleeding (OR 6.98, 95% CI 1.68-28.7; p = 0.006), 30-day readmission (OR 5.82, 95% CI 1.27-25.1; p = 0.018), and hemorrhoids recurrence (OR 11.4, 95% CI 1.18-116; p = 0.028). LHP is an effective treatment for hemorrhoids grades II-IV, but carries significant risk for bleeding and re-intervention in patients with grade IV hemorrhoids.
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Affiliation(s)
- Edward Ram
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Kayzer
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Zager
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roi Anteby
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ido Nachmany
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Carter
- Department of Gastroenterology Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Faculty Of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Horesh
- Department of General Surgery B, Sheba Medical Center, Ramat-Gan, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA. .,Department of Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
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Li Z, Jin L, Gong T, Qin K, Cui C, Wang Z, Wu J. An effective and considerable treatment of pilonidal sinus disease by laser ablation. Lasers Med Sci 2023; 38:82. [PMID: 36856904 PMCID: PMC9977879 DOI: 10.1007/s10103-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
The treatment of sacrococcygeal pilonidal disease (SPD) is still challenging. Although many non-surgical and surgical methods exist, no consensus has been reached on the best treatment. This study aimed to evaluate the efficacy of laser ablation using 1470-nm radial diode laser fiber in treating SPD. We retrospectively studied the data of our 48 patients who operated on this technique between March 2019 and July 2022. All patients were treated with laser ablation using 1470-nm radial diode laser fiber. The healing rate and recurrence rate, demographic and surgical data, postoperative pain, complications (wound infection, wound bleeding), the time of returning to regular work and life, and the time of wound healing were recorded. Postoperative pain was measured based on the visual analog scale (VAS) score. Postoperative follow-up was performed in the outpatient clinic every 1 week for 1 month. Among the 48 patients, 41 males and 7 females, with a mean age of 27.7 years (range 14-42), the healing rate was 100%, and the average healing time was 28.3 ± 5.5 days. Mean operative time was 15.5 ± 3.3 min. The recurrence rate was 2.1%. One patient relapsed 3 months after the operation. The patient underwent laser ablation again, and the sinus tract was closed. The median visual analog scale (VAS) score on the day of operation was 0(0,2). The median VAS score on the first, third, seventh, and fourteenth day after operation was 0(0,2), 0(0,1), 0(0,1), and 0(0,0), respectively. There was no wound infection or bleeding after the operation. The mean time to normal work/life was 7.1 ± 3.2 days. Almost all the patients felt very satisfied with the operation. Laser ablation using 1470-nm radial diode laser fiber is effective in SPD treatment. It is associated with minor wounds and mild postoperative pain. It is a simple, safe, and minimally invasive technique and its clinical application for acute and chronic SPD in the absence of abscess is promising.
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Affiliation(s)
- Zhicheng Li
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Lei Jin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Tianyun Gong
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kaijian Qin
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Can Cui
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhenyi Wang
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jiong Wu
- Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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Boerhave NHP, Klicks RJ, Dogan K. The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: An observational cohort study. Colorectal Dis 2023. [PMID: 36757069 DOI: 10.1111/codi.16514] [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: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
AIM Laser haemorrhoidoplasty (LHP) is an emerging nonexcisional surgical procedure in which the arteriovenous flow of the haemorrhoidal plexus is interrupted through laser coagulation. The aim of this cohort study was to assess efficacy of LHP in treating symptomatic haemorrhoidal disease through patient satisfaction, remission of symptoms (blood loss, pain, itching, soiling, mucosal prolapse) and recurrence of haemorrhoids. METHODS Patients who underwent treatment for symptomatic haemorrhoids (degrees 1-4) through an LHP procedure between 2015 and 2021 were included in the study. A 1470 nm-diode laser was used. A total of 200 patients (71% male, average age 51 years) were analysed. Primary outcomes were patient satisfaction and/or complete recovery of symptoms. Secondary outcomes were operating time, complications and recurrence rates. Patient satisfaction, postoperative blood loss, pain and complications were evaluated 6-7 weeks postoperatively. Room turnover time and operating time were documented. Recurrence of haemorrhoids following LHP treatment within 1 year was evaluated. RESULTS Patient satisfaction regarding LHP treatment was reached in 155 (84,7%) patients. Postoperative blood loss was reported by 44 (24,0%) patients during time of evaluation. Twenty-four (13,1%) patients reported postoperative pain after 6-7 weeks. Postoperative complications occurred in seven patients (3 anal fissures, 2 perianal abscess, 1 perianal fistula, 1 postoperative anaemia). Room turnover time (patient in to patient out) was 21 min with an average operating time of 7 min. Recurrence of haemorrhoids within 1 year occurred in 50 (27,3%) patients. CONCLUSIONS Laser haemorrhoidoplasty appears to be a promising and effective nonexcisional surgical procedure in the treatment of symptomatic haemorrhoidal disease with high patient satisfaction, acceptable postoperative symptoms, minimal complications and short operating times.
