{ "slug": "surgery-hemorrhoid", "question": "Do hemorrhoids need surgery, or can they be treated without an operation?", "shortTitle": "Hemorrhoids: Surgery vs Non-Surgical Treatment", "clinicalQuestion": "In adults with symptomatic internal or external hemorrhoids (Goligher grade I-IV), how do non-surgical treatments (rubber band ligation, sclerotherapy, infrared coagulation, dietary fiber) compare with surgical hemorrhoidectomy (including laser hemorrhoidoplasty) in symptom resolution, recurrence, and need for later surgery?", "pico": { "population": "Adults with symptomatic internal or external hemorrhoids of varying grades (I-IV)", "intervention": "Non-surgical treatments: rubber band ligation, sclerotherapy, infrared coagulation, dietary/fiber measures, or laser hemorrhoidoplasty", "comparator": "Conventional surgical hemorrhoidectomy (or no treatment/usual care for milder grades)", "outcomes": [ "Symptom resolution (bleeding, prolapse, pain) at 3-12 months", "Recurrence rate at 1 year", "Need for subsequent or repeat surgery", "Postoperative pain scores", "Time to return to normal activity", "Complication rate (bleeding, infection, stenosis)" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "anal-skin-tags", "anal-fissure" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Surgery works better than banding for stopping grade III hemorrhoids from coming back, but both approaches carry rare, serious risks.", "detail": "The trials that directly compared surgery with a non-surgical option (mainly rubber band ligation) looked at grade III hemorrhoids and found surgery caused far fewer recurrences, though it hurt more and took longer to recover from. Four studies, mostly single case reports, documented rare but serious complications - severe bleeding after banding, a bowel perforation after laser treatment, and a higher infection risk after surgery in people carrying resistant bacteria. Because the trials disagree with each other and are small, confidence in any single comparison is only moderate.", "studyIds": [ "pmid:39952268", "pmid:41553737", "pmid:40596934", "pmid:40492557", "pmid:41197059", "pmid:38849668", "pmid:37779168" ] }, "strength": { "level": "moderate", "why": "4 well-conducted randomised trials address this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.", "override": null }, "direction": { "level": "harm-signal", "why": "4 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 1452, "recordsScreened": 200, "included": 115, "rcts": 15, "systematicReviews": 20, "observational": 50, "participants": 424548, "yearFrom": 2023, "yearTo": 2026, "registeredTrialsWithoutResults": 2 }, "excluded": [], "outcomes": [ { "name": "Recurrence at 1 year", "status": "improvement", "note": "In head-to-head trials, surgery led to far fewer hemorrhoids coming back than banding (6% vs 48% in one trial) and failed far less often than a less invasive artery-ligation procedure (8% vs 61% in another). This advantage was tested specifically in grade III disease.", "studyIds": [ "pmid:39952268", "pmid:41553737", "pmid:40492557" ] }, { "name": "Need for subsequent or repeat surgery", "status": "possible-improvement", "note": "People first treated with banding or a less invasive procedure were more likely to need a later operation than those who had surgery first, in the two trials that tracked this.", "studyIds": [ "pmid:39952268", "pmid:41553737" ] }, { "name": "Time to return to normal activity", "status": "improvement", "note": "Trials consistently found people returned to work and daily activity sooner after banding or less invasive procedures than after surgery.", "studyIds": [ "pmid:39952268", "pmid:41553737", "pmid:40596934" ] }, { "name": "Complication rate (bleeding, infection, stenosis)", "status": "possible-harm", "note": "Serious complications were reported with both approaches, though mostly documented as single case reports rather than trial data: severe delayed bleeding after rubber band ligation, a bowel perforation needing emergency surgery after laser treatment, and higher surgical-site infection risk in people carrying resistant bacteria before surgery.", "studyIds": [ "pmid:41197059", "pmid:38849668", "pmid:37779168" ] }, { "name": "Outcomes beyond 1-2 years", "status": "not-studied", "note": "None of the trials comparing surgery with non-surgical treatment followed people for more than about 12 to 24 months, so what happens further out is not known.", "studyIds": [] } ], "benefits": [ { "text": "In a randomised trial of grade III hemorrhoids, surgery led to far fewer hemorrhoids returning within a year compared with rubber band ligation.", "studyIds": [ "pmid:39952268" ] }, { "text": "A randomised trial comparing open surgery with a less invasive artery-ligation procedure for grade III hemorrhoids found open surgery failed far less often, though it caused more pain and a slower return to work.", "studyIds": [ "pmid:41553737" ] }, { "text": "Office-based procedures like banding and sclerotherapy resolved bleeding and prolapse in many patients without surgery and let them recover faster, according to several studies, though most were not controlled trials.", "studyIds": [ "pmid:37349572", "pmid:41128083", "pmid:42067175" ] } ], "limitations": [ { "text": "Most of the studies on non-surgical treatments are retrospective or single-arm - they follow one group of patients before and after treatment without comparing them to a different treatment, making it hard to know what would have happened otherwise.", "studyIds": [ "pmid:42337174", "pmid:42323500", "pmid:40856750" ] }, { "text": "The randomised trials that directly compared surgery with a non-surgical option were small, ranging from about 36 to 87 people, and came from single centers, so results may not hold up elsewhere.", "studyIds": [ "pmid:39952268", "pmid:41553737", "pmid:41603644" ] }, { "text": "Studies used different hemorrhoid grades and different techniques (classic surgery, laser, artery ligation, stapling, banding), so a finding about one technique does not necessarily apply to another.", "studyIds": [ "pmid:40493094", "pmid:40586452" ] } ], "risks": [ { "text": "A case report describes massive rectal bleeding 15 days after routine rubber band ligation, requiring emergency endoscopic treatment.", "studyIds": [ "pmid:41197059" ], "severity": "serious" }, { "text": "A case report describes a bowel (rectal) perforation, severe infection, and organ failure after laser hemorrhoidoplasty, requiring emergency surgery and a colostomy.", "studyIds": [ "pmid:38849668" ], "severity": "serious" }, { "text": "People who carried antibiotic-resistant bacteria before hemorrhoid surgery had a much higher rate of infection at the surgical site afterward.", "studyIds": [ "pmid:37779168" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "Non-surgical options sound less frightening and don't require general anesthesia." }, { "text": "People want to avoid the pain and time off work that often come with surgery." }, { "text": "In-office procedures like banding can usually be done same-day without a hospital stay." }, { "text": "Doctors often suggest starting with the least invasive option, like fiber or banding, before considering surgery." } ], "keyStudies": [ "pmid:39952268", "pmid:41553737", "pmid:40596934", "pmid:40492557", "pmid:41197059", "pmid:38849668", "pmid:37779168", "pmid:42067175" ], "studies": [ { "id": "pmid:42816945", "pmid": "42816945", "doi": "10.1111/codi.70641", "nctId": null, "pmcid": null, "title": "LigaSure versus conventional excisional haemorrhoidectomy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials", "firstAuthor": "Barone", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "meta-analysis", "n": 3277, "nField": "reported", "population": "patients having surgery to remove hemorrhoids", "intervention": "LigaSure (energy-sealing device) hemorrhoidectomy", "comparator": "conventional excisional hemorrhoidectomy", "primaryOutcome": "postoperative pain and recovery after surgery", "result": "LigaSure reduced early pain, bleeding, blood loss, operating time and recovery time, but showed no difference in recurrence, infection, incontinence and several other outcomes", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools many randomised trials with over 3,000 patients, but the trials varied in quality and long-term outcomes like recurrence are still uncertain.", "directness": "indirect", "limitations": "Uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited.", "followUp": "", "plainFinding": "Less early pain than standard hemorrhoid surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42816945/", "sourceText": "BACKGROUND: Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy-based devices may reduce postoperative pain. We performed a systematic review and meta-analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy. METHODS: A systematic search of PubMed, Scopus, Web of Science and the Cochrane Central Register was performed up to July 2025. Randomised controlled trials comparing LigaSure with conventional techniques were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed with the I2 statistic, and trial sequential analysis (TSA) was applied to assess conclusiveness. RESULTS: Forty-three unique RCTs comprising 3,277 participants were analysed. LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks, reduced analgesic requirements and intraoperative blood loss, shorter operating time and time to return to daily activities, and lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention. No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence. CONCLUSION: LigaSure was associated with improvements in selected early perioperative outcomes, particularly postoperative pain and return to daily activities. However, uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited.", "provenance": [ { "field": "n", "quote": "Forty-three unique RCTs comprising 3,277 participants were analysed." }, { "field": "population", "quote": "Randomised controlled trials comparing LigaSure with conventional techniques were included." }, { "field": "intervention", "quote": "We performed a systematic review and meta-analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy." }, { "field": "comparator", "quote": "Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy-based devices may reduce postoperative pain." }, { "field": "primaryOutcome", "quote": "LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks" }, { "field": "result", "quote": "No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence." } ] }, { "id": "pmid:42798126", "pmid": "42798126", "doi": "10.1097/MD.0000000000050716", "nctId": null, "pmcid": "PMC13619253", "title": "A case report on the management of sepsis complicated by eroded mixed hemorrhoids following breast cancer chemotherapy", "firstAuthor": "Ye", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "51-year-old woman with breast cancer on chemotherapy who developed eroded, infected hemorrhoids and sepsis", "intervention": "non-surgical treatment combining antibiotics, blood/immune support, and local wound care (saline cleansing, infrared therapy, growth factor gel, zinc oxide ointment, suppositories, and a traditional Chinese medicine paste)", "comparator": "no comparison group; surgery was avoided due to high risk", "primaryOutcome": "resolution of fever, perianal infection, and healing of the eroded hemorrhoid", "result": "After 30 days, fever resolved, perianal swelling and inflammation completely resolved, and the eroded hemorrhoid healed entirely without surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this approach works in general.", "directness": "indirect", "limitations": "Only one patient, no comparison group, and the patient had a specific complicating condition (severe chemotherapy-induced immune suppression) that is not typical of most people with hemorrhoids.", "followUp": "30 days", "plainFinding": "Healed without surgery in one case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42798126/", "sourceText": "RATIONALE: Sepsis is a life-threatening complication in breast cancer patients undergoing chemotherapy, particularly when compounded by anorectal conditions. The management of eroded mixed hemorrhoids in the setting of severe chemotherapy-induced neutropenia and septicemia presents a clinical dilemma, as standard surgical interventions carry prohibitive risks. This case report details a successful conservative, multimodal approach to this rare and critical scenario. PATIENT CONCERNS: A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer developed a high fever (40.1°C) 1 week after her first cycle of neoadjuvant TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) chemotherapy. She presented with severe bone marrow suppression and constipation, which led to the manual reduction of prolapsed hemorrhoids, resulting in an eroded, inflamed perianal mass. DIAGNOSES: The patient was diagnosed with septicemia (confirmed by Escherichia coli bacteremia), chemotherapy-induced grade IV bone marrow suppression (white blood cell count 0.17 × 109/L, platelet count 6 × 109/L), and mixed hemorrhoids with erosion and secondary perianal infection. INTERVENTIONS: Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented. This included broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care. The local regimen comprised saline cleansing, infrared therapy, recombinant human epidermal growth factor gel, zinc oxide ointment, compound borneol ester suppositories, and the topical application of a self-prepared traditional Chinese medicine, \"Liuhe Dan.\" OUTCOMES: After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care. LESSONS: This case demonstrates that in severely neutropenic and thrombocytopenic patients, a conservative, integrated approach combining systemic anti-infective therapy with advanced local wound care and traditional Chinese medicine can successfully manage life-threatening sepsis originating from eroded hemorrhoids. It underscores the critical importance of perianal hygiene, prompt management of chemotherapy-induced constipation and bone marrow suppression, and the potential of nonsurgical strategies in high-risk surgical candidates.", "provenance": [ { "field": "n", "quote": "A 51-year-old female with stage IIIA human epidermal growth factor receptor 2-positive breast cancer" }, { "field": "population", "quote": "mixed hemorrhoids with erosion and secondary perianal infection" }, { "field": "intervention", "quote": "a conservative strategy was implemented. This included broad-spectrum systemic antibiotics (meropenem, vancomycin, amikacin, amphotericin B sequentially), aggressive hematologic support (granulocyte colony-stimulating factor, blood transfusions), and meticulous multimodal local wound care. The local regimen comprised saline cleansing, infrared therapy, recombinant human epidermal growth factor gel, zinc oxide ointment, compound borneol ester suppositories, and the topical application of a self-prepared traditional Chinese medicine, \"Liuhe Dan.\"" }, { "field": "comparator", "quote": "Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented." }, { "field": "primaryOutcome", "quote": "After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely" }, { "field": "result", "quote": "After 30 days of treatment, the patient became afebrile, and her perianal swelling and inflammation completely resolved. The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care." } ] }, { "id": "pmid:42755315", "pmid": "42755315", "doi": "10.62713/aic.4649", "nctId": null, "pmcid": null, "title": "Dynamic Changes and Influencing Factors of Acute Pain After Elastic Band Ligation of Internal Hemorrhoids in Patients With Mixed Hemorrhoids", "firstAuthor": "Pei", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2026, "design": "retrospective", "n": 173, "nField": "reported", "population": "patients with grade III or IV mixed hemorrhoids", "intervention": "elastic band ligation of internal hemorrhoids", "comparator": "no comparator; patients compared by pain trajectory groups", "primaryOutcome": "pattern of pain after the procedure over 14 days", "result": "patients split into a fast-relief group and a slow-relief group, with younger age, more anxiety/depression, less social support, and more ligations linked to worse pain recovery", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single-center retrospective study looking at pain patterns after the procedure, not comparing surgery to non-surgical treatment.", "directness": "indirect", "limitations": "single-center, retrospective design, no comparison group to non-surgical treatment, abstract does not report on hemorrhoid resolution outcomes", "followUp": "14 days", "plainFinding": "Pain patterns varied after banding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42755315/", "sourceText": "AIM: To investigate the dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids in patients with mixed hemorrhoids and to analyze the independent factors influencing the pain trajectory. METHODS: This single-center retrospective study included 173 patients with mixed hemorrhoids (grade III or IV) who underwent elastic band ligation of internal hemorrhoids at the Department of Proctology, The People's Hospital of Tinghu District, between April 2022 and April 2025. Baseline data, preoperative Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Social Support Rating Scale (SSRS) scores, and visual analog scale (VAS) pain scores on postoperative days 1, 3, 7, and 14 were collected. A growing mixture model (GMM) was used to identify pain progression trajectories. Univariate and multivariate logistic regression analyses were used to identify independent factors influencing trajectory categories, and receiver operating characteristic (ROC) curves were used to assess the discriminative power of risk factors. RESULTS: GMM analysis identified two pain progression trajectories: a rapid relief group (82 cases, 47.4%) and a poor relief group (91 cases, 52.6%). There were statistically significant differences in VAS scores at each postoperative time point and in intra-group time changes between the two groups (p < 0.001). Multivariate logistic regression analysis showed that age (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.85-0.96, p = 0.002), SAS score (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), SDS score (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009), SSRS total score (OR = 0.72, 95% CI: 0.65-0.81, p < 0.001), and number of ligations (OR = 4.96, 95% CI: 1.25-19.77, p = 0.023) were independent factors influencing the pain trajectory. ROC curve analysis showed that the area under the curve for the combination of these factors was 0.94 (95% CI: 0.91-0.97), the optimal cutoff value was 0.635, the sensitivity was 0.82, and the specificity was 0.96. CONCLUSIONS: Postoperative pain following elastic band ligation for mixed hemorrhoids exhibits heterogeneous trajectories. Younger age, higher preoperative anxiety and depression levels, lower levels of social support, and a greater number of ligations increase the risk of patients falling into an unfavorable relief trajectory. These factors may help identify patients at risk of unfavorable postoperative pain trajectories and inform individualized postoperative pain management.", "provenance": [ { "field": "population", "quote": "173 patients with mixed hemorrhoids (grade III or IV) who underwent elastic band ligation of internal hemorrhoids" }, { "field": "intervention", "quote": "elastic band ligation of internal hemorrhoids" }, { "field": "comparator", "quote": "GMM analysis identified two pain progression trajectories: a rapid relief group (82 cases, 47.4%) and a poor relief group (91 cases, 52.6%)" }, { "field": "primaryOutcome", "quote": "dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids" }, { "field": "result", "quote": "age (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.85-0.96, p = 0.002), SAS score (OR = 1.05, 95% CI: 1.01-1.10, p = 0.018), SDS score (OR = 1.05, 95% CI: 1.01-1.09, p = 0.009), SSRS total score (OR = 0.72, 95% CI: 0.65-0.81, p < 0.001), and number of ligations (OR = 4.96, 95% CI: 1.25-19.77, p = 0.023) were independent factors influencing the pain trajectory" }, { "field": "n", "quote": "included 173 patients with mixed hemorrhoids" } ] }, { "id": "pmid:42755308", "pmid": "42755308", "doi": "10.62713/aic.4511", "nctId": null, "pmcid": null, "title": "Monopolar Cautery Ablation as a Minimally Invasive Treatment Option for Grade II-III Hemorrhoidal Disease", "firstAuthor": "Benek", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2026, "design": "retrospective", "n": 61, "nField": "reported", "population": "patients with grade II-III hemorrhoidal disease who had surgery", "intervention": "monopolar cautery ablation (a less invasive cauterizing technique)", "comparator": "standard excisional hemorrhoidectomy (surgical removal of hemorrhoids)", "primaryOutcome": "recovery time, pain, satisfaction, and recurrence after surgery", "result": "Monopolar cautery ablation had shorter operative time, less pain medication need, faster return to daily activities, and higher satisfaction, but had more (non-significant) recurrences than excisional hemorrhoidectomy", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It was a small retrospective study with short follow-up, so the findings are not very reliable.", "directness": "indirect", "limitations": "Retrospective design and relatively short follow-up period, as noted by the authors themselves.", "followUp": "at least one year", "plainFinding": "Faster recovery but more recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42755308/", "sourceText": "AIM: Hemorrhoidal disease (HD) is a common condition worldwide that significantly impairs quality of life. This study aims to compare the effectiveness of excisional hemorrhoidectomy (EH) and monopolar cautery ablation (MPCA). METHODS: This retrospective study included 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease between January 2022 and December 2023. Patients were divided into two groups according to the surgical technique: the EH group and the MPCA group. All patients were followed for at least one year. The groups were compared in terms of operative time, postoperative pain scores (at the 12th hour, postoperative days 1, 7, and 14), duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates. RESULTS: Thirty-two patients underwent EH, and 29 underwent MPCA. Baseline characteristics, including age, sex, and hemorrhoidal stage, were comparable between the groups. Operative time and postoperative analgesic requirements were significantly lower in the MPCA group (both p < 0.001). The time to return to daily activities was significantly shorter in the MPCA group, while patient satisfaction was significantly higher (both p < 0.001). No significant differences were observed between the groups regarding hospital stay or postoperative bleeding and edema (p = 0.086, p = 1.000 and p = 0.600, respectively). No recurrences were detected in the EH group, whereas three recurrences were observed in the MPCA group (p = 0.102). CONCLUSIONS: Monopolar cautery ablation appears to be a suitable minimally invasive option for selected patients with grade II-III hemorrhoidal disease, offering advantages in terms of operative time, postoperative pain, and recovery. However, a higher short-term recurrence rate compared to excisional hemorrhoidectomy was observed. These findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period. Further prospective studies with longer follow-up are required to confirm long-term efficacy and safety.", "provenance": [ { "field": "n", "quote": "This retrospective study included 61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease" }, { "field": "population", "quote": "61 patients who underwent surgery for symptomatic grade II-III hemorrhoidal disease between January 2022 and December 2023" }, { "field": "intervention", "quote": "monopolar cautery ablation (MPCA)" }, { "field": "comparator", "quote": "excisional hemorrhoidectomy (EH)" }, { "field": "primaryOutcome", "quote": "operative time, postoperative pain scores (at the 12th hour, postoperative days 1, 7, and 14), duration of analgesic use, patient satisfaction, time to return to daily activities, postoperative complications, and recurrence rates" }, { "field": "result", "quote": "Operative time and postoperative analgesic requirements were significantly lower in the MPCA group (both p < 0.001). The time to return to daily activities was significantly shorter in the MPCA group, while patient satisfaction was significantly higher (both p < 0.001)." }, { "field": "result", "quote": "No recurrences were detected in the EH group, whereas three recurrences were observed in the MPCA group (p = 0.102)." }, { "field": "followUp", "quote": "All patients were followed for at least one year." }, { "field": "limitations", "quote": "These findings should be interpreted cautiously due to the retrospective design and relatively short follow-up period." } ] }, { "id": "pmid:42393699", "pmid": "42393699", "doi": "10.1186/s12893-026-04006-8", "nctId": null, "pmcid": "PMC13599113", "title": "Low excision and high suspension hemorrhoidectomy versus conventional Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids: a 12-month prospective randomized controlled trial", "firstAuthor": "Shu", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "rct", "n": 120, "nField": "reported", "population": "adults with grade III-IV mixed hemorrhoids", "intervention": "low excision and high suspension hemorrhoidectomy (LEHS), a newer hemorrhoid surgery", "comparator": "Milligan-Morgan hemorrhoidectomy (MM), the standard hemorrhoid surgery", "primaryOutcome": "treatment success at 12 weeks and hemorrhoid recurrence at 12 months", "result": "LEHS was as effective as MM with similar success and recurrence rates, but caused less pain, fewer complications, and better preserved anal function", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but from a single hospital with only 120 patients and the registration happened after the trial started, which raises some concern about reporting bias.", "directness": "indirect", "limitations": "single-center design, trial was registered retrospectively after enrollment, and it compares two surgical techniques rather than surgery versus non-surgical treatment", "followUp": "12 months", "plainFinding": "Newer surgery as effective, safer than standard surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42393699/", "sourceText": "BACKGROUND: Mixed hemorrhoids represent a highly prevalent benign anorectal disorder. Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment but carries substantial risks of severe postoperative pain, delayed recovery, and anal dysfunction due to extensive tissue resection. Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique, yet high-quality long-term comparative evidence remains limited. This study aimed to assess the efficacy, safety, and anal functional outcomes of LEHS versus MM for grade III-IV mixed hemorrhoids over 12 months. METHODS: This single-center, prospective, randomized, non-inferiority trial enrolled 120 eligible patients between January 2024 and June 2024, randomized 1:1 to LEHS or MM groups with allocation concealment and blinded outcome assessment. Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate; secondary outcomes included perioperative indicators, pain scores, recovery metrics, complications, anorectal manometry, and patient satisfaction. Statistical analysis was performed via SPSS 26.0 with a -10% non-inferiority margin (P < 0.05). RESULTS: Baseline characteristics were well balanced between groups (all P > 0.05). The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology (all P < 0.001), with higher patient satisfaction. CONCLUSIONS: LEHS is non-inferior to MM in clinical efficacy and long-term recurrence control for grade III-IV mixed hemorrhoids, with superior safety, faster recovery, and better-preserved anal function without excessive hypertonia. It is a reliable, minimally invasive surgical alternative worthy of clinical promotion. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07495046 (Registered: March 2026, retrospectively registered).", "provenance": [ { "field": "n", "quote": "enrolled 120 eligible patients between January 2024 and June 2024" }, { "field": "population", "quote": "grade III-IV mixed hemorrhoids" }, { "field": "intervention", "quote": "Low excision and high suspension hemorrhoidectomy (LEHS) is a refined, function-preserving technique" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MM) is the gold-standard treatment" }, { "field": "primaryOutcome", "quote": "Primary outcomes were 12-week clinical effective rate and 12-month hemorrhoid recurrence rate" }, { "field": "result", "quote": "The 12-week effective rate (96.4% vs. 92.9%) and 12-month recurrence rate (1.8% vs. 5.4%) confirmed LEHS non-inferiority (both P > 0.05). LEHS yielded longer operative time, less blood loss, lower VAS pain scores, faster recovery, fewer complications (14.8% vs. 33.3%, P = 0.027), and more favorable anorectal physiology" } ] }, { "id": "pmid:42348182", "pmid": "42348182", "doi": null, "nctId": null, "pmcid": null, "title": "Long-term impact of haemorrhoidal artery ligation on anal function and continence", "firstAuthor": "Anwar", "multipleAuthors": true, "journal": "Ir Med J", "year": 2026, "design": "systematic-review", "n": 671, "nField": "reported", "population": "patients who had minimally invasive hemorrhoid artery ligation procedures, followed for over 6 months", "intervention": "hemorrhoidal artery ligation techniques (HAL, Doppler-guided HAL, HAL with rectoanal repair, transanal hemorrhoidal dearterialisation)", "comparator": "comparison among the different HAL technique variants (no non-surgical comparator)", "primaryOutcome": "long-term bowel control (incontinence) more than 6 months after the procedure", "result": "2.5% of patients developed incontinence, mostly mild and temporary; the HAL-RAR variant had a higher rate (5.7%) than standard HAL (0%) or THD (1.0%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it combines only a small number of mixed-design studies (some retrospective) with inconsistent incontinence scoring, so the findings are not very reliable.", "directness": "indirect", "limitations": "small number of included studies (6), mix of retrospective and prospective designs, and no comparison to non-surgical treatment or to full hemorrhoidectomy.", "followUp": ">6 months", "plainFinding": "Low risk of lasting bowel leakage after minimally invasive surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42348182/", "sourceText": "AIMS: Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD) serve as minimally invasive alternatives to excisional haemorrhoidectomy, reducing pain while preserving sphincter function. Long-term faecal incontinence remains a concern due to its quality-of-life impact. This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques. METHODS: PRISMA 2020 guidelines directed searches of PROSPERO, MEDLINE, PubMed, Scopus, Cochrane Library, and ScienceDirect for 2015-2024 studies reporting continence >6 months after HAL-based procedures. Six studies (3 RCTs, 1 prospective, 2 retrospective cohorts; total n=671 patients) met PICOS criteria, with Wexner Incontinence Scores reported or retrospectively mapped. Quality appraisal used CASP Cohort Checklist. RESULTS: Seventeen (2.5%) of 671 patients developed postoperative faecal incontinence. Of these, 14 (82%) cases were mild (Wexner 1-4) and transient, resolving within 3-6 months; 3 (18%) were moderate (Wexner 5-8), primarily in HAL-RAR (9/158 [5.7%]). Standard HAL showed 0/76 (0%) cases; THD had 1/104 (1.0%); DG-HAL had 7/293 (2.4%). No severe incontinence occurred. DISCUSSION: HALO techniques demonstrate excellent long-term continence safety (overall 2.5% low-grade incontinence). HAL-RAR's higher risk (5.7%) warrants counselling. Standardised scoring and multicentre trials are recommended.", "provenance": [ { "field": "population", "quote": "reporting continence >6 months after HAL-based procedures" }, { "field": "intervention", "quote": "Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD)" }, { "field": "comparator", "quote": "Standard HAL showed 0/76 (0%) cases; THD had 1/104 (1.0%); DG-HAL had 7/293 (2.4%)." }, { "field": "primaryOutcome", "quote": "This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques." }, { "field": "result", "quote": "Seventeen (2.5%) of 671 patients developed postoperative faecal incontinence. Of these, 14 (82%) cases were mild (Wexner 1-4) and transient, resolving within 3-6 months; 3 (18%) were moderate (Wexner 5-8), primarily in HAL-RAR (9/158 [5.7%])." }, { "field": "n", "quote": "total n=671 patients" } ] }, { "id": "pmid:42337174", "pmid": "42337174", "doi": "10.1007/s10103-026-04932-2", "nctId": null, "pmcid": "PMC13290880", "title": "Laser hemorrhoidoplasty: two-year outcomes from a retrospective observational cohort study", "firstAuthor": "Elhardello", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2026, "design": "retrospective", "n": 77, "nField": "reported", "population": "adults over 18 with symptomatic hemorrhoids grade 2 to 4, mostly advanced (grade III or IV) with minimal to moderate prolapse", "intervention": "laser hemorrhoidoplasty (LHP), a minimally invasive laser procedure", "comparator": "none - single group, no comparator treatment reported", "primaryOutcome": "symptom resolution, pain, recurrence, complications, and patient satisfaction after treatment", "result": "over 90% had complete symptom resolution at 1 year, 9.1% recurrence, minimal pain, 81% highly satisfied, one complication requiring surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one treatment group with no comparison group, and many patients were lost to follow-up by 2 years, so it can't show if laser treatment is better than other options.", "directness": "indirect", "limitations": "Retrospective design, no comparator group, substantial loss to follow-up by 2 years (only 33.8% seen), so cannot establish whether outcomes differ from no treatment or other options.", "followUp": "2 years", "plainFinding": "Good symptom relief, low pain, few recur.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42337174/", "sourceText": "This study aimed at analysing the outcomes of laser hemorrhoidoplasty (LHP) in a 2-year period. LHP was carried out in 77 patients (83% of them had grade III or grade IV) treated over a two-year period. Inclusion criteria were an age above 18 years old, symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse. Post operative pain, recurrence of the disease, persistence of symptoms, complications, length of stay and patients' satisfaction were all documented. The distribution of patients along the follow-up period was: 77 patients (100%) seen in 3 months, 73 patients (94.8%) seen in 1 year, 51 patients (66.2%) seen in 3 months, 26 patients (33.8%) seen in 2 years. The procedure was well-tolerated and associated with commendable short- to medium-term outcomes. Over 90% of patients achieved complete and sustained symptom resolution over 1-year follow-up period, despite the predominance of advanced disease. Disease recurrence occurred in 9.1% of patients. Postoperative pain was minimal, with a low mean pain score and limited use of opioids. Hospital stay was one day for most patients, and most patients returned to normal activities within the first postoperative week. Overall, 81% of patients were highly satisfied, and 90% reported satisfactory outcomes. Postoperative complications occurred in only one patient, who developed a submucosal abscess requiring surgical intervention. LHP demonstrated favourable short- to medium-term outcomes, with low postoperative pain, minimal opioid use, and high patient satisfaction. LHP may be a promising minimally invasive option for advanced hemorrhoidal disease.", "provenance": [ { "field": "n", "quote": "LHP was carried out in 77 patients" }, { "field": "population", "quote": "Inclusion criteria were an age above 18 years old, symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse." }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "LHP was carried out in 77 patients (83% of them had grade III or grade IV) treated over a two-year period." }, { "field": "primaryOutcome", "quote": "Post operative pain, recurrence of the disease, persistence of symptoms, complications, length of stay and patients' satisfaction were all documented." }, { "field": "result", "quote": "Over 90% of patients achieved complete and sustained symptom resolution over 1-year follow-up period, despite the predominance of advanced disease. Disease recurrence occurred in 9.1% of patients." }, { "field": "result", "quote": "Overall, 81% of patients were highly satisfied, and 90% reported satisfactory outcomes." }, { "field": "followUp", "quote": "26 patients (33.8%) seen in 2 years." } ] }, { "id": "pmid:42323500", "pmid": "42323500", "doi": "10.1007/s10151-026-03371-z", "nctId": null, "pmcid": "PMC13529611", "title": "Cap-assisted endoscopic sclerotherapy for bleeding-predominant grade III hemorrhoids: efficacy and risk factor analysis focusing on two dimensions of bleeding score", "firstAuthor": "Wu", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 82, "nField": "reported", "population": "patients with bleeding-predominant grade III internal hemorrhoids", "intervention": "cap-assisted endoscopic sclerotherapy (injection of polidocanol via long needle)", "comparator": "none (single-arm study, before-after comparison)", "primaryOutcome": "improvement in hemorrhoid symptom severity, especially bleeding, at 3 months", "result": "96.3% effective for bleeding, 58.2% effective for prolapse, overall efficacy 85.4%; bleeding recurred in 25.3% over 24 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-arm retrospective study without a comparison group, so it cannot show how this treatment compares to surgery or other options.", "directness": "indirect", "limitations": "Single-arm retrospective observational study with no control or comparator group, and no randomization.", "followUp": "24 months", "plainFinding": "Non-surgical injection reduced bleeding, but recurred often.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42323500/", "sourceText": "BACKGROUND AND OBJECTIVES: Cap-assisted endoscopic sclerotherapy (CAES) via a long needle optimizes the visualization of operation field and enables precise injection of sclerosant, yet evidence regarding its application in high-grade internal hemorrhoids (HDs) remains limited. This study aims to evaluate the efficacy and safety of CAES therapy for bleeding-predominant grade III symptomatic internal HDs, and explore potential risk factors associated with postoperative bleeding persistence and recurrence. METHODS: This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle. Treatment efficacy was assessed at 3 months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding) and the score of the intensity dimension of the bleeding symptom. Bleeding recurrence was monitored during follow-ups. Logistic regression analysis was employed to explore potential risk factors associated with bleeding outcomes. RESULTS: (1) The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively. (2) During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79). (3) Exploratory logistic regression analysis suggested that a high pre-CAES bleeding intensity score (odds ratio [OR] = 2.887, p = 0.030) was significantly associated with non-excellent outcome (i.e., persistent bleeding); meanwhile, a high pre-CAES bleeding intensity score (OR = 3.981, p = 0.012) and a high post-CAES bleeding frequency score (OR = 3.803, p = 0.006) were significantly associated with post-CAES bleeding recurrence. (4) No severe complications were reported. CONCLUSIONS: CAES with long-needle injection of polidocanol may serve as an effective and safe therapeutic option for managing bleeding symptom in grade III internal HDs. The higher bleeding-associated scores, which encompass both bleeding frequency and intensity, may represent potential risk factors for persistent or recurrent bleeding after the CAES procedure.", "provenance": [ { "field": "n", "quote": "This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs" }, { "field": "population", "quote": "bleeding-predominant grade III symptomatic internal HDs" }, { "field": "intervention", "quote": "Cap-assisted endoscopic sclerotherapy (CAES) via a long needle" }, { "field": "comparator", "quote": "This single-arm retrospective observational study included 82 patients" }, { "field": "primaryOutcome", "quote": "Treatment efficacy was assessed at 3 months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding)" }, { "field": "result", "quote": "The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively." }, { "field": "result", "quote": "During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79)." } ] }, { "id": "pmid:42259698", "pmid": "42259698", "doi": "10.1016/j.rgmxen.2026.05.004", "nctId": null, "pmcid": null, "title": "What factors prolong symptoms in patients with hemorrhoidal disease who require surgery?", "firstAuthor": "Zayas-Bórquez", "multipleAuthors": true, "journal": "Rev Gastroenterol Mex (Engl Ed)", "year": 2026, "design": "retrospective", "n": 56, "nField": "reported", "population": "patients who had surgery for hemorrhoidal disease", "intervention": "hemorrhoidectomy (surgical removal of hemorrhoids)", "comparator": "no comparison group; factors like sex, age, smoking, constipation, BMI, and time to surgery were compared among the same surgical patients", "primaryOutcome": "how long patients had symptoms before surgery (years of disease)", "result": "men had symptoms for about 4.89 more years than women, and younger age at symptom onset was linked to longer symptom duration; constipation and BMI were not linked to symptom duration", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a small, retrospective study of only surgery patients with no comparison to non-surgical treatment, so it cannot show whether surgery is needed or whether non-surgical care would work.", "directness": "indirect", "limitations": "retrospective, cross-sectional design in a single hospital, small sample size, and the authors state the study was not designed for causal inference or prediction", "followUp": "", "plainFinding": "Sex and age affected symptom duration, not surgery need.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42259698/", "sourceText": "INTRODUCTION AND AIMS: Hemorrhoidal disease is a common condition and may affect quality of life. Although it tends to respond to conservative treatment, some cases require surgery. The present study examined clinical and demographic factors associated with symptom duration in surgically treated patients, with no causal inference or predictive intent. MATERIALS AND METHODS: A retrospective, cross-sectional study was conducted at the Hospital Universitario de Puebla on 56 patients who underwent hemorrhoidectomy (2019-2023). The factors of sex, age, smoking, constipation, BMI, and time to surgery were analyzed, employing descriptive statistics, linear regression, and K-Fold cross-validation. RESULTS: There was a significant association between sex and years of disease (p = 0.0427), with men having a mean 4.89 more years of disease than women (β = -4.89, 95% CI -9.61 to -0.17). There was a positive, non-significant association between age and years of disease (p = 0.0907). A significant inverse relation was identified between age at disease onset and years of disease (p < 0.001; β = -0.31, 95% CI -0.46 to -0.15), as well as a significant interaction between sex and age at onset (p < 0.001). CONCLUSIONS: Sex and age at disease onset were key factors associated with symptom duration in patients who underwent hemorrhoidectomy. Factors traditionally considered relevant, such as constipation and BMI, showed no significant association, highlighting the importance of considering complex interactions between clinical and demographic variables.", "provenance": [ { "field": "n", "quote": "on 56 patients who underwent hemorrhoidectomy (2019-2023)" }, { "field": "population", "quote": "56 patients who underwent hemorrhoidectomy (2019-2023)" }, { "field": "intervention", "quote": "56 patients who underwent hemorrhoidectomy (2019-2023)" }, { "field": "comparator", "quote": "The factors of sex, age, smoking, constipation, BMI, and time to surgery were analyzed" }, { "field": "primaryOutcome", "quote": "clinical and demographic factors associated with symptom duration in surgically treated patients" }, { "field": "result", "quote": "men having a mean 4.89 more years of disease than women (β = -4.89, 95% CI -9.61 to -0.17)" }, { "field": "result", "quote": "Factors traditionally considered relevant, such as constipation and BMI, showed no significant association" }, { "field": "limitations", "quote": "A retrospective, cross-sectional study was conducted" }, { "field": "limitations", "quote": "with no causal inference or predictive intent" } ] }, { "id": "pmid:42257743", "pmid": "42257743", "doi": "10.1007/s00384-026-05165-z", "nctId": null, "pmcid": "PMC13469372", "title": "Early hemodynamic changes following endoscopic sclerotherapy for hemorrhoidal disease assessed by transperineal ultrasound and their relationship with clinical outcomes", "firstAuthor": "Gravante", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2026, "design": "prospective-cohort", "n": 37, "nField": "reported", "population": "Patients with grade I-IV hemorrhoids treated with sclerotherapy", "intervention": "Endoscopic polidocanol foam sclerotherapy", "comparator": "No separate control group; lower-grade vs higher-grade hemorrhoids compared", "primaryOutcome": "Changes in blood flow (ultrasound) and symptom scores after treatment", "result": "Lower-grade hemorrhoids showed reduced blood flow and lasting symptom improvement; higher-grade hemorrhoids showed no blood flow change and symptoms worsened between 7 and 30 days", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small, short observational study with no control group, so it cannot prove the treatment itself caused the differences seen.", "directness": "direct", "limitations": "Small sample size (37 patients), no control/comparison treatment group, short 30-day follow-up.", "followUp": "30 days", "plainFinding": "Helps mild cases, not advanced ones.