The management of haemorrhoids

Horse Chestnut Extract. Update-2022

Horse chestnut is known as a venotonizing agent of plant origin. The main active ingredient of chestnut common extract is aescin. It has anti-edema, anti-inflammatory and venotonizing properties. The aescin medicinal agent should be used for chronic vein disease, hemorrhoidal disease and post-traumatic edema. The pharmacological properties of chestnut horse extract allow the inclusion of medications based on it in the rehabilitation program of patients who have suffered a new coronavirus infection (COVID-19).

Polidocanol Foam Injected at High Doses with Intravenous Needle: The (Almost) Perfect Treatment of Symptomatic Internal Hemorrhoids

Background and Aims

Hemorrhoid disorders are common. This study aimed to assess the efficacy and safety of polidocanol foam injected at high doses with intravenous needle for the treatment of symptomatic internal hemorrhoids that prolapse or bleed.

Methods

We evaluated 2,000 consecutive patients with prolapsed hemorrhoids (grades II/III/IV) recruited over 6 years. Foam injection was performed in one to four sessions with polidocanol 2%: 10 mL of the mixture (2 mL liquid plus air) or 20 mL (4 mL liquid plus air). The number of sessions and amount of foam injected depended on initial hemorrhoid size, compliance to receive foam, and clinical response. The mixture, prepared using a three-way tap connected to two 10/20-mL syringes, was injected immediately after preparation using an intravenous needle. The primary endpoint was self-reported satisfaction without major complications at 4 weeks.

Results

Efficacy was very high, with 1,957 patients (98%) reporting satisfaction regarding blood loss control and prolapse reduction. The procedure was well tolerated: 1,838 patients (92%) presented mild/no pain. Objective reduction of prolapse volume was documented in 86% of reobserved cases. Complications were rare and usually minor: only 3 cases of clinically significant bleeding (0.15%), 2 of whom were on dual antiplatelet therapy plus oral anticoagulation, 2 cases of rectal abscess, 8 hemorrhoid thromboses, and 1 urinary retention requiring catheter (0.7% severe complications).

Conclusions

Treatment of internal hemorrhoids with polidocanol foam injected in high doses is very effective and safe for the control of blood loss and prolapse, even for patients on anticoagulation/antiplatelet treatment.

Endoscopic monopolar coagulation of internal haemorrhoids: a surgeon's experience of the first 100 cases

AIM

The purpose of this study was to evaluate one surgeon's initial experience with a novel technique of retroflexed endoscopic coagulation of internal haemorrhoids.

METHOD

Patients who presented with symptoms and signs indicating Grade II-III haemorrhoids were counselled before the procedure. Those who were assessed to require an examination of their colon, based on their age and symptoms, underwent a full colonoscopy before treatment of the haemorrhoids. After the procedure, patients were routinely prescribed nonsteroidal anti-inflammatory drugs, antibiotics and laxatives.

RESULTS

The first 100 patients of median age 52.0 (20.8-78.5) years included 65 (65%) women. Five (5%) patients suffered from postprocedural complications, of which three (3%) were postprocedural bleeding and two (2%) were postprocedural pain, all treated conservatively. The recurrence rate was 6% at a median follow-up time of 36 (6-76) months. The median duration of follow-up was 36.5 (8.5-57.0) months.

CONCLUSION

This novel technique appears to be safe and effective for the treatment of Grade II-III internal haemorrhoids, and can be incorporated seamlessly into the end of a colonoscopy for the evaluation of haematochezia. Comparative trials should be performed.

Nonsurgical treatment of actively bleeding internal hemorrhoids with a novel endoscopic device (with video)

BACKGROUND

Internal hemorrhoids often present with bleeding, prolapse, and other symptoms. Currently used nonsurgical treatment modalities have limited effectiveness and usually require several treatment sessions.

OBJECTIVE

To evaluate effectiveness and safety of a novel endoscopic device for nonsurgical treatment of internal hemorrhoids.

DESIGN

Retrospective study.

SETTING

Single center.

PATIENTS

This study involved 23 patients with actively bleeding internal hemorrhoids.

INTERVENTION

The HET Bipolar System is a modified anoscope, with a treatment window, light source, and tissue temperature monitor. The device is inserted into the rectum under direct observation. The tissue carrying superior hemorrhoidal branches and the apex of the internal hemorrhoid is positioned inside the treatment window, clamped with incorporated tissue forceps, and treated with bipolar energy to ligate hemorrhoidal feeding vessels.

MAIN OUTCOME MEASUREMENTS

Rate of hemorrhoidal bleeding after the treatment.

RESULTS

The mean age of the patients was 64.3 ± 9.9 years (range 44-79 years). Eleven patients (47.8%) had grade I hemorrhoids and 12 patients (52.2%) had grade II hemorrhoids. In 18 patients (78.3%), treatment with the HET System was performed with the patient under conscious sedation. Five patients (21.7%) were treated without sedation. All patients tolerated treatment without complaints. The average follow-up period was 11.2 ± 4.7 months. No bleeding or prolapse occurred after the procedure in any of the treated patients.

LIMITATIONS

Retrospective study.

CONCLUSION

The newly developed HET System is easy to use, safe, and highly effective in eliminating bleeding in grade I and II internal hemorrhoids and prolapse in grade II internal hemorrhoids.

Radiowave ablation and mucopexy for prolapsing hemorrhoids--a pilot study

OBJECTIVE

The author proposes a technique of radiowave ablation and mucopexy of hemorrhoids for patients having symptomatic and prolapsing hemorrhoids and enumerates the events in such patients over 10 years.

MATERIAL AND METHOD

From May 1997 through December 2007, 3148 patients were included in the study. The hemorrhoids were ablated using radiowaves through a Ellman radiowave generator and were followed by suture ligation with absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed.

RESULTS

The mean procedure time was 8+/-0 min (range, 5-14 min). The mean total analgesic dose and duration of pain control using analgesics was 17+/-5 tablets, and 10+/-4 days respectively. The mean period of incapacity for work was 6 days [range 4-17 days]. Complications were identified in 4.8% patients. The postoperative follow-up after 4 weeks revealed therapeutic success in 3013 patients (95.7%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 3085 (98%) of patients and 3022 (96%) patients experienced no pain after defecation. Up to December 2006, a total of 2897 patients were treated with this method. 2246 patients responded to our inquiry conducted at the beginning of 2008. Ninety-six percent of these patients confirmed that they no longer experienced any bleeding or pain during defecation and ninety-two percent patients did not had any prolapse.

CONCLUSIONS

This study shows that radiowave ablation followed by suture ligation of hemorrhoids is a simple, cost effective and convenient modality in treating prolapsing hemorrhoids.