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Affiliation(s)
| | - Rutger J Klicks
- Department of Surgery, BovenIJ hospital, Amsterdam, The Netherlands
| | - Kemal Dogan
- Department of Surgery, BovenIJ hospital, Amsterdam, The Netherlands
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Wee IJY, Koo CH, Seow-En I, Ng YYR, Lin W, Tan EJKW. Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis. Ann Coloproctol 2023; 39:3-10. [PMID: 36593573 PMCID: PMC10009065 DOI: 10.3393/ac.2022.00598.0085] [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: 09/02/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids. METHODS PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities. RESULTS Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], -2.09; 95% confidence interval [CI], -3.44 to -0.75; P=0.002) and postoperative day 7 (MD, -3.94; 95% CI, -6.36 to -1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42-0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12- 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240). CONCLUSION LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.
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Affiliation(s)
- Ian Jun Yan Wee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Chee Hoe Koo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yvonne Ying Ru Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Wenjie Lin
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial. J Vasc Interv Radiol 2023; 34:736-744.e1. [PMID: 36736690 DOI: 10.1016/j.jvir.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. MATERIAL AND METHODS This study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months. RESULTS The mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups. CONCLUSIONS Despite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment.
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Latha S, Kamath N, Joseph G. Postoperative Discomfort Among Laparotomy Patients from a Selected Hospital at Mangaluru: An Observational Study. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2023. [DOI: 10.1055/s-0042-1760234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract
Background Factors causing postoperative discomfort after laparotomy are numerous and must be explored in depth. The postoperative distress may significantly affect the patient's state of well-being. Hence, the present study aims to assess the factors contributing to discomfort after laparotomy.
Aim The aim was to assess and compare the discomfort between open and laparoscopic abdominal surgery.
Objectives of the Study
1. To analyze the causes of patient's discomfort after abdominal surgery.2. To compare the discomfort between open and laparoscopic abdominal surgery.3. To determine the association between pain and selected variables among open and laparoscopic abdominal surgery.
Materials and Methods An exploratory approach with a prospective observational design was adopted for this study. Using the purposive sampling technique, 100 patients were selected to open and 100 to laparoscopic abdominal surgery groups. Data were collected using demographic and clinical proforma and standardized postoperative discomfort inventory 6 and 24 hours after the surgery. The assessment focused on the study variables such as symptoms after the surgery and the factors contributing to the postoperative discomfort.
Statistical Analysis The collected data were analyzed using descriptive and inferential statistics using the SPSS software version 20.
Results Among 200 participants, most of the open (68%) and laparoscopic abdominal surgeries (42%) belong to 25 to 35 years of age. Also, 54% and 13% were diabetic in open and laparoscopic abdominal surgery groups, respectively. Most samples (56% in open and 68% in laparoscopic surgery) stayed 5 and 10 hours in postoperative ICU. In open and laparoscopic abdominal surgeries, pain is the primary (100%) cause of postoperative discomfort after 6 hours of surgery. Movement restriction is also the reason for significant discomfort both in open (98%) and laparoscopic (100%) abdominal surgeries.In contrast, pain (99% and 100%), movement restriction (92% and 95%), and abdominal distention (61% and 34%) were the major problems contributing to the patient's discomfort after 24 hours of both open and laparoscopic surgeries too. There was a significant difference in causes of patient discomfort between open and laparoscopic abdominal surgery after 6 hours (P < 0.05), except for discomfort related to IV drip (P = 0.852), constipation (P = 0.2), and chills (P = 0.6).
Conclusion Even though pain is the major distressing factor both in open and laparoscopic surgeries, the current study highlights a few other factors that affect postoperative recovery. Nurses' attention to such distressing factors will fasten patients' recovery and quality of life after abdominal surgery.