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42257743/", "sourceText": "BACKGROUND: Polidocanol foam (PF) sclerotherapy has regained interest as a minimally invasive treatment for hemorrhoidal disease (HD). However, the early hemodynamic effects of sclerotherapy and their relationship with clinical outcomes remain poorly defined. This study aimed to evaluate early local hemodynamic changes following endoscopic PF sclerotherapy using transperineal ultrasound (TPUS) and to explore their association with patient-reported outcome measures (PROMs). METHODS: This prospective observational study included patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy. TPUS Doppler assessment of peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) was performed at baseline, 7 days, and 30 days post-treatment. Symptoms were evaluated using the PROM-HISS score. Hemodynamic and clinical outcomes were compared over time and stratified by HD severity (Goligher I-II vs III-IV). RESULTS: Thirty-seven patients completed follow-up. No significant differences in preoperative PSV were observed between lower- (Goligher I/II) and higher-grade HD (Goligher III/IV). After treatment, patients with lower-grade HD showed a significant reduction in PSV and RI at both 7 and 30 days (p < 0.01), indicating effective modulation of arterial inflow. In contrast, no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30 days (p = 0.012). PROM-HISS scores significantly improved in all patients at 7 days; however, symptom scores increased between 7 and 30 days in higher-grade HD. CONCLUSIONS: PF sclerotherapy induces early short-term hemodynamic changes detectable by TPUS in lower-grade HD, paralleling consistent short-term symptom improvement. In advanced HD, clinical benefit appears transient and not supported by objective vascular remodeling. TPUS emerges as a valuable non-invasive tool for functional assessment, follow-up, and treatment stratification after sclerotherapy.", "provenance": [ { "field": "n", "quote": "Thirty-seven patients completed follow-up." }, { "field": "population", "quote": "patients with Goligher grade I-IV HD treated with endoscopic PF sclerotherapy" }, { "field": "intervention", "quote": "endoscopic PF sclerotherapy" }, { "field": "comparator", "quote": "stratified by HD severity (Goligher I-II vs III-IV)" }, { "field": "primaryOutcome", "quote": "Symptoms were evaluated using the PROM-HISS score." }, { "field": "result", "quote": "patients with lower-grade HD showed a significant reduction in PSV and RI at both 7 and 30 days (p < 0.01), indicating effective modulation of arterial inflow." }, { "field": "result", "quote": "In contrast, no significant changes in PSV or RI were observed in higher-grade HD, while EDV increased at 30 days (p = 0.012)." }, { "field": "result", "quote": "PROM-HISS scores significantly improved in all patients at 7 days; however, symptom scores increased between 7 and 30 days in higher-grade HD." } ] }, { "id": "pmid:42129663", "pmid": "42129663", "doi": "10.1186/s12876-026-04921-3", "nctId": null, "pmcid": "PMC13348974", "title": "Effect of preoperative anemia on postoperative outcomes in mixed hemorrhoids: a retrospective observational study", "firstAuthor": "Long", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2026, "design": "retrospective", "n": 127, "nField": "reported", "population": "patients with mixed hemorrhoids who had surgery to remove them", "intervention": "having anemia before surgery", "comparator": "not having anemia before surgery", "primaryOutcome": "pain, bleeding, infection, swelling, urinary retention, sleep quality, healing time, and recurrence after surgery", "result": "patients with anemia before surgery had more pain and worse sleep in the first week after surgery, but no difference in bleeding, infection, healing time, or recurrence within a year", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective single-center study looking at a risk factor rather than comparing surgery to non-surgical treatment, so it carries limited weight for this question", "directness": "indirect", "limitations": "retrospective observational design, single center, authors say findings are exploratory and need confirmation in larger studies with better statistical adjustment", "followUp": "12 months", "plainFinding": "Anemia linked to more pain after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42129663/", "sourceText": "BACKGROUND: Anemia is a common complication of long-term hematochezia in patients with mixed hemorrhoids. This study aimed to evaluate the effect of preoperative anemia on the prognosis of mixed hemorrhoids after Milligan-Morgan hemorrhoidectomy. METHODS: A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy at the Affiliated Hospital of Southwest Medical University from January 2021 to August 2022 participated in this study, comprising 48 patients in the preoperative anemia group and 79 patients in the preoperative non-anemia group. Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months were retrospectively analyzed in the two groups. RESULTS: There were no significant differences in the demographic and baseline clinical characteristics between the two groups (P > 0.05). The visual analog scale pain scores at 12 h (P = 0.018), 1 day (P = 0.010), 3 days (P = 0.034), and 7 days (P = 0.001) after surgery and total analgesic consumption within 7 days (P = 0.036) in the preoperative anemia group were higher than those in the preoperative non-anemia group. The ISI within 7 days in the preoperative anemia group was higher than that in the preoperative non-anemia group (P = 0.046). There were no significant differences in delayed bleeding, wound infection, wound edema (P = 0.740), urinary retention (P = 0.648), anal stenosis, or wound healing time (P = 1.101) between the two groups. There were no significant differences in recurrence (prolapse or bleeding) rates within 12 months between the two groups (P = 0.513). CONCLUSIONS: In this retrospective observational study, preoperative anemia was associated with higher postoperative pain scores and poorer sleep quality within 7 days after Milligan-Morgan hemorrhoidectomy. However, no significant associations were observed between preoperative anemia and other postoperative complications, wound healing time, or 12-month recurrence rates. Given the observational design and the exploratory nature of the analysis, these findings should be interpreted with caution and require confirmation in larger, adequately powered studies with multivariable adjustment.", "provenance": [ { "field": "n", "quote": "A total of 127 patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "population", "quote": "patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "48 patients in the preoperative anemia group" }, { "field": "comparator", "quote": "79 patients in the preoperative non-anemia group" }, { "field": "primaryOutcome", "quote": "Postoperative complications such as postoperative pain, delayed bleeding, wound infection, wound edema, urinary retention, insomnia severity index (ISI) within 7 days, wound healing time, and recurrence rates (prolapse or bleeding) within 12 months" }, { "field": "result", "quote": "The visual analog scale pain scores at 12 h (P = 0.018), 1 day (P = 0.010), 3 days (P = 0.034), and 7 days (P = 0.001) after surgery and total analgesic consumption within 7 days (P = 0.036) in the preoperative anemia group were higher than those in the preoperative non-anemia group." }, { "field": "result", "quote": "There were no significant differences in delayed bleeding, wound infection, wound edema (P = 0.740), urinary retention (P = 0.648), anal stenosis, or wound healing time (P = 1.101) between the two groups." } ] }, { "id": "pmid:42120648", "pmid": "42120648", "doi": "10.1007/s10151-026-03353-1", "nctId": null, "pmcid": "PMC13337578", "title": "Feasibility and advantages of delivering radiofrequency ablation treatment for haemorrhoids under local anaesthesia in the outpatient setting in the UK: our initial experience", "firstAuthor": "Rajendiran", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "prospective-cohort", "n": 53, "nField": "reported", "population": "adults with grade II-III haemorrhoids that had not responded to conservative treatment", "intervention": "radiofrequency ablation (RFA) for haemorrhoids performed under local anaesthesia in an outpatient clinic", "comparator": "none - outcomes measured before and after treatment in the same patients, no comparison group", "primaryOutcome": "whether the procedure could be successfully completed as an outpatient under local anaesthesia", "result": "all patients completed the procedure as outpatients with same-day discharge and no major complications; haemorrhoid symptoms and quality of life improved significantly at 2-4 months, but 11.3% needed later surgery and 12-month data were limited and inconclusive", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small, single-group study without a comparison group and with major loss of follow-up by 12 months, so it cannot reliably show how long benefits last.", "directness": "direct", "limitations": "no control/comparator group, small sample (only 11 patients had 12-month data), substantial attrition and symptom-driven follow-up at 12 months", "followUp": "135 days", "plainFinding": "Short-term relief; long-term benefit unclear.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42120648/", "sourceText": "INTRODUCTION: Radiofrequency ablation (RFA) for haemorrhoids has emerged as a minimally invasive treatment for grade II-III haemorrhoids, offering reduced postoperative pain and faster recovery compared with conventional surgery. However, most published data describe the procedure in theatre under general anaesthesia, limiting accessibility and increasing costs. METHODS: We conducted a prospective evaluation of radiofrequency ablation performed under local anaesthesia in an outpatient setting for patients with grade II-III haemorrhoids refractory to conservative therapy for a period of 2 years between 2022 and 2024. Procedures were performed using the RAFAELO® system with proctoscopy. The primary outcome was the successful completion of procedure as outpatient. Secondary outcomes were resolution of symptoms and improvement of quality of life. These were assessed using the Haemorrhoid Symptom Score (HSS) and EuroQol Visual Analogue Scale (EQ-VAS) at 2-4 and 12 months. RESULTS: In total, 53 patients were included in the study with median age of 58 years. A total of 33.9% of patients were ASA 3/4; seven of these patients were on anticoagulants, and their medications were stopped according to the British Society of Gastroenterology (BSG) guidelines. All the patients were able to complete the procedure under local anaesthetic in outpatient setting. All procedures were completed under local anaesthesia with same-day discharge and no major complications. Median follow up was 135 days. At 2-4 months, significant improvement in HSS was observed (mean difference 9.50; 95% CI 5.34-13.66; p < 0.001). The 12-month findings (n = 11) suggested possible persistence of benefit but are limited by substantial attrition and symptom-driven follow-up and should not be generalised. The quality-of-life scores (EQ-VAS) showed a 63% improvement between preoperative and 2-4-month values (p < 0.001). No statistically significant improvement was observed at 12 months within the remits of a small symptom-selected sample (n = 11). In total, six patients (11.3%) required subsequent operative intervention. None of the patients who were on anticoagulants had any bleeding complications or any unplanned return to tertiary care. CONCLUSIONS: Our experience demonstrates that radiofrequency ablation treatment for haemorrhoids can be safely and effectively delivered in an outpatient setting under local anaesthesia, even among higher-risk patients. The study demonstrates encouraging short-term symptom improvement, but the limited and selective long-term data preclude firm conclusions regarding durability or broader service impact. Larger, controlled studies with structured long-term follow-up are required to define the role of outpatient RFA within haemorrhoid care pathways.", "provenance": [ { "field": "n", "quote": "In total, 53 patients were included in the study" }, { "field": "population", "quote": "patients with grade II-III haemorrhoids refractory to conservative therapy" }, { "field": "intervention", "quote": "radiofrequency ablation performed under local anaesthesia in an outpatient setting" }, { "field": "comparator", "quote": "We conducted a prospective evaluation of radiofrequency ablation performed under local anaesthesia in an outpatient setting for patients with grade II-III haemorrhoids refractory to conservative therapy" }, { "field": "primaryOutcome", "quote": "The primary outcome was the successful completion of procedure as outpatient." }, { "field": "result", "quote": "All procedures were completed under local anaesthesia with same-day discharge and no major complications." }, { "field": "result", "quote": "At 2-4 months, significant improvement in HSS was observed (mean difference 9.50; 95% CI 5.34-13.66; p < 0.001)." }, { "field": "result", "quote": "In total, six patients (11.3%) required subsequent operative intervention." }, { "field": "followUp", "quote": "Median follow up was 135 days." } ] }, { "id": "pmid:42067175", "pmid": "42067175", "doi": "10.1016/j.cgh.2026.04.008", "nctId": null, "pmcid": null, "title": "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review", "firstAuthor": "Qureshi", "multipleAuthors": true, "journal": "Clin Gastroenterol Hepatol", "year": 2026, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "non-surgical treatments such as diet/lifestyle changes, topical treatments, banding, and infrared coagulation", "comparator": "surgical hemorrhoidectomy", "primaryOutcome": "best practice recommendations for diagnosing and treating hemorrhoids", "result": "Most hemorrhoids can be managed with conservative measures or in-office procedures like banding and infrared coagulation, with surgery reserved for more severe or refractory cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an expert opinion-based guideline without a systematic review of evidence, so its recommendations carry less certainty.", "directness": "direct", "limitations": "Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.", "followUp": "", "plainFinding": "Most hemorrhoids treatable without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42067175/", "sourceText": "DESCRIPTION: Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two-thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation, and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or international normalized ratio greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are a common problem." }, { "field": "intervention", "quote": "Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids." }, { "field": "comparator", "quote": "Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids." }, { "field": "primaryOutcome", "quote": "to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease" }, { "field": "result", "quote": "Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting." }, { "field": "result", "quote": "Grade 4 internal hemorrhoids require surgical hemorrhoidectomy." }, { "field": "limitations", "quote": "Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations." } ] }, { "id": "pmid:42047132", "pmid": "42047132", "doi": "10.7417/CT.2026.2030", "nctId": null, "pmcid": null, "title": "Analysis of the quality of life of patients with haemorrhoids", "firstAuthor": "Baimanov", "multipleAuthors": true, "journal": "Clin Ter", "year": 2026, "design": "case-series", "n": 634, "nField": "reported", "population": "patients with hemorrhoids who underwent surgical treatment", "intervention": "surgical treatment of hemorrhoids", "comparator": "no non-surgical comparison group; quality of life assessed after surgery", "primaryOutcome": "quality of life (physical, emotional, social aspects) related to hemorrhoids", "result": "most patients reported improved quality of life and no significant physical limitations after surgery, with no significant discomfort in 88% of cases, though moderate or mild pain persisted in 46% of patients", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a survey-based observational study with no comparison group and no mention of how patients were selected or followed over time, so it can't show whether surgery is better than non-surgical care.", "directness": "indirect", "limitations": "No non-surgical comparator group; relies on a modified sociological questionnaire; selection and recall bias possible; methodology for timing of assessment not described.", "followUp": "", "plainFinding": "Better quality of life after surgery, but pain remained common.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42047132/", "sourceText": "Haemorrhoids are a chronic disease of the anorectal area characterised by pain, bleeding and discomfort, which significantly reduce the quality of life of patients, limiting their physical activity, emotional state and social interactions, especially in cases requiring surgery. Despite significant progress in surgical treatment methods, the impact of these methods on the quality of life of patients remains insufficiently studied. The study aimed to determine the impact of haemorrhoids and their surgical treatment on the quality of life of patients. The study involved 634 patients, most of whom were women (76.5%). Participants were divided by age group, professional activity and place of residence. A modified sociological questionnaire was used to assess the physical, emotional and social aspects of respondents' lives. The results of the study demonstrated that, in most cases, the quality of life of patients improved significantly after surgery: most respondents reported no significant limitations in physical activity, and it did not cause significant discomfort in 88% of cases, although moderate or mild pain persisted in 46% of patients. The findings demonstrate that timely surgical treatment of haemorrhoids has a positive impact on the quality of life of patients, reducing pain symptoms and improving their general condition. The practical significance of the study is determined by the possibility of using its results to improve approaches to the treatment and rehabilitation of patients with haemorrhoids, as well as to introduce standards for assessing the quality of life of patients with haemorrhoids to optimise therapy.", "provenance": [ { "field": "n", "quote": "The study involved 634 patients, most of whom were women (76.5%)." }, { "field": "population", "quote": "patients with haemorrhoids" }, { "field": "intervention", "quote": "surgical treatment of haemorrhoids" }, { "field": "comparator", "quote": "the quality of life of patients improved significantly after surgery" }, { "field": "primaryOutcome", "quote": "A modified sociological questionnaire was used to assess the physical, emotional and social aspects of respondents' lives." }, { "field": "result", "quote": "most respondents reported no significant limitations in physical activity, and it did not cause significant discomfort in 88% of cases, although moderate or mild pain persisted in 46% of patients" } ] }, { "id": "pmid:42026233", "pmid": "42026233", "doi": "10.1007/s10151-026-03291-y", "nctId": null, "pmcid": "PMC13269399", "title": "Milligan-Morgan hemorrhoidectomy, mucopexy, and hybrid combination for grade III hemorrhoids: a large retrospective cohort study", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 686, "nField": "reported", "population": "patients with symptomatic grade III hemorrhoids treated surgically", "intervention": "Milligan-Morgan hemorrhoidectomy, mucopexy, or a hybrid combination of both", "comparator": "different surgical techniques compared against each other (mucopexy alone vs MM alone vs hybrid combinations)", "primaryOutcome": "recurrence rate and patient-reported outcomes at 2 years, plus pain and complications at 30 days", "result": "Mucopexy caused less early pain but had more recurrence long-term, while Milligan-Morgan had the lowest recurrence and best long-term outcomes", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study comparing surgical methods to each other, not surgery versus non-surgical treatment, so it can't directly answer whether surgery is needed at all.", "directness": "indirect", "limitations": "Retrospective analysis.", "followUp": "2 years", "plainFinding": "Comparing surgical techniques, not surgery vs no surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42026233/", "sourceText": "BACKGROUND: Mucopexy has emerged as a nonexcisional alternative to Milligan-Morgan (MM) hemorrhoidectomy. OBJECTIVE: This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD). DESIGN: Retrospective cohort study. SETTING: Tertiary referral setting. PATIENTS: Symptomatic grade III HD treated between 2016 and 2018. INTERVENTIONS: Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone. MAIN OUTCOMES MEASURES: Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days. RESULTS: A total of 686 consecutive patients with III-degree HD were included in the analysis. The most frequent approach was MM alone (group 1, n = 309, 45%), followed by mucopexy alone (group 4, n = 138, 20.2%), then the combined approaches (group 2, n = 120, 17.5%; group 3, n = 119, 17.3%). Group 4 had the lowest pain scores and the highest 30-day PROM (p < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM. LIMITATIONS: Retrospective analysis. CONCLUSIONS: Mucopexy and the hybrid procedures reduce morbidity and enhances early postoperative PROM in grade III HD. However, its higher recurrence rate suggests that a patient- and pile-specific approach may help balance efficacy with surgical invasiveness.", "provenance": [ { "field": "n", "quote": "A total of 686 consecutive patients with III-degree HD were included in the analysis." }, { "field": "population", "quote": "Symptomatic grade III HD treated between 2016 and 2018." }, { "field": "intervention", "quote": "Four groups were defined: group 1 included patients treated with MM alone; group 2 received mucopexy on one pile combined with MM on the remaining two; group 3 underwent mucopexy on two piles with MM on the remaining one; and group 4 was treated with mucopexy alone." }, { "field": "comparator", "quote": "This study compares MM, mucopexy, and hybrid MM/mucopexy procedures in patients with grade III hemorrhoidal disease (HD)." }, { "field": "primaryOutcome", "quote": "Recurrence rates and patient-reported outcome measures (PROMs) using a visual-analogic scale (VAS) at 2 years, postoperative pain at 7 days, early complication rates at 30 days, and PROMs at 30 days." }, { "field": "result", "quote": "Group 4 had the lowest pain scores and the highest 30-day PROM (p < 0.001), whereas group 1 showed the best long-term results, with the lowest recurrence rate (4.2% versus 14.5% in group 4) and highest long-term PROM." } ] }, { "id": "pmid:41987169", "pmid": "41987169", "doi": "10.1186/s12893-026-03744-z", "nctId": null, "pmcid": "PMC13220367", "title": "Evaluation of short-term outcomes of Endoscopic Super-Hemorrhoidal Banding for mixed hemorrhoids with prolapsed internal hemorrhoids: a retrospective study", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "retrospective", "n": 480, "nField": "reported", "population": "patients with mixed hemorrhoids with Grade II-IV internal hemorrhoid prolapse", "intervention": "Endoscopic Super-Hemorrhoidal Banding (ESHB), a less invasive banding procedure", "comparator": "Milligan-Morgan hemorrhoidectomy (traditional surgical removal)", "primaryOutcome": "cure rate, operative time, hospital stay, pain, and complications", "result": "Similar cure rates between groups, but ESHB had shorter operative time and hospital stay, less pain, and fewer urinary retention complications", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without randomization, comparing two surgical approaches rather than surgery versus no surgery, so it cannot show whether avoiding surgery altogether works.", "directness": "indirect", "limitations": "Retrospective design; only short-term follow-up; compares two surgical techniques rather than surgical versus nonsurgical treatment", "followUp": "", "plainFinding": "Less invasive surgery, similar cure, less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41987169/", "sourceText": "BACKGROUND: To evaluate the clinical efficacy and safety of Endoscopic Super-hemorrhoidal Banding (ESHB) in treating mixed hemorrhoids with Grade II-IV internal hemorrhoid prolapse as the main symptom. METHODS: A retrospective analysis was conducted on clinical data of patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024. They were divided into two groups: patients underwent Milligan-Morgan hemorrhoidectomy (MMH) as the control group, and patients underwent ESHB as the observation group. Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared. RESULTS: 245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB. The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05). The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01). One patient in each group had severe postoperative bleeding, which stopped after surgical suture or endoscopic titanium clip closure. CONCLUSION: Short-term follow-up indicates that ESHB can effectively reposition the prolapsed anal cushions, preserve the anatomical structure and functional integrity of the anal cushions, alleviate symptoms associated with mixed hemorrhoids primarily characterized by internal hemorrhoid prolapse, shorten both the operative time and hospital stay, and reduce patients’ postoperative anal pain scores as well as the incidence of postoperative complications. It is an effective, safe, and simple minimally invasive treatment method; however, its long-term efficacy still requires further validation. TRIAL REGISTRATION: This was a retrospective observational study. Trial registration was performed retrospectively (registration no.: NCT06250140; registration date: January 31, 2024).", "provenance": [ { "field": "population", "quote": "patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024" }, { "field": "population", "quote": "Grade II-IV internal hemorrhoid prolapse as the main symptom" }, { "field": "intervention", "quote": "Endoscopic Super-hemorrhoidal Banding (ESHB)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH) as the control group" }, { "field": "n", "quote": "245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB" }, { "field": "result", "quote": "The cure rates were 69.36% in the ESHB group and 72.65% in the MMH group, with no statistically significant difference between the two groups (P > 0.05)." }, { "field": "result", "quote": "The observation group had significantly shorter operative time and hospital stay (P < 0.01), lower postoperative anal pain scores and incidence of urinary retention (P < 0.01)." }, { "field": "primaryOutcome", "quote": "Treatment outcomes included efficacy measurement, operative time, hospital stay, postoperative anal pain scores, and incidence of complications like bleeding and urinary retention were compared." } ] }, { "id": "pmid:41906143", "pmid": "41906143", "doi": "10.1186/s12893-026-03702-9", "nctId": null, "pmcid": "PMC13151250", "title": "Ruiyun procedure for hemorrhoids versus tissue-selective therapy stapler for grade II-III hemorrhoids: an exploratory retrospective comparative study", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "retrospective", "n": 192, "nField": "reported", "population": "adults with grade II-III hemorrhoids", "intervention": "Ruiyun procedure for hemorrhoids (RPH), a minimally invasive surgery", "comparator": "tissue-selecting therapy (TST) stapler surgery", "primaryOutcome": "treatment effectiveness rate at one month and hemorrhoid recurrence rate within one year after surgery", "result": "No significant differences were found in the overall clinical efficacy or the one-year recurrence rate between the groups (p > 0.05)", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "It is a retrospective comparison of two surgeries with possible differences in patient selection, so it cannot reliably show one technique is better than the other.", "directness": "indirect", "limitations": "Retrospective design with potential baseline differences between groups; authors state findings cannot be directly interpreted as evidence of superiority of either technique.", "followUp": "one year", "plainFinding": "Similar success, RPH recovered faster", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41906143/", "sourceText": "BACKGROUND: The Ruiyun procedure for hemorrhoids (RPH) and tissue-selecting therapy (TST) are two widely adopted minimally invasive techniques for treating Grade II-III hemorrhoids. This study aims to perform an exploratory comparison of the efficacy and safety of these two surgical techniques within a real-world clinical setting, thereby providing evidence to inform future prospective investigations. METHODS: A retrospective analysis was conducted on 192 patients with Grade II-III hemorrhoids, comprising 80 patients who underwent RPH and 112 who underwent TST. The primary outcomes were the treatment effectiveness rate at one month and the recurrence rate within one year postoperatively. Secondary outcomes included operative time, intraoperative blood loss, time to return to normal activities, postoperative anal pain, complication rates, patient satisfaction, and PROM scores. RESULTS: The two groups were comparable in baseline characteristics. No significant differences were found in the overall clinical efficacy or the one-year recurrence rate between the groups (p > 0.05). However, the RPH group demonstrated significant advantages, including shorter operative time, reduced intraoperative blood loss, faster return to normal activities, lower anal pain scores on postoperative days 1 and 3, a lower incidence of fecal urgency and higher patient satisfaction (all p < 0.05). No significant intergroup differences were observed in terms of anal distension, postoperative bleeding, anorectal stenosis, PROM scores, or anal pain on postoperative day 7 (p > 0.05). CONCLUSION: Within the context of this retrospective study, RPH demonstrated efficacy and safety in the treatment of Grade II–III hemorrhoids. It exhibited favorable outcomes in reducing intraoperative blood loss, shortening operative time, minimizing postoperative complications, and facilitating a rapid return to normal activities. However, given the potential differences in baseline characteristics between the two patient groups, these observations cannot be directly interpreted as evidence of the superiority or inferiority of either technique. The observed differences in efficacy may be partially attributable to disparities in patient selection.", "provenance": [ { "field": "population", "quote": "192 patients with Grade II-III hemorrhoids" }, { "field": "intervention", "quote": "80 patients who underwent RPH" }, { "field": "comparator", "quote": "112 who underwent TST" }, { "field": "primaryOutcome", "quote": "The primary outcomes were the treatment effectiveness rate at one month and the recurrence rate within one year postoperatively." }, { "field": "result", "quote": "No significant differences were found in the overall clinical efficacy or the one-year recurrence rate between the groups (p > 0.05)." }, { "field": "n", "quote": "A retrospective analysis was conducted on 192 patients with Grade II-III hemorrhoids" } ] }, { "id": "pmid:41894272", "pmid": "41894272", "doi": "10.1097/MD.0000000000048004", "nctId": null, "pmcid": "PMC13034956", "title": "Clinical outcomes of arterial detection ligation technique for grade II/III versus grade IV hemorrhoidal disease", "firstAuthor": "Bilgiç", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "retrospective", "n": 78, "nField": "reported", "population": "adults with grade II/III or grade IV hemorrhoids who had a minimally invasive surgical procedure", "intervention": "arterial detection ligation (ADL) with mucopexy in patients with grade IV hemorrhoids", "comparator": "the same ADL-mucopexy procedure in patients with grade II/III hemorrhoids", "primaryOutcome": "pain after surgery and return of hemorrhoids (recurrence)", "result": "grade IV patients had more pain, more painkiller use, and slower bowel recovery right after surgery, but satisfaction at 1 month and recurrence rates were similar between the two groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small retrospective study comparing two groups who both had the same surgery, so it cannot say whether surgery is better than non-surgical treatment.", "directness": "indirect", "limitations": "retrospective design, small sample size, no non-surgical comparison group, short follow-up for recurrence", "followUp": "1 month satisfaction assessment; recurrence follow-up duration not specified", "plainFinding": "Similar surgery outcomes across hemorrhoid severity.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41894272/", "sourceText": "Doppler-guided dearterialization with mucopexy is well established for grade II/III hemorrhoidal disease (HD), whereas evidence supporting its use in grade IV disease remains limited. The arterial detection ligation (ADL) system provides deeper Doppler penetration and improved arterial mapping, potentially enhancing outcomes in advanced disease. This study compared clinical outcomes of ADL-mucopexy between patients with grade II/III and grade IV HD. Patients who underwent ADL-mucopexy between July 2022 and March 2024 were retrospectively analyzed. Patients were classified into grade II/III and grade IV groups according to the Goligher classification. Primary outcomes included postoperative pain and recurrence, while secondary outcomes comprised operative time, tenesmus, bowel function parameters, and patient satisfaction. Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24). Patients with grade IV disease had significantly longer baseline toilet sitting times and symptom duration. Operative time and hospital stay were also longer in the grade IV group, while the number of mucopexies and external excisions was similar. Postoperatively, grade IV patients required more opioid analgesia, experienced longer times to first flatus and defecation, and reported higher 24-hour visual analog scale pain scores. Tenesmus at 1 week was more common in grade IV patients. Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up. ADL-mucopexy demonstrated comparable short-term clinical outcomes and patient satisfaction across different HD grades. Although patients with grade IV disease experienced greater early postoperative discomfort, recurrence rates and overall satisfaction were similar. ADL-mucopexy may be considered a potential minimally invasive surgical option in carefully selected patients with grade IV HD.", "provenance": [ { "field": "n", "quote": "Seventy-eight patients were included (grade II/III: n = 54; grade IV: n = 24)." }, { "field": "population", "quote": "Patients were classified into grade II/III and grade IV groups according to the Goligher classification." }, { "field": "intervention", "quote": "ADL-mucopexy between July 2022 and March 2024 were retrospectively analyzed" }, { "field": "comparator", "quote": "compared clinical outcomes of ADL-mucopexy between patients with grade II/III and grade IV HD" }, { "field": "primaryOutcome", "quote": "Primary outcomes included postoperative pain and recurrence" }, { "field": "result", "quote": "Despite these early differences, 1-month satisfaction scores were comparable between groups (8.8 vs 8.5). Recurrence was observed in 1 patient in each group during follow-up." } ] }, { "id": "pmid:41748745", "pmid": "41748745", "doi": "10.1007/s00384-025-05057-8", "nctId": null, "pmcid": "PMC12946293", "title": "Effectiveness and safety of 3% polidocanol foam sclerotherapy in hemorrhoidal disease: a multicenter, prospective study", "firstAuthor": "Yu", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2026, "design": "prospective-cohort", "n": 222, "nField": "reported", "population": "patients with grade I, II, or III hemorrhoids (internal or mixed type)", "intervention": "polidocanol foam sclerotherapy injection under anoscopy", "comparator": "rubber band ligation", "primaryOutcome": "clinical cure rate under anoscopy and symptom assessment at 4 weeks", "result": "similar cure rates between the two treatments (74.19% vs 83.13%, not statistically significant), with faster bleeding improvement in the sclerotherapy group", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was an observational study where patients chose their treatment rather than being randomly assigned, so differences between groups could be due to other factors.", "directness": "direct", "limitations": "open-label, observational design with treatment assignment based on physician assessment and patient willingness rather than randomization", "followUp": "12 weeks", "plainFinding": "Similar cure rate to rubber band ligation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41748745/", "sourceText": "AIM: To evaluate the effectiveness and safety of 3% polidocanol foam sclerotherapy (PFS) injection under anoscopy in the treatment of hemorrhoidal disease (HD) compared with rubber band ligation (RBL). METHOD: This was a multicenter, open-label, prospective, observational study that enrolled 222 patients with Goligher grade I, II, or III HD (internal or mixed), who were treated with 3% PFS or RBL, which depended on the physician's assessment and the patient's willingness. The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4 weeks post-treatment. RESULTS: A total of 222 patients from 14 centers participated in the study, with 127 patients receiving PFS and 95 patients receiving RBL. Among the effectiveness analysis set (EAS), the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05). The PFS group showed quicker and better improvement in hemorrhage score post-treatment than the RBL group, with the mean (SD) changes from baseline in hemorrhage score of the two groups (P < 0.001) at 1, 4, and 12 weeks being -3.44 (1.99) vs. -1.70 (2.19), -3.85 (1.80) vs. -2.75 (2.02), and -3.81 (1.84) vs. -2.89 (2.10), respectively. The incidences of adverse events (AEs) were 2.36% (3/127) in the PFS group and 3.16% (3/95) in the RBL group, respectively, and no serious adverse events (SAEs) occurred in both groups. CONCLUSION: Patients treated with PFS showed similar effectiveness and safety as those treated with RBL under anoscopy, and a quick improvement trend in hemorrhage score post-treatment was observed in patients treated with PFS, but it needs further verification. TRIAL REGISTRATION: This study has been registered on the website of Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ), registration number: ChiCTR2200060325.", "provenance": [ { "field": "n", "quote": "enrolled 222 patients" }, { "field": "population", "quote": "patients with Goligher grade I, II, or III HD (internal or mixed)" }, { "field": "intervention", "quote": "3% polidocanol foam sclerotherapy (PFS) injection under anoscopy" }, { "field": "comparator", "quote": "rubber band ligation (RBL)" }, { "field": "primaryOutcome", "quote": "The primary endpoint was the clinical cure rate under anoscopy and clinical symptoms assessment at 4 weeks post-treatment." }, { "field": "result", "quote": "the clinical cure rate was 74.19% (69/93) in the PFS group and 83.13% (69/83) in the RBL group (P > 0.05)" } ] }, { "id": "pmid:41693967", "pmid": "41693967", "doi": "10.3748/wjg.v32.i5.116007", "nctId": null, "pmcid": "PMC12897523", "title": "Endoscopic rubber band ligation, injection sclerotherapy, and sclerobanding for the treatment of internal hemorrhoids", "firstAuthor": "Zu", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2026, "design": "retrospective", "n": 201, "nField": "reported", "population": "patients with grade I-III internal hemorrhoids", "intervention": "endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), or endoscopic polidocanol sclerobanding (ESB)", "comparator": "the three endoscopic treatments compared against each other", "primaryOutcome": "clinical efficacy, recurrence rates, and postoperative adverse events", "result": "ESB and ERBL had lower overall recurrence than IS; for grade II-III hemorrhoids, ESB had lower recurrence and less pain than IS and ERBL; no differences among groups within 6 months or for grade I hemorrhoids", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized study comparing three procedures, so differences could be due to unmeasured factors rather than the treatments themselves.", "directness": "direct", "limitations": "Retrospective cohort design without randomization.", "followUp": "24 months", "plainFinding": "Non-surgical options work, varying by severity.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41693967/", "sourceText": "BACKGROUND: The clinical outcomes of endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB) have not yet been well studied. AIM: To evaluate the efficacy and safety of ERBL, IS, and ESB for treating grade I-III internal hemorrhoids. METHODS: This retrospective cohort study was performed on 201 patients, who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups). Postoperative follow-ups were initially carried out at 1, 3, and 6 months, and then every 6 months, with the longest follow-up extending to 24 months. The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events. Additionally, subgroup analysis was conducted based on the internal hemorrhoid grade (I or II-III). RESULTS: The patient distribution across the ERBL, IS, and ESB groups was 70, 66, and 65, respectively. Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P' = 0.024 and P' = 0.015, respectively). Subgroup analysis revealed that sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P' = 0.03), specifically for grade II-III internal hemorrhoids. No significant difference was found in grade I hemorrhoids. The ERBL group exhibited a higher incidence of postoperative pain, a worse median visual analog scale score, and a longer median duration of pain compared with those reported by the other groups (P < 0.001). This trend was consistent for grade II-III hemorrhoids. No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup. CONCLUSION: The three treatments evaluated (ERBL, IS, and ESB) provide durable clinical outcomes for grade I hemorrhoids, with no significant differences in postoperative adverse events. For grade II-III hemorrhoids, ESB possesses the dual advantages of lower recurrence rates and reduced postoperative pain compared with IS and ERBL.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study was performed on 201 patients" }, { "field": "population", "quote": "treating grade I-III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic rubber band ligation (ERBL), injection sclerotherapy (IS), and endoscopic polidocanol sclerobanding (ESB)" }, { "field": "comparator", "quote": "who were grouped according to their endoscopic treatment (ERBL, IS, and ESB groups)" }, { "field": "primaryOutcome", "quote": "The study analyzed clinical efficacy, short-term and overall recurrence rates, and postoperative adverse events." }, { "field": "result", "quote": "Both the ERBL and ESB groups demonstrated lower overall recurrence rates compared with the IS group (post-hoc analysis, P' = 0.024 and P' = 0.015, respectively)." }, { "field": "result", "quote": "sclerotherapy resulted in a higher total recurrence rate than that achieved by sclerobanding (45.95% vs 19.57%, P' = 0.03), specifically for grade II-III internal hemorrhoids" }, { "field": "result", "quote": "No significant differences were found among the three groups regarding clinical efficacy or recurrence rates within 6 months post-surgery, even when examined by subgroup." }, { "field": "followUp", "quote": "the longest follow-up extending to 24 months" } ] }, { "id": "pmid:41603644", "pmid": "41603644", "doi": "10.1097/DCR.0000000000004147", "nctId": null, "pmcid": null, "title": "Preliminary Results of Open Excisional Hemorrhoidectomy Combined With 3% Polidocanol Foam Sclerotherapy in Patients With Grade IV Hemorrhoidal Disease: A Randomized Controlled Open-Label Single-Center Study", "firstAuthor": "Yin", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2026, "design": "rct", "n": 36, "nField": "reported", "population": "adults aged 18 to 75 with grade IV hemorrhoids", "intervention": "Milligan-Morgan hemorrhoidectomy plus 3% polidocanol foam sclerotherapy", "comparator": "Milligan-Morgan hemorrhoidectomy alone", "primaryOutcome": "time to return to daily activities", "result": "Adding sclerotherapy to surgery shortened recovery time by about 5.78 days and reduced bleeding and pain medicine use, with similar satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The trial was small, not blinded, done at one center, and followed patients for only a short time, so its findings are not very reliable.", "directness": "indirect", "limitations": "Small sample size, nonblinded, single-center design, and short follow-up period.", "followUp": "1 to 2 months", "plainFinding": "Sclerotherapy added to surgery speeds recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41603644/", "sourceText": "BACKGROUND: The Milligan-Morgan hemorrhoidectomy remains the criterion standard for grade IV hemorrhoidal disease. However, postoperative pain, bleeding, and prolonged recovery persist as challenges. Sclerotherapy shows promise but lacks evidence in grade IV hemorrhoidal disease management. OBJECTIVE: This study evaluated the efficacy and safety of open excisional hemorrhoidectomy (Milligan-Morgan hemorrhoidectomy) combined with 3% polidocanol foam sclerotherapy in patients with grade IV hemorrhoidal disease. DESIGN: A randomized, open-label, single-center clinical trial. SETTINGS: Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China. PATIENTS: Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups. INTERVENTIONS: The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy; the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy. MAIN OUTCOME MEASURES: The primary outcome was the time to return to daily activities. Secondary outcomes included Hemorrhoidal Disease Symptom Score, Vaizey Incontinence scores, visual analog scale score, Short Health Scale for Hemorrhoidal Disease scores, postoperative bleeding grade, usage of analgesics, and satisfaction. RESULTS: The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs 25.06 ± 7.85 days; 95% CI, -11.27 to -0.29 days; p = 0.04), reduced postoperative bleeding (0-3 scale; estimate -0.45; 95% CI, -0.72 to -0.16; p = 0.002), lower analgesic use (0-3 scale; estimate -0.38; 95% CI, -0.66 to -0.09; p = 0.009), and improved symptom scores at 1 to 2 months (Z -2.52 and -2.11, p < 0.05). Median satisfaction scores were 10 versus 9.5 ( p = 0.12). No adverse events occurred. LIMITATIONS: Small sample size, nonblinded, single-center design, and short follow-up period. CONCLUSIONS: Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy significantly enhanced postoperative recovery, reduced complications, and demonstrated comparable patient satisfaction. Long-term follow-up is warranted to validate sustained efficacy. See Video Abstract. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2400087552. RESULTADOS PRELIMINARES DE LA HEMORROIDECTOMA ABIERTA COMBINADA CON ESCLEROTERAPIA CON ESPUMA DE POLIDOCANOL AL EN PACIENTES CON ENFERMEDAD HEMORROIDAL DE GRADO IV ESTUDIO ALEATORIZADO, CONTROLADO, ABIERTO Y UNICNTRICO: ANTECEDENTES:La hemorroidectomía de Milligan-Morgan sigue siendo el tratamiento de referencia para la enfermedad hemorroidal de grado IV. Sin embargo, el dolor postoperatorio, el sangrado y la recuperación prolongada siguen siendo un reto. La escleroterapia es prometedora, pero carece de evidencia en el tratamiento de la enfermedad hemorroidal de grado IV.Objetivo:Este estudio evaluó la eficacia y la seguridad de la hemorroidectomía por escisión abierta (hemorroidectomía de Milligan-Morgan) combinada con escleroterapia con espuma de polidocanol al 3 % en pacientes con enfermedad hemorroidal de grado IV.DISEÑO:Ensayo clínico aleatorizado, abierto y unicéntrico.ENTORNO:Departamento de Cirugía Anorrectal, Hospital Yueyang de Medicina Tradicional China y Occidental Integrada, Shanghái, China.PACIENTES:Se inscribieron 36 pacientes de entre 18 y 75 años con enfermedad hemorroidal de grado IV, que se distribuyeron aleatoriamente en dos grupos iguales.INTERVENCIONES:El grupo experimental recibió una hemorroidectomía Milligan-Morgan combinada con escleroterapia con espuma de polidocanol al 3 %; el grupo de control recibió una hemorroidectomía Milligan-Morgan.