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Evid Based Complement Alternat Med 2022 9;2022:5630487. Epub 2022 Jun 9.

Department of Obstetrics and Gynecology, People's Liberation Army Navy 971 Hospital, Qingdao, Shandong, China.

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

Methods: This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group ( = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group ( = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). Read More

Evid Based Complement Alternat Med 2022 31;2022:1633965. Epub 2022 May 31.

Department of Surgery, University of Saskatchewan, Saskatoon, Canada.

Background: Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Read More

Lasers Med Sci 2022 May 23. Epub 2022 May 23.

General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street, Mansoura, 35516, Dakahlia, Egypt.

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. Read More

Front Surg 2022 3;9:898850. Epub 2022 May 3.

Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.

Background: External hemorrhoidal thrombosis (EHT) is a common complication of hemorrhoidal disease. This condition causes extreme pain, likely resulting from internal anal sphincter hypertonicity, which traps the hemorrhoids below the dentate line thus leading to congestion and swelling. The choice of treatment remains controversial and both conservative and surgical options have been proposed in the last decades. Read More

Medicine (Baltimore) 2022 Mar;101(11)

Department of General Surgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA (Wuxi Taihu Hospital, Wuxi, China.

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. Read More

Ann Med Surg (Lond) 2022 Apr 14;76:103467. Epub 2022 Mar 14.

Digestive Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.

Introduction: Hemorrhoids are a common coloproctology problem and among 10% of cases need surgical intervention. However, the established surgical interventions still have many complications.

Case Presentation: We reported three female patients, who presented with circular 3rd degree internal hemorrhoids. Read More

Medicina (Kaunas) 2022 Mar 12;58(3). Epub 2022 Mar 12.

The Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom 73170, Thailand.

: Excisional hemorrhoidectomy is considered as a mainstay operation for high-grade hemorrhoids and complicated hemorrhoids. However, postoperative pain remains a challenging problem after hemorrhoidectomy. This systematic review aims to identify pharmacological and non-pharmacological interventions for reducing post-hemorrhoidectomy pain. Read More

Medicina (Kaunas) 2022 Mar 1;58(3). Epub 2022 Mar 1.

Faculty of Medicine, Gazi University, Cankaya, Ankara 06560, Turkey.

Anal stenosis, which develops as a result of aggressive excisional hemorrhoidectomy, especially with the stoutly use of advanced technologies (LigaSure, ultrasonic dissector, laser, etc.), has become common, causing significant deterioration in the patient's quality of life. Although non-surgical treatment is effective for mild anal stenosis, surgical reconstruction is unavoidable for moderate to severe anal stenosis that causes distressing, severe anal pain, and inability to defecate. Read More

Ann Med Surg (Lond) 2022 Jan 21;73:103203. Epub 2021 Dec 21.

Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.

Introduction: After hemorrhoidectomy, anal stenosis occurs, which is an uncommon but severe consequence. The majority of severe cases require advancement flap anoplasty.

Presentation Of Case: A 50-year-old female patient with a history of hemorrhoidectomy 10 months prior to admission complained of difficulty defecating, pain, and incomplete evacuation sensation, as well as a hole on the right side of the anal canal through which feces unintentionally passed. Read More

Int Med Case Rep J 2022 6;15:1-6. Epub 2022 Jan 6.

Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.

Background: Anal metastasis of colorectal adenocarcinoma is very rare, represented by only a handful of case reports in the literature. Previously, reports of metastasis to this region had occurred following a history of anorectal disease, such as anal fistulae. Antecedent trauma to the area from hemorrhoidectomy, fissures, or perineal retractor injury have also been implicated. Read More

Vopr Kurortol Fizioter Lech Fiz Kult 2021 ;98(6. Vyp. 2):65-71

Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russia.

Among all coloproctological diseases, hemorrhoids rank first among the reasons for visiting a proctologist. Its prevalence is 130-145 per 1.000 adults, and its proportion in the structure of colorectal diseases ranges from 34 to 41%. Read More

Surgery 2022 03 6;171(3):615-620. Epub 2021 Dec 6.