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Affiliation(s)
- S. Latha
- Department of Medical-Surgical Nursing, Nitte (Deemed to be University), Nitte Usha Institute of Nursing Sciences (NUINS), Mangaluru, Karnataka, India
| | - Neetha Kamath
- Dept of Community Health Nursing, Nitte (Deemed to be University), Nitte Usha Institute of Nursing Sciences (NUINS), Mangaluru, Karnataka, India
| | - Gincy Joseph
- Emergency Nursing and Life Support Course, RGUHS-JeevaRaksha Trust, Bengaluru, Karnataka, India
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19
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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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20
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Laser ablation of anal fistulae: a 6-year experience in a tertiary teaching hospital in Malaysia. Lasers Med Sci 2022; 37:3291-3296. [PMID: 36044123 DOI: 10.1007/s10103-022-03628-7] [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: 01/28/2021] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Several studies have investigated the role of laser ablation of anal fistulae in the European setting. However, long-term follow-up results following laser fistula ablations are not widely investigated and no study was performed in the Asia-Pacific, a region with a distinctive prevalence of tuberculosis. The primary objective of this study is to report a single-centre experience with laser ablation of anal fistulae in Malaysia over a period of 6 years. METHOD This was a retrospective observational study assessing the outcomes following 70 laser ablations of anal fistulae from February 2014 till December 2019. All cases were assessed using endoanal ultrasound. The laser ablation procedures were performed using laser systems and fibres from Endoteq Medizinische Laser GmBH, Germany, and Biolitec AG, Jena, Germany. Laser fibres were introduced into the fistula tract and laser energy was emitted radially in continuous mode when activated during the procedure. Pre-defined post-procedural outcomes (primary healing, healing failure or recurrence) were recorded as either present or absent during subsequent follow-up appointments and the data was analysed. RESULTS Over a median follow-up period of 10 months, primary healing was reported following 42 procedures (60.0%). Healing failure was reported following 28 procedures (40.0%) whilst recurrence was seen after 16 procedures (22.86%). No new cases of incontinence were reported following the procedure. CONCLUSION The reported primary healing rate following laser ablation of anal fistulae in this study appears consistent with existing literature published by other international centres. The most apparent clinical advantage of this procedure is sphincter-function preservation. However, the primary healing rate after isolated laser fistula ablation is still suboptimal. Judicious patient selection and application in anal fistulae with suitable characteristics could potentially improve the post-procedural outcomes.
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21
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Sofii I, Darmawan H, Ramadhini AS, Kurniawan F, Hanif AS. Comparison of anal dilatation versus no dilatation with a standardized dilator in reducing pain after hemorrhoidectomy: a randomized control trial. BMC Gastroenterol 2022; 22:379. [PMID: 35945514 PMCID: PMC9364542 DOI: 10.1186/s12876-022-02409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Post-operative pain is the main problem of hemorrhoidectomy. An adequate pain management can promote early mobilization, fast recovery, and reduce hospitalization costs. This study aimed to investigate the role of preoperative anal dilatation using a standardized anal dilator in reducing post-operative pain. METHOD This study was conducted using randomized prospective trial with a total of 40 subjects, who were divided into 2 groups. The first group received preoperative anal dilatation using a 33 mm anal dilator for 20 min, while the second group did not. The post-operative anal pain, edema, bleeding, and incontinence were observed in the first, second, and seventh day. RESULT The post-operative pain was significantly lower in the preoperative anal dilatation group for all days of observation (p < 0.05). The difference of post-operative bleeding and edema between groups were not significant. Fecal incontinence was initially significantly higher in the preoperative anal dilatation group, but the difference was insignificant at the seventh day (p = 0.500). CONCLUSION Preoperative anal dilatation significantly reduced post-operative pain. The side effect of fecal incontinence was only temporary until the seventh day after surgery. Trial Registration This trial was registered on Thai Clinical Trials Registry (TCTR) with TCTR identification number TCTR20220314002, on 14/03/2022 (retrospectively registered).
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Affiliation(s)
- Imam Sofii
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Gadjah Mada University/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
| | - Handy Darmawan
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Gadjah Mada University/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
| | - Amelia Sophia Ramadhini
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Gadjah Mada University/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
| | - Fauzan Kurniawan
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Gadjah Mada University/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
| | - Ahmad Shafa Hanif
- Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Gadjah Mada University/Dr, Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281 Indonesia
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22
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Elfallal AH, Fathy M, Elbaz SA, Emile SH. Comprehensive literature review of the applications of surgical laser in benign anal conditions. Lasers Med Sci 2022; 37:2775-2789. [PMID: 35606626 DOI: 10.1007/s10103-022-03577-1] [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: 04/19/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
Abstract
Surgery for benign anal conditions is a common practice and is usually followed by a good outcome. The present review aimed to summarize the emergence and evolution of different laser techniques used for the treatment of benign anal conditions and report their current outcome. PubMed and Scopus were searched for studies that assessed the use of laser in benign anal conditions. Anal conditions reviewed were hemorrhoids, anal fistula, anal warts, anal stenosis, and anal fissure. The full text of the studies retrieved was summarized in a narrative and tabular form. Laser techniques used for the treatment of hemorrhoidal disease were laser open hemorrhoidectomy, laser hemorrhoidoplasty, and Doppler-guided hemorrhoidal laser dearterialization. Resolution of hemorrhoidal symptoms was reported in 72-100% of patients after laser treatment. YAG laser, fistula laser closure, and photodynamic therapy have been used for the treatment of anal fistula with success rates ranging from 20 to 92.6%. Anal warts can be treated with photodynamic therapy with or without YAG or CO2 laser with a success rate up to 88%. A few studies reported the use of laser in the treatment of chronic anal fissure and anal stenosis. The use of laser in the treatment of benign anal conditions is associated with promising outcomes. Laser was most assessed in hemorrhoidal disease and anal fistula and showed more consistent success rates with hemorrhoidal disease than with anal fistula. Preliminary reports assessed the outcome of laser treatment in other conditions as anal fissure and warts with acceptable outcomes.