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal es el tiempo de retorno a las actividades diarias. Resultados secundarios: puntuación de los síntomas de la enfermedad hemorroidal, puntuaciones de incontinencia de Vaizey, escala analógica visual, puntuaciones de la escala breve de salud para la enfermedad hemorroidal, grado de sangrado postoperatorio, uso de analgésicos y satisfacción.RESULTADOS:El grupo experimental demostró una media de 5,78 días menos para volver a las actividades normales y al trabajo que el grupo de control (media ± DE: 19,28 ± 8,35 frente a 25,06 ± 7,85 días, IC del 95 %: -11,27 a -0,29 días, p = 0,04), reducción de la hemorragia posoperatoria (escala de 0 a 3, estimación: -0,45, IC del 95 %: -0,72 a -0,16, p = 0,002), menor uso de analgésicos (escala de 0 a 3, estimación: -0,38, IC del 95 %: -0,66 a -0,09, p = 0,009) y mejora de las puntuaciones de los síntomas a los 1-2 meses (Z -2,52 y -2,11, p < 0,05). Las puntuaciones medias de satisfacción fueron de 10 frente a 9,5 ( p = 0,12). No se produjeron acontecimientos adversos.LIMITACIONES:Tamaño reducido de la muestra, diseño no ciego, centro único y periodo de seguimiento corto.CONCLUSIONES:La hemorroidectomía de Milligan-Morgan combinada con escleroterapia con espuma de polidocanol al 3 % mejora significativamente la recuperación posoperatoria, reduce las complicaciones y demuestra una satisfacción comparable de los pacientes. Se justifica un seguimiento a largo plazo para validar la eficacia sostenida. Número de registro del ensayo clínico: Registro chino de ensayos clínicos: ChiCTR2400087552. ( AI-generated translation ).", "provenance": [ { "field": "population", "quote": "Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups." }, { "field": "intervention", "quote": "The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy" }, { "field": "comparator", "quote": "the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy." }, { "field": "primaryOutcome", "quote": "The primary outcome was the time to return to daily activities." }, { "field": "result", "quote": "The experimental group demonstrated a mean 5.78-day earlier return to normal activities and work than the control group (mean ± SD: 19.28 ± 8.35 vs 25.06 ± 7.85 days; 95% CI, -11.27 to -0.29 days; p = 0.04), reduced postoperative bleeding (0-3 scale; estimate -0.45; 95% CI, -0.72 to -0.16; p = 0.002), lower analgesic use (0-3 scale; estimate -0.38; 95% CI, -0.66 to -0.09; p = 0.009), and improved symptom scores at 1 to 2 months (Z -2.52 and -2.11, p < 0.05)." }, { "field": "n", "quote": "Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups." } ] }, { "id": "pmid:41553737", "pmid": "41553737", "doi": "10.1093/bjs/znaf282", "nctId": null, "pmcid": null, "title": "Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: open-label randomized clinical trial", "firstAuthor": "Fernandez-Hurtado", "multipleAuthors": true, "journal": "Br J Surg", "year": 2025, "design": "rct", "n": 50, "nField": "reported", "population": "adults with grade III hemorrhoids", "intervention": "open surgical removal of hemorrhoids (open excisional haemorrhoidectomy)", "comparator": "a less invasive surgery that cuts off blood supply to hemorrhoids (transanal haemorrhoidal dearterialization)", "primaryOutcome": "change in hemorrhoid symptom and quality-of-life scores at 12 months, and rate of treatment failure", "result": "Open surgery had a much lower failure rate (8%) than the less invasive procedure (61%), and all repeat operations happened in the less invasive group, though open surgery caused more pain and a longer return to work", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized trial testing its question directly, but it was small, from a single center, and not blinded.", "directness": "direct", "limitations": "Small single-centre trial, open-label (not blinded), some patients lost to follow-up.", "followUp": "12 months", "plainFinding": "Open surgery worked better but hurt more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41553737/", "sourceText": "BACKGROUND: Open excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores. METHODS: A prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation. RESULTS: From August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010). CONCLUSION: OEH is more effective than THD but is associated with greater early postoperative pain. REGISTRATION NUMBER: NCT06420986 (http://www.clinicaltrials.gov).", "provenance": [ { "field": "n", "quote": "50 patients were randomized (25 OEH patients and 25 THD patients)" }, { "field": "population", "quote": "patients with grade III haemorrhoids" }, { "field": "intervention", "quote": "Open excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease" }, { "field": "comparator", "quote": "Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence." }, { "field": "primaryOutcome", "quote": "The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline." }, { "field": "result", "quote": "CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001)." }, { "field": "result", "quote": "OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010)." } ] }, { "id": "pmid:41535511", "pmid": "41535511", "doi": "10.1007/s00384-026-05080-3", "nctId": null, "pmcid": "PMC12808294", "title": "Long-term outcomes of stapled haemorrhoidopexy versus conventional haemorrhoidectomy: An updated systematic review, meta-analysis and trial-sequential analysis of randomized controlled trials", "firstAuthor": "Lauricella", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2026, "design": "meta-analysis", "n": 2072, "nField": "reported", "population": "adults with grade II-IV hemorrhoids undergoing surgery", "intervention": "stapled haemorrhoidopexy (a stapling surgery for hemorrhoids)", "comparator": "conventional haemorrhoidectomy (traditional surgical removal of hemorrhoids)", "primaryOutcome": "long-term recurrence, need for repeat treatment, anal function, and quality of life", "result": "Stapled surgery had a higher chance of hemorrhoids coming back, especially prolapse-type recurrence, but no difference in need for further treatment, pain, bowel function, or quality of life", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools many randomized trials, but the statistical power check shows there still aren't enough patients studied to be fully confident in the recurrence finding.", "directness": "indirect", "limitations": "Trial-sequential analysis showed the accumulated evidence did not reach the required sample size, and there was some variability (heterogeneity) across trials.", "followUp": "minimum follow-up of 12 months", "plainFinding": "Stapled surgery recurs more than traditional surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41535511/", "sourceText": "PURPOSE: Stapled haemorrhoidopexy (SH) offers well-established short-term advantages over conventional haemorrhoidectomy (CH), but its long-term effectiveness remains controversial. This systematic review and meta-analysis aimed to compare long-term outcomes of SH versus CH in adult patients with grade II-IV haemorrhoids, incorporating Trial Sequential Analysis (TSA). METHODS: MEDLINE, EMBASE and CENTRAL were searched from January 2001 to October 2025 for randomized controlled trials (RCTs) comparing SH and CH with a minimum follow-up of 12 months. Two reviewers independently performed study selection, data extraction and risk-of-bias assessment (RoB-2). Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. TSA was applied to overall recurrence. RESULTS: Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed. SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I2 = 48%). TSA showed that the accrued information size (1,913 patients) did not reach the required information size (2,608 patients), indicating that current evidence remains underpowered. Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I2 = 12%), whereas bleeding-related recurrence did not differ between groups (RR = 1.20,95%CI = 0.63-2.26;I2 = 23%). No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL. CONCLUSION: SH is associated with a higher risk of long-term recurrence, particularly prolapse-related recurrence, compared with CH, while long-term pain, functional outcomes and QoL appear broadly comparable. These findings suggest that, although SH may remain an option for selected patients, CH provides more durable anatomical correction, and procedural choice should balance early recovery against long-term durability.", "provenance": [ { "field": "n", "quote": "Seventeen RCTs including 1,041 SH and 1,031 CH patients were analysed." }, { "field": "population", "quote": "adult patients with grade II-IV haemorrhoids" }, { "field": "intervention", "quote": "Stapled haemorrhoidopexy (SH)" }, { "field": "comparator", "quote": "conventional haemorrhoidectomy (CH)" }, { "field": "primaryOutcome", "quote": "Primary outcomes included recurrence, reintervention, anal function, and quality of life (QoL)." }, { "field": "result", "quote": "SH was associated with a higher risk of overall recurrence compared with CH (RR = 1.56,95%CI = 1.00-2.44;I2 = 48%)." }, { "field": "result", "quote": "Prolapse-related recurrence was significantly more frequent after SH (RR = 3.28,95%CI = 1.49-7.25;I2 = 12%), whereas bleeding-related recurrence did not differ between groups" }, { "field": "result", "quote": "No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL." }, { "field": "followUp", "quote": "minimum follow-up of 12 months" } ] }, { "id": "pmid:41480327", "pmid": "41480327", "doi": "10.3748/wjg.v31.i48.114738", "nctId": null, "pmcid": "PMC12754228", "title": "Transverse incision with longitudinal ligation procedure: Innovation, pitfalls, and clinical perspectives", "firstAuthor": "Hua", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids that have prolapsed all the way around the anus", "intervention": "a newer surgical technique called transverse incision with longitudinal ligation (TILL)", "comparator": "the standard Milligan-Morgan hemorrhoidectomy surgery", "primaryOutcome": "short-term results including pain, healing time, and narrowing of the anus", "result": "TILL showed less pain, quicker healing, and lower risk of anal stenosis than the standard surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a letter commenting on a single small retrospective study with short follow-up, not new research itself, so it carries very little weight.", "directness": "indirect", "limitations": "The letter notes the original study was retrospective, single-center, had a small sample size, and short follow-up, limiting generalizability and ability to assess recurrence.", "followUp": "", "plainFinding": "Newer surgery technique, less pain, faster healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41480327/", "sourceText": "The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids. A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis. TILL reduces tissue tension and controls blood supply, allowing effective removal of diseased tissue while maintaining anal function and structure. However, the study's limitations, including its retrospective, single-center design, small sample size, and short follow-up, restrict the findings' generalizability and ability to assess long-term outcomes like recurrence. Larger, multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.", "provenance": [ { "field": "population", "quote": "treating circumferential prolapsed hemorrhoids" }, { "field": "intervention", "quote": "The transverse incision with longitudinal ligation (TILL) procedure is a new method for treating circumferential prolapsed hemorrhoids." }, { "field": "comparator", "quote": "better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results" }, { "field": "primaryOutcome", "quote": "showing less pain, quicker healing, and lower risk of anal stenosis" }, { "field": "result", "quote": "A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results, showing less pain, quicker healing, and lower risk of anal stenosis." } ] }, { "id": "pmid:41397826", "pmid": "41397826", "doi": "10.3760/cma.j.cn441530-20250328-00128", "nctId": null, "pmcid": null, "title": "[Endoscopic rubber band ligation and injection therapy for grade I - III internal hemorrhoids: analysis of clinical efficacy and safety]", "firstAuthor": "Liao", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2025, "design": "retrospective", "n": 313, "nField": "reported", "population": "Adults with grade I-III internal hemorrhoids who had not improved with diet/medication and could not or would not have surgery", "intervention": "Endoscopic rubber band ligation (ERBL)", "comparator": "Endoscopic injection sclerotherapy (EIS)", "primaryOutcome": "Treatment success (cure/effective rate) within 3 months after the procedure, plus recurrence, pain, and complications", "result": "Cure/effective rates were similar between ERBL and EIS; EIS caused less pain and anal distension, but ERBL had a non-significant trend toward lower recurrence in grade III hemorrhoids; ERBL had significantly more complications (bleeding, urinary retention) than EIS", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective single-center study using statistical matching rather than a randomized trial, so differences between groups could still be due to unmeasured factors.", "directness": "direct", "limitations": "Retrospective design, single center, propensity score matching used to balance groups, short follow-up for recurrence assessment", "followUp": "3 months", "plainFinding": "Both non-surgical options worked similarly; side effects differed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397826/", "sourceText": "Objective: To explore the clinical efficacy and safety of endoscopic rubber band ligation (ERBL) and endoscopic injection sclerotherapy (EIS) in the treatment of grade I-III internal hemorrhoids, to provide a basis for the individualized treatment of patients with internal hemorrhoids in clinical practice. Methods: A retrospective cohort study was conducted. A total of 613 patients with grade I to III internal hemorrhoids who underwent ERBL or EIS at The Sixth Affiliated Hospital of Sun Yat-sen University from December 2019 to November 2023 were retrospectively collected. Inclusion criteria: (1) Patients diagnosed with symptomatic grade I-III internal hemorrhoids who failed conservative treatments such as diet adjustment and medication; (2) Patients who were unable or unwilling to receive surgical treatment due to multiple underlying systemic diseases. Exclusion criteria: (1) Patients with grade I-III internal hemorrhoids complicated with incarceration, thrombosis or other complications; (2) Patients with a history of hemorrhoid surgery; (3) Patients complicated with perianal abscess, anal fistula, active proctitis, rectal tumor, polyp, radiation proctitis or inflammatory bowel disease; (4) Patients with incomplete clinical data or lost to follow-up. This study was divided into the ERBL group and the EIS group based on different treatment. Baseline characteristics, postoperative effective rate, recurrence rate, pain score, anal distension, anal edema, complication rate, and treatment satisfaction were compared between the two groups. Results: After balancing with propensity score matching (PSM), a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group. There were no statistically significant differences in baseline characteristics, such as gender, age, body mass index, Goligher classification, and laboratory test indicators, between the two groups (all P > 0.05), indicating that the two groups were comparable. The cure rates of the ERBL group and the EIS group were 64.0% (128/200) and 62.8% (71/113), respectively. The marked effective rates were 31.5% (63/200) and 34.5% (39/113), and the ineffective rates were 4.5% (9/200) and 2.7% (3/113), respectively. Statistical analysis revealed no statistically significant difference in efficacy between the two groups within 3 months after the operation (χ²=0.858, P=0.651). The recurrence rate of the ERBL group was lower than that of the EIS group [13.1% (25/191) vs. 18.2% (20/110)], but the difference was not statistically significant (χ²=1.424, P=0.233). Subgroup analysis showed that the recurrence rates of ERBL and EIS were similar in grade I-II internal hemorrhoids [10.3% (15/146) vs. 10.5% (9/86), χ²=0.002, P=0.963]; in grade III internal hemorrhoids, the recurrence rate of the ERBL group was lower than that of the EIS group [22.2% (10/45) vs. 45.8% (11/24), χ²=4.121, P=0.042]. Still, the difference was not statistically significant after Bonferroni correction (χ²=4.121, corrected P>0.025). Compared with the ERBL group, the EIS group had a lower pain score on the first day after operation [0 (0, 0) vs. 1 (0, 3), Z=-8.211, P<0.001] and a lower incidence of anal distension [25.7% (29/113) vs. 61.5% (123/200), χ²=37.122, P<0.001], with statistically significant differences. The total incidence of complications in the ERBL group was significantly higher than that in the EIS group [29.5% (59/200) vs. 4.4% (5/113), χ²=27.910, P<0.001], mainly reflected in postoperative bleeding [18.0% (36/200) vs. 3.5% (4/113), χ²=13.544, P<0.001] and urinary retention [8.5% (17/200) vs. 0, χ²=10.157, P=0.001], with statistically significant differences. There were no statistically significant differences in postoperative satisfaction, health status score, and the proportion of returning to everyday life within 1 month between the two groups (all P>0.05). Conclusions: Both ERBL and EIS are effective minimally invasive therapies for grade I-III internal hemorrhoids. EIS is preferred for grade I and II internal hemorrhoids to reduce complications, while ERBL shows a trend in reducing the recurrence rate of grade III internal hemorrhoids. Clinical decisions should be made comprehensively based on the classification, patient tolerance, and prognosis.", "provenance": [ { "field": "n", "quote": "a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group" }, { "field": "population", "quote": "Patients diagnosed with symptomatic grade I-III internal hemorrhoids who failed conservative treatments such as diet adjustment and medication" }, { "field": "population", "quote": "Patients who were unable or unwilling to receive surgical treatment due to multiple underlying systemic diseases" }, { "field": "intervention", "quote": "endoscopic rubber band ligation (ERBL)" }, { "field": "comparator", "quote": "endoscopic injection sclerotherapy (EIS)" }, { "field": "primaryOutcome", "quote": "Statistical analysis revealed no statistically significant difference in efficacy between the two groups within 3 months after the operation (χ²=0.858, P=0.651)." }, { "field": "result", "quote": "The cure rates of the ERBL group and the EIS group were 64.0% (128/200) and 62.8% (71/113), respectively." }, { "field": "result", "quote": "Compared with the ERBL group, the EIS group had a lower pain score on the first day after operation [0 (0, 0) vs. 1 (0, 3), Z=-8.211, P<0.001] and a lower incidence of anal distension [25.7% (29/113) vs. 61.5% (123/200), χ²=37.122, P<0.001], with statistically significant differences." }, { "field": "result", "quote": "The total incidence of complications in the ERBL group was significantly higher than that in the EIS group [29.5% (59/200) vs. 4.4% (5/113), χ²=27.910, P<0.001]" }, { "field": "result", "quote": "in grade III internal hemorrhoids, the recurrence rate of the ERBL group was lower than that of the EIS group [22.2% (10/45) vs. 45.8% (11/24), χ²=4.121, P=0.042]. Still, the difference was not statistically significant after Bonferroni correction (χ²=4.121, corrected P>0.025)." } ] }, { "id": "pmid:41282992", "pmid": "41282992", "doi": "10.7717/peerj.20252", "nctId": null, "pmcid": "PMC12633121", "title": "The effect of endoscopic polidocanol carbon dioxide foam for internal hemorrhoids: a retrospective study", "firstAuthor": "Xiang", "multipleAuthors": true, "journal": "PeerJ", "year": 2025, "design": "retrospective", "n": 158, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "endoscopic polidocanol carbon dioxide foam sclerotherapy", "comparator": "endoscopic polidocanol air foam sclerotherapy", "primaryOutcome": "treatment success and complications one month after treatment", "result": "Similar effectiveness between groups, but carbon dioxide foam caused fewer cases of anal pain and swelling", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized study comparing two foam types, not surgery versus no surgery, so it only indirectly addresses whether hemorrhoids need surgery.", "directness": "indirect", "limitations": "Retrospective design, non-randomized, compares two non-surgical sclerotherapy techniques rather than surgery vs no surgery.", "followUp": "1 month", "plainFinding": "Fewer side effects, similar success rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41282992/", "sourceText": "AIM: This article aims to explore the effectiveness of polidocanol carbon dioxide foam as a therapy for internal hemorrhoids. METHODS: A retrospective analysis was conducted on 158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids between October 2022 and September 2023. Among the patients, 78 underwent endoscopic polidocanol sclerotherapy with polidocanol air foam (control group), while 80 received polidocanol carbon dioxide foam (study group). The primary outcomes of this study were clinical effect and the incidence of complications 1 month after surgery. Patient self-reports of anal bleeding and anal prolapse served as the foundation for establishing three categories of clinical efficacy criteria. The clinical effect was determined based on the efficacy index, which was employed to assess treatment effectiveness. The occurrence of several postoperative complications was documented, specifically including anal pain, anal swelling, urinary retention, perianal infection, ectopic embolization, and anal edema. Secondary outcomes encompassed the surgical cost, duration of hospital stay, and the administered dosage of polidocanol. RESULT: The treatment success at the end of the sclerotherapy session in the study and control group were 85.0% and 83.3%, respectively (P = 0.829). One month following endoscopic sclerotherapy, the study group exhibited an effective rate of 98.8%, while the control group showed a rate of 98.0%. Compared with the clinical effects one month after surgery of the two groups of patients, postoperative complications, surgical cost, hospitalization time and the dosage of polidocanol, we found 11 patients with anal pain and 12 patients with anal swelling in the control group. Within the study group, three patients experienced anal pain, while four patients presented with anal swelling. The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05), and importantly, no severe complications were observed. Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05). CONCLUSION: The clinical effectiveness of endoscopic polidocanol carbon dioxide foam is on par with that of polidocanol air foam. In sclerotherapy for internal hemorrhoids, the use of endoscopic polidocanol carbon dioxide foam can significantly decrease complications such as anal swelling and pain.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids between October 2022 and September 2023." }, { "field": "population", "quote": "158 patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids" }, { "field": "intervention", "quote": "80 received polidocanol carbon dioxide foam (study group)" }, { "field": "comparator", "quote": "78 underwent endoscopic polidocanol sclerotherapy with polidocanol air foam (control group)" }, { "field": "primaryOutcome", "quote": "The primary outcomes of this study were clinical effect and the incidence of complications 1 month after surgery." }, { "field": "result", "quote": "The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05), and importantly, no severe complications were observed." }, { "field": "result", "quote": "Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05)." } ] }, { "id": "pmid:41269316", "pmid": "41269316", "doi": "10.1007/s00464-025-12399-5", "nctId": null, "pmcid": null, "title": "Flexible endoscopic treatment of internal hemorrhoids with versus without intravenous anesthesia: a retrospective study of 559 cases", "firstAuthor": "Dai", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2026, "design": "retrospective", "n": 559, "nField": "reported", "population": "patients with grade II-III internal hemorrhoids undergoing endoscopic treatment", "intervention": "endoscopic hemorrhoid treatment (rubber band ligation or sclerotherapy) with intravenous anesthesia", "comparator": "same endoscopic treatment without anesthesia", "primaryOutcome": "procedure time, retreatment rate, symptom improvement, discomfort, satisfaction, and cost", "result": "anesthesia group had shorter procedure times and lower retreatment rates, with similar symptom improvement and satisfaction between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences between groups could be due to factors other than anesthesia.", "directness": "direct", "limitations": "Retrospective design; not randomized", "followUp": "", "plainFinding": "Non-surgical endoscopic treatment works well either way.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41269316/", "sourceText": "BACKGROUND: Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids; however, the impact of intravenous anesthesia on clinical outcomes remains uncertain. This study compared the efficacy, safety, and cost-effectiveness of endoscopic treatment performed with versus without anesthesia. METHODS: We retrospectively analyzed 559 patients who underwent endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS) from May 2023 to November 2024. Patients were stratified by anesthesia modality (intravenous propofol vs. no anesthesia). Primary outcomes included procedure time, retreatment rate, symptom improvement, postoperative discomfort, patient satisfaction, total cost, and cost acceptance. Subgroup analysis was performed for EPFS cases. RESULTS: Baseline characteristics were similar between groups. The anesthesia group had shorter procedure times (median 10.5 vs. 11.3 min, P = 0.036) and a lower retreatment rate (1.3% vs. 6.2%, P = 0.003). Rates of symptom improvement (83.1% vs. 82.7%, P = 0.940), postoperative discomfort, and patient satisfaction were comparable. Although the total treatment cost was higher in the anesthesia group (CNY 2,140.6 vs. 1,732.7, P < 0.001), cost acceptance remained high in both groups (85.8% vs. 91.4%, P = 0.173). Subgroup analysis of EPFS cases yielded consistent findings. CONCLUSIONS: Flexible endoscopic treatment for internal hemorrhoids is safe and effective regardless of anesthesia use. Intravenous anesthesia improves procedural efficiency and reduces retreatment rates without compromising symptom relief or satisfaction. These findings support individualized anesthesia strategies tailored to patient preferences and institutional resources.", "provenance": [ { "field": "n", "quote": "retrospectively analyzed 559 patients" }, { "field": "population", "quote": "Flexible endoscopic therapies are effective for grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic rubber band ligation (ERBL) or polidocanol foam sclerotherapy (EPFS)" }, { "field": "comparator", "quote": "Patients were stratified by anesthesia modality (intravenous propofol vs. no anesthesia)" }, { "field": "primaryOutcome", "quote": "Primary outcomes included procedure time, retreatment rate, symptom improvement, postoperative discomfort, patient satisfaction, total cost, and cost acceptance." }, { "field": "result", "quote": "The anesthesia group had shorter procedure times (median 10.5 vs. 11.3 min, P = 0.036) and a lower retreatment rate (1.3% vs. 6.2%, P = 0.003). Rates of symptom improvement (83.1% vs. 82.7%, P = 0.940), postoperative discomfort, and patient satisfaction were comparable." } ] }, { "id": "pmid:41266707", "pmid": "41266707", "doi": "10.1007/s13304-025-02460-2", "nctId": null, "pmcid": null, "title": "Global knowledge mapping and technological evolution in hemorrhoid therapy: a multi-tool bibliometric analysis", "firstAuthor": "Chen", "multipleAuthors": false, "journal": "Updates Surg", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "published research literature on hemorrhoidal disease treatment", "intervention": "not a treatment study; maps research trends in hemorrhoid therapy literature", "comparator": "not applicable", "primaryOutcome": "patterns and trends in published research on hemorrhoid therapy", "result": "describes a steady increase in publications, identifies core research areas (banding, surgery, laser), and notes an emerging trend toward minimally invasive and outpatient techniques, but reports no clinical outcome data comparing treatments", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a bibliometric mapping of published literature, not a clinical study comparing treatments, so it cannot show whether surgery or non-surgical treatment works better", "directness": "indirect", "limitations": "abstract states 'comprehensive analyses mapping its research landscape...are lacking' and notes 'key knowledge gaps persist in long-term efficacy comparisons and standardized guideline development', indicating no actual patient outcome data was analyzed", "followUp": "", "plainFinding": "No treatment outcome data reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41266707/", "sourceText": "Hemorrhoidal disease imposes a significant global healthcare burden. However, comprehensive analyses mapping its research landscape and technological evolution are lacking. This study employed advanced bibliometric techniques to characterize the knowledge structure, collaborative networks, research hotspots, and emerging trends in hemorrhoid therapy over the past two decades. A total of 2764 relevant publications were retrieved from the Web of Science Core Collection (WoSCC). Multi-tool bibliometric analysis and scientific visualization were conducted using VOSviewer (v1.6.19), CiteSpace (v6.2.R4), and Bibliometrix (v4.1.3). Analyses included publication trends, country/institutional contributions, author/institutional collaboration networks, journal co-citation analysis, keyword co-occurrence/clustering, thematic evolution, and burst detection. Annual publications showed a steady increase, signifying growing research interest. China and the United States were the dominant contributors. International collaboration networks displayed regional clustering. Core research domains identified through keyword co-occurrence and clustering included Rubber Band Ligation (RBL), hemorrhoidectomy (Milligan-Morgan, Ferguson, stapled), laser therapy, pain management, postoperative complications, and quality of life. Burst detection and thematic evolution mapping highlighted emerging frontiers such as minimally invasive techniques (Doppler-guided hemorrhoidal artery ligation [DG-HAL], laser hemorrhoidoplasty), day surgery/ambulatory management, evidence-based guidelines, and long-term outcomes/comparative effectiveness. This first multi-tool bibliometric analysis comprehensively delineates the global research architecture and dynamic evolution of hemorrhoid therapy. It confirms the established role of conventional surgical techniques while identifying a clear shift towards minimally invasive procedures and outpatient management. Key knowledge gaps persist in long-term efficacy comparisons and standardized guideline development. These findings provide researchers, clinicians, and policymakers with an evidence-based roadmap to guide future investigations, resource allocation, and clinical practice optimization in hemorrhoidal disease management.", "provenance": [ { "field": "population", "quote": "A total of 2764 relevant publications were retrieved from the Web of Science Core Collection (WoSCC)." }, { "field": "intervention", "quote": "characterize the knowledge structure, collaborative networks, research hotspots, and emerging trends in hemorrhoid therapy over the past two decades" }, { "field": "comparator", "quote": "Core research domains identified through keyword co-occurrence and clustering included Rubber Band Ligation (RBL), hemorrhoidectomy (Milligan-Morgan, Ferguson, stapled), laser therapy, pain management, postoperative complications, and quality of life." }, { "field": "primaryOutcome", "quote": "Analyses included publication trends, country/institutional contributions, author/institutional collaboration networks, journal co-citation analysis, keyword co-occurrence/clustering, thematic evolution, and burst detection." }, { "field": "result", "quote": "It confirms the established role of conventional surgical techniques while identifying a clear shift towards minimally invasive procedures and outpatient management." }, { "field": "limitations", "quote": "Key knowledge gaps persist in long-term efficacy comparisons and standardized guideline development." } ] }, { "id": "pmid:41241446", "pmid": "41241446", "doi": "10.1016/j.suc.2025.08.003", "nctId": null, "pmcid": null, "title": "Hemorrhoids", "firstAuthor": "Egawa", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with hemorrhoid disease", "intervention": "Surgical and nonoperative treatments for hemorrhoids", "comparator": "Comparison between different treatment options", "primaryOutcome": "Not clearly stated", "result": "The abstract does not report a specific outcome result, only that a review of treatment options is presented", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing treatment options without presenting study data or outcomes to judge effectiveness.", "directness": "direct", "limitations": "Abstract does not report study methodology, data, or specific outcome results; it is a general review.", "followUp": "", "plainFinding": "Review of treatment options, no results given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41241446/", "sourceText": "Hemorrhoid disease is common in the Western world with a billion-dollar impact on health care spending. Numerous treatments are available, including surgical and nonoperative options. A plan of care should be made that is tailored to disease anatomy, symptom severity, and relevant medical comorbidities after addressing modifiable risk factors. The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease.", "provenance": [ { "field": "population", "quote": "Hemorrhoid disease is common in the Western world" }, { "field": "intervention", "quote": "Numerous treatments are available, including surgical and nonoperative options." }, { "field": "comparator", "quote": "Numerous treatments are available, including surgical and nonoperative options." }, { "field": "primaryOutcome", "quote": "The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease." }, { "field": "result", "quote": "The authors present a review of the disease pathophysiology, diagnosis, and treatment options for hemorrhoid disease." } ] }, { "id": "pmid:41239416", "pmid": "41239416", "doi": "10.1186/s12893-025-03289-7", "nctId": null, "pmcid": "PMC12619312", "title": "Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "retrospective", "n": 253, "nField": "reported", "population": "patients with grade I-III internal hemorrhoids treated at one hospital", "intervention": "endoscopic sclerotherapy, rubber band ligation, or combined ligation-sclerotherapy (non-surgical endoscopic treatments)", "comparator": "the three endoscopic treatment methods compared against each other", "primaryOutcome": "treatment effectiveness within 3 months and symptom recurrence after 3 months", "result": "all three treatments were effective (90.6%-95.8%), with combined therapy having the highest efficacy and lowest recurrence rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective, single-center study without a surgical comparison group, so it can't say how these treatments stack up against surgery.", "directness": "indirect", "limitations": "retrospective design; no surgical or untreated comparison group; unequal group sizes; single center", "followUp": "", "plainFinding": "Non-surgical treatments worked well without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41239416/", "sourceText": "OBJECTIVE: This study aimed to evaluate the comparative effectiveness, safety, and recurrence rates of endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT) for grades I - III internal hemorrhoids. METHODS: A retrospective analysis was conducted on patients who underwent endoscopic minimally-invasive treatment for internal hemorrhoids at Wuhu First People's Hospital from January 2020 to December 2024. Patients were divided into ES, RBL, and CT groups. Safety was evaluated by recording post-procedural pain and adverse events. Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment. Patient satisfaction was also recorded. RESULTS: A total of 253 patients were included (168 males, 85 females; mean age 46.2 ± 12.8 years), with 107 in the ES group, 122 in the RBL group, and 24 in the CT group. Hemorrhoid grade distribution was 68 cases (26.9%) of Grade I, 112 cases (44.2%) of Grade II, and 73 cases (28.9%) of Grade III. In terms of efficacy, for all grades combined, the efficacy rate was 90.6% (95/107) for ES, 92.6% (113/122) for RBL, and 95.8% (23/24) for CT. CT showed the highest efficacy, especially for grade III hemorrhoids (95.0% [19/20]). Regarding safety, ES had a lower proportion of severe pain (6.5% [7/107]). Adverse events had low rates (bleeding: 4.2-6.6%; fever: 2.8-4.2%) with no significant inter-group differences. Patient satisfaction rates were 84.1% (90/107) for ES, 82.0% (100/122) for RBL, and 83.3% (20/24) for CT, with no substantial variation. For recurrence rates, CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95]), particularly evident in higher-grade hemorrhoids. CONCLUSION: Endoscopic treatments, especially CT, are effective and relatively safe for grades I - III internal hemorrhoids. CT shows promise in terms of efficacy and recurrence prevention, especially for more severe cases.", "provenance": [ { "field": "n", "quote": "A total of 253 patients were included" }, { "field": "population", "quote": "grades I - III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT)" }, { "field": "comparator", "quote": "Patients were divided into ES, RBL, and CT groups." }, { "field": "primaryOutcome", "quote": "Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment." }, { "field": "result", "quote": "the efficacy rate was 90.6% (95/107) for ES, 92.6% (113/122) for RBL, and 95.8% (23/24) for CT" }, { "field": "result", "quote": "CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95])" } ] }, { "id": "pmid:41236452", "pmid": "41236452", "doi": "10.1053/j.gastro.2025.07.031", "nctId": null, "pmcid": "PMC12758572", "title": "An Evidence-Based Practical Review on Common Benign Anorectal Disorders: Hemorrhoids, Anal Fissure, Dyssynergic Defecation, and Fecal Incontinence", "firstAuthor": "Bharucha", "multipleAuthors": true, "journal": "Gastroenterology", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids and other common anorectal problems", "intervention": "conservative treatments such as rubber band ligation for milder hemorrhoids, with surgery reserved for severe cases", "comparator": "surgery (excisional hemorrhoidectomy) versus non-surgical treatment", "primaryOutcome": "how hemorrhoids are treated depending on severity", "result": "Treatment is applied stepwise, starting with conservative therapy (e.g., rubber band ligation for grade I-II hemorrhoids), with surgery reserved for more severe disease", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a general narrative review describing usual practice, not a study comparing treatments head-to-head.", "directness": "indirect", "limitations": "Covers multiple unrelated anorectal conditions broadly rather than focusing specifically on hemorrhoid treatment outcomes; no study design, sample size, or comparative data given.", "followUp": "", "plainFinding": "Mild cases treated without surgery; severe cases need surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41236452/", "sourceText": "This evidence-based practical review is focused on the clinical features, investigations, and treatment of hemorrhoids, chronic anal fissures, dyssynergic defecation (DD), and fecal incontinence (FI), which are arguably the most common benign anorectal diseases encountered by gastroenterologists. These diseases are associated with bowel disturbances, which should be evaluated preferably with questionnaires, and with anal weakness and/or DD, often evident on a thorough digital rectal examination. Fissures and DD are closely linked to constipation, whereas FI is typically associated with diarrhea. For most patients with mild symptoms, lifestyle changes, dietary adjustments, and/or pharmacotherapy suffice. Some patients require tests to rule out serious diseases; assess anorectal functions, which are discussed in detail; and to identify structural abnormalities, such as rectoceles, which are occasionally clinically significant. Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease; for anal fissures, topical therapy using a calcium channel antagonist or nitroglycerine, followed by botulinum toxin and, less frequently, lateral internal sphincterotomy for chronic fissures. Anorectal biofeedback therapy is effective for managing DD and, together with bowel modifiers tailored to the specific symptoms (ie, constipation and/or diarrhea), is also used for FI. Biofeedback therapy is not widely accessible, and many patients are treated by pelvic floor physical therapists. For FI, minimally invasive options include sacral neuromodulation and anal dextranomer injection, with colostomy or anal sphincteroplasty now rarely required. Surgical interventions must balance long-term effectiveness with potential risks. Key topics for future research are proposed.", "provenance": [ { "field": "population", "quote": "hemorrhoids, chronic anal fissures, dyssynergic defecation (DD), and fecal incontinence (FI)" }, { "field": "intervention", "quote": "starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease" }, { "field": "comparator", "quote": "with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease" }, { "field": "primaryOutcome", "quote": "Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible" }, { "field": "result", "quote": "Treatments are applied stepwise, starting with conservative therapy with simpler treatments when feasible (eg, rubber band ligation for grade I-II hemorrhoids), with surgery, usually excisional hemorrhoidectomy, being reserved for more severe disease" } ] }, { "id": "pmid:41197059", "pmid": "41197059", "doi": null, "nctId": null, "pmcid": null, "title": "Massive Rectal Bleeding After Rubber Band Ligation of Internal Hemorrhoids: A Case Report", "firstAuthor": "Turunen", "multipleAuthors": true, "journal": "WMJ", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 34-year-old woman with internal hemorrhoids", "intervention": "rubber band ligation of internal hemorrhoids", "comparator": "none", "primaryOutcome": "delayed rectal bleeding after the procedure", "result": "she had massive rectal bleeding 15 days after the procedure from an ulcer at the banding site, which was treated successfully with clips and spray", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how common or rare this problem is", "directness": "direct", "limitations": "single case report; no comparison group; cannot estimate how often this happens", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41197059/", "sourceText": "INTRODUCTION: Rubber band ligation (RBL) is a common treatment for internal hemorrhoids. Although generally safe, complications such as delayed bleeding can occur, particularly in patients taking anticoagulants, antiplatelets, or nonsteroidal anti-inflammatory drugs (NSAIDs). CASE PRESENTATION: A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids. She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders. Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications. DISCUSSION: Massive bleeding following RBL is rare, especially in patients without traditional bleeding risk factors. Literature review identified only one similar case. Most reported cases involve patients on aspirin or other blood-thinning agents. This case adds to the limited data on severe post-RBL bleeding in low-risk individuals and highlights the potential for delayed presentation. CONCLUSIONS: This case highlights the potential for delayed and significant bleeding post-RBL, even in patients without traditional bleeding risk factors. Vigilance beyond the immediate postoperative period is essential, and patients should be counseled on signs of delayed complications.", "provenance": [ { "field": "n", "quote": "A 34-year-old White woman presented with massive rectal bleeding" }, { "field": "population", "quote": "A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids" }, { "field": "intervention", "quote": "Rubber band ligation (RBL) is a common treatment for internal hemorrhoids" }, { "field": "comparator", "quote": "She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders" }, { "field": "primaryOutcome", "quote": "presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids" }, { "field": "result", "quote": "Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications." } ] }, { "id": "pmid:41128083", "pmid": "41128083", "doi": "10.17235/reed.2025.11628/2025", "nctId": null, "pmcid": null, "title": "Office-based treatments for hemorrhoidal disease grades I-III ‒ Comparing rubber band ligation and polidocanol foam sclerotherapy", "firstAuthor": "Guimarães", "multipleAuthors": true, "journal": "Rev Esp Enferm Dig", "year": 2026, "design": "retrospective", "n": 441, "nField": "reported", "population": "Patients with hemorrhoids (grades I-III) treated in an outpatient clinic", "intervention": "Rubber band ligation (RBL)", "comparator": "Polidocanol foam sclerotherapy (PFS)", "primaryOutcome": "Whether the hemorrhoid symptoms resolved after treatment (clinical success)", "result": "Rubber band ligation led to symptom resolution more often than foam sclerotherapy, but caused more side effects", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without randomization, so differences between groups could be due to other factors, not just the treatment.", "directness": "direct", "limitations": "Retrospective cohort design (not randomized), so treatment groups may have differed in ways that affected results.", "followUp": "", "plainFinding": "Banding works better; sclerotherapy is safer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41128083/", "sourceText": "BACKGROUND: office-based treatments for hemorrhoidal disease (HD) are recommended when medical management fails. Both, rubber band ligation (RBL) and polidocanol foam sclerotherapy (PFS) can be used. However, few studies compare these treatments. This study aimed to compare the efficacy and safety of PFS versus RBL. METHODS: this retrospective cohort study analyzed patients with HD treated with RBL and/or PFS between January 2015 and April 2024. The patients were classified into two categories: standard treatment of up to four sessions (ST) or double standard treatment (DT) of up to eight sessions. The outcomes were clinical success (CS), relapse, relapse-free survival (RFS) and treatment failure (TF). Adverse events were registered. RESULTS: in total, 441 patients were included, 290/441 (65.8 %) treated with RBL, 105/441 (23.8 %) with PFS and 46/441 (10.4 %) with both. After treatment, 289/395 patients (73.2 %) achieved CS, with 260/289 (90.0 %) needing ST and 29/289 (10.0 %) DT. Patients treated with RBL were significantly more effective in achieving CS (78.6 % vs 58.1 %, p < .001, phi = .205). Of the patients with CS, 61/289 (21.1 %) relapsed (75.4 % of RBL and 24.6 % of PFS, p = .544, phi = .033) with a median time to relapse of 15.5 (14.5) months (17.0 [15.0] of RBL vs 12.0 [7.0] of PFS, p = .008, r = .339). RFS did not differ between groups. A total of 49/395 (12.4 %) required surgery (13.8 % of RBL vs 8.6 % of PFS, p = .164, phi = .070). Goligher I/II and RBL were independent predictors of CS. A total of 49/1,223 (4 %) adverse events were reported, 41/49 (83.7 %) related to RBL and 8/49 (16.3 %) related to PFS (p = .003, phi = .086). CONCLUSIONS: patients treated with RBL appeared more likely to achieve CS, while PFS showed a more favorable safety profile.", "provenance": [ { "field": "design", "quote": "this retrospective cohort study analyzed patients with HD treated with RBL and/or PFS between January 2015 and April 2024" }, { "field": "n", "quote": "in total, 441 patients were included" }, { "field": "population", "quote": "office-based treatments for hemorrhoidal disease (HD) are recommended when medical management fails" }, { "field": "intervention", "quote": "Both, rubber band ligation (RBL) and polidocanol foam sclerotherapy (PFS) can be used" }, { "field": "comparator", "quote": "This study aimed to compare the efficacy and safety of PFS versus RBL" }, { "field": "primaryOutcome", "quote": "The outcomes were clinical success (CS), relapse, relapse-free survival (RFS) and treatment failure (TF)" }, { "field": "result", "quote": "Patients treated with RBL were significantly more effective in achieving CS (78.6 % vs 58.1 %, p < .001, phi = .205)." }, { "field": "result", "quote": "patients treated with RBL appeared more likely to achieve CS, while PFS showed a more favorable safety profile." } ] }, { "id": "pmid:41091564", "pmid": "41091564", "doi": "10.1177/25785478251386982", "nctId": null, "pmcid": null, "title": "Laser Hemorrhoidoplasty for Grade III Hemorrhoidal Disease: Safety and Efficacy in a Brazilian Multicenter Retrospective Cohort Study", "firstAuthor": "de Oliveira", "multipleAuthors": true, "journal": "Photobiomodul Photomed Laser Surg", "year": 2026, "design": "retrospective", "n": 100, "nField": "reported", "population": "adults with symptomatic grade III hemorrhoids", "intervention": "laser hemorrhoidoplasty (a minimally invasive laser procedure)", "comparator": "none; single-group study with no comparison treatment", "primaryOutcome": "pain levels, hemorrhoid symptoms, and complications after treatment", "result": "pain peaked at day 7 then nearly resolved by day 14 and stayed low up to a year, symptoms disappeared by day 30, and most complications were mild", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective study of one treatment group with no comparison to surgery or other options, so it can't show whether laser treatment works better or worse than alternatives.", "directness": "indirect", "limitations": "retrospective design, no control or comparison group, and nearly half of patients had some complication over follow-up", "followUp": "1 year", "plainFinding": "Pain and symptoms improved after laser treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41091564/", "sourceText": "BACKGROUND: Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative to excisional hemorrhoidectomy, but data remain heterogeneous, particularly regarding energy settings and safety outcomes. METHODS: This multicenter retrospective cohort included 100 patients with symptomatic grade III hemorrhoids treated with LHP across six Brazilian centers between January 2021 and August 2023. Primary outcomes were postoperative pain (Visual Analog Scale-VAS), proctological symptoms (Proctological Symptoms Scale-PSS), and complications. Associations between total laser energy and complications were analyzed using multivariable logistic regression. RESULTS: Median VAS peaked at 3.0 on day 7 and declined to near-complete remission by day 14, remaining minimal up to 1 year. PSS scores improved in parallel, reaching zero from day 30. The 30-day complication rate averaged 19.7%, peaking at 27% on day 14, with a cumulative per-patient rate of 44%. Most complications were mild (edema, skin tags), and only four patients required reintervention. Higher total energy was associated with increased complications from day 14 onwards, although the clinical effect was modest. Adjunctive CO2 laser excision of skin tags (n = 49) did not increase morbidity. CONCLUSIONS: LHP proved safe and effective for grade III hemorrhoids, ensuring early pain relief and symptom resolution with high satisfaction. Energy standardization may help minimize risks, and adjunctive CO2 skin-tag excision appears feasible without added morbidity.", "provenance": [ { "field": "n", "quote": "This multicenter retrospective cohort included 100 patients" }, { "field": "population", "quote": "100 patients with symptomatic grade III hemorrhoids treated with LHP" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative to excisional hemorrhoidectomy" }, { "field": "comparator", "quote": "This multicenter retrospective cohort included 100 patients with symptomatic grade III hemorrhoids treated with LHP across six Brazilian centers" }, { "field": "primaryOutcome", "quote": "Primary outcomes were postoperative pain (Visual Analog Scale-VAS), proctological symptoms (Proctological Symptoms Scale-PSS), and complications." }, { "field": "result", "quote": "Median VAS peaked at 3.0 on day 7 and declined to near-complete remission by day 14, remaining minimal up to 1 year. PSS scores improved in parallel, reaching zero from day 30. The 30-day complication rate averaged 19.7%, peaking at 27% on day 14, with a cumulative per-patient rate of 44%." } ] }, { "id": "pmid:41047429", "pmid": "41047429", "doi": "10.1007/s00384-025-04999-3", "nctId": null, "pmcid": "PMC12497663", "title": "Modified sclerobanding versus rubber band ligation for grade II/III hemorrhoidal disease: a retrospective study", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 307, "nField": "reported", "population": "patients with grade II or III hemorrhoids", "intervention": "modified sclerobanding (rubber band ligation plus polidocanol foam sclerotherapy)", "comparator": "traditional rubber band ligation alone", "primaryOutcome": "rate of treatment failure and delayed major bleeding after the procedure", "result": "the new combined method had no cases of delayed major bleeding and lower rates of recurrence and treatment failure than standard banding", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was a retrospective, non-randomized comparison of two office procedures, so bias and confounding can't be ruled out.", "directness": "indirect", "limitations": "retrospective design, baseline differences between groups (anticoagulant history, hospital stay), not a comparison to actual surgery", "followUp": "One-year follow-up", "plainFinding": "Less bleeding, fewer recurrences than standard banding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41047429/", "sourceText": "PURPOSE: This study aimed to evaluate the efficacy and safety of a modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS), for treating grade II/III hemorrhoidal disease (HD). METHODS: We retrospectively included patients with grade II/III HD who underwent RBL from January to December 2021 and mSB from January 2022 to February 2023 at Ningbo Medical Center Lihuili Hospital. The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB), while the secondary outcomes included postoperative complications such as pain, swelling, anal edema, and variations in bleeding grade. Long-term follow-up evaluated the HD Symptom Score (HDSS), Short Health Scale for HD (SHS-HD), and Patient Satisfaction (PS). RESULTS: Among the 307 patients, 162 received mSB and 125 underwent traditional RBL. The baseline characteristics were similar, except for the anticoagulant history and hospital stay length (P < 0.05). The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05). Postoperative complications were comparable between the groups, but the mSB group showed greater improvement in bleeding by the seventh day (P < 0.05). One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS. CONCLUSIONS: The modified sclerobanding procedure reduces the number of ligation sessions, lowers the risk of delayed bleeding, and decreases treatment failure rates without increasing the risk of postoperative complications.", "provenance": [ { "field": "population", "quote": "patients with grade II/III HD who underwent RBL" }, { "field": "intervention", "quote": "modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS)" }, { "field": "comparator", "quote": "traditional RBL" }, { "field": "primaryOutcome", "quote": "The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB)" }, { "field": "result", "quote": "The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05)." }, { "field": "n", "quote": "Among the 307 patients, 162 received mSB and 125 underwent traditional RBL." }, { "field": "followUp", "quote": "One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS." } ] }, { "id": "pmid:40922264", "pmid": "40922264", "doi": "10.1097/MD.0000000000044368", "nctId": null, "pmcid": "PMC12419330", "title": "Combined therapy of HIFU rectoanal lifting (HIFU-RAL) and sclerotherapy for prolapsed hemorrhoids and rectal mucosal prolapse: A case series", "firstAuthor": "Suzuki", "multipleAuthors": false, "journal": "Medicine (Baltimore)", "year": 2025, "design": "case-series", "n": 10, "nField": "reported", "population": "adults with prolapsed hemorrhoids or rectal mucosal prolapse causing discomfort", "intervention": "combined HIFU rectoanal lifting procedure plus sclerotherapy injection", "comparator": "none (single-arm case series, before-and-after comparison)", "primaryOutcome": "whether prolapse was reduced or resolved and whether problems recurred or caused complications", "result": "prolapse was visibly reduced or resolved in all cases right after treatment, with no complications or recurrence during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "only 10 patients with no comparison group, so it cannot show whether this works better than other treatments.", "directness": "direct", "limitations": "Very small number of patients (10), no control group, no randomization, and no comparison to surgery or other nonsurgical treatments.", "followUp": "median: 16.0 months", "plainFinding": "Prolapse reduced, no complications seen.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40922264/", "sourceText": "RATIONALE: Prolapsed hemorrhoids can impair quality of life due to associated symptoms such as pain. While hemorrhoidectomy is considered the gold standard for treating prolapsed hemorrhoids, this procedure inevitably involves complications such as postoperative pain, bleeding, and delayed recovery. Therefore, there is an increasing need for treatment options that are immediate, effective, and minimally invasive, while also taking into account patients' physical and social backgrounds, preferences, and values. In this study, we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids and assessed its efficacy. PATIENT CONCERNS: This case series included 10 symptomatic patients, consisting of 5 men and 5 women. The mean patient age was 67.2 ± 11.0 years, and the median disease duration was 8.0 years (interquartile range: 3.5-38.8 years). All patients complained of prolapse and discomfort that impaired their daily lives. DIAGNOSES: Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse. INTERVENTIONS: HIFU-RAL is a transanal HIFU technique originally developed to treat fecal and urinary incontinence. In this procedure, circumferential ultrasound energy was delivered to the longitudinal muscle of the rectum through the mucosal surface, oral to the dentate line. In ALTA sclerotherapy, the sclerosant was injected into the internal hemorrhoids for prolapsed hemorrhoids and into the submucosal layer of the rectum for rectal mucosal prolapse. The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time. OUTCOMES: The combined HIFU-RAL procedure and ALTA sclerotherapy were completed in 19.2 ± 6.6 minutes. In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure. During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed. LESSONS: The HIFU-RAL procedure combined with ALTA sclerotherapy is a promising, minimally invasive, office-based treatment for prolapsed hemorrhoids. The HIFU-RAL procedure induces contraction of the heated rectal longitudinal muscle, repositioning hemorrhoids to their anatomical site and visibly reducing or eliminating the area of prolapsed lesions.", "provenance": [ { "field": "n", "quote": "This case series included 10 symptomatic patients, consisting of 5 men and 5 women." }, { "field": "population", "quote": "Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse." }, { "field": "intervention", "quote": "we applied a transanal high-intensity focused ultrasound (HIFU) technique, namely HIFU rectal lifting (HIFU-RAL), combined with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for treating prolapsed hemorrhoids" }, { "field": "comparator", "quote": "The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time." }, { "field": "primaryOutcome", "quote": "In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure." }, { "field": "result", "quote": "In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure. During the follow-up period (median: 16.0 months; interquartile range: 10.5-25.8 months), no adverse events or recurrences were observed." }, { "field": "followUp", "quote": "median: 16.0 months; interquartile range: 10.5-25.8 months" } ] }, { "id": "pmid:40877526", "pmid": "40877526", "doi": "10.1007/s00384-025-04944-4", "nctId": null, "pmcid": "PMC12394367", "title": "Outcomes of embolization therapy of superior rectal arteries for the management of grade 1 to 3 internal hemorrhoids: a systematic Review of clinical studies", "firstAuthor": "Al Jnainati", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "systematic-review", "n": 810, "nField": "reported", "population": "Adults with grade 1 to 3 internal hemorrhoids who didn't respond to office treatments or who wanted to avoid surgery", "intervention": "Embolization of the superior rectal artery (a catheter procedure called \"Emborrhoid\") to block blood flow to hemorrhoids", "comparator": "Mostly no direct comparator (single-arm case series); a couple of small studies compared it to rubber-band ligation or sclerotherapy", "primaryOutcome": "Whether the procedure worked technically, whether symptoms (especially bleeding) improved, side effects, and whether hemorrhoids came back", "result": "Procedure succeeded technically 93-100% of the time; symptoms improved in 63-94% of patients; side effects were mild (pelvic discomfort, nausea, low fever) with no serious injury; hemorrhoids recurred in 8-20% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The studies were too different to combine into one solid answer, were mostly small single-center case series without a comparison group, and only two small studies directly compared this treatment to others.", "directness": "direct", "limitations": "Substantial heterogeneity blocked meta-analysis; small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity", "followUp": "", "plainFinding": "Artery-blocking procedure eases hemorrhoid bleeding safely.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40877526/", "sourceText": "BACKGROUND: Superior rectal artery embolization (\"Emborrhoid\") offers a catheter-based alternative for grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable. METHODS: Following PRISMA 2020, PubMed and Embase were searched (Jan 2014-Jan 2024). Two reviewers independently screened records, extracted data, and applied RoB 2, ROBINS-I, or an adapted Newcastle-Ottawa Scale. Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence. Substantial heterogeneity blocked meta-analysis; results were narratively synthesized. RESULTS: Twenty-two studies encompassing 810 procedures qualified. Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief. Reported complications were mild and self-limited (pelvic discomfort, nausea, and low-grade fever); no ischemic injury, continence disturbance, or mortality occurred. Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted. Patient-reported satisfaction exceeded 80% in every series. Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis. CONCLUSIONS: Current evidence suggests Emborrhoid is a safe, effective bridge between office procedures and surgery-particularly valuable for frail or anticoagulated patients. Yet small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity. Multicenter randomized studies with harmonized outcomes and ≥ 24-month follow-up are required to confirm long-term efficacy, cost-effectiveness, and optimal patient selection.", "provenance": [ { "field": "n", "quote": "Twenty-two studies encompassing 810 procedures qualified." }, { "field": "population", "quote": "Superior rectal artery embolization (\"Emborrhoid\") offers a catheter-based alternative for grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable." }, { "field": "intervention", "quote": "Superior rectal artery embolization (\"Emborrhoid\") offers a catheter-based alternative for grade I-III internal hemorrhoids" }, { "field": "comparator", "quote": "Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis." }, { "field": "primaryOutcome", "quote": "Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence." }, { "field": "result", "quote": "Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief." }, { "field": "result", "quote": "Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted." }, { "field": "limitations", "quote": "Substantial heterogeneity blocked meta-analysis; results were narratively synthesized." }, { "field": "limitations", "quote": "Yet small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity." } ] }, { "id": "pmid:40856750", "pmid": "40856750", "doi": "10.1007/s00464-025-12120-6", "nctId": null, "pmcid": null, "title": "Multicenter analysis of the efficacy and factors related to recurrence of endoscopic sclerotherapy for internal hemorrhoids: a large-sample, retrospective cohort study", "firstAuthor": "Zhu", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2025, "design": "retrospective", "n": 1147, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "endoscopic sclerotherapy (an injection treatment, non-surgical)", "comparator": "none (single-group outcome and recurrence analysis)", "primaryOutcome": "treatment success and recurrence rate of hemorrhoids", "result": "92.85% treatment success; 12.21% recurrence, with higher BMI, lack of exercise linked to more recurrence and lower hemorrhoid grade, working position, diet linked to less recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it can't directly prove sclerotherapy is better than surgery or no treatment.", "directness": "indirect", "limitations": "Retrospective design, no control/comparison group, multiple centers may differ in practice, and follow-up time varied widely (3 to 49 months).", "followUp": "3 to 49 months (mean: 25.61 ± 13.23 months)", "plainFinding": "Injection treatment worked well, low recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40856750/", "sourceText": "BACKGROUND: Internal hemorrhoids are common, and while endoscopic sclerotherapy is emerging as a treatment, large-scale, multi-center data on its efficacy, safety, and recurrence rates are lacking. We summarized three-center large-sample endoscopic hemorrhoid sclerotherapy data, assess efficacy, complications, recurrence, and analyze recurrence factors (severity, lifestyle). METHODS: A retrospective analysis of patients with internal hemorrhoids treated with endoscopic sclerotherapy at three centers from December 2018 to December 2022 was conducted. Clinical and follow-up data were collected to assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates. The recurrence rate, recurrence time, and related factors for different hemorrhoid grades were analyzed. RESULTS: A total of 1147 patients underwent the procedure: 637 at Shenzhen Hospital of Southern Medical University, 177 at No. 964 Hospital, and 333 at Third Affiliated Hospital, Army Medical University. The overall effective rate was 92.85% (1065/1147). Postoperative safety measures showed the effective group had significantly lower pain (1 (0,1) vs. 2 (2,3)), bleeding (0 (0,1) vs. 2 (1,3)), and urination scores (0 (0,0) vs. 0 (0,1)) compared to the ineffective group. The overall recurrence rate was 12.21% (130/1065), with follow-up periods ranging from 3 to 49 months (mean: 25.61 ± 13.23 months). Recurrence time was earlier with increasing hemorrhoid grade (p < 0.05). Temporal analysis revealed that for Grades I, II, and III, recurrence rates within one year were 28, 39.78, and 75%, respectively, vs 72, 60.22, and 25% beyond 1 year. Multivariate logistic regression indicated higher BMI and lack of exercise were associated with increased recurrence (p < 0.05), while lower hemorrhoid grade, working position, and dietary habits were protective factors (p < 0.05). CONCLUSION: Endoscopic sclerotherapy is a safe and effective treatment for internal hemorrhoids with a low short-term recurrence rate. Key factors influencing recurrence include BMI, exercise, hemorrhoid grade, working position, and dietary habits, providing insights for optimizing treatment strategies.", "provenance": [ { "field": "population", "quote": "patients with internal hemorrhoids treated with endoscopic sclerotherapy" }, { "field": "intervention", "quote": "endoscopic sclerotherapy" }, { "field": "comparator", "quote": "A retrospective analysis of patients with internal hemorrhoids treated with endoscopic sclerotherapy at three centers" }, { "field": "primaryOutcome", "quote": "assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates" }, { "field": "result", "quote": "The overall effective rate was 92.85% (1065/1147)." }, { "field": "result", "quote": "The overall recurrence rate was 12.21% (130/1065)" }, { "field": "result", "quote": "higher BMI and lack of exercise were associated with increased recurrence (p < 0.05), while lower hemorrhoid grade, working position, and dietary habits were protective factors (p < 0.05)" }, { "field": "n", "quote": "A total of 1147 patients underwent the procedure" }, { "field": "followUp", "quote": "follow-up periods ranging from 3 to 49 months (mean: 25.61 ± 13.23 months)" } ] }, { "id": "pmid:40813828", "pmid": "40813828", "doi": "10.1007/s00431-025-06392-2", "nctId": null, "pmcid": "PMC12354542", "title": "Pediatric external hemorrhoids: clinical characteristics and outcomes of conservative treatment versus injection sclerotherapy", "firstAuthor": "Docter", "multipleAuthors": true, "journal": "Eur J Pediatr", "year": 2025, "design": "retrospective", "n": 44, "nField": "reported", "population": "children with external hemorrhoids", "intervention": "injection sclerotherapy", "comparator": "conservative watchful waiting", "primaryOutcome": "symptom resolution and complications", "result": "sclerotherapy resolved symptoms in most after 1-2 injections but caused skin erosion in over a third; conservative treatment resolved symptoms within a year though lesions persisted", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, retrospective study without randomization, so it cannot reliably prove one treatment is better.", "directness": "indirect", "limitations": "Retrospective design, no randomization, small sample, diagnosis often based on parent photographs rather than exam.", "followUp": "", "plainFinding": "Both options worked, but sclerotherapy had risks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40813828/", "sourceText": "UNLABELLED: Pediatric external hemorrhoids are rare and often misdiagnosed. This study assesses clinical presentation, risk factors, and treatment outcomes, comparing conservative management with injection sclerotherapy. A retrospective cohort study (2007-2024) was conducted at a tertiary pediatric hospital, including pediatric patients treated with conservative therapy (watchful waiting) or injection sclerotherapy for external hemorrhoids. Data from medical records were analyzed for patient history, presentation, treatment outcomes, and complications. Forty-four patients (86.4% male) were included. Mean age at symptom onset and presentation was respectively 4.0 (range 0-11) and 5.8 (range 2-13) years, with a median diagnostic delay of 20.5 months. All reported anal protrusion/swelling during/after defecation, though this was only visible on examination in 11.4%; diagnosis was otherwise based on parent-provided photographs (63.6%) or reference images (25.0%). Additional symptoms included pain (45.5%), bleeding (18.2%), anal itching (13.6%), anxiety (9.1%) and tenesmus (6.8%). Thirty-one patients (70.5%) underwent injection sclerotherapy, with a 69.2% success rate after one, and 90.3% after two injections. Thirteen patients (29.5%) were treated conservatively with watchful waiting, with symptoms resolving within one year, although the lesion(s) persisted. Skin erosion occurred in 35.5% of patients treated with injection sclerotherapy, leading to constipation and defecation anxiety in 9.1% of patients. CONCLUSION: Pediatric external hemorrhoids present as anal protrusion/swelling, often accompanied by anorectal pain. Diagnosis is often delayed due to its intermittent nature. Parent-provided photographs can confirm diagnosis. Both conservative management and injection sclerotherapy are viable treatments; injection sclerotherapy offers a definitive resolution but carries risks of relapse and complications. WHAT IS KNOWN: • Pediatric external hemorrhoids are often misdiagnosed and mismanaged. WHAT IS NEW: • Due to the intermittent nature of external hemorrhoids, diagnosis is often delayed, making parent-provided photographs highly valuable for accurate assessment. • Both conservative management and injection sclerotherapy are viable treatments. • Injection sclerotherapy carries risks of relapse and complications.", "provenance": [ { "field": "n", "quote": "Forty-four patients (86.4% male) were included." }, { "field": "population", "quote": "pediatric patients treated with conservative therapy (watchful waiting) or injection sclerotherapy for external hemorrhoids" }, { "field": "intervention", "quote": "injection sclerotherapy" }, { "field": "comparator", "quote": "conservative therapy (watchful waiting)" }, { "field": "primaryOutcome", "quote": "treatment outcomes, and complications" }, { "field": "result", "quote": "Thirty-one patients (70.5%) underwent injection sclerotherapy, with a 69.2% success rate after one, and 90.3% after two injections. Thirteen patients (29.5%) were treated conservatively with watchful waiting, with symptoms resolving within one year, although the lesion(s) persisted. Skin erosion occurred in 35.5% of patients treated with injection sclerotherapy, leading to constipation and defecation anxiety in 9.1% of patients." } ] }, { "id": "pmid:40810375", "pmid": "40810375", "doi": "10.1097/DCR.0000000000003939", "nctId": null, "pmcid": null, "title": "Safety of Hemorrhoid Procedures in Patients Who Are Immunocompromised: The Mayo Clinic Experience", "firstAuthor": "Hajjar", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "retrospective", "n": 55, "nField": "reported", "population": "adults with hemorrhoids who were immunocompromised (mostly due to medications)", "intervention": "office-based or surgical procedures for hemorrhoids performed while immunosuppressed", "comparator": "none (no comparison group; outcomes described within this treated group)", "primaryOutcome": "infection or wound complications after the procedure", "result": "25% of patients had an adverse event, including 3 cases of cellulitis; no cases of pelvic sepsis or need for IV antibiotics", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, retrospective single-center study without a comparison group, so it can only suggest safety, not prove it.", "directness": "indirect", "limitations": "The retrospective nature of the study and the heterogeneity of the study population.", "followUp": "", "plainFinding": "Hemorrhoid surgery seemed safe despite immunosuppression.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40810375/", "sourceText": "BACKGROUND: Hemorrhoidal disease and immunosuppression are prevalent. Management of hemorrhoidal disease in this patient population is challenging. Most societies recommend conservative management due to the presumed risks of morbid complications, including sepsis and impaired healing. Data on the risks of office-based and operative procedures in immunocompromised patients are scant. OBJECTIVE: To evaluate postoperative outcomes after both office-based procedures and operative intervention for hemorrhoidal disease in immunocompromised patients. DESIGN: Retrospective medical record review. SETTINGS: Single-center, tertiary referral center. PATIENTS: Adult patients were included who had hemorrhoidal disease and primarily medication-induced immunosuppression and were undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression at Mayo Clinic in Rochester between 2010 and 2023. MAIN OUTCOME MEASURES: The primary outcome was the development of infectious complications or wound complications. RESULTS: Fifty-five immunocompromised patients, with a median age of 60 years, underwent a total of 68 hemorrhoidal procedures during the study time frame. All patients had immunosuppression induced by medication, except for 1 patient with bone marrow failure syndrome. The most common reason for immunosuppression was rheumatoid arthritis, followed by prior kidney transplant. The most common medications were chronic corticosteroids and methotrexate in more than one-third of patients each. Of 68 total interventions, hemorrhoidectomy (32%) and excision of a thrombosed hemorrhoid (26%) were the 2 most common operations performed. Sixteen adverse events were reported in 14 patients (25%). Three cases of postoperative cellulitis were documented after thrombosed external hemorrhoid excision, hemorrhoidopexy, and Whitehead hemorrhoidectomy. No postoperative intravenous antibiotics were administered. No cases of pelvic sepsis were documented. LIMITATIONS: The retrospective nature of the study and the heterogeneity of the study population. CONCLUSIONS: These data suggest that office-based and surgical procedures are safe and feasible in patients with immunosuppression. See Video Abstract . SEGURIDAD DE LOS PROCEDIMIENTOS PARA EL TRATAMIENTO DE HEMORROIDES EN PACIENTES INMUNODEPRIMIDOS LA EXPERIENCIA DE LA CLNICA MAYO: ANTECEDENTES:La enfermedad hemorroidal y la inmunosupresión son prevalentes. El tratamiento de la enfermedad hemorroidal en esta población de pacientes es difícil. La mayoría de las sociedades recomiendan un tratamiento conservador debido a los riesgos presuntos de complicaciones mórbidas, como sepsis y alteración de la cicatrización. Los datos sobre los riesgos de los procedimientos ambulatorios y quirúrgicos en pacientes inmunodeprimidos son escasos.OBJETIVO:Evaluar los resultados posoperatorios tras procedimientos ambulatorios y cirugía para la enfermedad hemorroidal en pacientes inmunodeprimidos.DISEÑO:Revisión retrospectiva de historias clínicas.ENTORNO:Centro terciario de referencia único.PACIENTES:Pacientes adultos con enfermedad hemorroidal e inmunosupresión inducida principalmente por medicamentos que se sometieron a un procedimiento ambulatorio o a una intervención quirúrgica para la enfermedad hemorroidal mientras estaban en tratamiento inmunosupresor en la Clínica Mayo de Rochester entre 2010 y 2023.PPRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la aparición de complicaciones infecciosas o complicaciones de la herida.RESULTADOS:Cincuenta y cinco pacientes inmunodeprimidos, con una mediana de edad de 60 años, se sometieron a un total de 68 procedimientos hemorroidales durante el periodo de estudio. Todos los pacientes presentaban inmunosupresión inducida por medicación, excepto uno con síndrome de insuficiencia medular. La causa más frecuente de inmunosupresión fue la artritis reumatoide, seguida de un trasplante renal previo. Los medicamentos más frecuentes fueron los corticosteroides crónicos y el metotrexato, en más de un tercio de los pacientes. De las 68 intervenciones totales, la hemorroidectomía (32 %) y la extirpación de una hemorroide trombosada (26 %) fueron las dos operaciones más comunes realizadas. Se notificaron 16 eventos adversos en 14 (25 %) pacientes. Se documentaron tres casos de celulitis posoperatoria tras la extirpación de una hemorroide externa trombosada, una hemorroidopexia y una hemorroidectomía de Whitehead. No se administraron antibióticos intravenosos postoperatorios. No se documentaron casos de sepsis pélvica.LIMITACIONES:El carácter retrospectivo del estudio y la heterogeneidad de la población estudiada.CONCLUSIONES:Estos datos sugieren que los procedimientos ambulatorios y quirúrgicos son seguros y viables en pacientes con inmunosupresión. (AI-generated translation ).", "provenance": [ { "field": "n", "quote": "Fifty-five immunocompromised patients, with a median age of 60 years, underwent a total of 68 hemorrhoidal procedures" }, { "field": "population", "quote": "Adult patients were included who had hemorrhoidal disease and primarily medication-induced immunosuppression" }, { "field": "intervention", "quote": "undergoing an office-based procedure or operative intervention for hemorrhoidal disease while on immunosuppression" }, { "field": "comparator", "quote": "Retrospective medical record review." }, { "field": "primaryOutcome", "quote": "The primary outcome was the development of infectious complications or wound complications." }, { "field": "result", "quote": "Sixteen adverse events were reported in 14 patients (25%). Three cases of postoperative cellulitis were documented after thrombosed external hemorrhoid excision, hemorrhoidopexy, and Whitehead hemorrhoidectomy. No postoperative intravenous antibiotics were administered. No cases of pelvic sepsis were documented." }, { "field": "limitations", "quote": "The retrospective nature of the study and the heterogeneity of the study population." } ] }, { "id": "pmid:40665575", "pmid": "40665575", "doi": "10.1111/codi.70163", "nctId": null, "pmcid": "PMC12264406", "title": "Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta-analysis of randomized controlled trials", "firstAuthor": "Tutino", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2025, "design": "meta-analysis", "n": 514, "nField": "reported", "population": "adults with hemorrhoids of different severity levels undergoing minimally invasive artery ligation surgery", "intervention": "hemorrhoidal artery ligation guided by Doppler ultrasound (DG-HAL)", "comparator": "hemorrhoidal artery ligation without Doppler guidance (HAL)", "primaryOutcome": "recurrence of hemorrhoids after the procedure", "result": "Doppler-guided ligation had a higher recurrence rate than non-Doppler ligation, with similar pain levels; when combined with mucopexy, no difference was found between the two", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools seven randomized trials totaling only 514 patients, which strengthens the evidence but the trials themselves were likely small and varied in technique.", "directness": "indirect", "limitations": "The abstract does not detail heterogeneity between trials, blinding, or long-term follow-up duration.", "followUp": "", "plainFinding": "Doppler guidance did not reduce recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40665575/", "sourceText": "AIM: Haemorrhoidal arterial ligation (HAL) with or without mucopexy (recto-anal repair, RAR) is a minimally invasive technique for the treatment of haemorrhoidal disease. It is still debated if it should be performed with Doppler guidance (DG-HAL) or without. The primary aim of this study was to find evidence that the use of Doppler guidance reduces the risk of recurrence. The secondary aim was to evaluate the benefit of Doppler guidance on postoperative complications. METHODS: A comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2020). The population, intervention, comparison, outcomes and study design (PICOS) framework was used for eligibility criteria. Data were extracted independently by two reviewers for initial screening and for eligibility to be included in the meta-analysis of randomized controlled trials. Random effects meta-analysis, leave-one-out meta-analysis and meta-regression were performed to assess the main outcomes. RESULTS: Seven randomized controlled trials, published between 2008 and 2023, were selected. They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees. The HAL technique was performed in 255 patients and DG-HAL in 259 patients. The meta-analysis revealed that the DG-HAL procedure was associated with a significant risk of recurrence (P = 0.007) and similar postoperative pain (P = 0.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG-HAL-RAR and HAL-RAR regarding the risk of recurrence (P = 0.36) and postoperative pain (P = 0.31). CONCLUSION: In conclusion, this meta-analysis did not find superiority of DG-HAL over HAL with or without RAR in reducing postoperative complications and recurrence.", "provenance": [ { "field": "n", "quote": "They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees." }, { "field": "population", "quote": "They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees." }, { "field": "intervention", "quote": "DG-HAL in 259 patients" }, { "field": "comparator", "quote": "The HAL technique was performed in 255 patients" }, { "field": "primaryOutcome", "quote": "The primary aim of this study was to find evidence that the use of Doppler guidance reduces the risk of recurrence." }, { "field": "result", "quote": "The meta-analysis revealed that the DG-HAL procedure was associated with a significant risk of recurrence (P = 0.007) and similar postoperative pain (P = 0.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG-HAL-RAR and HAL-RAR regarding the risk of recurrence (P = 0.36) and postoperative pain (P = 0.31)." } ] }, { "id": "pmid:40634906", "pmid": "40634906", "doi": "10.1186/s12893-025-02918-5", "nctId": null, "pmcid": "PMC12243282", "title": "Tissue selecting therapy stapler minimally invasive surgery to treat severe hemorrhoids", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "rct", "n": 141, "nField": "reported", "population": "patients with severe hemorrhoids", "intervention": "tissue selecting therapy (TST) stapler surgery", "comparator": "PPH surgery and EPH (rubber band ligation and staple) surgery", "primaryOutcome": "treatment effectiveness, complications, and anal muscle function after surgery", "result": "TST had higher effectiveness rate, shorter hospital stay and operation time, less blood loss, and fewer complications than PPH or EPH", "resultDirection": "benefit", "quality": "low", "qualityWhy": "although randomized, the abstract gives no detail on blinding, how randomization was concealed, or loss to follow-up, and all three compared groups are surgical, so it says nothing about non-surgical treatment.", "directness": "indirect", "limitations": "Abstract does not report blinding, dropout, or long-term follow-up beyond 3 months; all compared treatments are surgical, not non-surgical options.", "followUp": "Three months after surgery", "plainFinding": "Less invasive surgery option, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40634906/", "sourceText": "BACKGROUND: Severe hemorrhoids have a serious impact on patients' quality of life. At present, the main method for treating severe hemorrhoids is surgery, but surgical treatment causes greater trauma to patients and has a high degree of complications. There is an urgent need to find new surgical methods to solve these problems. To assess the ability of tissue-selective therapy stapler (TST) minimally invasive surgery to treat severe hemorrhoids by studying the clinical efficacy, postoperative complications, and anal dynamics of selective supramedullary hemorrhoid stomy. METHODS: In our hospital, between March 2015 and February 2018, 141 patients with severe hemorrhoids were included into three groups according to the block randomization method: the TST group, the pieces per hour the PPH group, and the eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid (EPH)group. There were 47 patients in each group. The clinical efficacy of the three groups of patients, changes in hospital stay time, operation time, intraoperative blood loss, postoperative complications, and anal dynamic indicators (rectal resting pressure, anal resting pressure, anorectal pressure difference, rectal tolerance, rectal perception threshold and length of the anal high-pressure zone) were observed and compared. RESULTS: The total effective rate in the TST group was 93.62%, which was higher than the 74.47% and 72.34% in the PPH and EPH groups, respectively, after treatment. Hospitalization time, operation time, and intraoperative blood loss were lower in the TST group than in the EPH and PPH groups. Three months after surgery, the rectal resting pressure, rectal tolerance, and rectal sensing thresholds of patients in the TST group were lower than those in the PPH and EPH groups, and the anal canal resting pressure, the anorectal pressure difference and the length of the anal high-pressure zone were greater than those in the PPH and EPH groups. After surgery, the complication rate in the TST group was 10.64%, which was lower than the 27.66% and 31.91% reported in the PPH and EPH groups, respectively. CONCLUSION: Minimally invasive TST is effective in treating severe hemorrhoids, can significantly improve anorectal motility, has a low incidence of postoperative complications and is highly safe.", "provenance": [ { "field": "n", "quote": "141 patients with severe hemorrhoids were included into three groups" }, { "field": "population", "quote": "patients with severe hemorrhoids" }, { "field": "intervention", "quote": "tissue-selective therapy stapler (TST) minimally invasive surgery" }, { "field": "comparator", "quote": "the PPH group, and the eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid (EPH)group" }, { "field": "primaryOutcome", "quote": "clinical efficacy of the three groups of patients, changes in hospital stay time, operation time, intraoperative blood loss, postoperative complications, and anal dynamic indicators" }, { "field": "result", "quote": "The total effective rate in the TST group was 93.62%, which was higher than the 74.47% and 72.34% in the PPH and EPH groups, respectively, after treatment." }, { "field": "result", "quote": "the complication rate in the TST group was 10.64%, which was lower than the 27.66% and 31.91% reported in the PPH and EPH groups, respectively." } ] }, { "id": "pmid:40596934", "pmid": "40596934", "doi": "10.1186/s12876-025-04089-2", "nctId": null, "pmcid": "PMC12211330", "title": "Comparison of efficacy and safety between surgical and conservative treatments for hemorrhoids: a meta-analysis", "firstAuthor": "Quan", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2025, "design": "meta-analysis", "n": 760, "nField": "reported", "population": "patients with hemorrhoids, including pregnant women with thrombosed external hemorrhoids", "intervention": "surgical treatment for hemorrhoids", "comparator": "non-invasive conservative treatment for hemorrhoids", "primaryOutcome": "complete symptom resolution and pain scores", "result": "Surgery led to more complete symptom resolution and better early pain relief, but pain outcomes were similar by 10 days; surgery also reduced recurrence and sped recovery in pregnant thrombosed cases, with similar rates of bleeding and urinary retention but some surgery-specific complications", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "This pooled analysis of only seven studies and 760 patients found consistent benefits for surgery, but the number of included studies is small and variability between them (noted by I2 values) limits confidence.", "directness": "direct", "limitations": "Based on only seven studies with some statistical heterogeneity between them (I2 up to 55%)", "followUp": "", "plainFinding": "Surgery relieves symptoms faster, fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40596934/", "sourceText": "OBJECTIVES: Hemorrhoids, a common anorectal condition, can be managed through surgical or conservative treatments. The aim of this meta-analysis is to compare the efficacy and safety of surgical and conservative treatments for hemorrhoids. METHODS: A systematic search was conducted from of PubMed, Embase, the Cochrane Library, and Web of Science from their inception to September 25, 2024. Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids. Statistical analyses included pooled odds ratios (ORs) and mean differences (MDs)/standard mean differences (SMDs) with 95% confidence intervals (CIs). RESULTS: Seven studies, including 760 patients, were analyzed. Surgery achieved higher rates of complete symptom resolution than conservative therapy (OR = 2.96, 95% CI: 1.66-5.28, p < 0.001). Overall pain scores favored surgery (SMD = -0.93, 95% CI: 1.73 to -0.13, p = 0.02). Subgroup analysis showed clear superiority within four days (SMD = -1.26, 95% CI -1.84 to -0.68) but parity beyond ten days (SMD = 0.00, 95% CI -0.44 to 0.44; p = 0.99). Comparable patterns were observed in pregnant women with thrombosed external hemorrhoids. Rates of postoperative bleeding (OR: 1.09; 95% CI: 0.42 to 2.82, p = 0.86; I2 = 41%, p = 0.15) and urinary retention (OR: 1.75; 95% CI: 0.30 to 10.31, p = 0.54; I2 = 45%, p = 0.18) did not differ significantly between groups. Surgical-specific adverse events were infrequent (incontinence 3%, persistent pain 5%, watery discharge 6%). Surgery shortened recovery in pregnant thrombosed cases by approximately seven days (MD: -6.80; 95% CI: -7.64 to -5.96, p < 0.001; I2 = 55%, p = 0.14) and reduced overall recurrence (95% CI: 0.10 to 0.37, p < 0.001; I2 = 0%, p = 0.97). CONCLUSION: Surgical treatments provide superior symptom relief, faster recovery, and lower recurrence but with some specific post-treatment complications, while conservative treatments are safer and less invasive but with provides slower symptom relief and higher recurrence rates. Individualized treatment should consider symptom severity, patient preferences, and risk tolerance.", "provenance": [ { "field": "n", "quote": "Seven studies, including 760 patients, were analyzed." }, { "field": "population", "quote": "Eligible studies compared surgical treatments with non-invasive conservative treatments in hemorrhoids." }, { "field": "population", "quote": "Comparable patterns were observed in pregnant women with thrombosed external hemorrhoids." }, { "field": "intervention", "quote": "surgical or conservative treatments" }, { "field": "comparator", "quote": "non-invasive conservative treatments in hemorrhoids" }, { "field": "primaryOutcome", "quote": "Surgery achieved higher rates of complete symptom resolution than conservative therapy" }, { "field": "result", "quote": "Overall pain scores favored surgery (SMD = -0.93, 95% CI: 1.73 to -0.13, p = 0.02). Subgroup analysis showed clear superiority within four days (SMD = -1.26, 95% CI -1.84 to -0.68) but parity beyond ten days (SMD = 0.00, 95% CI -0.44 to 0.44; p = 0.99)." }, { "field": "result", "quote": "Rates of postoperative bleeding (OR: 1.09; 95% CI: 0.42 to 2.82, p = 0.86; I2 = 41%, p = 0.15) and urinary retention (OR: 1.75; 95% CI: 0.30 to 10.31, p = 0.54; I2 = 45%, p = 0.18) did not differ significantly between groups." }, { "field": "result", "quote": "Surgery shortened recovery in pregnant thrombosed cases by approximately seven days (MD: -6.80; 95% CI: -7.64 to -5.96, p < 0.001; I2 = 55%, p = 0.14) and reduced overall recurrence (95% CI: 0.10 to 0.37, p < 0.001; I2 = 0%, p = 0.97)." } ] }, { "id": "pmid:40586790", "pmid": "40586790", "doi": "10.1007/s00104-025-02335-7", "nctId": null, "pmcid": null, "title": "[Hemorrhoidal disease and stage-dependent treatment (including anal prolapse)]", "firstAuthor": "Schwandner", "multipleAuthors": false, "journal": "Chirurgie (Heidelb)", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids at different stages, including anal prolapse", "intervention": "non-surgical treatments (conservative care, sclerotherapy, rubber band ligation) and minimally invasive procedures", "comparator": "conventional surgical hemorrhoidectomy", "primaryOutcome": "symptom control and avoiding recurrence", "result": "early-stage hemorrhoids respond to conservative and interventional treatments, while advanced stages need surgery or minimally invasive procedures", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a general review of treatment approaches without original study data, patient numbers, or outcome statistics.", "directness": "direct", "limitations": "no study design, patient numbers, or comparative outcome data are given; it is a narrative overview rather than a study of outcomes.", "followUp": "", "plainFinding": "Mild cases treated without surgery; severe cases need it.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40586790/", "sourceText": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease. Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV). In this context, \"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation). In cases of acute anal prolapse, a conservative and topical approach is indicated. The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence.", "provenance": [ { "field": "population", "quote": "The treatment of hemorrhoidal disease is carried out depending on the symptoms and stage of the disease." }, { "field": "intervention", "quote": "conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II)" }, { "field": "comparator", "quote": "surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV)" }, { "field": "primaryOutcome", "quote": "The ultimate goal of all treatment strategies for hemorrhoidal disease is symptom control and long-term absence of recurrence." }, { "field": "result", "quote": "Although conservative and interventional treatment options (including sclerotherapy, rubber band ligation) are indicated in early stages (stages I and II), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV)." } ] }, { "id": "pmid:40586452", "pmid": "40586452", "doi": "10.1111/ans.70242", "nctId": null, "pmcid": null, "title": "Laser Hemorrhoidoplasty: Procedure, Outcomes and Future Directions", "firstAuthor": "di Schiano di Visconte", "multipleAuthors": false, "journal": "ANZ J Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids of different severity grades", "intervention": "laser hemorrhoidoplasty (a laser-based procedure for hemorrhoids)", "comparator": "traditional excisional surgery for hemorrhoids", "primaryOutcome": "effectiveness, safety, and long-term outcomes of the laser procedure", "result": "Laser treatment reduced pain and recovery time but had higher recurrence rates, especially for the worst-graded hemorrhoids, where surgery worked better long-term", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a general review discussing the topic without describing a systematic search method or pooling of data, so it carries little weight as evidence.", "directness": "direct", "limitations": "The abstract does not describe how studies were selected or analyzed, and does not report specific numbers, making it hard to judge the strength of the claims.", "followUp": "", "plainFinding": "Less pain, but worse for severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40586452/", "sourceText": "Laser hemorrhoidoplasty (LHP) has emerged as a minimally invasive technique for the treatment of hemorrhoidal disease (HD), offering advantages such as reduced postoperative pain, shorter recovery time, and improved patient satisfaction compared with traditional surgical methods. This study critically evaluated the efficacy, safety, and long-term outcomes of LHP across different grades of hemorrhoids. Although LHP demonstrates clear benefits in the management of early-grade hemorrhoids, particularly grades II and III, its limitations are more apparent in advanced cases. The procedure employs laser wavelengths of 980 nm and 1470 nm, each with distinct tissue penetration characteristics that influence clinical outcomes. However, higher recurrence rates, especially for Grade IV HD, remain a clinical limitation. The efficacy of LHP is influenced by factors such as the laser wavelength selection, energy parameters, and procedural techniques. Although LHP offers advantages in terms of postoperative pain reduction and recovery, excisional methods remain superior for managing advanced HD, particularly in terms of long-term symptom resolution. Future research should focus on standardizing protocols, exploring hybrid techniques, and the executing of large-scale, long-term studies to optimize the role of LHP in comprehensive hemorrhoid management strategies.", "provenance": [ { "field": "population", "quote": "treatment of hemorrhoidal disease (HD)" }, { "field": "population", "quote": "across different grades of hemorrhoids" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "compared with traditional surgical methods" }, { "field": "comparator", "quote": "excisional methods remain superior for managing advanced HD" }, { "field": "primaryOutcome", "quote": "critically evaluated the efficacy, safety, and long-term outcomes of LHP" }, { "field": "result", "quote": "offering advantages such as reduced postoperative pain, shorter recovery time, and improved patient satisfaction" }, { "field": "result", "quote": "higher recurrence rates, especially for Grade IV HD, remain a clinical limitation" }, { "field": "result", "quote": "excisional methods remain superior for managing advanced HD, particularly in terms of long-term symptom resolution" } ] }, { "id": "pmid:40576944", "pmid": "40576944", "doi": "10.1007/s13304-025-02302-1", "nctId": null, "pmcid": null, "title": "Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis", "firstAuthor": "Martins", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 851, "nField": "reported", "population": "patients with thrombosed external hemorrhoids", "intervention": "surgical treatment (excision)", "comparator": "conservative (nonoperative) treatment", "primaryOutcome": "recurrence and bleeding risk", "result": "surgery had lower recurrence risk but similar bleeding risk compared to conservative treatment", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools six studies with moderate-to-high heterogeneity and the abstract does not describe the quality or randomization of the included trials.", "directness": "direct", "limitations": "heterogeneity between studies (I2 up to 60%) and the abstract does not specify study designs included", "followUp": "", "plainFinding": "Surgery lowers recurrence, same bleeding risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40576944/", "sourceText": "Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement. Treatment options remain controversial, with limited evidence guiding the choice between surgical and conservative approaches. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify clinical trials comparing surgery with conservative treatment in thrombosed external hemorrhoids. Statistical analyses were performed using Review Manager 5.4.1 with a random-effects model. Heterogeneity was assessed using the I2 test. We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment. Surgical treatment was associated with a lower risk of recurrence compared to conservative management (RR 0.49; 95% CI 0.26-0.91; P < 0.05; I2 = 54%). However, there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I2 = 60%). Subgroup analyses of the excision surgery group revealed no differences between approaches. Our main findings indicated no significant difference in bleeding between surgery and conservative treatment groups. However, operative management is associated with significantly lower recurrences, which should be the preferred choice.", "provenance": [ { "field": "n", "quote": "We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment." }, { "field": "population", "quote": "Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement." }, { "field": "intervention", "quote": "Surgical treatment was associated with a lower risk of recurrence compared to conservative management" }, { "field": "comparator", "quote": "comparing surgery with conservative treatment in thrombosed external hemorrhoids" }, { "field": "primaryOutcome", "quote": "Surgical treatment was associated with a lower risk of recurrence compared to conservative management (RR 0.49; 95% CI 0.26-0.91; P < 0.05; I2 = 54%)." }, { "field": "result", "quote": "there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I2 = 60%)" } ] }, { "id": "pmid:40530787", "pmid": "40530787", "doi": "10.1097/SLE.0000000000001381", "nctId": null, "pmcid": "PMC12303241", "title": "The Comparison Between Endoscopic Ligation and Sclerotherapy on the Treatment Effect and Anorectal Function in Patients With Internal Hemorrhoids", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2025, "design": "prospective-cohort", "n": 32, "nField": "reported", "population": "patients with internal hemorrhoids undergoing minimally invasive endoscopic treatment", "intervention": "endoscopic ligation", "comparator": "cap-assisted endoscopic sclerotherapy (CAES)", "primaryOutcome": "treatment effect, symptom relief, complications, psychological condition, and anorectal function", "result": "no significant difference in treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups, though each method showed certain advantages in specific measures", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small, non-randomized comparison of only 32 patients with short 3-month follow-up limits confidence in the findings.", "directness": "indirect", "limitations": "Small sample size, no mention of randomization, short follow-up period of only 3 months.", "followUp": "3-month follow-up", "plainFinding": "Both non-surgical methods worked similarly well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40530787/", "sourceText": "OBJECTIVE: To evaluate the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed. METHODS: Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited, with a 3-month follow-up. Patients were divided into 2 groups, with Group A undergoing endoscopic ligation (n=14) and Group B receiving CAES (n=18). The Clinical efficacy and anorectal function between the 2 groups before and after treatment were compared, and the psychological changes in patients before and after treatment were evaluated by various scales. RESULTS: There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding. The comprehensive multiscale psychological evaluation showed no significant difference between the 2 groups before and after treatment, but the psychological condition of patients in both groups was significantly improved after treatment. Besides, patients in Group A were better in the improvement of constipation scale, and patients in Group B had a greater improvement in the pain scale. As for anorectal function, there was no significant difference before and after treatment, except for the squeeze duration before treatment. In the comparison pretreatment and post-treatment, patients in Group A had significant differences in resting (average), first defecation and squeeze (average), while patients in Group B had significant differences in resting (average) and first defecation. CONCLUSIONS: Two endoscopic therapies were effective in treating internal hemorrhoids, with no significant difference in terms of treatment effect, symptom relief, complication rate, psychological condition, and anorectal function when compared between 2 groups. However, when compared within each group, the different methods had their own advantages in the evaluation of treatment effect and anorectal function.", "provenance": [ { "field": "n", "quote": "Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited" }, { "field": "population", "quote": "patients with internal hemorrhoids" }, { "field": "intervention", "quote": "Group A undergoing endoscopic ligation (n=14)" }, { "field": "comparator", "quote": "Group B receiving CAES (n=18)" }, { "field": "primaryOutcome", "quote": "the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed" }, { "field": "result", "quote": "There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding." }, { "field": "followUp", "quote": "with a 3-month follow-up" } ] }, { "id": "pmid:40493094", "pmid": "40493094", "doi": "10.1007/s10151-025-03170-y", "nctId": null, "pmcid": "PMC12152054", "title": "Limitations of the Goligher classification in randomized trials for hemorrhoidal disease: a qualitative systematic review of selection criteria", "firstAuthor": "van Oostendorp", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoidal disease enrolled in randomized trials comparing treatments", "intervention": "various treatments for hemorrhoidal disease studied in trials, including at least one surgical arm", "comparator": "other treatment arms or classification systems used in the same trials", "primaryOutcome": "how patients were selected and classified (using systems like the Goligher classification) in hemorrhoid treatment trials", "result": "most trials used the Goligher classification but often did not describe or cite it properly, and classification/selection criteria were inconsistent across studies", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this review examines how trials classified and selected patients rather than comparing surgery with non-surgical treatment outcomes, so it cannot show which works better.", "directness": "indirect", "limitations": "most studies did not fully describe or cite the classification system used, and 70% of studies reporting recurrence lacked adequate inclusion criteria or references to the classification", "followUp": "", "plainFinding": "Inconsistent classification, no direct treatment comparison.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40493094/", "sourceText": "BACKGROUND: The diverse range of therapeutic options for hemorrhoidal disease (HD) highlights the need for precise classification systems to guide treatment. Although the Goligher classification remains the most widely used, it has been criticized for its simplicity and limited ability to capture symptom severity or guide treatment decisions. This study aims to evaluate the patient selection criteria and classification systems employed in randomized controlled trials (RCTs) for HD. METHODS: A systematic review was conducted following the 2020 PRISMA guidelines. A comprehensive search of databases identified randomized controlled trials (RCTs) comparing treatments for HD, focusing on classification systems used for patient enrollment. Eligible studies included adult patients and at least one arm involving surgical treatment. RESULTS: Out of 6692 records, 162 studies met the inclusion criteria, with a median cohort size of 84 patients and 55.4% male. Most studies (86.4%) used the Goligher system, though the majority did not fully describe or cite the system. Only 13.6% of studies employed more recent alternative classification systems. The most common outcome measures across studies were postoperative pain (147 studies) and complications (133 studies). Recurrence rates were reported in 42% of studies, yet 70% of these did not provide adequate inclusion criteria or references to Goligher's classification. CONCLUSIONS: The inconsistent application of the Goligher classification and the variability in patient selection criteria across RCTs highlight the need for more nuanced and standardized systems. Future research should focus on refining classification methods and incorporating patient-reported outcomes to improve the reliability and relevance of HD trials. PROSPERO REGISTRATION: CRD42023387339.", "provenance": [ { "field": "population", "quote": "Eligible studies included adult patients and at least one arm involving surgical treatment." }, { "field": "intervention", "quote": "randomized controlled trials (RCTs) comparing treatments for HD" }, { "field": "comparator", "quote": "focusing on classification systems used for patient enrollment" }, { "field": "primaryOutcome", "quote": "evaluate the patient selection criteria and classification systems employed in randomized controlled trials (RCTs) for HD" }, { "field": "result", "quote": "Most studies (86.4%) used the Goligher system, though the majority did not fully describe or cite the system." }, { "field": "result", "quote": "70% of these did not provide adequate inclusion criteria or references to Goligher's classification" }, { "field": "limitations", "quote": "70% of these did not provide adequate inclusion criteria or references to Goligher's classification" } ] }, { "id": "pmid:40492557", "pmid": "40492557", "doi": "10.1097/DCR.0000000000003832", "nctId": null, "pmcid": "PMC12345815", "title": "Cost-Effectiveness of Rubber Band Ligation Versus Hemorrhoidectomy for the Treatment of Grade III Hemorrhoids: Analysis Using Evidence From the HOLLAND Randomized Controlled Trial", "firstAuthor": "van Oostendorp", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "rct", "n": 79, "nField": "reported", "population": "Adults with symptomatic grade III hemorrhoids", "intervention": "Surgery to remove hemorrhoids (hemorrhoidectomy)", "comparator": "Rubber band ligation (non-surgical banding procedure)", "primaryOutcome": "Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months", "result": "Surgery gave better quality of life and far fewer recurrences than banding, but cost more; whether surgery was worth the extra cost depended on how much society is willing to pay", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It's a randomized trial comparing real treatments, but the number of patients is small and the cost-effectiveness conclusion is uncertain and depends on assumptions.", "directness": "direct", "limitations": "Small sample size may limit generalizability and the ability to detect rare but costly complications; procedural costs were based on average hospital prices rather than detailed bottom-up costing.", "followUp": "24 months", "plainFinding": "Surgery worked better but cost more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40492557/", "sourceText": "BACKGROUND: Hemorrhoids significantly impact quality of life and health care costs. Although rubber band ligation and hemorrhoidectomy are common treatments for grade III hemorrhoids, comparative cost-effectiveness data are limited. OBJECTIVE: To assess the cost-effectiveness and cost-utility of rubber band ligation compared to hemorrhoidectomy from a societal perspective within the context of the HOLLAND trial. DESIGN: Cost-effectiveness and cost-utility analyses using data from a multicenter, randomized controlled trial. SETTINGS: Ten Dutch hospitals participating in the HOLLAND trial. PATIENTS: Adults with symptomatic grade III hemorrhoids randomly assigned to receive rubber band ligation or hemorrhoidectomy treatment. INTERVENTIONS: Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy. MAIN OUTCOME MEASURES: Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months from a societal perspective. RESULTS: Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation). Hemorrhoidectomy resulted in better clinical outcomes with a quality-adjusted life year difference of 0.08 (95% CI, 0.04-0.13) and a recurrence difference of 33.5% (95% CI, 15.3%-51.7%). Hospital costs were higher for hemorrhoidectomy (€1364; 95% CI, 895-1834; p < 0.001), as were societal costs (€1984; 95% CI, -132 to 4101; p = 0.066). The incremental cost-utility ratio for hemorrhoidectomy was €24,042 per quality-adjusted life year gained, and the incremental cost-effectiveness ratio was €5918 per recurrence avoided. The probability of hemorrhoidectomy being cost-effective was 45.5% at €20,000 per quality-adjusted life year and 83.9% at €50,000 per quality-adjusted life year. For recurrence avoidance, probabilities were 98.3% and 99.8%, respectively. LIMITATIONS: The small sample size may limit generalizability and the ability to detect rare but costly complications. Procedural costs were based on average hospital prices, which is a pragmatic approach but is less detailed than bottom-up costing. CONCLUSIONS: In patients with grade III hemorrhoids, hemorrhoidectomy provides better long-term clinical outcomes, including higher quality of life and lower recurrence rates compared to rubber band ligation. However, its cost-effectiveness varies depending on societal willingness-to-pay thresholds. Caution is warranted before discarding it as a first-line treatment solely based on health care costs or limited operating room availability. See Video Abstract . CLINICAL TRIAL REGISTRATION NUMBER: NCT04621695. COSTOEFECTIVIDAD DE LA LIGADURA CON BANDA ELSTICA VERSUS HEMORROIDECTOMA PARA EL TRATAMIENTO DE HEMORROIDES DE GRADO III ANLISIS UTILIZANDO EVIDENCIA DEL ENSAYO HOLLAND CONTROLADO ALEATORIZADO: ANTECEDENTES:Las hemorroides afectan significativamente la calidad de vida y los costos de atención médica. Si bien la ligadura con banda elástica y la hemorroidectomía son tratamientos comunes para las hemorroides de grado III, los datos comparativos de costo-efectividad son limitados.OBJETIVO:Evaluar el costo-efectividad y el costo-utilidad de la ligadura con banda elástica en comparación con la hemorroidectomía desde una perspectiva social en el contexto del ensayo HOLLAND.DISEÑO:Análisis de costo-efectividad y costo-utilidad utilizando datos de un ensayo controlado aleatorizado multicéntrico.ESTABLECIMIENTO:Diez hospitales holandeses participantes en el ensayo HOLLAND.PACIENTES:Adultos con hemorroides sintomáticas de grado III aleatorizados a ligadura con banda elástica o hemorroidectomía.INTERVENCIONES:Ligadura con banda elástica (hasta dos sesiones) o hemorroidectomía escisional.PRINCIPALES MEDIDAS DE VALORACIÓN:Costo por año de vida ajustado a calidad (AVAC) ganado y costo por recurrencia evitada durante 24 meses desde una perspectiva social.RESULTADOS:Se analizaron setenta y nueve pacientes (33 hemorroidectomía, 46 ligadura con banda elástica). La hemorroidectomía presentó mejores resultados clínicos, con una diferencia de AVAC de 0,08 (IC del 95 %, 0,04-0,13) y una diferencia de recurrencia del 33,5 % (IC del 95 %, 15,3 %-51,7 %). Los costes hospitalarios fueron mayores para la hemorroidectomía (1364 €; IC del 95 %, 895-1834; p < 0,001), al igual que los costes sociales (1984 €; IC del 95 %, -132-4101; p = 0,066). La razón costo-utilidad incremental para la hemorroidectomía fue de 24.042 € por AVAC ganado, y la razón costo-efectividad incremental fue de 5.918 € por recurrencia evitada. La probabilidad de que la hemorroidectomía sea costo-efectiva fue del 45,5% con 20.000 €/AVAC y del 83,9% con 50.000 €/AVAC. Para la prevención de la recurrencia, las probabilidades fueron del 98,3% y del 99,8%, respectivamente.LIMITACIONES:El pequeño tamaño de la muestra puede limitar la generalización y la capacidad de detectar complicaciones poco frecuentes pero costosas. Los costos del procedimiento se basaron en los precios hospitalarios promedio, lo cual constituye un enfoque pragmático, aunque menos detallado que el cálculo de costos ascendente.CONCLUSIONES:En pacientes con hemorroides de grado III, la hemorroidectomía ofrece mejores resultados clínicos a largo plazo, incluyendo una mayor calidad de vida y menores tasas de recurrencia en comparación con la ligadura con banda elástica. Sin embargo, su costo-efectividad varía en función de los umbrales de disposición a pagar de la sociedad. Se recomienda precaución antes de descartarla como tratamiento de primera línea basándose únicamente en los costos sanitarios o la disponibilidad limitada de quirófanos. (Traducción--Ingrid Melo ).", "provenance": [ { "field": "n", "quote": "Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation)." }, { "field": "population", "quote": "Adults with symptomatic grade III hemorrhoids randomly assigned to receive rubber band ligation or hemorrhoidectomy treatment." }, { "field": "intervention", "quote": "Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy." }, { "field": "comparator", "quote": "Rubber band ligation (up to 2 sessions) or excisional hemorrhoidectomy." }, { "field": "primaryOutcome", "quote": "Cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months from a societal perspective." }, { "field": "result", "quote": "Hemorrhoidectomy resulted in better clinical outcomes with a quality-adjusted life year difference of 0.08 (95% CI, 0.04-0.13) and a recurrence difference of 33.5% (95% CI, 15.3%-51.7%)." }, { "field": "result", "quote": "The probability of hemorrhoidectomy being cost-effective was 45.5% at €20,000 per quality-adjusted life year and 83.9% at €50,000 per quality-adjusted life year." } ] }, { "id": "pmid:40481245", "pmid": "40481245", "doi": "10.1007/s13304-025-02258-2", "nctId": null, "pmcid": "PMC12420758", "title": "Real-world use of polidocanol foam sclerotherapy for hemorrhoidal disease: insights from an international survey and systematic review with clinical practice recommendations", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Updates Surg", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoidal disease, mainly grade II and III", "intervention": "polidocanol foam sclerotherapy injected into hemorrhoids", "comparator": "rubber band ligation", "primaryOutcome": "treatment success rate and recurrence rate", "result": "polidocanol foam was seen as more successful and less likely to recur than rubber band ligation, based on expert survey and review, not a controlled trial", "resultDirection": "benefit", "quality": "low", "qualityWhy": "the comparison numbers come from expert opinion and a non-pooled review of studies with wide variation in technique, not from a controlled trial directly comparing the two treatments.", "directness": "direct", "limitations": "wide variation among experts in patient selection, technique, and follow-up care; comparison to rubber band ligation based on perceived rates rather than a controlled study", "followUp": "", "plainFinding": "Possibly fewer recurrences than banding.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40481245/", "sourceText": "Polidocanol foam sclerotherapy has gained increasing attention as a minimally invasive treatment for hemorrhoidal disease (HD). However, significant variability exists in its clinical application regarding patient selection, procedural techniques, and postoperative management. This study aimed to assess real-world practice patterns among international experts, summarize existing evidence through a systematic literature review, and develop evidence-based clinical practice recommendations. A systematic review was conducted in MEDLINE, EMBASE, and CENTRAL to identify studies evaluating polidocanol foam sclerotherapy for HD. A total of 20 studies met the inclusion criteria. Additionally, an international survey was distributed to 30 experts in proctology and colorectal surgery to explore variations in indications, perioperative management, technique, and follow-up. Survey responses were analyzed descriptively to identify common trends and areas of divergence. Subsequently, based on both the experts' opinions and the results of the survey, a Delphi method was employed to produce clinical practice recommendations. The questions for the Delphi process were developed by the authors leading the project, followed by a detailed discussion with the whole panel of experts. Most experts (90%) reported using polidocanol foam sclerotherapy primarily for Goligher grade II HD, with 67% extending its use to grade III cases. Preoperative bowel preparation and anesthesia use varied widely. The preferred concentration was 3% polidocanol, with 2 mL injected per hemorrhoidal pile in most cases. Post-procedural care lacked standardization, though stool softeners and flavonoids were commonly recommended. Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%). Adverse events were infrequent. The present article offers a comprehensive suite of clinical practice expert-based recommendations concerning the use of polidocanol foam sclerotherapy for HD. However, there is still significant variation in its application. These findings highlight the need for standardized guidelines and further research to optimize procedural strategies and long-term outcomes.", "provenance": [ { "field": "population", "quote": "Most experts (90%) reported using polidocanol foam sclerotherapy primarily for Goligher grade II HD, with 67% extending its use to grade III cases." }, { "field": "intervention", "quote": "Polidocanol foam sclerotherapy has gained increasing attention as a minimally invasive treatment for hemorrhoidal disease (HD)." }, { "field": "comparator", "quote": "Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%)." }, { "field": "primaryOutcome", "quote": "Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%)." }, { "field": "result", "quote": "Compared to rubber band ligation, polidocanol foam was perceived as having higher success rates (88.3% vs. 66.7%) and lower recurrence rates (16.1% vs. 41.2%). Adverse events were infrequent." } ] }, { "id": "pmid:40455826", "pmid": "40455826", "doi": "10.1093/bjsopen/zraf023", "nctId": null, "pmcid": "PMC12129066", "title": "Preoperative enema for anal surgery: randomized clinical trial", "firstAuthor": "Tsai", "multipleAuthors": true, "journal": "BJS Open", "year": 2025, "design": "rct", "n": 266, "nField": "reported", "population": "adults with grade III or IV hemorrhoids or anal fistulas having surgery", "intervention": "preoperative enema before anal surgery", "comparator": "no preoperative enema", "primaryOutcome": "pain scores and painkiller use after surgery, days 0 to 7", "result": "no significant difference in pain or complications overall, but less pain on days 2-4 in the enema group among patients having Milligan-Morgan hemorrhoidectomy", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but the positive finding came from a smaller subgroup analysis, which is less reliable.", "directness": "indirect", "limitations": "abstract does not mention blinding; subgroup findings are exploratory and from a single hospital", "followUp": "day 0 to day 7", "plainFinding": "Enema before surgery mostly made no difference.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40455826/", "sourceText": "BACKGROUND: Haemorrhoidal surgery and anal fistula surgery are two of the most common procedures in proctology. Currently, there is no definitive consensus on the need to administer a preoperative enema. The objective of this study was to evaluate the efficacy and benefits of preoperative enemas in anal surgical procedures. METHODS: Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled in a randomized clinical study comparing the use of preoperative enema (intervention) versus no preoperative enema (control). The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7. Secondary outcomes of interest were postoperative complications, including surgical site infection, postoperative bleeding and urinary retention. Subgroup analyses were performed according to the type of procedure for the same outcomes. RESULTS: A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group. No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups. Subgroup analysis revealed that patients undergoing stapled haemorrhoidopexy and anal fistula surgery also showed no significant differences in postoperative visual analogue scale scores, analgesic consumption, and postoperative complications between the enema and control groups. However, in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027). CONCLUSION: Preoperative enema in anal surgery did not yield additional benefits or reduce complications when compared with patients who did not undergo enema before anal surgery. Based on the study findings, its use can be omitted in anal surgery, especially for patients undergoing stapled haemorrhoidopexy and anal fistula surgery.", "provenance": [ { "field": "n", "quote": "A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group." }, { "field": "population", "quote": "Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled" }, { "field": "intervention", "quote": "preoperative enema (intervention)" }, { "field": "comparator", "quote": "no preoperative enema" }, { "field": "primaryOutcome", "quote": "The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7." }, { "field": "result", "quote": "No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups." }, { "field": "result", "quote": "in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027)." } ] }, { "id": "pmid:40399727", "pmid": "40399727", "doi": "10.1007/s13304-025-02255-5", "nctId": null, "pmcid": null, "title": "SHAPE-skin-sparing hemorrhoidectomy and PExy: a novel technique for the surgical treatment of hemorrhoidal disease", "firstAuthor": "Grossi", "multipleAuthors": true, "journal": "Updates Surg", "year": 2025, "design": "case-series", "n": 21, "nField": "reported", "population": "patients with advanced (grade III-IV) hemorrhoids", "intervention": "a new surgical technique called SHAPE (skin-sparing hemorrhoidectomy and pexy)", "comparator": "none (before-and-after comparison within same patients)", "primaryOutcome": "change in hemorrhoid symptom severity scores after surgery", "result": "Symptom scores dropped sharply after surgery, with few complications and no lasting pain", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small study of only 21 patients with no comparison group and just one month of follow-up, so it can't show how this technique compares to other treatments or holds up long-term.", "directness": "indirect", "limitations": "Small sample size, no control group, and only short-term (1-month) follow-up; long-term efficacy and recurrence not yet assessed.", "followUp": "1-month", "plainFinding": "Fewer symptoms after new surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40399727/", "sourceText": "Hemorrhoidal disease (HD) is a prevalent condition that often requires surgical intervention in advanced stages. This study evaluates the short-term outcomes of Skin-Sparing Hemorrhoidectomy and Pexy (SHAPE), a novel hybrid technique that integrates the excisional approach of closed hemorrhoidectomy with the tissue-sparing and fixation benefits of suture ligation with mucopexy. SHAPE selectively excises the internal hemorrhoidal column while preserving the anoderm and incorporates mucopexy to reposition prolapsed tissue, potentially reducing both recurrence and morbidity. A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns. At 1-month follow-up, patients experienced a significant reduction in symptoms, with the Hemorrhoidal Disease Severity Score (HDSS) decreasing from a median of 16 to 0 (p < 0.001) and the Short Health Scale (SHS) from 20 to 4 (p < 0.001). The median operative time was 22 min, and hospital stay was typically 1 day. Complications occurred in five patients (four cases of urinary retention, one bleeding requiring revision). No persistent pain was reported. SHAPE appears to be a promising alternative that combines the advantages of excisional and tissue-sparing techniques. Further studies are needed to assess its long-term efficacy and recurrence rates.", "provenance": [ { "field": "population", "quote": "21 consecutive patients with grade III-IV HD" }, { "field": "intervention", "quote": "Skin-Sparing Hemorrhoidectomy and Pexy (SHAPE)" }, { "field": "comparator", "quote": "A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns." }, { "field": "primaryOutcome", "quote": "the Hemorrhoidal Disease Severity Score (HDSS) decreasing from a median of 16 to 0 (p < 0.001) and the Short Health Scale (SHS) from 20 to 4 (p < 0.001)" }, { "field": "result", "quote": "patients experienced a significant reduction in symptoms, with the Hemorrhoidal Disease Severity Score (HDSS) decreasing from a median of 16 to 0 (p < 0.001)" }, { "field": "n", "quote": "21 consecutive patients with grade III-IV HD" } ] }, { "id": "pmid:40346473", "pmid": "40346473", "doi": "10.1186/s12876-025-03963-3", "nctId": null, "pmcid": "PMC12063411", "title": "Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy for the management of grade III/IV hemorrhoids: a retrospective study", "firstAuthor": "Long", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2025, "design": "retrospective", "n": 255, "nField": "reported", "population": "adults with grade III or IV hemorrhoids who had surgery", "intervention": "Milligan-Morgan hemorrhoidectomy combined with rubber band ligation and polidocanol foam sclerotherapy", "comparator": "Milligan-Morgan hemorrhoidectomy alone", "primaryOutcome": "recurrence rate, hemorrhoid severity score, and patient satisfaction 12 months after surgery", "result": "lower recurrence and higher satisfaction with the combined procedure, but no difference in hemorrhoid severity score", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a retrospective, non-randomized, single-center comparison of two surgical techniques, so bias and confounding cannot be ruled out.", "directness": "indirect", "limitations": "Retrospective design without randomization, single center, and both groups still underwent surgery rather than comparing surgery to non-surgical treatment.", "followUp": "12 months", "plainFinding": "Combined surgery technique had fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40346473/", "sourceText": "BACKGROUND: Hemorrhoids are one of the most common and annoying benign diseases in the field of colorectal surgery. A Milligan-Morgan hemorrhoidectomy (MMH) is the most frequently applied surgical technique due to its clear efficacy and high success rate, but the reported postoperative complications remain a major problem. This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids. METHODS: This was a single-center retrospective study. A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study. The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery. Secondary outcomes included intraoperative outcomes and postoperative outcomes. RESULTS: Follow-up was conducted by telephone or outpatient visit 12 months after surgery. The recurrence rate was lower in the MMH + RBL + PFS group than in the MMH group (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group than in the MMH group (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). The median operation time in the two groups was similar (16 min (15-20 min) vs.16 min (15-18 min), p > 0.05). The median number of incisions in the the MMH + RBL + PFS group was 3 (2-3), while that in the MMH group was 3 (3-4) (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). Visual analog scale pain scores were lower in the MMH + RBL + PFS group than in the MMH group at the first postoperative defecation at 12 h and at 1, 3, and 7 days (all p < 0.05). The wound healing time was shorter in the MMH + RBL + PFS group than in the MMH group (27.62 ± 3.74 vs. 28.73 ± 4.48 days, respectively, p < 0.05). The incidence of urinary retention was lower in the MMH + RBL + PFS group than in the MMH group (5.47% vs. 12.60, respectively, p < 0.05). Nine patients (one case in the MMH + RBL + PFS group and eight cases in the MMH group (p < 0.05)) had delayed bleeding and were successfully controlled with manual compression or surgical hemostasis. No cases had anal stenosis in the MMH + RBL + PFS group, and six cases (4.72%) had it in the MMH group, all with mild anal stenosis and successfully treated by dilatation alone (p < 0.01). No incision infection or anal incontinence occurred in either group. At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05). CONCLUSIONS: Compared with the MMH, the MMH + RBL + PFS surgical procedure is safe and effective for grade III/IV hemorrhoids, which is associated with a lower recurrence rate, a higher patient satisfaction score, a lower postoperative pain score, fewer postoperative complications, and a shorter wound healing time.", "provenance": [ { "field": "population", "quote": "A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study." }, { "field": "intervention", "quote": "This study aimed to retrospectively evaluate the efficacy and safety of a MMH combined with rubber band ligation and polidocanol foam sclerotherapy (MMH + RBL + PFS) for the management of grade III/IV hemorrhoids." }, { "field": "comparator", "quote": "A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study." }, { "field": "primaryOutcome", "quote": "The primary outcomes included recurrence rates, hemorrhoid severity score (HSS), and patient satisfaction 12 months after surgery." }, { "field": "result", "quote": "At the 12-month follow-up after surgery, the recurrence rate was lower in the MMH + RBL + PFS group (0.78%) than in the MMH group (7.09%) (p < 0.05). The patient satisfaction score was higher in the MMH + RBL + PFS group (91.41%) than in the MMH group (81.10%) (p < 0.05), and there was no significant difference in the HSS between the two groups (p > 0.05)." }, { "field": "n", "quote": "A total of 255 patients with grade III/IV hemorrhoids who underwent MMH + RBL + PFS (n = 128) or MMH (n = 127) between May 2022 and June 2023 were included in the study." } ] }, { "id": "pmid:40338393", "pmid": "40338393", "doi": "10.1007/s10151-025-03144-0", "nctId": null, "pmcid": "PMC12062045", "title": "Efficacy and safety of office-based procedures for hemorrhoidal disease in patients with inflammatory bowel disease", "firstAuthor": "Carvalho", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "retrospective", "n": 129, "nField": "reported", "population": "people with inflammatory bowel disease (ulcerative colitis or Crohn's disease) who also have hemorrhoids", "intervention": "office-based, nonsurgical treatments for hemorrhoids: rubber band ligation and polidocanol injection (sclerotherapy)", "comparator": "rubber band ligation compared with polidocanol injection sclerotherapy", "primaryOutcome": "whether the hemorrhoid treatment worked (clinical success), came back, or caused complications", "result": "Treatment worked in 88% of patients, 16% of those had the problem come back, and complications occurred in 5.6% of procedures, with no severe complications like incontinence", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It is a fairly large multicenter study but retrospective with no comparison to surgery or to a non-IBD control group within the paper.", "directness": "direct", "limitations": "Retrospective design; only 55% of patients were in endoscopic remission at treatment time; no direct comparison group without IBD or group treated surgically reported in this abstract.", "followUp": "55.3 ± 34.5 months", "plainFinding": "Nonsurgical treatment worked well, low risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40338393/", "sourceText": "BACKGROUND: Hemorrhoidal disease (HD) affects 2-20% of patients with inflammatory bowel disease (IBD) but treatment recommendations are scarce due to fear of higher morbidity in these patients. Currently, there is almost no data regarding nonsurgical treatment for HD in patients with IBD. This study aimed to evaluate the safety and efficacy of office-based procedures for HD in patients with IBD. METHODS: A Portuguese multicenter retrospective study of patients with IBD undergoing office-based treatment for HD between July 2013 and December 2021 was performed. Data regarding the patients' IBD (type, disease location, medication, endoscopic remission) and HD (clinical success, recurrence, complications) were analyzed. RESULTS: A total of 129 patients were included, 90 with ulcerative colitis and 37 with Crohn's disease. Only 55% of patients presented endoscopic remission and 18% were under biologics. Additionally, 77 patients underwent rubber band ligation (RBL), 44 underwent polidocanol injection, and 8 had both treatments, for a total of 304 procedures. The treatment of HD was effective in 88% of patients, of which 16% relapsed (mean follow-up time of 55.3 ± 34.5 months). Complications were described in 17 (5.6%) procedures, 2 (0.66%) requiring invasive treatment. There were no cases of suppuration, stenosis, or anal incontinence. Success, relapse, and complications were not associated with IBD features. Clinical success and recurrence were similar between RBL and polidocanol foam sclerotherapy (PFS). RBL had more complications than PFS (15.6% versus 2.6%). CONCLUSIONS: This study is the first to focus exclusively on office-based procedures for hemorrhoidal disease in patients with IBD, demonstrating similar efficacy to the general population and a low complication rate.", "provenance": [ { "field": "n", "quote": "A total of 129 patients were included, 90 with ulcerative colitis and 37 with Crohn's disease." }, { "field": "population", "quote": "patients with IBD undergoing office-based treatment for HD" }, { "field": "intervention", "quote": "77 patients underwent rubber band ligation (RBL), 44 underwent polidocanol injection, and 8 had both treatments, for a total of 304 procedures" }, { "field": "comparator", "quote": "Clinical success and recurrence were similar between RBL and polidocanol foam sclerotherapy (PFS)." }, { "field": "primaryOutcome", "quote": "Data regarding the patients' IBD (type, disease location, medication, endoscopic remission) and HD (clinical success, recurrence, complications) were analyzed." }, { "field": "result", "quote": "The treatment of HD was effective in 88% of patients, of which 16% relapsed (mean follow-up time of 55.3 ± 34.5 months). Complications were described in 17 (5.6%) procedures, 2 (0.66%) requiring invasive treatment." }, { "field": "followUp", "quote": "mean follow-up time of 55.3 ± 34.5 months" } ] }, { "id": "pmid:40310510", "pmid": "40310510", "doi": "10.1007/s00384-025-04894-x", "nctId": null, "pmcid": "PMC12045805", "title": "Assessment of long-term outcomes following Milligan-Morgan hemorrhoidectomy with Doppler transperineal ultrasound and endoscopy: a pilot study", "firstAuthor": "Gravante", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "case-series", "n": 23, "nField": "reported", "population": "patients who had surgical removal of hemorrhoids (Milligan-Morgan hemorrhoidectomy)", "intervention": "follow-up assessment using Doppler ultrasound and endoscopy after hemorrhoid surgery", "comparator": "no comparison group; patients compared to themselves based on ultrasound findings", "primaryOutcome": "whether Doppler ultrasound patterns matched clinical symptoms and endoscopic signs of recurrence after surgery", "result": "Ultrasound vascular pattern was linked to endoscopic signs of recurrence, but not to patient-reported symptoms; absence of the pattern ruled out recurrence in all cases", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This was a small pilot study of only 23 patients with no control group, looking at imaging after surgery rather than comparing surgery to non-surgical treatment.", "directness": "indirect", "limitations": "Small pilot sample, no comparison group, and no assessment of non-surgical treatment options.", "followUp": "26 months of follow-up (range 14-48)", "plainFinding": "Ultrasound detected recurrence after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40310510/", "sourceText": "PURPOSE: Hemorrhoidectomy remains the gold-standard treatment for advanced hemorrhoidal disease, but long-term outcomes vary depending on the surgical technique and assessment method. This study aims to show the long-term results achieved using a combination of transperineal ultrasound (TPUS) and endoscopy in patients who underwent Milligan-Morgan hemorrhoidectomy (MM). METHODS: A consecutive series of MM patients treated between February 2020 and December 2023 were contacted and underwent a clinical proctological evaluation, a Doppler TPUS, and an endoscopic check of the anal canal. All investigations were performed using the ESAOTE MyLab XPRO80. TPUS anatomy, including Doppler views, was assessed on the axial, sagittal, and coronal planes. Outcome measures consisted of the description of Doppler TPUS modifications following MM, and their relationship with clinical and endoscopic findings. RESULTS: Twenty-three patients were available for the analysis at 26 months of follow-up (range 14-48). Fifteen patients had a Doppler vascular pattern (65.2%), eight patients a scattered pattern (34.8%). No correlation was present between residual symptoms and the Doppler vascular pattern (p = 0.089). The vascular pattern was associated with endoscopic signs of recurrences (p = 0.003), and its absence was able to predict the lack of internal recurrences in all patients (100%). CONCLUSION: Doppler TPUS could help in the long-term assessment of patients presenting residual symptoms after MM. If confirmed in larger future cohort studies, the 100% negative predictive value of the vascular pattern could be used to exclude internal recurrences during postoperative follow-up.", "provenance": [ { "field": "n", "quote": "Twenty-three patients were available for the analysis at 26 months of follow-up" }, { "field": "population", "quote": "patients who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "underwent a clinical proctological evaluation, a Doppler TPUS, and an endoscopic check of the anal canal" }, { "field": "comparator", "quote": "A consecutive series of MM patients treated between February 2020 and December 2023 were contacted" }, { "field": "primaryOutcome", "quote": "Outcome measures consisted of the description of Doppler TPUS modifications following MM, and their relationship with clinical and endoscopic findings." }, { "field": "result", "quote": "No correlation was present between residual symptoms and the Doppler vascular pattern (p = 0.089). The vascular pattern was associated with endoscopic signs of recurrences (p = 0.003), and its absence was able to predict the lack of internal recurrences in all patients (100%)." }, { "field": "followUp", "quote": "26 months of follow-up (range 14-48)" } ] }, { "id": "pmid:40062327", "pmid": "40062327", "doi": "10.3748/wjg.v31.i8.98704", "nctId": null, "pmcid": "PMC11886522", "title": "Sclerotherapy for hemorrhoidal disease: Recent evolutions of an oldies goldy", "firstAuthor": "Gravante", "multipleAuthors": false, "journal": "World J Gastroenterol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with grade I-III internal hemorrhoids", "intervention": "sclerotherapy using polidocanol foam, alone or combined with rubber-band ligation (sclerobanding), including an endoscopic delivery version", "comparator": "endoscopic rubber band ligation", "primaryOutcome": "effectiveness and outcomes of treating hemorrhoids", "result": "the newer foam-based and combined technique showed promising results compared with endoscopic rubber band ligation", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an editorial commentary discussing other studies, not original research with its own data or methods.", "directness": "indirect", "limitations": "it is an editorial opinion piece commenting on another publication, without presenting its own patient data, numbers, or study methodology.", "followUp": "", "plainFinding": "Promising, but not proven yet.