Division of Colon and Rectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. Electronic address:

Background: Current American Society of Colorectal Surgery Clinical Practice Guidelines for Ambulatory Anorectal Surgery endorse use of monitored anesthesia care, general anesthesia, or spinal anesthesia based on physician and patient preference. Although several studies support the use of monitored anesthesia care over general anesthesia, the literature regarding spinal anesthesia is limited and heterogenous due to small sample sizes and disparate spinal anesthesia techniques. Saddle block anesthesia is a form of spinal anesthesia that localizes to the lowermost sacral spinal segments allowing for preservation of lower extremity motor function and faster recovery. Read More

Asian J Surg 2021 Nov 25. Epub 2021 Nov 25.

General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China.

Background: This prospective randomized controlled study compared the short- and long-term efficacy and advantages of modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of grade III and IV circumferential prolapsed hemorrhoids (CPH).

Methods: A total of 186 consecutive patients with grade III or IV CPH were enrolled. The patients were randomized to MPSH (n = 93) or MMH (n = 93) treatment groups. Read More

Trials 2021 Nov 13;22(1):797. Epub 2021 Nov 13.

West China School of Nursing, Sichuan University/ Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Background: Pressure dressings have been used after open hemorrhoidectomy to protect surgical wounds and manage postoperative bleeding for many years. However, pressure dressings may increase the incidence of postoperative complications, such as urinary retention, medical adhesive-related skin injury, and pain. A previous controlled trial included 67 patients who underwent Milligan-Morgan hemorrhoidectomy. Read More

Tech Coloproctol 2022 Jan 27;26(1):53-60. Epub 2021 Oct 27.

Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Neihu District, Section 2, Cheng-Kong Rd, No. 325, Taipei, 114, Taiwan, ROC.

Background: Hemorrhoidectomy is the standard procedure for treating high-grade hemorrhoids. However, postoperative pain usually causes patients to delay or refuse surgical treatment. Because maximal resting pressure in the internal anal sphincter plays a major role in post-hemorrhoidectomy pain, Botulinum toxin injections have been proposed to reduce it. Read More

Ann Surg Treat Res 2021 Oct 1;101(4):206-213. Epub 2021 Oct 1.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Purpose: Postoperative pain and delayed wound healing are the main complications following anal surgery associated with poor quality of life. Hyaluronic acid (HA) supports tissue regeneration and rapid wound healing by promoting cell proliferation and migration. We investigated the effects of HA on perianal wound healing in a rat model. Read More

Arq Bras Cir Dig 2021 15;34(2):e1594. Epub 2021 Oct 15.

Department of Anorectal, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, China.

Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life.

Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery.

Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. Read More

Curr Opin Gastroenterol 2022 01;38(1):61-66

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.

Purpose Of Review: There continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed. Read More

Tech Coloproctol 2021 Dec 5;25(12):1319-1321. Epub 2021 Oct 5.

Department of MedicoSurgical Proctology, Institut Léopold Bellan, Paris, France.

Background: The aim of this study was to evaluate the outcome of hemorrhoidal surgery in patients with inflammatory bowel disease (IBD) undergoing surgery at our center.

Methods: All adult patients with IBD undergoing hemorrhoidal surgery in our department between November 1, 2013 and July 7, 2020 were included in the study. At the time of surgery, the patients' IBD was in clinical, biological and endoscopic remission, and none of the patients had specific primary anoperineal lesions. Read More

Front Surg 2021 9;8:730261. Epub 2021 Sep 9.

Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania.

General or regional anesthesia is predominantly used for anorectal surgery, however in the recent years more attention was drawn in the use of local anesthesia for anorectal surgery. In this study we present the technique and results of the use of local perianal anesthetic infiltration for minor anorectal operations. In this cohort study patients undergoing surgery for hemorrhoids, anal fissures and low anal fistulas were included. Read More

Front Surg 2021 30;8:711958. Epub 2021 Aug 30.

Department of Surgical Science, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.

Hemorrhoidectomy is still the most effective surgical treatment for hemorrhoidal disease, but it is, however, associated with complications such as pain and stenosis. We proposed to break the "vicious circle" of "pain-sphincteric spasm-stenosis-pain" with the postoperative use of self-mechanical anal dilation. We retrospectively analyzed patients with hemorrhoidal disease presenting with a minimum of piles of three quadrants, treated with radiofrequency hemorrhoidectomy between January 2018 and December 2019. Read More

Front Surg 2021 16;8:708051. Epub 2021 Aug 16.

Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.

Single or double prolapsed pile instead of full muco-hemorrhoidal prolapse is a common finding in patients with symptomatic III or IV degree hemorrhoids. For this selected group of patients, relief of symptoms could be achieved by managing the single/double prolapsed piles instead of performing traditional hemorrhoidectomy. The aim of this single-center study was to evaluate the safety and medium- and long-term effectiveness of an outpatient tailored Milligan-Morgan hemorrhoidectomy (MMH) performed under local anesthesia (LA). Read More

J Anus Rectum Colon 2021 29;5(3):261-267. Epub 2021 Jul 29.

Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.

Objectives: There was an urgent need to create a simple, reliable hemorrhoidectomy procedure for high-risk cases in our university hospital. We performed linear pinched hemorrhoidectomy (LPH) and evaluated its effectiveness compared to conventional hemorrhoidectomy (CH).

Methods: We included 215 Goligher grade 3 and 4 hemorrhoid cases in this study. Read More

Cureus 2021 Jun 13;13(6):e15630. Epub 2021 Jun 13.

General Surgery, ACS Medical College Hospital, Chennai, IND.

Background Hemorrhoids are a common condition that presents with bleeding per rectum, pain at rest and defecation, mucosal discharge, and prolapse. Surgical hemorrhoidectomy is the treatment method of choice for Grade 3 and Grade 4 hemorrhoids. Hemorrhoidectomy is associated with postoperative pain and no single surgical technique has been proved to significantly reduce the pain. Read More

Minerva Surg 2021 Jun;76(3):264-270

Emergency Department, Puzi Hospital, Taiwan, China.

Background: Doppler-guided hemorrhoid artery ligation and stapled hemorrhoidopexy have been used in surgical practices to avoid post-hemorrhoidectomy pain. Our study compared Doppler-guided hemorrhoid artery ligation with suture mucopexy (DGHAL-SM) and ligature-assisted pile excision (LAP) for greater than three grades of internal hemorrhoids.

Methods: Eighty patients with greater than 3 grades of internal hemorrhoids were selected (age range: 20-28 years; average age: 23 years) between January and June 2015. Read More

Arq Bras Cir Dig 2021 14;34(1):e1560. Epub 2021 May 14.

Digestive and Colorectal Surgery Division, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.

Background: The surgical procedure: three dearterializations and three mucopexies.Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly.

Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Read More

J Comp Eff Res 2021 07 30;10(10):801-813. Epub 2021 Apr 30.

State Scientific Center of Coloproctology, Ministry of Health of Russian Federation, Moscow, Russia.

Hemorrhoidal disease (HD) is common in adults. Treatment is largely conservative, although more invasive procedures may be required. Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used, but a recent and comprehensive review of supporting evidence is lacking. Read More

BJS Open 2021 03;5(2)

Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.

Background: Arterial hyperflow to haemorrhoids has been implicated as a possible pathophysiological co-factor in haemorrhoidal disease. The purpose of this study was to investigate how transanal haemorrhoidal dearterialization (THD) can influence haemodynamic parameters at the level of the haemorrhoidal piles.

Methods: Patients with grade III haemorrhoids selected for THD between July and December 2018 were evaluated using endoanal ultrasonography and colour Doppler imaging at the level of internal haemorrhoids before and 1 year after the surgical procedure. Read More

Surg Innov 2022 Feb 8;29(1):27-34. Epub 2021 Apr 8.

Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy.

Purpose: Hemorrhoidal disease (HD) is a widespread condition severely influencing patients' quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. Read More

J Ayub Med Coll Abbottabad 2021 Jan-Mar;33(1):125-128

Department of Surgery, Dow University OF Health Sciences, Karachi, Pakistan.

Background: Hemorrhoids are one of the most common anal pathology affecting millions of people around the world. Milligan-Morgan open hemorrhoidectomy is the most effective hemorrhoidectomy method used as gold standard procedure. Post-operative pain is recognized as a distressing complication of hemorrhoidectomy leading to increase hospital stay and psychological stress to both patient and surgeon. Read More