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Affiliation(s)
- Ahmed Hossam Elfallal
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Mohammad Fathy
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Samy Abbas Elbaz
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt. .,Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
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23
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Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review. BMC Surg 2022; 22:124. [PMID: 35365158 PMCID: PMC8973564 DOI: 10.1186/s12893-022-01553-8] [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: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hemophilia is a recessive hemorrhagic disease relevant to X chromosome. In mild hemophilia cases, spontaneous bleeding is rare and the blood clotting function is normal, but severe bleeding may occur after trauma or surgery. Therefore, missed diagnosis of hemophilia before operation may contribute to bleeding after hemorrhoid operation. Case presentation A 21-year-old male was hospitalized in the anorectal department because of repeated bleeding after hemorrhoid surgery. Despite several suture hemostasis procedures, the patient still suffered from recurrent bleeding. He had no family history of hemophilia or bleeding tendency, and had not been diagnosed with hemophilia before this admission. The diagnosis of mild hemophilia B was made after further examination of coagulation indexes. By using frozen plasma and coagulation factor complex to supplement coagulation factors, the patient’s bleeding was stopped and he was discharged after 23 days in hospital. During the follow-up, lower-than-normal coagulation factors were still found in him, but no bleeding occurred again. Conclusions The undiagnosed patient with mild hemophilia B has an increased risk of bleeding after hemorrhoid surgery because of the consumption of coagulation factors. This case report aims to address the importance of hemophilia screening before operation and reduce the risk of postoperative bleeding. For patients with recurrent bleeding after hemorrhoid surgery, hemophilia should be further excluded. Wound bleeding may recur in hemophilia patients after suture hemostasis. Therefore, prompt supplementation of coagulation factors is needed to help stop bleeding once the diagnosis of hemophilia is made.
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24
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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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25
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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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Zeng A, Gu G, Deng L. Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6473754. [PMID: 34539803 PMCID: PMC8443359 DOI: 10.1155/2021/6473754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022]
Abstract
Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients' postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient's wound healing and hospital stay, while improving the patient's anal function and reducing postoperative complications, and is worthy of clinical promotion and application.
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Affiliation(s)
- Aiying Zeng
- The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical College, University of South China, Hengyang, Hunan 421001, China
| | - Gang Gu
- The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical College, University of South China, Hengyang, Hunan 421001, China
| | - Lin Deng
- The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical College, University of South China, Hengyang, Hunan 421001, China
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27
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Trigui A, Rejab H, Akrout A, Trabelsi J, Zouari A, Majdoub Y, Amar MB, Mzali R. Laser utility in the treatment of hemorrhoidal pathology: a review of literature. Lasers Med Sci 2021; 37:693-699. [PMID: 34331606 DOI: 10.1007/s10103-021-03333-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001). Similarly, LHP laser treatment was significantly superior to surgical treatment in terms of operative duration (p < 0.00001), intraoperative bleeding (p < 0.00001), postoperative pain at H12 and H24 (p < 0.00001 and p = 0.0003), and postoperative bleeding rate (p < 0.001). The laser represents a revolution in the field of proctology mainly in the treatment of hemorrhoidal pathology. It is a safe, effective, and less painful mini-invasive technique. More rigorous studies will be needed to better evaluate this technique.