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40062327/", "sourceText": "Treatments for low degree hemorrhoids (I-III degree) are numerous and so are their counterparts for higher degrees. These treatments present nebulous differences in terms of indications and outcomes among techniques. Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications: Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol, which is more effective than the liquid one. Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation (the historical counterpart of sclerotherapy) in a technique called \"sclerobanding\". In this article, we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids, and present results compared with endoscopic rubber band ligation. The results achieved are promising.", "provenance": [ { "field": "population", "quote": "patients with grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "the combination of polidocanol foam with rubber-band ligation (the historical counterpart of sclerotherapy) in a technique called \"sclerobanding\"" }, { "field": "intervention", "quote": "further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids" }, { "field": "comparator", "quote": "present results compared with endoscopic rubber band ligation" }, { "field": "result", "quote": "The results achieved are promising." }, { "field": "primaryOutcome", "quote": "Various articles have already shown promising results" } ] }, { "id": "pmid:39969619", "pmid": "39969619", "doi": "10.1007/s10103-025-04355-5", "nctId": null, "pmcid": null, "title": "Multilayered numerical modelling of bio-thermal aspects during laser assisted treatment of internal haemorrhoid developed in rectum", "firstAuthor": "Dutta", "multipleAuthors": false, "journal": "Lasers Med Sci", "year": 2025, "design": "lab", "n": null, "nField": "not-reported", "population": "computer model of rectum tissue layers (not real patients)", "intervention": "laser-based heat therapy aimed at internal haemorrhoid tissue", "comparator": "published numerical model used for verification", "primaryOutcome": "temperature changes within the layered rectal tissue during laser treatment", "result": "the model showed a temperature drop at the boundaries between tissue layers, matching previous published models", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a theoretical computer simulation, not a study on real patients, so it cannot show whether the treatment actually works or is safe.", "directness": "indirect", "limitations": "purely mathematical/computational modeling with no human or animal data, no patient outcomes measured", "followUp": "", "plainFinding": "Computer model simulates laser heat spread.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39969619/", "sourceText": "Haemorrhoids are swollen blood vessels developed around the anus. Internal haemorrhoids are generally not visible from outside due to its growth inside the rectum and it is generally considered as painless. However, a prolapsed internal haemorrhoid may cause discomfort, pain and irritation. For the treatment of internal haemorrhoid, laser assisted therapy would be helpful due to its rooted advantages such as post-surgery minimal pain, lesser bleeding, quicker healing, shorter recovery period, shorter surgical and overall treatment duration, lower risk of recurrence and least risk of post-surgical infections. The genesis of present research work deals with the development of mathematical modelling to capture the bio-thermal response during laser assisted therapy of internal haemorrhoid developed in the rectum. The explicit form of finite difference method is employed as numerical tool for the mathematical study and the physical domain is considered as multilayered tissue (three different layers of rectum: muscle, submucosa and mucosa). A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum. Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate. Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue. The research outcome is verified with the published numerical model with negligible variation.", "provenance": [ { "field": "population", "quote": "the physical domain is considered as multilayered tissue (three different layers of rectum: muscle, submucosa and mucosa)" }, { "field": "intervention", "quote": "A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum." }, { "field": "comparator", "quote": "The research outcome is verified with the published numerical model with negligible variation." }, { "field": "primaryOutcome", "quote": "Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate." }, { "field": "result", "quote": "Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue." } ] }, { "id": "pmid:39957120", "pmid": "39957120", "doi": "10.62713/aic.3746", "nctId": null, "pmcid": null, "title": "Clinical Efficacy of Automatic Ruiyun Procedure for Hemorrhoids and Procedure for Prolapse and Hemorrhoids in the Treatment of Mixed Hemorrhoids: A Comparative Study", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2025, "design": "retrospective", "n": 120, "nField": "reported", "population": "patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine (The 1st People's Hospital of Baiyin) from January 2019 to December 2023", "intervention": "60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group", "comparator": "the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group", "primaryOutcome": "Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences", "result": "RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time.", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective single-center study comparing two surgical techniques, which carries more risk of bias than a randomized trial.", "directness": "indirect", "limitations": "retrospective cohort study...using propensity score matching (PSM) with a ratio of 1:1 for nearest neighbor matching grouping", "followUp": "12th week", "plainFinding": "Newer surgery outperformed standard hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39957120/", "sourceText": "AIM: The occurrence of mixed hemorrhoids becomes increasingly more frequent with age, posing psychological pressure and distress to affected patients. This retrospective study aims to compare the clinical efficacy of automatic Ruiyun procedure for hemorrhoids and procedure for prolapse and hemorrhoids in the treatment of mixed hemorrhoids. METHODS: A retrospective cohort study of patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine (The 1st People's Hospital of Baiyin) from January 2019 to December 2023 was conducted using propensity score matching (PSM) with a ratio of 1:1 for nearest neighbor matching grouping. In this study, 60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group. The postoperative medical humanistic evaluation, clinical efficacy evaluation, subjective evaluation of patients, the occurrence of complications and the rate of unplanned readmission were compared between the two groups. RESULTS: Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences (p < 0.001). There were statistically significant intra-group and between-group differences between RPH group and PPH group in the visual analogue scale (VAS) scores on the 4th and 6th postoperative days (p < 0.001). The European Quality of Life-5 Dimensions, 5-Level Version (EQ-5D-5L) score in the RPH group was lower than that in the PPH group at the 12th week of follow-up (p < 0.001), signifying an improved level of quality of life. There was no difference in Vaizey's Fecal Incontinence Rating Scale score between the RPH group and the PPH group at the 12th week of follow-up (p > 0.05). The rate of unplanned postoperative readmission was higher in the PPH group than in the RPH group, although the difference was not of statistical significance (p > 0.05). CONCLUSIONS: RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time.", "provenance": [ { "field": "n", "quote": "60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group, and the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group" }, { "field": "population", "quote": "patients with mixed hemorrhoids who visited the Third Affiliated Hospital of Gansu University of Chinese Medicine (The 1st People's Hospital of Baiyin) from January 2019 to December 2023" }, { "field": "intervention", "quote": "60 cases were grouped under the Ruiyun procedure for hemorrhoids (RPH) group" }, { "field": "comparator", "quote": "the other 60 cases were categorized in the procedure for prolapse and hemorrhoids (PPH) group" }, { "field": "primaryOutcome", "quote": "Surgical time, intraoperative blood loss, duration of postoperative pain, length of hospital stay and hospitalization expenses between the two groups presented statistically significant differences" }, { "field": "result", "quote": "RPH outperforms PPH in the treatment of mixed hemorrhoids with a shortened surgical time." } ] }, { "id": "pmid:39952268", "pmid": "39952268", "doi": "10.1097/DCR.0000000000003679", "nctId": null, "pmcid": "PMC11999089", "title": "Comparison of Rubber Band Ligation and Hemorrhoidectomy in Patients With Symptomatic Hemorrhoids Grade III: A Multicenter, Open-Label, Randomized Controlled Noninferiority Trial", "firstAuthor": "van Oostendorp", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2025, "design": "rct", "n": 87, "nField": "reported", "population": "adults with symptomatic grade III hemorrhoids", "intervention": "rubber band ligation (non-surgical banding, up to 2 sessions)", "comparator": "hemorrhoidectomy (surgical removal)", "primaryOutcome": "quality of life at 12 months and hemorrhoid recurrence rate", "result": "Banding was not as good as surgery for quality of life, and recurrence was much more common with banding (47.5% vs 6.1%), though banding caused less pain and allowed faster return to work", "resultDirection": "harm", "quality": "low", "qualityWhy": "The trial stopped early due to funding problems, leaving very few patients and limited power to be sure of the results.", "directness": "direct", "limitations": "Early termination due to funding constraints resulted in a small sample size and limited statistical power; recruitment was hindered by patient preferences and the COVID-19 pandemic.", "followUp": "12 months", "plainFinding": "Surgery better long-term; banding less painful short-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39952268/", "sourceText": "BACKGROUND: The optimal management strategy for grade III hemorrhoids remains a subject of ongoing debate. Hemorrhoidectomy is the criterion standard, but rubber band ligation offers a less invasive outpatient alternative. Treatment variability persists due to a lack of consensus on the preferred strategy. OBJECTIVE: To directly compare the effectiveness of rubber band ligation and hemorrhoidectomy in the treatment of grade III hemorrhoids. DESIGN: Open-label, parallel-group, randomized controlled noninferiority trial. SETTINGS: Multicenter study across 10 Dutch hospitals from October 2019 to September 2022. PATIENTS: Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study. Exclusion criteria included prior rectal/anal surgery, more than 1 rubber band ligation/injection within the preceding 3 years, rectal radiation, preexisting sphincter injury, IBD, medical unfitness for surgery (ASA higher than 3), pregnancy, or hypercoagulability disorders. INTERVENTIONS: Randomized 1:1 to rubber band ligation or hemorrhoidectomy, with up to 2 banding sessions allowed. MAIN OUTCOME MEASURES: Primary outcomes included 12-month health-related quality of life and recurrence rate. Secondary outcomes included complications, pain, work resumption, and patient-reported outcome measures. RESULTS: Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy). Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%). Complication rates were comparable. Pain scores after hemorrhoidectomy were higher during the first week (visual analogue scale 4 vs 1; p = 0.002). Rubber band ligation group returned to work sooner (1 vs 9 days; p = 0.021). Patient-reported hemorrhoidal symptom scores favored hemorrhoidectomy. LIMITATIONS: The primary limitation of the study was its early termination due to funding constraints, resulting in a relatively small sample size and limited statistical power. Patient recruitment was hindered by significant treatment preferences and the COVID-19 pandemic. CONCLUSIONS: Hemorrhoidectomy may benefit patients with grade III hemorrhoids in terms of quality of life, recurrence risk, and symptom burden, whereas rubber band ligation allows faster recovery with less pain. These findings can guide clinical decision-making. See Video Abstract . CLINICAL TRIAL REGISTRATION NUMBER: NCT04621695. COMPARACIN DE LA LIGADURA CON BANDA ELSTICA Y LA HEMORROIDECTOMA EN PACIENTES CON HEMORROIDES SINTOMTICAS GRADO III ENSAYO MULTICNTRICO, ABIERTO, ALEATORIZADO, CONTROLADO Y DE NO INFERIORIDAD: ANTECEDENTES:La estrategia óptima de tratamiento para las hemorroides grado III sigue siendo un tema de debate continuo. La hemorroidectomía es el estándar de oro, pero la ligadura con banda elástica ofrece una alternativa ambulatoria menos invasiva. La variabilidad del tratamiento persiste debido a la falta de consenso sobre la estrategia preferida.OBJETIVO:Comparar directamente la eficacia de la ligadura con banda elástica y la hemorroidectomía en el tratamiento de las hemorroides grado III.DISEÑO:Ensayo de no inferioridad, controlado, aleatorizado, de grupos paralelos y abierto.ENTORNO CLINICO:Estudio multicéntrico en 10 hospitales holandeses desde octubre de 2019 hasta septiembre de 2022.PACIENTES:Pacientes (≥18 años) con hemorroides sintomáticas grado III (Goligher). Exclusiones: cirugía rectal/anal previa, >1 ligadura con banda elástica/inyección en los tres años anteriores, radiación rectal, lesión preexistente del esfínter, enfermedad inflamatoria intestinal, incapacidad médica para la cirugía (ASA >3), embarazo o trastornos de hipercoagulabilidad.INTERVENCIONES:Aleatorización 1:1 para ligadura con banda elástica o hemorroidectomía, con hasta dos sesiones de ligadura permitidas.PRINCIPALES MEDIDAS DE RESULTADOS:Primarias: calidad de vida relacionada con la salud a los 12 meses y tasa de recurrencia. Secundarias: complicaciones, dolor, reanudación del trabajo y medidas de resultados informadas por el paciente.RESULTADOS:Se aleatorizaron ochenta y siete pacientes (47 ligadura con banda elástica frente a 40 hemorroidectomía). La ligadura con banda elástica no fue no inferior a la hemorroidectomía en años de vida ajustados por calidad (-0,045, intervalo de confianza del 95 %: -0,087 a -0,004). La tasa de recurrencia fue peor en el grupo de ligadura con banda elástica (47,5 % frente a 6,1 %), con una diferencia de riesgo absoluto del 41 % (intervalo de confianza del 95 %: 24 %-59 %). Las tasas de complicaciones fueron comparables. Las puntuaciones de dolor posthemorroidectomía fueron más altas durante la primera semana (escala analógica visual 4 frente a 1; p = 0,002). El grupo de ligadura con banda elástica volvió al trabajo antes (1 frente a 9 días; p = 0,021). Las puntuaciones de síntomas hemorroidales notificadas por los pacientes favorecieron a la hemorroidectomía.LIMITACIONES:La principal limitación del estudio fue su finalización temprana debido a las limitaciones de financiación, lo que dio lugar a un tamaño de muestra relativamente pequeño y a un poder estadístico limitado. El reclutamiento de pacientes se vio obstaculizado por las preferencias significativas de tratamiento y la pandemia de COVID-19.CONCLUSIONES:La hemorroidectomía puede beneficiar a los pacientes con hemorroides de grado III en términos de calidad de vida, riesgo de recurrencia y carga de síntomas, mientras que la ligadura con banda elástica permite una recuperación más rápida con menos dolor. Estos hallazgos pueden orientar la toma de decisiones clínicas. (Traducción- Dr. Francisco M. Abarca-Rendon )NÚMERO DE REGISTRO DEL ENSAYO CLÍNICO:NCT04621695.", "provenance": [ { "field": "n", "quote": "Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy)." }, { "field": "population", "quote": "Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study." }, { "field": "intervention", "quote": "Randomized 1:1 to rubber band ligation or hemorrhoidectomy, with up to 2 banding sessions allowed." }, { "field": "comparator", "quote": "Hemorrhoidectomy is the criterion standard" }, { "field": "primaryOutcome", "quote": "Primary outcomes included 12-month health-related quality of life and recurrence rate." }, { "field": "result", "quote": "Rubber band ligation was not noninferior to hemorrhoidectomy in quality-adjusted life years (-0.045; 95% CI, -0.087 to -0.004). Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%)." }, { "field": "result", "quote": "Pain scores after hemorrhoidectomy were higher during the first week (visual analogue scale 4 vs 1; p = 0.002). Rubber band ligation group returned to work sooner (1 vs 9 days; p = 0.021)." }, { "field": "limitations", "quote": "The primary limitation of the study was its early termination due to funding constraints, resulting in a relatively small sample size and limited statistical power." }, { "field": "followUp", "quote": "Primary outcomes included 12-month health-related quality of life and recurrence rate." } ] }, { "id": "pmid:39945661", "pmid": "39945661", "doi": "10.23736/S2724-5691.25.10771-5", "nctId": null, "pmcid": null, "title": "Clinical evidence and rationale of topical nifedipine and lidocaine ointment in the treatment of anal fissure and hemorrhoidal disease", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Minerva Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with anal fissure or hemorrhoids, including pain after hemorrhoid surgery", "intervention": "nifedipine 0.3% and lidocaine 1.5% ointment applied to the anal area", "comparator": "topical lidocaine alone or lidocaine plus hydrocortisone", "primaryOutcome": "pain relief and healing of fissures or thrombosed hemorrhoids", "result": "the combination ointment relieved pain, helped thrombosed hemorrhoids resolve, healed chronic fissures, and controlled post-surgery pain better than comparator treatments", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a non-systematic literature review that itself says the evidence it collected is limited, so it cannot be weighted as strongly as controlled trials.", "directness": "indirect", "limitations": "the authors state the available literature is limited and call for further studies to confirm the results; no details on number of trials, patients, or statistical analysis are given.", "followUp": "", "plainFinding": "Topical ointment eased pain, no surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39945661/", "sourceText": "INTRODUCTION: Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating. Pain after hemorrhoidectomy is also common and distressing. These conditions are at least initially managed conservatively. An ointment formulation containing the calcium channel blocker nifedipine and the local anesthetic lidocaine has an established role in the treatment of rectal conditions, particularly conditions associated with anal sphincter hypertonia such as hemorrhoidal disease and anal fissure. This review aimed to compile the evidence for the use of nifedipine 0.3% and lidocaine 1.5% ointment in treating these common but bothersome anorectal diseases. EVIDENCE ACQUISITION: A comprehensive literature search was conducted, updated to 07 August 2024, using PubMed and MEDLINE databases to identify studies of lidocaine and nifedipine, alone or in combination, for the topical treatment of anal fissure or hemorrhoidal disease. Articles identified in the literature search were supplemented by ad hoc searches and supplemented by relevant literature known to the authors. EVIDENCE SYNTHESIS: Nifedipine 0.3% and lidocaine 1.5% ointment is effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy. The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%. CONCLUSIONS: Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited, nifedipine 0.3% and lidocaine 1.5% ointment should be considered a valid treatment option for clinicians treating anorectal diseases. Further studies are warranted to confirm and extend the results reported.", "provenance": [ { "field": "population", "quote": "Anorectal conditions such as hemorrhoidal disease and anal fissure are frequently painful and debilitating." }, { "field": "intervention", "quote": "nifedipine 0.3% and lidocaine 1.5% ointment" }, { "field": "comparator", "quote": "The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%." }, { "field": "primaryOutcome", "quote": "Nifedipine 0.3% and lidocaine 1.5% ointment is effective in relieving pain and aiding the resolution of thrombosed hemorrhoids, reducing resting anal pressure and healing chronic anal fissures, and controlling pain after hemorrhoidectomy." }, { "field": "result", "quote": "The ointment was significantly better than controls consisting of topical lidocaine 1.5% alone or in combination with hydrocortisone acetate 1%." }, { "field": "limitations", "quote": "Although the available literature on the topical application of nifedipine and lidocaine in anorectal diseases is limited" } ] }, { "id": "pmid:39934277", "pmid": "39934277", "doi": "10.1007/s00464-025-11601-y", "nctId": null, "pmcid": null, "title": "Clinical effects of endoscopic resection of hypertrophied anal papillae combined with internal hemorrhoid ligation therapy: a retrospective study", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2025, "design": "retrospective", "n": 47, "nField": "reported", "population": "patients with enlarged anal papillae, with or without internal hemorrhoids", "intervention": "endoscopic removal of anal papillae plus tying off internal hemorrhoids", "comparator": "endoscopic removal of anal papillae alone", "primaryOutcome": "pain, bleeding, swelling after surgery, and effectiveness at 3 months", "result": "combined procedure caused more and longer-lasting pain, but bleeding, swelling, and success rates were similar between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small, retrospective comparison of two surgical techniques without randomization, so it can't reliably show which approach is better.", "directness": "indirect", "limitations": "retrospective design, small sample size, and it compares two surgical methods rather than surgery versus non-surgical treatment", "followUp": "3 months", "plainFinding": "More pain, but similar healing results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39934277/", "sourceText": "OBJECTIVES: To explore the postoperative complications and efficacy of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoid ligation. METHODS: A retrospective study was conducted on 47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation. The patients were divided into two groups based on the surgical procedure: the anal papillae resection group and the anal papillae resection + internal hemorrhoid ligation group. The analysis included patient age, gender, anal papillae diameter, postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively. RESULTS: There were no statistically significant differences in age, gender, or anal papillae diameter among the two patient groups. The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day. Both the pain intensity and duration showed statistically significant differences (P < 0.05). However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema. At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups. CONCLUSION: The complication rate of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoids ligation is low, and the therapeutic effect is good.", "provenance": [ { "field": "n", "quote": "A retrospective study was conducted on 47 patients" }, { "field": "population", "quote": "47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation" }, { "field": "intervention", "quote": "the anal papillae resection + internal hemorrhoid ligation group" }, { "field": "comparator", "quote": "the anal papillae resection group" }, { "field": "primaryOutcome", "quote": "postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively" }, { "field": "result", "quote": "The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day." }, { "field": "result", "quote": "However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema." }, { "field": "result", "quote": "At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups." } ] }, { "id": "pmid:39923169", "pmid": "39923169", "doi": "10.33314/jnhrc.v22i03.5135", "nctId": null, "pmcid": null, "title": "Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid", "firstAuthor": "Sapkota Upadhya", "multipleAuthors": true, "journal": "J Nepal Health Res Counc", "year": 2024, "design": "case-series", "n": 28, "nField": "reported", "population": "patients with lower gastrointestinal bleeding due to hemorrhoids", "intervention": "colonoscopic rubber band ligation", "comparator": "none reported", "primaryOutcome": "resolution of hemorrhoid symptoms (bleeding, prolapse, irritation, discharge, pain) and patient satisfaction", "result": "Symptoms resolved in almost all patients, with bleeding and prolapse improved in over 90%, and most patients rated the treatment as excellent", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a small, single-center case series with no comparison group, so it cannot show whether banding works better than other treatments or surgery.", "directness": "direct", "limitations": "No control group; small sample of 28 patients; short follow-up; over half had post-procedure complications.", "followUp": "3 months", "plainFinding": "Non-surgical banding relieved hemorrhoid symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39923169/", "sourceText": "BACKGROUND: Lower gastrointestinal bleeding is a significant cause of morbidity and mortality. Hemorrhoids are frequently encountered cause of lower gastrointestinal bleeding in outpatient settings in Nepal. Rubber band ligation is one of the most important, cost-effective, and commonly used treatments for first to third-degree internal hemorrhoids. Colonoscopic Rubber band ligation provides enhanced visualization and maneuverability, improving safety and efficacy of Rubber band ligation compared to traditional Rubber band ligation methods. This study aimed to assess the safety, efficacy, and patient acceptance of Colonoscopic Rubber band ligation for lower Lower gastrointestinal bleeding due to hemorrhoids. METHODS: This study, conducted in a tertiary care center of Nepal over one year, explores the immediate, late complications, efficacy and treatment satisfaction of patients undergoing Colonoscopic Rubber band ligation for lower GI bleeding due to hemorrhoids. RESULTS: We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding. Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively. 75% were able to resume work the day after the procedure. Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as \"excellent help\". CONCLUSIONS: Colonoscopic Rubber band ligation is feasible, safe and efficient for the treatment of symptomatic grade II hemorrhoids with most patients experiencing relief and high satisfaction. Further multicenter research with longer follow-up is needed to confirm long-term effectiveness.", "provenance": [ { "field": "n", "quote": "We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding." }, { "field": "population", "quote": "patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding" }, { "field": "intervention", "quote": "Colonoscopic Rubber band ligation" }, { "field": "comparator", "quote": "Colonoscopic Rubber band ligation is feasible, safe and efficient for the treatment of symptomatic grade II hemorrhoids" }, { "field": "primaryOutcome", "quote": "Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively." }, { "field": "result", "quote": "78.6% of patients rated Colonoscopic Rubber band ligation treatment as \"excellent help\"." } ] }, { "id": "pmid:39854786", "pmid": "39854786", "doi": "10.1016/j.surg.2024.109139", "nctId": null, "pmcid": null, "title": "The prevalence of incontinence after excisional hemorrhoidectomy and stapled hemorrhoidopexy: A systematic review and meta-analysis", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "Surgery", "year": 2025, "design": "meta-analysis", "n": 31132, "nField": "reported", "population": "people having surgery for symptomatic hemorrhoids", "intervention": "stapled hemorrhoidopexy surgery", "comparator": "excisional hemorrhoidectomy surgery", "primaryOutcome": "incontinence (loss of bowel control) after surgery, early and late", "result": "no significant difference in incontinence risk between the two surgical procedures; incontinence was uncommon overall", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "Large meta-analysis of many trials, but it compares two surgery types to each other (not surgery vs non-surgical treatment) and notes considerable heterogeneity between studies.", "directness": "indirect", "limitations": "Considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies.", "followUp": "", "plainFinding": "Similar low incontinence risk between two surgeries.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39854786/", "sourceText": "BACKGROUND: Excisional hemorrhoidectomy and stapled hemorrhoidopexy are 2 common procedures for treating symptomatic hemorrhoids. However, concerns persist regarding the risk of postoperative complications and their unclear prevalence in the literature. This systematic review aims to evaluate and compare the prevalence of incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy. METHODS: A systematic search of Medline, EMBASE, and CENTRAL identified studies published in the past 25 years that reported incontinence after excisional treatments for hemorrhoids. Primary outcomes included early (<3 months) and late (≥3 months) fecal incontinence. Secondary outcomes included postoperative bleeding, urinary retention, and recurrence. Single-arm meta-analyses of proportions were performed using R with meta-regression. RESULTS: In total, 139 studies were included in the meta-analysis, including 68 randomized controlled trials with 8,445 participants and 71 observational studies with 22,687 participants. Early incontinence rates were 5.32% in randomized controlled trials (95% confidence interval, 2.74-8.51%) and 1.03% in nonrandomized controlled trials (95% confidence interval, 0.28-2.09%). Late incontinence rates were 2.48% in randomized controlled trials (95% confidence interval, 1.09-4.25%) and 1.44% in nonrandomized controlled trials (95% confidence interval, 0.71-2.37%). There was no significant difference in the risk of incontinence or other postoperative complications between stapled hemorrhoidopexy and excisional hemorrhoidectomy, both in randomized controlled trials and nonrandomized controlled trials. CONCLUSION: Incontinence after stapled hemorrhoidopexy and excisional hemorrhoidectomy is uncommon, and there appears to be no significant difference in risk between the 2 procedures. However, considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies. Future research should standardize definitions and methods for assessing incontinence and include preoperative assessments to more accurately define the risks of complications associated with hemorrhoid surgery.", "provenance": [ { "field": "population", "quote": "Excisional hemorrhoidectomy and stapled hemorrhoidopexy are 2 common procedures for treating symptomatic hemorrhoids." }, { "field": "intervention", "quote": "stapled hemorrhoidopexy" }, { "field": "comparator", "quote": "excisional hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Primary outcomes included early (<3 months) and late (≥3 months) fecal incontinence." }, { "field": "result", "quote": "There was no significant difference in the risk of incontinence or other postoperative complications between stapled hemorrhoidopexy and excisional hemorrhoidectomy, both in randomized controlled trials and nonrandomized controlled trials." }, { "field": "n", "quote": "68 randomized controlled trials with 8,445 participants and 71 observational studies with 22,687 participants" }, { "field": "limitations", "quote": "considerable heterogeneity was observed, likely the result of differences in assessment and reporting methods across studies" } ] }, { "id": "pmid:39762601", "pmid": "39762601", "doi": "10.1007/s00464-024-11491-6", "nctId": null, "pmcid": null, "title": "Rubber band ligation or shaobei injection for the endoscopic treatment of symptomatic hemorrhoids? A retrospective study", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2025, "design": "retrospective", "n": 413, "nField": "reported", "population": "Patients with grade I-IV symptomatic hemorrhoids treated using endoscopy", "intervention": "Endoscopic Shaobei injection", "comparator": "Endoscopic rubber band ligation", "primaryOutcome": "Recurrence rate, postoperative pain, complications, quality of life and satisfaction after treatment", "result": "No difference in recurrence or symptom improvement between groups, but the injection group had less pain and fewer complications than the band ligation group", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a retrospective, non-randomized comparison relying on propensity score matching, which can reduce but not eliminate bias from unmeasured factors.", "directness": "direct", "limitations": "Retrospective design, no randomization, groups had significant baseline differences before matching, and outcomes were only tracked for 3 months.", "followUp": "3 months", "plainFinding": "Similar results, less pain with injection", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39762601/", "sourceText": "BACKGROUND: It is unknown whether Shaobei injection is superior to band ligation for endoscopic symptomatic hemorrhoid treatment. We compared the clinical efficacy, safety, and health economics of the two techniques. AIMS: This study aims to compare the efficacy, safety and health economics of endoscopic injection of Shaobei and endoscopic ligation in the treatment of grade I-IV symptomatic hemorrhoids. METHODS: This retrospective cohort study collected clinical data from 413 patients with grade I-IV symptomatic hemorrhoids treated with endoscopy between January 2019 and March 2023. Recurrence rate, postoperative complications, hospitalization costs, hospitalization time, postoperative quality of life (QoL), and postoperative satisfaction were compared between Shaobei injection (treatment group; n = 79) and band ligation (control group; n = 334) groups within 3 months postoperatively. RESULTS: Before propensity score matching (PSM), the basic characteristics of patients significantly differed between groups (P < 0.05); no differences existed after PSM (Shaobei injection: n = 53; band ligation: n = 83). Recurrence rates did not differ between groups at 3 months postoperatively (P = 0.439). Postoperative symptom grading did not differ between groups (all P > 0.05) but was improved from baseline (all P < 0.001). However, the injection group experienced significantly less pain than the band ligation group on postoperative days 1 (P < 0.001) and 7 (P = 0.003). Significantly lower incidences were observed in the injection than in the ligation group for postoperative anal distention within 1 day (P < 0.001) and complications within 7 days (P < 0.001). No differences between groups were observed for other variables. CONCLUSION: Endoscopic Shaobei injection is effective and safe for treating grade I-IV symptomatic hemorrhoids, with less postoperative discomfort and fewer postoperative complications than with band ligation.", "provenance": [ { "field": "population", "quote": "patients with grade I-IV symptomatic hemorrhoids treated with endoscopy" }, { "field": "intervention", "quote": "Shaobei injection" }, { "field": "comparator", "quote": "band ligation" }, { "field": "n", "quote": "413 patients with grade I-IV symptomatic hemorrhoids treated with endoscopy between January 2019 and March 2023" }, { "field": "primaryOutcome", "quote": "Recurrence rate, postoperative complications, hospitalization costs, hospitalization time, postoperative quality of life (QoL), and postoperative satisfaction were compared" }, { "field": "result", "quote": "Recurrence rates did not differ between groups at 3 months postoperatively (P = 0.439). Postoperative symptom grading did not differ between groups (all P > 0.05) but was improved from baseline (all P < 0.001). However, the injection group experienced significantly less pain than the band ligation group on postoperative days 1 (P < 0.001) and 7 (P = 0.003). Significantly lower incidences were observed in the injection than in the ligation group for postoperative anal distention within 1 day (P < 0.001) and complications within 7 days (P < 0.001)." } ] }, { "id": "pmid:39579281", "pmid": "39579281", "doi": "10.1007/s10151-024-03022-1", "nctId": null, "pmcid": "PMC11585511", "title": "Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations", "firstAuthor": "LHP Recommendation Development Group", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2024, "design": "guideline", "n": 49, "nField": "reported", "population": "people with symptomatic hemorrhoids", "intervention": "laser hemorrhoidoplasty (a minimally invasive laser procedure)", "comparator": "no comparator; expert consensus on how to perform the procedure", "primaryOutcome": "agreement among experts on best practice recommendations for performing the procedure", "result": "Experts reached consensus on all 21 practice recommendations, with 16 reaching strong consensus", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an expert consensus/guideline based on opinion and literature review rather than a trial comparing treatments, so it cannot show whether the procedure works better than alternatives.", "directness": "indirect", "limitations": "Abstract does not report patient outcomes, only expert agreement on technique standards; based on expert opinion where literature was lacking.", "followUp": "", "plainFinding": "Expert agreement on laser procedure technique.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39579281/", "sourceText": "BACKGROUND: Laser hemorrhoidoplasty (LHP) has emerged as a novel, minimally invasive technique for managing symptomatic hemorrhoids, gaining popularity among clinicians. Despite its increasing adoption, significant variations exist in the application of LHP across different practices. PURPOSE: The aim of these recommendations was to spell out some basic principles and recommendations for performing a standard LHP procedure. METHODS: The Recommendation Development Group (RDG) consisting of surgeons with experience in LHP were invited to formulate recommendations for the procedure. The recommendations were generated following systematic literature research and discussion amongst experts (expert opinion) where no substantial literature was available. The developed recommendations were voted upon by a panelist via the Delphi process. Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above. RESULTS: The RDG developed 21 recommendations that were voted upon by 49 panelists. Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus. CONCLUSION: The RDP offers a comprehensive suite of guidelines to enhance the safety and efficacy of standard LHP procedures. Out of 21 detailed recommendations, 16 reached strong consensus, collectively addressing the full spectrum of LHP procedures-from laser settings and preoperative preparations to perioperative strategies and postoperative care. This coherent framework is anticipated not only to standardize but also to refine the LHP technique across the board, thereby elevating the management of symptomatic hemorrhoidal disease.", "provenance": [ { "field": "n", "quote": "voted upon by 49 panelists" }, { "field": "population", "quote": "symptomatic hemorrhoids" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "The developed recommendations were voted upon by a panelist via the Delphi process." }, { "field": "primaryOutcome", "quote": "Consensus was a priori defined as agreement of 75% and above, with strong consensus defined as 85% and above." }, { "field": "result", "quote": "Consensus was reached for all 21 recommendations after the first Delphi round, including 16 recommendations with strong consensus." } ] }, { "id": "pmid:39563748", "pmid": "39563748", "doi": "10.3748/wjg.v30.i42.4583", "nctId": null, "pmcid": "PMC11572621", "title": "Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure", "firstAuthor": "Mou", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with grade II and III internal hemorrhoids", "intervention": "endoscopic polidocanol foam sclerobanding (EFSB), a technique combining foam injection with rubber band ligation", "comparator": "endoscopic rubber band ligation (ERBL) alone", "primaryOutcome": "prolapse recurrence and post-procedural pain", "result": "abstract states EFSB is a novel therapy but says larger, longer studies are needed to confirm findings", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary discussing another study rather than reporting new data, so it carries very little independent evidence weight.", "directness": "indirect", "limitations": "The abstract itself provides no original data; it summarizes another trial and calls for larger samples and longer follow-up to confirm findings.", "followUp": "one-year follow-up", "plainFinding": "New method, results not yet confirmed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39563748/", "sourceText": "In the study, we comment on the article by Qu et al. Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.", "provenance": [ { "field": "population", "quote": "patients with grades II and III internal hemorrhoids" }, { "field": "intervention", "quote": "Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation" }, { "field": "comparator", "quote": "compare ERBL and EFSB in patients with grades II and III internal hemorrhoids" }, { "field": "primaryOutcome", "quote": "long-term relief from prolapse recurrence and reduced 24-h post-procedural pain" }, { "field": "result", "quote": "Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings." }, { "field": "followUp", "quote": "with one-year follow-up" } ] }, { "id": "pmid:39493328", "pmid": "39493328", "doi": "10.3748/wjg.v30.i38.4246", "nctId": null, "pmcid": "PMC11525876", "title": "Endoscopic polidocanol foam sclerobanding for the treatment of Grade II-III internal hemorrhoids: The focus of clinical practice", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with Grade II-III internal hemorrhoids", "intervention": "endoscopic polidocanol foam sclerotherapy combined with rubber band ligation", "comparator": "", "primaryOutcome": "long-term symptom relief and endoscopic healing", "result": "not reported in this abstract", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary letter discussing another study's methods, not a report of new patient outcomes.", "directness": "indirect", "limitations": "The abstract is a letter responding to another article and does not present original trial results or data.", "followUp": "", "plainFinding": "No new results; commentary only", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39493328/", "sourceText": "We have read the article by Qu et al with great interest, as it presents an integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation in patients with Grade II-III internal hemorrhoids. The authors conducted a prospective, multicenter, randomized study to evaluate the long-term symptomatic and endoscopic efficacy of this combined intervention. In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research.", "provenance": [ { "field": "population", "quote": "patients with Grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "integration of endoscopic polidocanol foam sclerotherapy with rubber band ligation" }, { "field": "primaryOutcome", "quote": "long-term symptomatic and endoscopic efficacy of this combined intervention" }, { "field": "result", "quote": "In this discussion, we focus on the procedural steps of this combined strategy and suggest potential avenues for future research." } ] }, { "id": "pmid:39351248", "pmid": "39351248", "doi": "10.3748/wjg.v30.i36.4021", "nctId": null, "pmcid": "PMC11439121", "title": "Redefining hemorrhoid therapy with endoscopic polidocanol foam sclerobanding", "firstAuthor": "Rao", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "rct", "n": 195, "nField": "reported", "population": "adults with grade II and III internal hemorrhoids", "intervention": "endoscopic polidocanol foam sclerobanding (EFSB), a non-surgical injection and banding technique", "comparator": "endoscopic rubber band ligation (ERBL)", "primaryOutcome": "recurrence rate, post-procedural pain, symptom relief, and patient satisfaction", "result": "EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a multicenter randomized trial, which is strong evidence, but the single-blind design and short follow-up period limit confidence in the results.", "directness": "direct", "limitations": "single-blind design and relatively short follow-up period", "followUp": "", "plainFinding": "Less pain and recurrence than banding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39351248/", "sourceText": "Hemorrhoids are a common and painful condition, with conventional treatments such as endoscopic rubber band ligation (ERBL) and injection sclerotherapy often falling short due to high recurrence rates and significant post-operative pain. A clinical trial by Qu et al introduces a novel approach called endoscopic poli-docanol foam sclerobanding (EFSB). This multicenter randomized trial involved 195 patients with grade II and III internal hemorrhoids and demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL. The study's strengths include its robust design, comprehensive outcome evaluation, and patient-centered approach. Despite limitations such as the single-blind design and relatively short follow-up period, the findings suggest that EFSB could enhance clinical practice by offering a more effective and patient-friendly treatment option. Further research is needed to validate these results and explore the long-term benefits and cost-effectiveness of EFSB.", "provenance": [ { "field": "n", "quote": "involved 195 patients" }, { "field": "population", "quote": "195 patients with grade II and III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic poli-docanol foam sclerobanding (EFSB)" }, { "field": "comparator", "quote": "compared to ERBL" }, { "field": "primaryOutcome", "quote": "significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction" }, { "field": "result", "quote": "demonstrated that EFSB significantly reduced recurrence rates and post-procedural pain while improving symptom relief and patient satisfaction compared to ERBL" }, { "field": "limitations", "quote": "Despite limitations such as the single-blind design and relatively short follow-up period" } ] }, { "id": "pmid:39169548", "pmid": "39169548", "doi": "10.1111/codi.17140", "nctId": null, "pmcid": null, "title": "Global treatment of haemorrhoids-A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons", "firstAuthor": "Samalavicius", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "registry", "n": 1005, "nField": "reported", "population": "surgeons worldwide who treat hemorrhoid patients", "intervention": "conservative (non-surgical) treatment such as fiber, water intake, bowel training, banding", "comparator": "surgical treatment (excisional hemorrhoidectomy)", "primaryOutcome": "which treatment surgeons use first for each grade of hemorrhoids", "result": "conservative treatment was used first for grade I-III hemorrhoids, surgery was first-line only for grade IV", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a global opinion survey of surgeons' practice habits, not a study measuring patient outcomes or comparing treatments head-to-head.", "directness": "indirect", "limitations": "self-reported, voluntary questionnaire of surgeon practice patterns with no patient outcome data or control group.", "followUp": "", "plainFinding": "Surgeons use surgery mainly for severe hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39169548/", "sourceText": "AIM: There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. METHODS: The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. RESULTS: The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I-IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids - with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. CONCLUSION: Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed.", "provenance": [ { "field": "n", "quote": "The survey was completed by 1005 surgeons from 103 countries" }, { "field": "population", "quote": "surgeons from 103 countries" }, { "field": "intervention", "quote": "The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%)." }, { "field": "comparator", "quote": "surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%)" }, { "field": "primaryOutcome", "quote": "assess a global view of how surgeons manage haemorrhoids" }, { "field": "result", "quote": "Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%)." } ] }, { "id": "pmid:39132755", "pmid": "39132755", "doi": "10.57264/cer-2024-0070", "nctId": null, "pmcid": "PMC11426285", "title": "An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study)", "firstAuthor": "Godeberge", "multipleAuthors": true, "journal": "J Comp Eff Res", "year": 2024, "design": "prospective-cohort", "n": 3505, "nField": "reported", "population": "adults with acute hemorrhoid symptoms, mostly mild to moderate grade (Goligher I and II)", "intervention": "non-surgical treatments, mainly venoactive drugs (especially micronized purified flavonoid fraction, MPFF)", "comparator": "different venoactive drugs compared to each other (MPFF vs diosmin), no surgical or placebo comparator", "primaryOutcome": "improvement in hemorrhoid symptoms (pain, bleeding, swelling, itching) and quality of life", "result": "Conservative drug treatments, mostly MPFF, improved pain, bleeding, swelling, itching and quality of life, with MPFF outperforming diosmin", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was an observational study without a surgical or placebo comparison group, so it cannot show whether drugs work better than no treatment or surgery.", "directness": "indirect", "limitations": "Observational design with no control group, no comparison to surgery or placebo, and most patients had milder grade I-II hemorrhoids.", "followUp": "4-week", "plainFinding": "Symptoms improved with non-surgical drug treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39132755/", "sourceText": "Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5 ± 13.7 years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001), treatment impact at 1 week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p < 0.001) and shorter times to improvement (mean ± SD 3.9 ± 1.5 days vs diosmin 4.2 ± 1.7 days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.", "provenance": [ { "field": "n", "quote": "Of 3592 participants, 3505 were analyzed" }, { "field": "population", "quote": "adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification)" }, { "field": "population", "quote": "72.1% Goligher grade I and II" }, { "field": "intervention", "quote": "Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%)" }, { "field": "comparator", "quote": "MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001)" }, { "field": "primaryOutcome", "quote": "Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire)" }, { "field": "result", "quote": "All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL." }, { "field": "followUp", "quote": "The 4-week observational prospective CHORALIS study" } ] }, { "id": "pmid:39086750", "pmid": "39086750", "doi": "10.3748/wjg.v30.i27.3326", "nctId": null, "pmcid": "PMC11287420", "title": "Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study", "firstAuthor": "Qu", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "rct", "n": 195, "nField": "reported", "population": "adults with grade II-III internal hemorrhoids", "intervention": "endoscopic polidocanol foam sclerotherapy combined with rubber band ligation (EFSB)", "comparator": "endoscopic rubber band ligation alone (ERBL)", "primaryOutcome": "hemorrhoid symptom severity, prolapse recurrence, and post-procedure pain", "result": "EFSB had lower symptom severity scores, lower prolapse recurrence (11.2% vs 21.6%), and less pain than ERBL alone at 12 months", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "This was a randomized multicenter trial with reasonable follow-up, but it compared two non-surgical techniques rather than against surgery or no treatment, limiting what it tells us about surgery necessity.", "directness": "indirect", "limitations": "Abstract does not report blinding, and comparison is between two endoscopic techniques, not between surgery and non-surgical treatment.", "followUp": "12 months", "plainFinding": "Combined foam and banding worked better than banding alone", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39086750/", "sourceText": "BACKGROUND: Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain. AIM: To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL. METHODS: This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range. RESULTS: One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]. CONCLUSION: Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.", "provenance": [ { "field": "n", "quote": "A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled" }, { "field": "population", "quote": "patients diagnosed with grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "cap-assisted endoscopic polidocanol foam sclerobanding (EFSB)" }, { "field": "comparator", "quote": "an ERBL group" }, { "field": "primaryOutcome", "quote": "Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS)" }, { "field": "result", "quote": "The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038)" }, { "field": "result", "quote": "HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up" } ] }, { "id": "pmid:39084191", "pmid": "39084191", "doi": "10.1159/000540256", "nctId": null, "pmcid": null, "title": "Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis", "firstAuthor": "Jee", "multipleAuthors": true, "journal": "Dig Surg", "year": 2024, "design": "meta-analysis", "n": 465, "nField": "reported", "population": "patients with hemorrhoids undergoing surgery", "intervention": "transanal hemorrhoidal dearterialization (THD), a less invasive surgical technique", "comparator": "conventional excisional hemorrhoidectomy (CEH)", "primaryOutcome": "recurrence of hemorrhoids", "result": "THD had higher recurrence than CEH but faster return to normal activity; complication rates were similar between the two", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "Based on only 6 randomized trials with 465 patients total, giving reasonably reliable but not highly precise estimates.", "directness": "indirect", "limitations": "Small number of trials and patients; this compares two surgical techniques, not surgery versus non-surgical treatment.", "followUp": "", "plainFinding": "Less invasive surgery heals faster but recurs more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39084191/", "sourceText": "INTRODUCTION: Although effective, conventional excisional haemorrhoidectomy (CEH) is associated with significant postoperative pain. Novel techniques such as transanal haemorrhoidal dearterialization (THD) are suggested to reduce pain but may result in higher recurrence rates. We aimed to compare short- and long-term outcomes of CEH and THD in the present meta-analysis. METHODS: A PRISMA-compliant meta-analysis was performed, searching PubMed, Embase, and CENTRAL databases for randomised controlled trials (RCTs) from 1995 to December 2022. The primary objective was recurrence. Secondary objectives included complication rates, length of stay (LOS), operative time, and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. Subgroup analysis was also performed. RESULTS: A total of 6 RCTs encompassing 465 patients were captured. There were 142 (59%) males in the CEH group and 129 (54%) in the THD group. On random-effects analysis, THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001). There were no differences in bleeding (p = 0.12), urinary retention (p = 0.97), incontinence (p = 0.41), anal stenosis (p = 0.19), thrombosed residual haemorrhoids (p = 0.16), operating time (p = 0.19), or LOS (p = 0.22). Results remained similar on subgroup analysis. CONCLUSIONS: CEH is associated with lower recurrence but similar complication rates to THD, although patients take longer to return to baseline function postoperatively.", "provenance": [ { "field": "n", "quote": "A total of 6 RCTs encompassing 465 patients were captured." }, { "field": "population", "quote": "compare short- and long-term outcomes of CEH and THD" }, { "field": "intervention", "quote": "transanal haemorrhoidal dearterialization (THD)" }, { "field": "comparator", "quote": "conventional excisional haemorrhoidectomy (CEH)" }, { "field": "primaryOutcome", "quote": "The primary objective was recurrence." }, { "field": "result", "quote": "THD had a higher recurrence rate (odds ratio = 2.76, 95% confidence interval [CI] = 1.03-7.38, p = 0.04) albeit a shorter return to baseline compared to CEH (mean difference = -14.05 days, 95% CI = -20.38 to -7.72, p < 0.0001)." } ] }, { "id": "pmid:39048788", "pmid": "39048788", "doi": "10.1007/s00384-024-04690-z", "nctId": null, "pmcid": "PMC11269455", "title": "A systematic review comparing the efficacy of 980 nm vs. 1470 nm wavelengths in laser hemorrhoidoplasty", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2024, "design": "meta-analysis", "n": 2492, "nField": "reported", "population": "patients with hemorrhoidal disease", "intervention": "Laser Hemorrhoidoplasty (LHP) using 980 nm or 1470 nm wavelengths", "comparator": "open hemorrhoidectomy", "primaryOutcome": "operative duration, postoperative pain, complications, and recurrence rate", "result": "LHP was faster and caused less pain and fewer complications than open hemorrhoidectomy, but 1470-nm LHP had higher recurrence; 980-nm LHP recurrence was similar to surgery", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "This pools many studies including randomized trials, but most are non-randomized and no studies directly compared the two laser types head-to-head.", "directness": "direct", "limitations": "No direct studies comparing the two wavelengths; mix of randomized and non-randomized trials", "followUp": "", "plainFinding": "Laser treatment less painful, but may recur more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39048788/", "sourceText": "BACKGROUND: Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option for the management of hemorrhoidal disease that has been increasingly adopted by surgeons over the last decade. Two wavelengths; 980 nm and 1470 nm have been employed in LHP. However, no data exist comparing the effects of these two wavelengths for this indication. This systematic review investigates both wavelengths for the management of hemorrhoids via the LHP procedure. METHODS: This systematic analysis and meta-analysis was performed following the PICOS and PRISMA guidelines. A systematic research of MEDLINE, Scopus, Clinicaltrials.gov, Embase, Cochrane Central Register of Controlled Trials, CENTRAL and Google Scholar databases from inception until March 2024 was performed. RESULTS: Overall, 19 studies including seven randomized control trials (RCT) and 12 non-randomized control trials with a total of 2492 patients were included in this systematic review and meta-analysis. The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy, postoperative pain and the rate of postoperative complications were significantly lower following LHP. There was no statistically significant difference in the rate of recurrence between LHP with the 980-nm wavelength and open hemorrhoidectomy. However, LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy. CONCLUSION: Although no direct studies have compared the two wavelengths used in LHP, the outcomes of LHP seem to be independent of the wavelength used. Both wavelengths, when correctly used provide similar results, which are mostly better compared to open hemorrhoidectomy in terms of postoperative complications and postoperative pain, but not in terms of recurrence, where at least for the 1470-nm wavelength, LHP seems to show a higher recurrence rate when compared to open hemorrhoidectomy. Although a direct comparison of both wavelengths was not possible, technical issues regarding number of shots and energy per pile represent relevant parameters for recurrence after LHP.", "provenance": [ { "field": "n", "quote": "a total of 2492 patients were included in this systematic review and meta-analysis" }, { "field": "population", "quote": "management of hemorrhoidal disease" }, { "field": "intervention", "quote": "Laser Hemorrhoidoplasty (LHP) is a minimally invasive surgical option" }, { "field": "comparator", "quote": "open hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The duration of LHP with both wavelengths was significantly shorter compared to open hemorrhoidectomy, postoperative pain and the rate of postoperative complications were significantly lower following LHP." }, { "field": "result", "quote": "LHP with 1470-nm wavelength resulted in significantly higher recurrence rate compared to hemorrhoidectomy." } ] }, { "id": "pmid:38965992", "pmid": "38965992", "doi": "10.5604/01.3001.0054.4819", "nctId": null, "pmcid": null, "title": "Hemorrhoidal laser ablation procedure: a minimally invasive treatment for grades II, III, and IV using a 1470 nm diode laser", "firstAuthor": "Kavraal", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2024, "design": "retrospective", "n": 138, "nField": "reported", "population": "patients with symptomatic grade II, III, and IV internal hemorrhoids", "intervention": "laser treatment (Hemorrhoidal Laser Ablation) using a 1470 nm diode laser", "comparator": "none (single-arm retrospective case series)", "primaryOutcome": "symptom resolution, hemorrhoid size reduction, recurrence and satisfaction", "result": "No intraoperative complications; recurrence 0.8% short-term and 5% long-term, with 95% satisfaction and symptom relief", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective case series with no comparison group, so results could be due to other factors, not just the treatment.", "directness": "direct", "limitations": "retrospective study design without a control group", "followUp": "up to five years", "plainFinding": "Fewer symptoms, low recurrence, high satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38965992/", "sourceText": "<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>.", "provenance": [ { "field": "n", "quote": "The cohort included 138 patients with symptomatic hemorrhoids who underwent Hemorrhoidal Laser Ablation" }, { "field": "population", "quote": "symptomatic grade II, III, and IV internal hemorrhoids" }, { "field": "intervention", "quote": "Patients were treated with a 1470 nm diode laser." }, { "field": "comparator", "quote": "This retrospective study aimed to present our experience with Hemorrhoidal Laser Ablation" }, { "field": "primaryOutcome", "quote": "evaluate the efficacy and safety of this relatively recent technique" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:38955875", "pmid": "38955875", "doi": "10.1007/s10151-024-02940-4", "nctId": null, "pmcid": null, "title": "Clinical outcomes of laser hemorrhoidoplasty with feeding vessels suture ligation: a retrospective study in a single center", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 323, "nField": "reported", "population": "adults with symptomatic grade II-III hemorrhoids undergoing surgery", "intervention": "laser hemorrhoidoplasty with suture ligation of feeding vessels", "comparator": "traditional Milligan-Morgan hemorrhoidectomy", "primaryOutcome": "postoperative pain and complications", "result": "laser hemorrhoidoplasty group had less pain and lower rate of urinary retention than traditional surgery group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized, single-center study comparing two surgical techniques, which limits how much confidence we can place in the results.", "directness": "indirect", "limitations": "Retrospective design, single center, not randomized, and compares two surgical approaches rather than surgery versus non-surgical treatment.", "followUp": "", "plainFinding": "Laser surgery caused less pain than traditional surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38955875/", "sourceText": "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.", "provenance": [ { "field": "n", "quote": "The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy." }, { "field": "population", "quote": "patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty with feeding vessel suture ligation" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:38849668", "pmid": "38849668", "doi": "10.1007/s10151-024-02939-x", "nctId": null, "pmcid": null, "title": "Rectal perforation after laser hemorrhoidoplasty: a case report", "firstAuthor": "Smets", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a 31-year-old woman with hemorrhoids treated by laser hemorrhoidoplasty", "intervention": "laser hemorrhoidoplasty (a minimally invasive laser treatment for hemorrhoids)", "comparator": "none", "primaryOutcome": "serious complications after the procedure", "result": "she developed a rectal perforation, severe abdominal infection, sepsis and multiple organ failure, needing emergency surgery and a colostomy", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or how this treatment compares to others.", "directness": "direct", "limitations": "only one patient; no comparison group; described as the first such case reported, so how common this is cannot be judged from this report.", "followUp": "", "plainFinding": "Rare but serious complication reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38849668/", "sourceText": "This case report outlines the intricate management of rectal perforation following laser hemorrhoidoplasty in a 31-year-old female, leading to an acute abdomen, sepsis, and multiorgan failure. Urgent laparoscopic exploration and the establishment of a double-loop colostomy were undertaken, marking the beginning of a complex course characterized by relapsed pelvic sepsis. Laser hemorrhoidoplasty has gained widespread acceptance for its minimally invasive approach in treating hemorrhoids. Remarkably, to our knowledge, the case we present is the first major complication reported after laser hemorrhoidoplasty, likely attributed to collateral thermic and mechanical tissue damage.", "provenance": [ { "field": "n", "quote": "a 31-year-old female" }, { "field": "population", "quote": "rectal perforation following laser hemorrhoidoplasty in a 31-year-old female" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty has gained widespread acceptance for its minimally invasive approach in treating hemorrhoids." }, { "field": "comparator", "quote": "This case report outlines the intricate management of rectal perforation following laser hemorrhoidoplasty" }, { "field": "primaryOutcome", "quote": "leading to an acute abdomen, sepsis, and multiorgan failure" }, { "field": "result", "quote": "Urgent laparoscopic exploration and the establishment of a double-loop colostomy were undertaken, marking the beginning of a complex course characterized by relapsed pelvic sepsis." } ] }, { "id": "pmid:38797851", "pmid": "38797851", "doi": "10.1186/s12893-024-02425-z", "nctId": null, "pmcid": "PMC11129420", "title": "Laser hemorrhoidoplasty vs. rubber band ligation: a randomized trial comparing 2 mini-invasive treatment for grade II hemorrhoids", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "BMC Surg", "year": 2024, "design": "rct", "n": 70, "nField": "reported", "population": "adults with grade II hemorrhoids", "intervention": "laser hemorrhoidoplasty", "comparator": "rubber band ligation", "primaryOutcome": "postoperative pain, bleeding, anal distension, and recurrence", "result": "laser treatment caused less pain, bleeding, and distension in first 2 weeks and faster return to activity, but recurrence rates were similar at 1 year", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, from a single center, and did not use blinding, which limits confidence.", "directness": "indirect", "limitations": "small sample size from a single center; abstract does not mention blinding", "followUp": "1 year", "plainFinding": "Laser eased symptoms faster, same recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38797851/", "sourceText": "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.", "provenance": [ { "field": "population", "quote": "70 patients with grade II hemorrhoids" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "Rubber Band Ligation (RBL)" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05)." }, { "field": "n", "quote": "A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group)" } ] }, { "id": "pmid:38762410", "pmid": "38762410", "doi": "10.1016/j.asjsur.2024.04.156", "nctId": null, "pmcid": null, "title": "Diode laser hemorrhoidoplasty versus conventional Milligan-Morgan and Ferguson hemorrhoidectomy for symptomatic hemorrhoids: Meta-analysis", "firstAuthor": "Cheng", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2024, "design": "meta-analysis", "n": 1196, "nField": "reported", "population": "adults with symptomatic hemorrhoids undergoing surgical treatment", "intervention": "laser hemorrhoidoplasty (minimally invasive laser procedure)", "comparator": "conventional hemorrhoidectomy (Milligan-Morgan or Ferguson surgery)", "primaryOutcome": "amount of bleeding during surgery and bleeding afterward", "result": "Laser hemorrhoidoplasty caused less blood loss, less post-op bleeding, shorter operation time, less pain on day 1, and less anal narrowing than conventional surgery, but no difference in incontinence, urinary retention or hemorrhoid recurrence", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools 17 trials with over a thousand patients and found consistent results across subgroups, but it compares two surgical techniques rather than surgery versus non-surgical care, and trial quality varied.", "directness": "indirect", "limitations": "Abstract does not report individual study quality in detail beyond a 'low risk of bias' subgroup; both compared treatments are surgical procedures, not a surgery-vs-no-surgery comparison.", "followUp": "", "plainFinding": "Laser surgery less bleeding than traditional surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38762410/", "sourceText": "Conventional hemorrhoidectomy is the mainstay of treatment for symptomatic haemorrhoids, but reported postoperative complications remains the main concern. On the contrary, with its minimally invasive nature, laser hemorrhoidoplasty showed the potential to reduce postoperative complications and discomfort. Therefore, we performed a systemic review and meta-analysis to evaluate the postoperative outcome of laser hemorrhoidoplasty compared to conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques. Of all studies from PubMed, EMBASE, Cochrane database, and Google Scholar, we included 17 trials with 1196 patients, of whom 596 (49.8 %) underwent laser hemorrhoidoplasty and 600 (50.2 %) underwent conventional hemorrhoidectomy. The primary outcomes were operative blood loss and postoperative haemorrhage, and the secondary outcomes were the operative time, postoperative pain score, complications, and haemorrhoid recurrence. In this study, we found that laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy. However, incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups. Consistent results were found in 5 subgroup analyses, including studies with low risk of bias, studies using 1470 nm laser, and studies using 980 nm laser, studies conducted in Asia, and studies conducted in Europe and America.", "provenance": [ { "field": "n", "quote": "17 trials with 1196 patients" }, { "field": "population", "quote": "symptomatic haemorrhoids" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty" }, { "field": "comparator", "quote": "conventional hemorrhoidectomies, including Milligan-Morgan and Ferguson techniques" }, { "field": "primaryOutcome", "quote": "The primary outcomes were operative blood loss and postoperative haemorrhage" }, { "field": "result", "quote": "laser hemorrhoidoplasty showed benefits in operative blood loss (weighted mean difference [WMD]: -16.43 ml, 95 % confidence interval [CI]: -23.82 to -9.04), postoperative hemorrhage/bleeding (odds ratio [OR]: 0.16, 95 % CI: 0.10 to 0.28), operative time (WMD: -12.42 min, 95 % CI: -14.56 to -10.28), postoperative pain score on day 1 (WMD: -2.50, 95 % CI: -3.13 to -1.88), and anal stenosis (OR: 0.14, 95 % CI: 0.03 to 0.65) in comparison with conventional hemorrhoidectomy" }, { "field": "result", "quote": "incidence of fecal/flatus incontinence, urinary retention and hemorrhoid recurrence were not significantly different between the 2 groups" } ] }, { "id": "pmid:38677814", "pmid": "38677814", "doi": "10.1016/j.suc.2023.11.001", "nctId": null, "pmcid": null, "title": "Management of Hemorrhoids and Anal Fissures", "firstAuthor": "Akinmoladun", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids and anal fissures", "intervention": "medical and surgical treatment options for hemorrhoids", "comparator": "different treatment options compared to each other", "primaryOutcome": "successful treatment and complication rates", "result": "Abstract describes a review of treatment options without giving specific comparative results", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review describing available treatments rather than presenting new comparative data or outcomes.", "directness": "direct", "limitations": "Abstract does not report specific study results, numbers of patients, or statistical outcomes comparing treatments.", "followUp": "", "plainFinding": "Reviews treatment options, no specific results given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38677814/", "sourceText": "Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures.", "provenance": [ { "field": "population", "quote": "Hemorrhoids and anal fissures are two of the most common benign anorectal diseases." }, { "field": "intervention", "quote": "numerous medical and surgical treatment options are available, each with different rates of success and complications" }, { "field": "comparator", "quote": "numerous medical and surgical treatment options are available, each with different rates of success and complications" }, { "field": "primaryOutcome", "quote": "evidence-based treatment options for hemorrhoids and anal fissures" }, { "field": "result", "quote": "the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures" } ] }, { "id": "pmid:38580520", "pmid": "38580520", "doi": "10.1016/j.jviscsurg.2024.03.005", "nctId": null, "pmcid": null, "title": "Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management", "firstAuthor": "Fathallah", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2024, "design": "prospective-cohort", "n": 472, "nField": "reported", "population": "patients with hemorrhoidal disease", "intervention": "surgical treatment", "comparator": "medical and/or instrumental treatment", "primaryOutcome": "bleeding and prolapse scores, and patient satisfaction after treatment", "result": "Surgery improved symptoms more and gave higher satisfaction (73% vs 54%), but only 17% of patients needed surgery overall", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center observational study without randomization, so differences between treatment groups could be due to other factors, not just the treatment itself.", "directness": "direct", "limitations": "Single-center, non-randomized, observational design; surgery group may differ systematically from non-surgery group (more severe disease).", "followUp": "", "plainFinding": "Most treated without surgery; surgery most effective.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38580520/", "sourceText": "INTRODUCTION: There are very few French studies on hemorrhoidal disease and its management. PATIENTS AND METHODS: Prospective single-center study from July to December 2021 including 472 patients. RESULTS: Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery. CONCLUSION: Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.", "provenance": [ { "field": "n", "quote": "Prospective single-center study from July to December 2021 including 472 patients." }, { "field": "population", "quote": "Prospective single-center study from July to December 2021 including 472 patients." }, { "field": "intervention", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "comparator", "quote": "Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%)." }, { "field": "primaryOutcome", "quote": "After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)." }, { "field": "result", "quote": "improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)" }, { "field": "result", "quote": "Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences" } ] }, { "id": "pmid:38518140", "pmid": "38518140", "doi": null, "nctId": null, "pmcid": null, "title": "Observation on Efficacy of Selective Malposition Ligation Combined with Hemorrhoid and Fistula I in Complex Mixed Hemorrhoid", "firstAuthor": "Zhu", "multipleAuthors": true, "journal": "Altern Ther Health Med", "year": 2024, "design": "retrospective", "n": 423, "nField": "reported", "population": "patients undergoing surgery for complex mixed hemorrhoids", "intervention": "selective malposition ligation surgery combined with an oral herbal formula called hemorrhoid and fistula I", "comparator": "malposition ligation surgery alone, or selective malposition ligation surgery without the herbal formula", "primaryOutcome": "pain, swelling, bleeding, wound healing time, and complication rates after surgery", "result": "the combined approach led to less pain, swelling and bleeding, faster wound healing, and fewer complications than either surgery-alone group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "patients were not randomized but grouped by the time period they had surgery, which makes bias likely.", "directness": "indirect", "limitations": "not randomized, groups assigned by time period rather than random allocation, and all patients received surgery so this does not address nonoperative treatment", "followUp": "7 days", "plainFinding": "Faster healing, fewer complications with add-on therapy", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38518140/", "sourceText": "OBJECTIVE: The efficacy of selective malposition ligation combined with hemorrhoid and fistula I prescription and the improvement of complications were assessed to improve surgical efficiency and safety. METHODS: 423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects and enrolled into group A (malposition ligation), group B (selective malposition ligation), and group C (selective malposition ligation and hemorrhoid and fistula I), each with 141 cases. RESULTS: The scores for visual analogue scale (VAS), edema, and hemorrhage of group C 8h, 1 day, 2 days, 3 days, 5 days, and 7 days after surgery were all inferior to those in groups A and B, while that of group B was inferior to that in group A (P < .05). The duration of wound healing of group C (15.33 ± 2.78 days) was shorter than that of groups A (21.78 ± 3.22 days) and B (18.34 ± 3.01 days), and this duration of group B was shorter than that of group A (P < .05). The total effective rate of group C (96.45%) was superior to that of groups B (96.45%) and A (82.27%). The total effective rate of group B was superior to that of group A. The falling-off rate of the rubber ring in groups C and B was inferior to that in group A. The incidence of total complications in group C (9.93%) was inferior to that in groups B (30.50%) and A (30.50%), while that of group B was inferior to that in group A (P < .05). CONCLUSION: After selective malposition ligation, the oral intake of hemorrhoid and fistula I could promote the recovery of wounds among patients with complex mixed hemorrhoids and reduce the incidence of postoperative hemorrhage and edema. Hence, it has significant clinical application values.", "provenance": [ { "field": "n", "quote": "423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects" }, { "field": "population", "quote": "423 patients undergoing complex mixed hemorrhoid surgery at different time points were included as research objects" }, { "field": "intervention", "quote": "group C (selective malposition ligation and hemorrhoid and fistula I)" }, { "field": "comparator", "quote": "group A (malposition ligation), group B (selective malposition ligation)" }, { "field": "primaryOutcome", "quote": "The scores for visual analogue scale (VAS), edema, and hemorrhage of group C 8h, 1 day, 2 days, 3 days, 5 days, and 7 days after surgery were all inferior to those in groups A and B" }, { "field": "result", "quote": "The duration of wound healing of group C (15.33 ± 2.78 days) was shorter than that of groups A (21.78 ± 3.22 days) and B (18.34 ± 3.01 days)" }, { "field": "result", "quote": "The incidence of total complications in group C (9.93%) was inferior to that in groups B (30.50%) and A (30.50%)" } ] }, { "id": "pmid:38480640", "pmid": "38480640", "doi": "10.1007/s13304-024-01798-3", "nctId": null, "pmcid": null, "title": "Sclerotherapy with 3% polidocanol foam for the treatment of mucocutaneous bridges and/or residual piles after open excisional hemorrhoidectomy", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "retrospective", "n": 18, "nField": "reported", "population": "patients with severe (grade IV) hemorrhoidal disease", "intervention": "sclerotherapy with polidocanol foam applied to leftover skin bridges/piles after open hemorrhoid surgery", "comparator": "no separate comparison group; outcomes measured before and after treatment in the same patients", "primaryOutcome": "hemorrhoid symptom score and quality-of-life/continence scores", "result": "78% of patients were symptom-free at 3 months, with a significant drop in symptom scores and no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, single-center retrospective study of only 18 patients with no comparison group and just 3 months of follow-up, so it cannot reliably show whether the treatment works.", "directness": "indirect", "limitations": "Retrospective design, very small sample size, no control group, and short follow-up period; study combines surgery with sclerotherapy rather than testing non-surgical treatment alone.", "followUp": "3 months", "plainFinding": "Fewer symptoms after surgery plus sclerotherapy.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38480640/", "sourceText": "Injection sclerotherapy is an effective and safe treatment in selected cases. It might be used as the first treatment for I-III degree hemorrhoidal disease (HD), but also as a bridge therapy for more severe cases not amenable to invasive treatments. However, concerning the long-term recurrence rate, open excisional hemorrhoidectomy remains the gold standard in cases of III- and IV-degree HD. In this context, it is recommended to perform the excision of no more than three piles and to preserve the muco-cutaneous bridges to avoid post-operative anal stenosis. The aim of this study is to evaluate surgical outcomes and efficacy of the combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles. This was a single-center retrospective study and a total of 18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification, were enrolled between January 2023 and June 2023 and their follow-up continued until October 2023 after reaching 3 months of follow-up. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms and their impact on quality of life and continence. A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months. Moreover, a statistically significant decrease in the median HDSS and short health scale for HD (SHS-HD) score was registered from 16 preoperatively (T0) to 2 at 3-month follow-up (T3). Neither post-operative bleeding nor any type of complications occurred. The use of sclerotherapy in combination with the traditional open excisional hemorrhoidectomy has shown promising results. Further structured studies are needed and greater dissemination and education of the general surgeon on the subject is necessary.", "provenance": [ { "field": "n", "quote": "a total of 18 patients with IV-degree HD" }, { "field": "population", "quote": "18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification" }, { "field": "intervention", "quote": "the combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles" }, { "field": "comparator", "quote": "a statistically significant decrease in the median HDSS and short health scale for HD (SHS-HD) score was registered from 16 preoperatively (T0) to 2 at 3-month follow-up (T3)" }, { "field": "primaryOutcome", "quote": "The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms and their impact on quality of life and continence." }, { "field": "result", "quote": "A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months." }, { "field": "followUp", "quote": "their follow-up continued until October 2023 after reaching 3 months of follow-up" } ] }, { "id": "pmid:38436741", "pmid": "38436741", "doi": "10.1007/s00384-024-04609-8", "nctId": null, "pmcid": "PMC10912253", "title": "Analgesic effect of local anaesthetic in haemorrhoid banding: systematic review and meta-analysis", "firstAuthor": "Watson", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2024, "design": "meta-analysis", "n": 342, "nField": "reported", "population": "adults having rubber band ligation for hemorrhoids", "intervention": "local anaesthetic given during hemorrhoid banding", "comparator": "no local or regional anesthesia during banding", "primaryOutcome": "patient-reported pain scores after the banding procedure", "result": "Local anaesthetic lowered pain scores at 1 hour but showed no clear difference at 6 or 24 hours", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The evidence was rated low quality because of inconsistency between studies and imprecise, small sample sizes.", "directness": "indirect", "limitations": "small sample sizes and substantial heterogeneity across studies", "followUp": "24 h", "plainFinding": "Less pain only in first hour.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38436741/", "sourceText": "PURPOSE: Rubber band ligation of haemorrhoids can be,painful and there is no consensus regarding the optimal analgesic strategy. This study aims to determine whether there is a difference in post-procedural pain in adults undergoing haemorrhoid banding who have received local anaesthetic, a pudendal nerve block or no regional or local analgesia. METHODS: MEDLINE, Embase, Google Scholar and clinical trial registries were searched for randomised trials of local anaesthetic or pudendal nerve block use in banding. Primary outcomes were patient-reported pain scores. The quality of the evidence was assessed using the GRADE approach. RESULTS: Seven studies were included in the final review. No articles were identified that studied pudendal nerve blocks. The difference in numerical pain scores between treatment groups favoured the local anaesthetic group at all timepoints. The mean difference in scores on a 10-point scale was at 1 h,-1.43 (95% CI-2.30 to-0.56, p < 0.01, n = 342 (175 in treatment group)); 6 h,-0.52 (95% CI-1.04 to 0.01, p = 0.05, n = 250 (130 in treatment group)); and 24 h,-0.31 (95% CI-0.82 to 0.19, p = 0.86, n = 247 (127 in treatment group)). Of reported safety outcomes, vasovagal symptoms proceeded to meta-analysis, with a risk ratio of 1.01 (95% CI 0.64-1.60). The quality of the evidence was rated down to 'low' due to inconsistency and imprecision. CONCLUSION: This review supports the use of LA for reducing early post-procedural pain following haemorrhoid banding. The evidence was limited by small sample sizes and substantial heterogeneity across studies. REGISTRATION: PROSPERO (ID CRD42022322234).", "provenance": [ { "field": "population", "quote": "adults undergoing haemorrhoid banding" }, { "field": "intervention", "quote": "local anaesthetic" }, { "field": "comparator", "quote": "no regional or local analgesia" }, { "field": "primaryOutcome", "quote": "Primary outcomes were patient-reported pain scores." }, { "field": "result", "quote": "The mean difference in scores on a 10-point scale was at 1 h,-1.43 (95% CI-2.30 to-0.56, p < 0.01, n = 342 (175 in treatment group)); 6 h,-0.52 (95% CI-1.04 to 0.01, p = 0.05, n = 250 (130 in treatment group)); and 24 h,-0.31 (95% CI-0.82 to 0.19, p = 0.86, n = 247 (127 in treatment group))." }, { "field": "n", "quote": "n = 342 (175 in treatment group)" }, { "field": "qualityWhy", "quote": "The quality of the evidence was rated down to 'low' due to inconsistency and imprecision." } ] }, { "id": "pmid:38428446", "pmid": "38428446", "doi": "10.1080/00015458.2024.2326273", "nctId": null, "pmcid": null, "title": "Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for hemorrhoidal disease: a systematic review and meta-analysis", "firstAuthor": "Manaki", "multipleAuthors": true, "journal": "Acta Chir Belg", "year": 2024, "design": "meta-analysis", "n": 4249, "nField": "reported", "population": "patients with hemorrhoidal disease (various grades)", "intervention": "ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy injection", "comparator": "none specified; pooled single-arm outcomes across studies", "primaryOutcome": "recurrence of hemorrhoids and treatment complications", "result": "Pooled recurrence rate was 10% and complication rate was 5.2%, with no significant link to disease grade", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The review pools mostly uncontrolled studies without a comparison group, so it cannot show how ALTA compares to surgery or other treatments.", "directness": "direct", "limitations": "No control group comparisons reported; abstract calls for high-quality randomized controlled trials and longer follow-up", "followUp": "not specified", "plainFinding": "Non-surgical injection may treat hemorrhoids effectively.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38428446/", "sourceText": "BACKGROUND: We conducted a systematic review to assess the safety and efficacy of Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for the treatment of hemorrhoidal disease. METHODS: Our study was conducted in accordance with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-analyses) 2020. Primary endpoints included overall recurrence and type of recurrence while secondary endpoints included postoperative complications, reintervention, presence of rectal ulcer, rectal stricture, defecation abnormalities and perianal abscess. Α regression analysis, where the percentage of patients with grade II, III and IV hemorrhoidal disease was used as a covariate, was also performed. RESULTS: Twelve studies with 4249 patients met all the inclusion criteria and were eventually included. The crude and pooled estimates of the overall recurrence and complications by the end of follow-up were 10% (95% CI, 6.52%-14.08%) and 5.20% (95% CI, 2.59%-8.52%), respectively. Regression analysis displayed no correlation between recurrence and the grade of hemorrhoid disease II, β= -0.0012 (95% CI, -0.0074 to 0.0049) (p = .64), grade III β= -0.0006 (95% CI, -0.0056 to 0.0045) (p = .79) and grade IV β = 0.0025 (95% CI, -0.0075 to 0.0124). However, a trend suggestive of increased recurrence was observed in patient populations with a higher proportion of grade IV disease. CONCLUSION: ALTA sclerotherapy may be a safe and viable alternative for patients with hemorrhoidal disease. Long-term follow-up and high-quality randomized controlled trials will help define the place of ALTA sclerotherapy in the armamentarium of treatment of hemorrhoids.", "provenance": [ { "field": "n", "quote": "Twelve studies with 4249 patients met all the inclusion criteria and were eventually included." }, { "field": "population", "quote": "patients with hemorrhoidal disease" }, { "field": "intervention", "quote": "Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy for the treatment of hemorrhoidal disease" }, { "field": "comparator", "quote": "Primary endpoints included overall recurrence and type of recurrence" }, { "field": "primaryOutcome", "quote": "Primary endpoints included overall recurrence and type of recurrence while secondary endpoints included postoperative complications" }, { "field": "result", "quote": "The crude and pooled estimates of the overall recurrence and complications by the end of follow-up were 10% (95% CI, 6.52%-14.08%) and 5.20% (95% CI, 2.59%-8.52%), respectively." } ] }, { "id": "pmid:38408874", "pmid": "38408874", "doi": "10.1097/DCR.0000000000003085", "nctId": null, "pmcid": null, "title": "Hemorrhoidectomy: Does Age Make a Difference?", "firstAuthor": "Capece", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "retrospective", "n": 961, "nField": "reported", "population": "adults aged 18 to 75 with symptomatic grade II or III internal hemorrhoids", "intervention": "surgical removal of hemorrhoids (hemorrhoidectomy)", "comparator": "in-office procedures or medical management without surgery", "primaryOutcome": "whether patients chose surgery as initial treatment and how long it took to reach surgery, based on age and hemorrhoid grade", "result": "Grade III patients chose surgery first more often than grade II patients (27.6% vs 4.1%), and younger patients (18-30 and 31-50) chose surgery first more often than older patients (51-75) (23.5% and 22% vs 12.8%); among those who progressed to surgery after initial non-surgical treatment, time to surgery did not differ by age or grade", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It is a retrospective study looking only at treatment choices and timing, not at whether surgery or non-surgical care actually worked better, and the authors note patient and surgeon bias could affect results.", "directness": "indirect", "limitations": "Data only looked at age groups and their treatment selection; personal biases of surgeon and patient may alter results.", "followUp": "", "plainFinding": "Most grade II cases skipped surgery first.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38408874/", "sourceText": "BACKGROUND: Grade II and III hemorrhoids often require a multimodal approach that may ultimately culminate in surgical resection. Age and overall medical conditioning around the time of diagnosis can often impact the decision. OBJECTIVE: The objective of this study was to evaluate patients with a diagnosis of symptomatic grade II or grade III hemorrhoids and determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention. DESIGN: A retrospective cohort study. SETTINGS: Group practice at a single institution. PATIENTS: Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included. Patients with thrombosed hemorrhoids or surgical contraindications to hemorrhoidectomy were excluded. A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids. INTERVENTION: Treatments included hemorrhoidectomy, in-office procedures, and/or medical management. MAIN OUTCOME MEASURES: Baseline demographics, treatment choices, and time to hemorrhoidectomy (if applicable) were stratified and analyzed on the basis of hemorrhoid grade (grade II and III) and age groupings that were predetermined by the authors (18-30, 31-50, and 51-75 years). RESULTS: Patients with grade III versus grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in the age groups of 18 to 30 and 30 to 50 years were more likely to choose hemorrhoidectomy as the initial treatment management compared to those in the age group of 51 to 75 years (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age. LIMITATIONS: Data only looked at age groups and their treatment selection. Personal biases of surgeon and patient may alter results. CONCLUSIONS: Our study shows that the younger population tends to seek hemorrhoidectomy first over the older population. See Video Abstract . HEMORROIDECTOMA LA EDAD MARCA LA DIFERENCIA: ANTECEDENTES:Las hemorroides de grado II y III a menudo requieren un abordaje multimodal que en última instancia puede culminar en una resección quirúrgica. La edad y el estado médico general en el momento del diagnóstico a menudo pueden afectar la decisión.OBJETIVO:El objetivo de este estudio fue evaluar a pacientes con diagnóstico de hemorroides sintomáticas grado II o grado III y determinar la progresión a hemorroidectomía en función de la edad y el intervalo de tiempo entre el diagnóstico y la intervención quirúrgica.