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Affiliation(s)
- Aymen Trigui
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia.
| | - Haithem Rejab
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Amira Akrout
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Jihen Trabelsi
- Department of Epidemiology, Hedi Cheker Hospital, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Amine Zouari
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Youssef Majdoub
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Mohamed Ben Amar
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
| | - Rafik Mzali
- Department of General and Digestive Surgery, Habib Bourguiba Hospital, Faculty of Medicine, University of Sfax, 3029, Sfax, Tunisia
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28
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Romic I, Augustin G, Bogdanic B, Bruketa T, Moric T. Laser treatment of pilonidal disease: a systematic review. Lasers Med Sci 2021; 37:723-732. [PMID: 34291332 DOI: 10.1007/s10103-021-03379-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
Pilonidal disease (PD) is a common condition, and there is still an ongoing debate on ideal management that should be minimally invasive, safe, and efficient. The use of radially emitting laser in the treatment of chronic PD is a novel minimally invasive technique, and initial studies with a small number of patients showed promising results. This study aimed to assess the efficacy and safety of chronic PD treatment with a laser using a systematic review of the published literature. A systematic review was conducted after PubMed, Scopus, Embase, Web of Science, and the Cochrane database search for studies reporting laser treatment of chronic PD. Also, our unpublished prospective single-center study was included in this review. Ten of 87 studies were eligible for the review, including 971 patients. The median age of the patients was 26 (range 13-68), and the median operative time was 26 (range 6-65) min. With a median follow-up of 12 (range 7-25) months, 917 (94.4%) patients achieved primary healing with a weighted mean recurrence rate of 3.8%. The weighted mean complication rate was 10% (95% CI 5.7-14.3%, I2 = 82.28, p < 0.001), and all were minor. The published literature demonstrates that laser treatment is a promising procedure in the management of chronic PD. Furthermore, the review showed that standardized operative techniques and perioperative steps were used. The results were limited to the mild chronic PD. Classification of PD severity and standardized outcome reporting is required to define indications and contraindications for laser PD treatment. Randomized controlled trials are needed to determine the long-term effectiveness and superiority of laser treatment over other methods.
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Affiliation(s)
- Ivan Romic
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branko Bogdanic
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Bruketa
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | - Trpimir Moric
- Department of Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
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Robleda G, Baños JE. Health Care Professionals' Assessment of Patient Discomfort After Abdominal Surgery. J Perianesth Nurs 2021; 36:553-558. [PMID: 33966992 DOI: 10.1016/j.jopan.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to classify elements of patients' discomfort in the resuscitation room after open or laparoscopic abdominal surgery as per health care professionals' perceptions. DESIGN A prospective cross-sectional study at a tertiary hospital in Spain. METHODS Resuscitation room nurses administered the Postoperative Discomfort Inventory to physicians and nurses with >1 year experience working closely with patients who had undergone abdominal surgery, asking them to score nine items related to patients' discomfort in the first 8 hours after surgery on an 11-point scale (0 = absent to 10 = very severe). Interobserver agreement among proxy reporters was measured with the Spearman's ρ; correlations >0.35 was considered adequate agreement. FINDINGS Of 125 eligible professionals, 116 (93%) participated (63 [54%] nurses and 53 [46%] physicians; mean age, 38 ± 12 years; 86 [74%] women). Professionals' perception of discomfort differed significantly between patients undergoing open surgery and those undergoing laparoscopic surgery; after open surgery, the most common types were pain (7.1 ± 1.8), movement restriction (7 ± 1.75), and dry mouth (6.6 ± 2.6), whereas after laparoscopic surgery, the most common types were dry mouth (5.85 ± 2.8), abdominal bloating (5.3 ± 2.5), and pain (5 ± 2.2). The Spearman's ρ correlations were inadequate for all items except for dry mouth in open surgery (r = 0.40). CONCLUSIONS Pain, movement restriction, abdominal bloating, and dry mouth were the main causes of discomfort. Our findings highlight the need to be vigilant for all manifestations of discomfort after abdominal surgery to enable timely treatment.
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Affiliation(s)
- Gemma Robleda
- Campus Docent, Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain; Ibero-American Cochrane Center, Department of Epidemiology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
| | - Josep-E Baños
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; School of Medicine, Universitat de Vic -Universitat Central de Catalunya, Vic, Spain
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Abstract
BACKGROUND Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, especially in a surgical day care setting. OBJECTIVE The aim of this study was to investigate the use of pudendal nerve block in patients undergoing hemorrhoidectomy. DATA SOURCES PubMed, Google Scholar, Cochrane Library, and Web of Science databases were searched up to December 2020. STUDY SELECTION Randomized trials evaluating the pudendal nerve block effect in patients undergoing hemorrhoidectomy were selected. INTERVENTIONS Hemorrhoidectomy under general or spinal anesthesia with or without pudendal nerve block was performed. MAIN OUTCOME MEASURES Opioid consumption, pain on the visual analogue scale, length of hospital stay, and readmission rate were the main outcomes of interest and were plotted by using a random-effects model. RESULTS The literature search revealed 749 articles, of which 14 were deemed eligible. A total of 1214 patients were included, of whom 565 received the pudendal nerve block. After hemorrhoidectomy, patients in the pudendal nerve block group received opioids less frequently (relative risk, 0.364; 95% CI, 0.292-0.454, p < 0.001) and in a lower cumulative dose (standardized mean difference, -0.935; 95% CI, -1.280 to -0.591, p < 0.001). Moreover, these patients experienced less pain at 24 hours (standardized mean difference, -1.862; 95% CI, -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (standardized mean difference, -0.742; 95% CI, -1.145 to -0.338, p < 0.001), and had a lower readmission rate (relative risk, 0.239; 95% CI, 0.062-0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary end point, and the overall evidence quality was judged "high." LIMITATIONS Occurrence of publication bias among some secondary end points and heterogeneity are the main limitations of this study. CONCLUSIONS This systematic review and meta-analysis show significant advantages of pudendal nerve block use. A reduction in opioid consumption, postoperative pain, complications, and length of stay can be demonstrated. Despite the limitations, pudendal nerve block in patients undergoing hemorrhoidectomy should be considered.
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Longchamp G, Liot E, Meyer J, Toso C, Buchs NC, Ris F. Non-excisional laser therapies for hemorrhoidal disease: a systematic review of the literature. Lasers Med Sci 2021; 36:485-496. [PMID: 32914275 PMCID: PMC7952353 DOI: 10.1007/s10103-020-03142-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022]
Abstract
Non-excisional laser therapies are emerging treatment for grades II and III hemorrhoidal disease (HD). However, so far, their efficiency is based on low-level evidence. Therefore, we aimed to systematically review the efficiency of non-excisional laser therapies for HD. MEDLINE/Pubmed, Web of science, Embase, and Cochrane were searched from database implementation until the April 17th, 2020. We included studies reporting at least one of surgical indicators of postoperative outcomes of laser therapies, encompassing laser hemorrhoidoplasty (LH) and hemorrhoidal laser procedure (HeLP). Fourteen studies describing LH and HeLP were included, representing 1570 patients. The main intraoperative complication was bleeding (0-1.9% of pooled patients for LH, 5.5-16.7% of pooled patients for HeLP). Postoperative complications occurred in up to 64% of patients after LH and 23.3% after HeLP. Resolution of symptoms ranged between 70 and 100% after LH and between 83.6 and 90% after HeLP. Moreover, four randomized controlled trials included in our review reported similar resolution after LH compared with hemorrhoidectomy or mucopexy and after HeLP compared with rubber band ligation. Recurrence rate was reported to range between 0 and 11.3% after LH and between 5 and 9.4% after HeLP. When compared with hemorrhoidectomy, LH showed conflicting results with one randomized controlled trial reporting similar recurrence rate, but another reporting decreased recurrences associated with hemorrhoidectomy. Laser therapies showed lower postoperative pain than hemorrhoidectomy or rubber band ligation. LH and HeLP are safe and effective techniques for the treatment of grades II and III HD.
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Affiliation(s)
- Gregoire Longchamp
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Emilie Liot
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Jeremy Meyer
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Frederic Ris
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
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Clinical Outcomes and Effectiveness of Laser Treatment for Hemorrhoids: A Systematic Review. World J Surg 2021; 45:1222-1236. [PMID: 33469736 DOI: 10.1007/s00268-020-05923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Laser treatment is increasingly used in the treatment of symptomatic hemorrhoids, and several studies have attempted to describe its clinical outcomes. In this systematic review, we aimed to comprehensively analyze the clinical outcomes and effectiveness of laser treatment. METHODS We performed a systematic review of currently available data on laser treatment for hemorrhoids. We searched MEDLINE and Google Scholar between January 2009 and May 2020. Studies that described the clinical outcomes and effectiveness of laser treatment were selected based on pre-specified inclusion criteria with a minimum follow-up period of 3 months. Qualitative synthesis of the clinical outcomes, effectiveness and complications was performed. RESULTS Nineteen studies including 1937 patients were analyzed. The majority were males (n = 1239) and included grade 2 and 3 hemorrhoids. In the majority (n = 1750, 90.34%), the 980 nm wave length diode laser was used as the energy source. Doppler-guided localization was performed in six studies (n = 579, 29.89%). All studies (n = 1937) reported low postoperative pain scores and nine studies (n = 1131) showed significantly lower pain compared to open technique. Furthermore, six studies (n = 1023) showed significantly less intra- and postoperative bleeding compared to open technique. Seven studies (n = 1052) reported long-term follow-up results and were found to be satisfactory in terms of symptom relief and recurrence. This study was limited by heterogeneity of outcomes precluding a meta-analysis. CONCLUSION Laser treatment had acceptable clinical outcomes for grade 2 and 3 hemorrhoids with lower rates of postoperative pain and bleeding with satisfactory long-term outcomes.
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Hemorrhoid laser procedure (HeLP) for second- and third-degree hemorrhoids: results from a long-term follow-up analysis. Lasers Med Sci 2021; 37:309-315. [PMID: 33439376 DOI: 10.1007/s10103-021-03249-6] [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: 11/04/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
We aimed to analyze the results of 5-year consecutive use of the hemorrhoidal laser procedure (HeLP) in patients with second- to third-grade hemorrhoids with minimal or moderate mucosal prolapse. A total of 189 patients were treated between April 2012 and October 2017. We reported perioperative complications, postoperative pain, improvement of hemorrhoids grade, and relapse of hemorrhoidal disease (HD). Improvement of symptoms was assessed using the Patient Global Improvement (PGI) Scale. No severe intraoperative complications were observed. The median follow-up was 42 months (range 6-62 months). Pain after surgery was absent in 94% of patients. No cases of rectal tenesmus or alterations of defecation habits were reported. Symptoms and HD improvement reached a "plateau" at 3 to 6 months following surgery. We observed a significant decrease in HD degree, occurrence of bleeding, pain, itching, and acute HD. Complete resolution of HD was reported in > 60% of patients 1 year after surgery. The individual level of improvement in symptoms was consistent (very much and much improved, according to PGI-I score) for about 90% of patients during the follow-up. This study confirmed that the HeLP is a safe, painless, and effective procedure for the treatment of HD in selected cases.
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Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial. Surg Endosc 2021; 36:143-148. [PMID: 33415419 DOI: 10.1007/s00464-020-08248-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy. Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up. Primary endpoint was resolution of symptoms and secondary endpoints were recurrence rate, type of recurrences, re-operation rate, and potential predictive factors for failure. METHODS Bleeding was assessed on a score from 0 to 4 (none = 0; < 1/month = 1; 1/week = 2; > 1/week = 3; 3-4/week = 4), frequency of hemorrhoid-related symptoms with a score of 0-3 (2/year = 1; 3-5/year = 2; < 5/year = 3). Constipation and fecal incontinence were assessed by means of validated scores. Quality of life and pain at defecation were assessed using a visual analog scale of 0-10 (0 = worst possible-10 = best possible quality of life and 0 = no pain-10 = worst pain imaginable, respectively). Recurrence rate and need for re-operation were reported. Potential predictive factors of failure were analyzed by means of univariate analysis. RESULTS Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial; 8 patients were lost at follow-up. Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients. Statistically significant improvement of quality of life, pain reduction, bleeding and frequency of acute symptoms were reported. Of 28 patients with persistent or recurrent symptoms, 12 had pain (4.35%), 10 had bleeding (3.6%) and 6 had increasing prolapse at defecation (2.2%). Eleven out of twenty-eight patients required additional surgery. Constipation and III-IV grade hemorrhoids were associated with statistically significant higher failure rates (p = 0.046 and 0.012, respectively). Better results were reported in patients reporting preoperative high-grade pain at evacuation. CONCLUSIONS The Doppler-guided hemorrhoidal laser procedure showed efficacy at long-term follow-up. It can be considered as 'first-line' treatment in patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms in whom conservative treatment failed.
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Abstract
Introduction Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.
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Bachtsetzis C, Papaioannou A, Bekas S, Lazaridou A, Bachtsetzis G. Emergency treatment of bleeding hemorrhoids in a patient taking aspirin and clopidogrel using a 1470 nm diode laser and the ELITE minimal invasive technique. J Surg Case Rep 2020; 2020:rjaa470. [PMID: 33294163 PMCID: PMC7700773 DOI: 10.1093/jscr/rjaa470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
A 74-year-old male patient, receiving anticoagulation treatment after previous angioplasty stenting for severe coronary artery disease, was admitted to the clinic with a 2-day rectal bleeding. Clinical examination followed by an urgent colonoscopy to exclude other potential reasons for his symptoms both confirmed the diagnosis of Grade III thrombosed hemorrhoids. Due to the acute presentation of the case along with the existing medication of the patient, the decision was made to treat the problem using the expert laser intrahemorrhoidal therapy technique, which is a diode laser minimally invasive operation without the need to stop any of the patient’s medication.
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Affiliation(s)
| | | | - Spyridon Bekas
- Obstetrics and Gynaecology Department, Queen Elizabeth University Hospital, Glasgow, UK
| | - Athina Lazaridou
- Oncology Department, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - George Bachtsetzis
- General Surgery Department, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece
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Terracciano G, Brusciano L, Gualtieri G, Gambardella C, Sturiale A, Lucido FS, Tolone S, Docimo L. Late rectal anastomotic leakage treated with diode laser FiLaC probe. A case report of a new minimal invasive treatment. Int J Surg Case Rep 2020; 77S:S132-S134. [PMID: 33041258 PMCID: PMC7876918 DOI: 10.1016/j.ijscr.2020.09.016] [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: 07/16/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023] Open
Abstract
Anastomotic leak is a common and potentially dangerous postoperative complication in colo-rectal surgery. Low anastomotic leak conservative treatment requires five months or more for a complete resolution and a complex management. The FiLaC laser diode technology could be a good option to reduce the healing time and to minimize patient’s discomfort.
Introduction Anastomotic Leakage (AL) is one of the most important early postoperative complication of the adenocarcinoma’s surgical treatment. Fistula Laser Closure (FiLaC®) is a minimal invasive technique that use diode laser energy to obtain the fistula track obliteration and it is finding large application for other affection characterized by fistula tracts presence. Presentation of case A 56 years old male, with no clinical history of adenocarcinoma in his family, underwent a laparoscopic low anterior resection with ileostomy for a rectal adenocarcinoma. Approximately 3 months after the procedure an anastomotic leak with an associated abscess was found. The patient underwent an endoscopic FiLaC off-label procedure on the AL and after further 4 months, he obtained a complete resolution of the anastomosis dehiscence. Discussion The literature is poor about the minimal invasive AL treatment and there is no paper about the management of the AL with the FiLaC® procedure. For asymptomatic patients a conservative solution is preferred, it could be considered a drain positioning for emptying abscesses and for irrigation or the use of an Endosponge to decrease the resolution time. The FiLaC® procedure could be a more feasible technique that could also reduce the healing time as well with no discomfort for the patient. Conclusion Considering the results and our patient healing time, we think that an off-label application of FiLaC® procedure on asymptomatic low anastomotic leak could be an opportunity for a morbidity resolution shorter than the simple wait and see strategy, and more sustainable for the patient.
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Affiliation(s)
- Gianmattia Terracciano
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Luigi Brusciano
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giorgia Gualtieri
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudio Gambardella
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy; Medical, Clinical and Experimental Sciences PhD Student, Department of Cardiothoracic Sciences - University of Campania "Luigi Vanvitelli", School of Medicine, Naples, Italy
| | - Alessandro Sturiale
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Division of General, Mini-Invasive and Obesity Surgery- Master of Coloproctology and Master of Pelvi-Perineal Rehabilitation, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
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Comparison of Centella with Flavonoids for Treatment of Symptoms in Hemorrhoidal Disease and After Surgical Intervention: A Randomized Clinical Trial. Sci Rep 2020; 10:8009. [PMID: 32409760 PMCID: PMC7224176 DOI: 10.1038/s41598-020-64772-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Phlebotonics’ effects were evaluated to reduce time-to-stop bleeding and anal irritation in 130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients) in the short time. Sixty patients were randomized to receive the routine treatment (both conservative and surgical) (control Group C). The treated group (both conservative and surgical) was divided into two subgroups: one treated with flavonoids (Group A, n = 73), the other with Centella (Group B, n = 66). Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42). Healing was estimated with Kaplan-Meier method, the Kruskal-Wallis test estimated changes in the VAS scores. The HD median time-to-stop bleeding was 2 weeks for Groups A and B; 3 weeks for Group C. VAS scores comparison among Groups (irritation): A vs C, p = 0.007; B vs C, p = 0.041; and A vs B, p = 0.782 resulted respectively. As for operated hemorrhoids, the time-to-stop bleeding was 3 and 4 weeks in Groups A and B and 5 in Group C. Histopathology showed an association between flavonoids and piles’ fibrosis (p = 0.008). Phlebotonics in HD, as well as after surgery, showed significant beneficial effects. Flavonoids are the most effective phlebotonics against bleeding and anal irritation.
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Gallo G, Martellucci J, Sturiale A, Clerico G, Milito G, Marino F, Cocorullo G, Giordano P, Mistrangelo M, Trompetto M. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24:145-164. [PMID: 31993837 PMCID: PMC7005095 DOI: 10.1007/s10151-020-02149-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication.The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE.These guidelines are inclusive and not prescriptive.The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.
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Affiliation(s)
- G Gallo
- Department of Surgical and Medical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - J Martellucci
- Department of General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - A Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - G Clerico
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy
| | - G Milito
- Department of General Surgery, Tor Vergata University, Rome, Italy
| | - F Marino
- Operative Unit of General Surgery, IRCCS de Bellis, Castellana Grotte, Bari, Italy
| | - G Cocorullo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - P Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, Barts Health, London, UK
| | - M Mistrangelo
- Department of General and Minimally Invasive Surgery, University of Turin, Turin, Italy
| | - M Trompetto
- Department of Colorectal Surgery, Santa Rita Clinic, Vercelli, Italy.
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