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:Práctica grupal en una sola institución.PACIENTES:Se incluyó a pacientes de 18 a 75 años con hemorroides internas de grado II o III entre 2015 y 2020. Se excluyeron los pacientes con hemorroides trombosadas o contraindicaciones quirúrgicas para hemorroidectomía. Un total de 961 pacientes cumplieron los criterios de inclusión para hemorroides de Grado II (n=442) y III (n=519).INTERVENCIÓN:Los tratamientos incluyeron hemorroidectomía, procedimientos en el consultorio y/o manejo médico.PRINCIPALES MEDIDAS DE RESULTADO:Los datos demográficos iniciales, las opciones de tratamiento y el tiempo hasta la hemorroidectomía (si corresponde) se estratificaron y analizaron según el grado de hemorroides (grado II y III) y los grupos de edad predeterminados por los autores (18-30, 31-50). y 51-75).RESULTADOS:Los pacientes con hemorroides de Grado III versus Grado II tuvieron más probabilidades de elegir la hemorroidectomía como tratamiento inicial (27,6% versus 4,1%). Los pacientes de los grupos de edad de 18 a 30 y de 30 a 50 años tenían más probabilidades de elegir la hemorroidectomía como tratamiento inicial en comparación con los de 51 a 75 años (23,5% y 22% frente a 12,8%). En los pacientes que inicialmente fueron tratados con manejo médico o procedimientos en el consultorio y luego progresaron a hemorroidectomía, no se observaron diferencias significativas en el tiempo hasta la hemorroidectomía según el grado o la edad de las hemorroides.LIMITACIONES:Los datos solo analizan los grupos de edad y su selección de tratamiento. Los sesgos personales del cirujano y del paciente pueden alterar los resultados.CONCLUSIÓN:Nuestro estudio muestra que la población más joven tiende a buscar primero la hemorroidectomía que la población de mayor edad. (Traducción-Dr. Felipe Bellolio ).", "provenance": [ { "field": "n", "quote": "A total of 961 patients met inclusion criteria for grade II (n = 442) and III (n = 519) hemorrhoids." }, { "field": "population", "quote": "Patients aged 18 to 75 years with grade II or grade III internal hemorrhoids between 2015 and 2020 were included." }, { "field": "intervention", "quote": "Treatments included hemorrhoidectomy, in-office procedures, and/or medical management." }, { "field": "comparator", "quote": "Treatments included hemorrhoidectomy, in-office procedures, and/or medical management." }, { "field": "primaryOutcome", "quote": "Baseline demographics, treatment choices, and time to hemorrhoidectomy (if applicable) were stratified and analyzed on the basis of hemorrhoid grade (grade II and III) and age groupings" }, { "field": "result", "quote": "Patients with grade III versus grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in the age groups of 18 to 30 and 30 to 50 years were more likely to choose hemorrhoidectomy as the initial treatment management compared to those in the age group of 51 to 75 years (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age." } ] }, { "id": "pmid:38403495", "pmid": "38403495", "doi": "10.1016/j.ajg.2024.01.007", "nctId": null, "pmcid": null, "title": "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)", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Arab J Gastroenterol", "year": 2024, "design": "retrospective", "n": 66, "nField": "reported", "population": "patients with grade III internal hemorrhoids", "intervention": "endoscopic rubber band ligation plus injection sclerotherapy using lidocaine plus lauromacrogol solution", "comparator": "same procedure using lauromacrogol alone", "primaryOutcome": "postoperative pain level and pain relief time", "result": "lower pain scores and faster pain relief with lidocaine plus lauromacrogol, no difference in side effects or treatment success", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, retrospective study comparing two non-surgical additive techniques, not surgery versus no surgery.", "directness": "indirect", "limitations": "Retrospective design, small and unequal group sizes, short follow-up of only 1 month.", "followUp": "1 month", "plainFinding": "Less pain with added lidocaine.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38403495/", "sourceText": "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.", "provenance": [ { "field": "population", "quote": "grade Ⅲ internal hemorrhoids patients who underwent ERBL combined with IS" }, { "field": "intervention", "quote": "lidocaine plus lauromacrogol group, 20 patients" }, { "field": "comparator", "quote": "control group (lauromacrogol group, 46 patients)" }, { "field": "primaryOutcome", "quote": "Postoperative pain (quantized by Visual Analogue Scale, VAS), pain relief time and postoperative adverse reactions were compared" }, { "field": "result", "quote": "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)" }, { "field": "n", "quote": "control group (lauromacrogol group, 46 patients) and study group (lidocaine plus lauromacrogol group, 20 patients)" } ] }, { "id": "pmid:38330500", "pmid": "38330500", "doi": "10.1093/postmj/qgae013", "nctId": null, "pmcid": null, "title": "Evaluation of a novel disposable endoscope for retroflexed endoscopic rubber band ligation of internal hemorrhoids: a randomized pilot study", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Postgrad Med J", "year": 2024, "design": "rct", "n": 42, "nField": "reported", "population": "adults with Grade II and III internal hemorrhoids", "intervention": "rubber band ligation using a new disposable endoscope", "comparator": "rubber band ligation using a traditional reusable endoscope", "primaryOutcome": "safety and treatment effectiveness of the banding procedure", "result": "both endoscope types were equally safe and effective, with similar therapeutic effects and complication rates", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a very small pilot trial of only 42 patients comparing two devices for the same procedure, not surgery versus non-surgical treatment.", "directness": "indirect", "limitations": "Small pilot study size; compares two endoscope types rather than addressing whether surgery is needed versus non-operative treatment.", "followUp": "postoperative Day 30", "plainFinding": "Disposable scope works as well as reusable one.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38330500/", "sourceText": "PURPOSE: Retroflexed endoscopic rubber band ligation (ERBL) for treating Grade II and III internal hemorrhoids using disposable endoscopes has not been previously assessed. We therefore compared the safety and effectiveness of ERBL for internal hemorrhoids using novel disposable endoscopes versus traditional reusable endoscopes. METHODS: This prospective randomized controlled trial involved 42 patients who underwent ERBL for Grade II and III internal hemorrhoids using either a disposable endoscope (n = 21) or a reusable endoscope (n = 21). Safety was assessed by the incidence of equipment failure, device-related adverse events, and in-procedure stability of vital signs. Effectiveness was assessed by the postoperative therapeutic effect, feasibility of retroflexed ERBL, and incidence of complications. RESULTS: In terms of safety, no life-threatening events, equipment failure, or device-related adverse effects occurred during the procedures in either group. The rate of diastolic blood pressure stability was significantly different between the two groups (P = .049), but the rates of systolic blood pressure and heart rate stability were similar. In terms of effectiveness, the therapeutic effects on postoperative Day 30 were similar in both groups. Image clarity and endoscopic flexibility in the disposable endoscope group were mildly inferior to those in the reusable endoscope group, but without statistical significance. Matching between the endoscope and ligating device was 100% in both groups. The incidence of complications on postoperative Days 1 and 10 was not significantly different between the two groups. CONCLUSION: Compared with reusable endoscopes, disposable endoscopes are equally safe, feasible, and reliable in ERBL for internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "This prospective randomized controlled trial involved 42 patients who underwent ERBL for Grade II and III internal hemorrhoids using either a disposable endoscope (n = 21) or a reusable endoscope (n = 21)." }, { "field": "population", "quote": "ERBL for Grade II and III internal hemorrhoids" }, { "field": "intervention", "quote": "using either a disposable endoscope (n = 21)" }, { "field": "comparator", "quote": "or a reusable endoscope (n = 21)" }, { "field": "primaryOutcome", "quote": "Safety was assessed by the incidence of equipment failure, device-related adverse events, and in-procedure stability of vital signs. Effectiveness was assessed by the postoperative therapeutic effect, feasibility of retroflexed ERBL, and incidence of complications." }, { "field": "result", "quote": "In terms of effectiveness, the therapeutic effects on postoperative Day 30 were similar in both groups." }, { "field": "result", "quote": "The incidence of complications on postoperative Days 1 and 10 was not significantly different between the two groups." } ] }, { "id": "pmid:38261136", "pmid": "38261136", "doi": "10.1007/s10151-023-02908-w", "nctId": null, "pmcid": "PMC10806988", "title": "Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "meta-analysis", "n": 9729, "nField": "reported", "population": "patients with hemorrhoidal disease, median age 52, mostly male", "intervention": "sclerotherapy (injection treatment, mainly with polidocanol)", "comparator": "other conservative or surgical treatments", "primaryOutcome": "treatment success rate, recurrence rate, and complications", "result": "similar success and recurrence rates, but fewer complications than comparator treatments", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it pools many studies and randomized trials, but the included studies vary in design, severity of disease, and quality, so confidence is only moderate", "directness": "direct", "limitations": "the abstract does not describe limitations of the individual studies in detail, though it calls for further research into long-term outcomes", "followUp": "", "plainFinding": "Fewer complications, similar success rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38261136/", "sourceText": "BACKGROUND: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of sclerotherapy methods for hemorrhoidal disease (HD) over the past 40 years. METHODS: The review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive literature search was conducted, including studies reporting the use of sclerotherapy in patients with HD. Study eligibility criteria were defined, and data were extracted independently by the authors. Random-effects meta-analyses were performed to assess outcomes of interest. RESULTS: Out of 1965 records identified, 44 studies met the inclusion criteria, involving 9729 patients. The majority of studies were conducted in Japan, followed by the UK, Italy, and Portugal. The median age of participants was 52 years, and the majority were male. The Goligher grade distribution indicated varying degrees of HD severity. Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent. The procedure was generally performed without pre-injection analgesia. The meta-analysis of 14 randomized controlled trials (RCTs) revealed that sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92). CONCLUSIONS: This systematic review highlights the safety and efficacy of sclerotherapy for HD, which yields similar success rates and fewer complications compared to other conservative or surgical approaches. Further research is warranted to optimize sclerotherapy techniques and evaluate long-term outcomes. REGISTRATION: PROSPERO 2023 CRD42023396910.", "provenance": [ { "field": "n", "quote": "44 studies met the inclusion criteria, involving 9729 patients" }, { "field": "population", "quote": "The median age of participants was 52 years, and the majority were male." }, { "field": "intervention", "quote": "Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent." }, { "field": "comparator", "quote": "compared to other conservative or surgical approaches" }, { "field": "primaryOutcome", "quote": "success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92)" }, { "field": "result", "quote": "sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92)" } ] }, { "id": "pmid:38174849", "pmid": "38174849", "doi": "10.1308/rcsann.2023.0097", "nctId": null, "pmcid": "PMC11658878", "title": "Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients", "firstAuthor": "Batra", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2025, "design": "retrospective", "n": 20, "nField": "reported", "population": "patients with symptomatic hemorrhoids who are on blood-thinning medication", "intervention": "injection sclerotherapy (a non-surgical in-office treatment)", "comparator": "no comparison group; some patients needed alternative procedures", "primaryOutcome": "symptoms (bleeding) going away for at least six months", "result": "90% of patients had their symptoms resolve using injection sclerotherapy while staying on their blood thinners, with no complications reported", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective case review with only 20 patients and no comparison group, so it can't prove the treatment works better than alternatives.", "directness": "direct", "limitations": "Retrospective design, small sample size, no control group, single center.", "followUp": "at least six months", "plainFinding": "Symptoms resolved without surgery in most.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38174849/", "sourceText": "BACKGROUND: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients. METHODS: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution. RESULTS: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported. CONCLUSION: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.", "provenance": [ { "field": "n", "quote": "A total of 20 patients" }, { "field": "population", "quote": "Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation." }, { "field": "intervention", "quote": "Injection sclerotherapy (IST) has been proposed as a treatment option for these patients." }, { "field": "comparator", "quote": "two (10%) patients requiring alternative interventions" }, { "field": "primaryOutcome", "quote": "The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months." }, { "field": "result", "quote": "Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment" }, { "field": "followUp", "quote": "no patient reporting bleeding for at least six months" } ] }, { "id": "pmid:38174653", "pmid": "38174653", "doi": "10.1111/ans.18849", "nctId": null, "pmcid": null, "title": "Use of pudendal nerve blocks in rubber band ligation of haemorrhoids: an Australia-wide cross-sectional analysis", "firstAuthor": "Watson", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2024, "design": "registry", "n": 346542, "nField": "reported", "population": "adults in Australia who had rubber band ligation for hemorrhoids", "intervention": "pudendal nerve block used during rubber band ligation", "comparator": "rubber band ligation without a pudendal nerve block", "primaryOutcome": "how often pudendal nerve blocks were used, and whether use varied by patient and hospital factors", "result": "4.04% of rubber band ligation admissions involved a pudendal nerve block, with use rising from 1.62% to 6.63% over the study period and much higher use in private hospitals", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a registry analysis of practice patterns, not of whether the procedure or the nerve block actually improves pain or outcomes.", "directness": "indirect", "limitations": "Aggregate administrative data only, no outcome measures such as pain or complication rates reported, and no comparison of rubber band ligation to surgery.", "followUp": "", "plainFinding": "Nerve block use varies, outcomes not studied.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38174653/", "sourceText": "BACKGROUND: Surgeons vary in their approach to preventing pain post rubber band ligation (RBL) of haemorrhoids, with pudendal nerve blocks (PNB) being one analgesic strategy. No data exists on how commonly PNBs are used in RBL in Australia, and whether use varies by year and patient and hospital characteristics. METHODS: Aggregate data from the National Hospital Morbidity Database was obtained for all admissions for RBL in Australia from 2012 to 2021, with and without a PNB, overall and in relation to sex, age group, hospital remoteness, hospital sector, and year of procedure. Adjusted relative risks (adj. RR) of PNB were estimated using Poisson regression, mutually adjusting for all variables. RESULTS: Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB. The proportion of patients receiving a PNB increased between 2012-2013 and 2020-2021, from 1.62% to 6.63% (adj. RR 3.99, CI 3.64-4.36). Patients most likely to receive a PNB were female (adj. RR 1.10; CI 1.07-1.14) aged 25-34 years (adj. RR 1.13; CI 1.01-1.26); in major-city (adj. RR 1.25 CI 1.20-1.30) and private hospitals (adj. RR 3.28 CI 3.13-3.45). CONCLUSION: This is the first published analysis of the use of PNB in RBL. Pudendal nerve block use has increased over time, with substantial variation in practice. Blocks were more than three times as likely to be used in private compared to public hospitals. If evidence supporting PNB use is established, equitable access to the procedure should be pursued.", "provenance": [ { "field": "n", "quote": "Of the 346 542 admissions for RBL, 14013 (4.04%) involved a PNB." }, { "field": "population", "quote": "all admissions for RBL in Australia from 2012 to 2021" }, { "field": "intervention", "quote": "pudendal nerve blocks (PNB) being one analgesic strategy" }, { "field": "comparator", "quote": "with and without a PNB" }, { "field": "primaryOutcome", "quote": "whether use varies by year and patient and hospital characteristics" }, { "field": "result", "quote": "The proportion of patients receiving a PNB increased between 2012-2013 and 2020-2021, from 1.62% to 6.63%" } ] }, { "id": "pmid:38157069", "pmid": "38157069", "doi": "10.1007/s00104-023-02010-9", "nctId": null, "pmcid": "PMC11649745", "title": "Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial", "firstAuthor": "Nada", "multipleAuthors": true, "journal": "Chirurgie (Heidelb)", "year": 2024, "design": "rct", "n": 70, "nField": "reported", "population": "adults with grade III and grade IV hemorrhoids (piles)", "intervention": "harmonic scalpel hemorrhoidectomy (HSH)", "comparator": "stapled hemorrhoidopexy (SH)", "primaryOutcome": "procedure time, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year", "result": "HSH had less bleeding, lower recurrence at 1 year, and higher patient satisfaction than SH, though SH was faster", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small single-center trial comparing two surgical techniques, not addressing whether surgery is needed at all, with only 1-year follow-up.", "directness": "indirect", "limitations": "Single-center, single-blind design with modest sample size and short 1-year follow-up; study compares two surgical methods rather than surgery versus non-surgical treatment.", "followUp": "1 year", "plainFinding": "Harmonic scalpel surgery had fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38157069/", "sourceText": "BACKGROUND: This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year. PATIENTS AND METHODS: This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles. RESULTS: The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024). CONCLUSION: Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.", "provenance": [ { "field": "population", "quote": "included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles" }, { "field": "intervention", "quote": "group II underwent HSH" }, { "field": "comparator", "quote": "Group I underwent SH" }, { "field": "primaryOutcome", "quote": "This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year." }, { "field": "result", "quote": "There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024)." }, { "field": "n", "quote": "included 50 (68.75%) male and 20 (31.25%) female patients" } ] }, { "id": "pmid:38110270", "pmid": "38110270", "doi": "10.3760/cma.j.cn441530-20231012-00128", "nctId": null, "pmcid": null, "title": "[Chinese expert consensus on the treatment of hemorrhoids by injection(2023 edition)]", "firstAuthor": "Anorectal Branch of Chinese Medical Doctor Association", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2023, "design": "guideline", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids, usually aged 25-65", "intervention": "injection therapy for hemorrhoids", "comparator": "no specific comparator stated", "primaryOutcome": "effectiveness and safety of injection treatment for hemorrhoids", "result": "expert consensus recommendations on drug types and methods for hemorrhoid injection treatment, no outcome data reported", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an expert consensus statement summarizing recommendations rather than a study reporting trial results or outcome data", "directness": "direct", "limitations": "no specific study data, outcomes, or comparative results are reported; it is a consensus/guideline document", "followUp": "", "plainFinding": "Consensus guidance, no outcome data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38110270/", "sourceText": "Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old, clinical bleeding, swelling, prolapse, pain, itching and anal discomfort, and repeatedly attacks and aggravated gradually, seriously affecting the quality of life of patients. The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures. Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy. As a result, it is favored by clinicians and patients. The injection treatment of hemorrhoids has been mentioned in various hemorrhoid treatment guidelines and consensus at home and abroad, but there is no special expert consensus for reference. Led by the Anorectal Physicians Branch of the Chinese Medical Doctor Association and the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association, experts in related fields in China were invited to review the latest evidence-based medical evidence at home and abroad and conducted evidence quality assessment and recommendation strength classification according to the GRADE system. This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition), aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment, and to provide reference for standardizing the use of different drugs and dosage forms, so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment.", "provenance": [ { "field": "population", "quote": "Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old" }, { "field": "intervention", "quote": "Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy." }, { "field": "comparator", "quote": "The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures." }, { "field": "primaryOutcome", "quote": "aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment, and to provide reference for standardizing the use of different drugs and dosage forms, so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment." }, { "field": "result", "quote": "This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition)" } ] }, { "id": "pmid:37957477", "pmid": "37957477", "doi": "10.1007/s11845-023-03566-5", "nctId": null, "pmcid": null, "title": "Excisional haemorrhoidectomy in Crohn's disease - is it time to question an old dogma?", "firstAuthor": "Geraghty", "multipleAuthors": true, "journal": "Ir J Med Sci", "year": 2024, "design": "systematic-review", "n": 67, "nField": "reported", "population": "patients with Crohn's disease who had hemorrhoid surgery", "intervention": "excisional hemorrhoidectomy (surgical removal of hemorrhoids)", "comparator": "no comparator; outcomes pooled across studies", "primaryOutcome": "complications including wound healing problems, proctectomy, bleeding, and other post-operative issues", "result": "no cases of proctectomy from poor wound healing; low rates of complications like bleeding, fissures, abscess, stricture", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small combined patient numbers from only four studies, with no control group and no randomization.", "directness": "indirect", "limitations": "Small cohort size, review of existing studies rather than new trial, no comparator group, further prospective trials recommended.", "followUp": "", "plainFinding": "Surgery seems safe in Crohn's patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37957477/", "sourceText": "BACKGROUND: Haemorrhoidectomy in Crohn's disease is controversial due to fears over poor wound healing leading to proctectomy. We aim to review the available literature and establish the role of excisional haemorrhoidectomy in Crohn's disease. METHODS: A review of the current scientific literature was conducted using Medline, PubMed and the Cochrane Central Registry of Controlled Trials. Clinical trials from 2005 to present, reporting outcomes of excisional haemorrhoidectomy in Crohn's disease, were included. Review articles and case reports were excluded. RESULTS: A cohort of 67 patients across four studies was included in this review. There were no reported cases of proctectomy related to haemorrhoidectomy or poor wound healing. One patient (1.5%) had a non-healing wound post-operatively. Four (6%) cases of post-operative bleeding were identified, two (3%) patients were diagnosed with anal fissures and two (3%) were treated after developing perianal abscess post-procedure. There was one (1.5%) case of urinary retention, and one (1.5%) subject developed an anal stricture. CONCLUSION: The current available evidence suggests a role for excisional haemorrhoidectomy in Crohn's disease patients with well-controlled symptomatic disease, though further prospective analysis is certainly warranted. The preferred operation (open vs closed) remains unclear. FUTURE RECOMMENDATIONS: Further prospective trials are required to investigate the optimal approach to haemorrhoidectomy in Crohn's disease.", "provenance": [ { "field": "n", "quote": "A cohort of 67 patients across four studies was included in this review." }, { "field": "population", "quote": "Haemorrhoidectomy in Crohn's disease is controversial due to fears over poor wound healing leading to proctectomy." }, { "field": "intervention", "quote": "excisional haemorrhoidectomy in Crohn's disease" }, { "field": "comparator", "quote": "Review articles and case reports were excluded." }, { "field": "primaryOutcome", "quote": "There were no reported cases of proctectomy related to haemorrhoidectomy or poor wound healing." }, { "field": "result", "quote": "There were no reported cases of proctectomy related to haemorrhoidectomy or poor wound healing. One patient (1.5%) had a non-healing wound post-operatively. Four (6%) cases of post-operative bleeding were identified, two (3%) patients were diagnosed with anal fissures and two (3%) were treated after developing perianal abscess post-procedure." }, { "field": "limitations", "quote": "further prospective analysis is certainly warranted" } ] }, { "id": "pmid:37949364", "pmid": "37949364", "doi": "10.1016/j.cireng.2023.09.006", "nctId": null, "pmcid": null, "title": "Haemorrhoidal artery distribution in patients with grade III and IV haemorrhoids treated with artery ligation and rectoanal repair. Assessment of Doppler guidance", "firstAuthor": "Puigdollers", "multipleAuthors": true, "journal": "Cir Esp (Engl Ed)", "year": 2024, "design": "case-series", "n": 146, "nField": "reported", "population": "Adults with grade III or IV hemorrhoids who had a Doppler-guided artery ligation procedure", "intervention": "Doppler-guided hemorrhoidal artery ligation and rectoanal repair (a minimally invasive surgical technique)", "comparator": "No comparison group; all patients received the same procedure", "primaryOutcome": "Number and clock-position locations of artery ligatures needed to stop blood flow (Doppler silence)", "result": "On average 7 ligatures and 3 mucopexies were needed per patient, with artery locations varying between patients, especially more on the right side of the rectum", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a single-group descriptive study of surgical technique with no comparison group, so it cannot show whether surgery works better than non-surgical treatment.", "directness": "indirect", "limitations": "No control or comparator group; focuses on anatomical/technical details of one surgical procedure rather than comparing surgery to non-surgical treatment or reporting symptom outcomes.", "followUp": "", "plainFinding": "Mapped artery locations, no outcomes reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37949364/", "sourceText": "INTRODUCTION: While haemorrhoidal dearterialization and mucopexy are accepted as a valid alternative to haemorrhoidectomy, differences exist regarding the fixed or variable location of the arteries to be ligated. Our aim was to shed light on this issue of arterial distribution in candidates for surgery. METHODS: The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain. The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence. RESULTS: In total, 146 patients were included: 111 (76%) men, and 35 (24%) women. Average age was 54 years (21-84). Grade III and grade IV haemorrhoids were diagnosed in 106 (72.6%) and 40 (27.4%) patients, respectively. The average number of ligatures per patient was 7 (range 2-12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1-4). The most frequent mucopexy locations were the left posterior, right posterior, and right anterior octants. CONCLUSIONS: While the greatest frequency of arterial ligatures occurred in odd-numbered clock positions, non-negligible percentages occurred in even-numbered clock positions, which, in our opinion, makes the use of Doppler necessary, given that arterial distribution is not the same in all patients. We also noted that more ligatures and mucopexies were needed on the right half of the rectal circumference than on the left side, suggesting greater right-side vascularization.", "provenance": [ { "field": "n", "quote": "In total, 146 patients were included" }, { "field": "population", "quote": "consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)" }, { "field": "intervention", "quote": "Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR)" }, { "field": "comparator", "quote": "The study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain." }, { "field": "primaryOutcome", "quote": "The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence." }, { "field": "result", "quote": "The average number of ligatures per patient was 7 (range 2-12). Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1-4)." } ] }, { "id": "pmid:37848640", "pmid": "37848640", "doi": "10.1007/s10151-023-02863-6", "nctId": null, "pmcid": null, "title": "Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids", "firstAuthor": "Tsunoda", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with grade III hemorrhoids", "intervention": "ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy combined with rectal mucopexy, a non-excisional surgery", "comparator": "none - no separate comparison group described in the methods", "primaryOutcome": "treatment success rate, postoperative pain, complications, and patient satisfaction", "result": "cumulative success rates were 96.5% at one year, 85.3% at three years, and 85.3% at five years, with low pain scores, few complications (5.3%), and high satisfaction (≥9/10)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective single-group case series with no comparison group, so it cannot show whether this treatment works better than surgery or no treatment.", "directness": "direct", "limitations": "Retrospective design using prospectively collected data from a single institution, no control or comparison group reported.", "followUp": "five years", "plainFinding": "High success, low pain, few problems.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37848640/", "sourceText": "BACKGROUND: Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for the treatment of internal hemorrhoids. ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study investigated the midterm outcomes of AM surgery in patients with hemorrhoids. METHODS: Patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution. Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed. RESULTS: The median number of ALTA injection procedures was 3 (range 1-4), and the median total injection dose was 19 mL (range 7-32 mL). The median number of mucopexy procedures was 2 (range 1-4). The median postoperative pain score (0 = no pain at all, 10 = worst pain imaginable) at rest or during defecation were ≤2. The total dose of analgesics administered during the first two weeks after surgery was 1 (range 0-25). Six patients (5.3%) showed postoperative complications: five showed Clavien-Dindo (C-D) grade I and one showed C-D grade IIIa complications. Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively. Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year. CONCLUSIONS: AM surgery is an effective non-excisional surgery with satisfactory mid-term results for grade III hemorrhoids, and is associated with lower complication rates, postoperative analgesic requirements, and higher patient satisfaction.", "provenance": [ { "field": "population", "quote": "Patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis" }, { "field": "intervention", "quote": "ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse" }, { "field": "intervention", "quote": "AM surgery is an effective non-excisional surgery with satisfactory mid-term results for grade III hemorrhoids" }, { "field": "comparator", "quote": "patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution" }, { "field": "primaryOutcome", "quote": "Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed." }, { "field": "result", "quote": "Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively." }, { "field": "result", "quote": "Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year." }, { "field": "result", "quote": "Six patients (5.3%) showed postoperative complications: five showed Clavien-Dindo (C-D) grade I and one showed C-D grade IIIa complications." } ] }, { "id": "pmid:37846728", "pmid": "37846728", "doi": "10.1177/00031348231207301", "nctId": null, "pmcid": null, "title": "Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease", "firstAuthor": "Cemil", "multipleAuthors": true, "journal": "Am Surg", "year": 2024, "design": "rct", "n": 85, "nField": "reported", "population": "adults aged 18-70 with grade 2 or 3 hemorrhoids whose symptoms persisted despite at least one month of medical treatment", "intervention": "laser hemorrhoidoplasty", "comparator": "Milligan-Morgan surgical hemorrhoidectomy", "primaryOutcome": "post-surgery pain, bleeding, and need for pain medication", "result": "Laser treatment caused less bleeding and lower pain scores right after surgery, but study authors concluded it was not more advantageous than standard surgery once pain is managed with simple painkillers", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small randomized trial comparing two surgical methods with only short-term follow-up, so it doesn't address whether surgery is needed at all.", "directness": "indirect", "limitations": "Only early/short-term results reported; unequal group sizes; compares two surgical techniques rather than surgery versus non-surgical care.", "followUp": "within 10 days", "plainFinding": "No clear surgery advantage, laser vs cutting.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37846728/", "sourceText": "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.", "provenance": [ { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty" }, { "field": "comparator", "quote": "Milligan-Morgan (MM) hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Postoperative VAS score and complications were recorded within 10 days." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness" }, { "field": "n", "quote": "total 85 patients aged 18-70 years old" }, { "field": "followUp", "quote": "Postoperative VAS score and complications were recorded within 10 days." } ] }, { "id": "pmid:37779168", "pmid": "37779168", "doi": "10.1007/s00384-023-04535-1", "nctId": null, "pmcid": "PMC10543959", "title": "Colonization of multidrug-resistant Gram-negative bacteria increases risk of surgical site infection after hemorrhoidectomy: a cross-sectional study of two centers in southern China", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "retrospective", "n": 432, "nField": "reported", "population": "patients with hemorrhoids who had hemorrhoid surgery", "intervention": "carrying multidrug-resistant bacteria in the rectum/anus before surgery", "comparator": "not carrying multidrug-resistant bacteria", "primaryOutcome": "infection at the surgical site after hemorrhoid surgery", "result": "patients colonized with multidrug-resistant bacteria had a much higher rate of surgical site infection than non-carriers", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a cross-sectional observational study at two centers without randomization, so it can show an association but not prove cause, and it doesn't address whether surgery itself is needed versus non-surgical treatment.", "directness": "indirect", "limitations": "cross-sectional design, risk of confounding, only two centers in one region, does not compare surgical to non-surgical treatment", "followUp": "", "plainFinding": "Bacterial colonization raised infection risk after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37779168/", "sourceText": "PURPOSE: The present study aims to determine the rectoanal colonization rate and risk factors for the colonization of present multidrug-resistant bacteria (MDRBs). In addition, the relationship between MDRB colonization and surgical site infection (SSI) following hemorrhoidectomy was explored. METHODS: A cross-sectional study was conducted in the Department of Colorectal Surgery of two hospitals. Patients with hemorrhoid disease, who underwent hemorrhoidectomy, were included. The pre-surgical screening of multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization was performed using rectal swabs on the day of admission. Then, the MDRB colonization rate was determined through the rectal swab. Logistic regression models were established to determine the risk factors for MDRB colonization and SSI after hemorrhoidectomy. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 432 patients met the inclusion criteria, and the MDRB colonization prevalence was 21.06% (91/432). The independent risk factors for MDRB colonization were as follows: patients who received ≥ 2 categories of antibiotic treatment within 3 months (odds ratio (OR): 3.714, 95% confidence interval (CI): 1.436-9.605, p = 0.007), patients with inflammatory bowel disease (IBD; OR: 6.746, 95% CI: 2.361-19.608, p < 0.001), and patients with high serum uric acid (OR: 1.006, 95% CI: 1.001-1.010, p = 0.017). Furthermore, 41.57% (37/89) of MDRB carriers and 1.81% (6/332) of non-carriers developed SSIs, with a total incidence of 10.21% (43/421). Based on the multivariable model, the rectoanal colonization of MDRBs (OR: 32.087, 95% CI: 12.052-85.424, p < 0.001) and hemoglobin < 100 g/L (OR: 4.130, 95% CI: 1.556-10.960, p = 0.004) were independently associated with SSI after hemorrhoidectomy. CONCLUSION: The rectoanal colonization rate of MDRBs in hemorrhoid patients is high, and this was identified as an independent risk factor for SSI after hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "A total of 432 patients met the inclusion criteria" }, { "field": "population", "quote": "Patients with hemorrhoid disease, who underwent hemorrhoidectomy, were included." }, { "field": "intervention", "quote": "the rectoanal colonization of MDRBs" }, { "field": "comparator", "quote": "1.81% (6/332) of non-carriers developed SSIs" }, { "field": "primaryOutcome", "quote": "the relationship between MDRB colonization and surgical site infection (SSI) following hemorrhoidectomy was explored" }, { "field": "result", "quote": "41.57% (37/89) of MDRB carriers and 1.81% (6/332) of non-carriers developed SSIs" } ] }, { "id": "pmid:37659951", "pmid": "37659951", "doi": "10.1016/j.asjsur.2023.08.194", "nctId": null, "pmcid": null, "title": "A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease", "firstAuthor": "Onder", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2023, "design": "retrospective", "n": 91, "nField": "reported", "population": "patients with third degree hemorrhoidal disease", "intervention": "Doppler-guided hemorrhoidal artery ligation (ADHL)", "comparator": "Ligasure hemorrhoidectomy (LH), a bipolar energy surgical removal method", "primaryOutcome": "operative time, hospital stay, postoperative pain, bleeding, and recurrence after surgery", "result": "ADHL had shorter operative time, shorter hospital stay (1.5 vs 3.05 days), quicker resolution of bleeding (1.4 vs 4.9 days), and similar recurrence rates (4 vs 3 patients) compared to LH", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study comparing two surgical techniques without randomization, so it cannot reliably separate treatment effects from other differences between patients.", "directness": "indirect", "limitations": "Retrospective design, no randomization, and the authors state prospective randomized trials are needed to confirm results.", "followUp": "", "plainFinding": "Less pain, shorter stay with artery ligation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37659951/", "sourceText": "BACKGROUND: Hemorrhoidal disease (HD) is the most common disease of the anorectal region. Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure, which is basically an electrosurgical device, is one of the treatment methods Ligasure hemorrhoidectomy (LH). In another method applied for the first time by Morinaga, the vascular plexus is provided by Doppler-guided ligation of the hemorrhoidal arteries (ADHL). In our study, we aimed to compare and evaluate the results of these two minimally invasive treatment methods. MATERIALS AND METHODS: Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study. Demographic data, complaints, number of hemorrhoidal structures, location, complications, operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results were evaluated from the patient files. RESULTS: The number of patients included in the study was 91. While 54 patients were treated with ADHL (group 1), 37 patients (group 2) were treated with LH. Although the gender distribution between the groups was similar, there was male predominance in both groups. The mean operative time was shorter in group 1. The number of packages was 2.7 in group 1 and 2.4 in group 2. The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group. In the postoperative period, bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2. While recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH. CONCLUSION: ADHL and LH techniques have advantages and disadvantages over each other. Although the ADHL technique seems to be superior to LH in terms of post-defecation pain and shorter hospital stay, prospective randomized controlled studies are needed to determine which method should be chosen in which patient.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease (HD) is the most common disease of the anorectal region" }, { "field": "population", "quote": "Patients treated with ADHL and LH for HD" }, { "field": "intervention", "quote": "Doppler-guided ligation of the hemorrhoidal arteries (ADHL)" }, { "field": "comparator", "quote": "Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure" }, { "field": "n", "quote": "The number of patients included in the study was 91." }, { "field": "result", "quote": "The mean operative time was shorter in group 1." }, { "field": "result", "quote": "The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group." }, { "field": "result", "quote": "bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2" }, { "field": "result", "quote": "recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH" }, { "field": "primaryOutcome", "quote": "operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results" } ] }, { "id": "pmid:37655699", "pmid": "37655699", "doi": "10.1039/d3fo02936k", "nctId": null, "pmcid": null, "title": "Positive efficacy of Lactiplantibacillus plantarum MH-301 as a postoperative adjunct to endoscopic sclerotherapy for internal hemorrhoids: a randomized, double-blind, placebo-controlled trial", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Food Funct", "year": 2023, "design": "rct", "n": 103, "nField": "reported", "population": "Adults with internal hemorrhoids (grade I-III) who underwent endoscopic sclerotherapy", "intervention": "Probiotic Lactiplantibacillus plantarum MH-301 taken for 4 weeks after the sclerotherapy procedure", "comparator": "Placebo after the same sclerotherapy procedure", "primaryOutcome": "Percentage of patients whose hemorrhoid symptom score dropped to zero after treatment", "result": "87.8% improved in the probiotic group versus 70.2% in the placebo group, a significant difference", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a well-designed randomized, double-blind, placebo-controlled trial, but it was modest in size and only tested a probiotic add-on after surgery, not surgery itself.", "directness": "indirect", "limitations": "Abstract does not report blinding of outcome assessors beyond double-blind design, long-term follow-up, or whether findings generalize beyond this specific procedure and probiotic strain.", "followUp": "", "plainFinding": "Probiotic helped recovery after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37655699/", "sourceText": "Background: Endoscopic sclerotherapy is a widely used minimally invasive procedure for internal hemorrhoids, yet postoperative symptoms remain a concern. The purpose of this study is to investigate the postoperative adjuvant efficacy of Lactiplantibacillus plantarum. Method: In this study, patients (≥18 years) with internal hemorrhoids that conformed to Goligher's classification of grade I-III received administration of L. plantarum MH-301 for 4 weeks following endoscopic sclerotherapy. The primary clinical endpoint in this study was the improvement rate, which was defined as the percentage of patients whose n-HDSS score decreased to 0 following the procedure. Stools were collected for high-throughput sequencing analysis post operation. Result: A total of 103 participants (51 in the LP group and 52 in the C group) were recruited, with 96 completing the entire trial (49 in the LP group and 47 in the C group). The primary clinical endpoint showed a higher improvement rate in the LP group (87.8% vs. 70.2%, P = 0.045). High-throughput sequencing analysis demonstrated that the LP group had a greater diversity of intestinal microbiota and a higher relative abundance of beneficial bacteria such as Bifidobacterium, Megamonas, and Lactobacillus. No significant difference in postoperative complications and adverse events was found. Conclusion: This paper concludes that the administration of L. plantarum MH-301 after endoscopic sclerotherapy can further increase the efficacy of the procedure and improve bowel movements. Regulation of intestinal microbiota may be the potential mechanism for the efficacy of L. plantarum MH-301.", "provenance": [ { "field": "population", "quote": "patients (≥18 years) with internal hemorrhoids that conformed to Goligher's classification of grade I-III received administration of L. plantarum MH-301 for 4 weeks following endoscopic sclerotherapy" }, { "field": "intervention", "quote": "administration of L. plantarum MH-301 for 4 weeks following endoscopic sclerotherapy" }, { "field": "comparator", "quote": "51 in the LP group and 52 in the C group" }, { "field": "primaryOutcome", "quote": "The primary clinical endpoint in this study was the improvement rate, which was defined as the percentage of patients whose n-HDSS score decreased to 0 following the procedure." }, { "field": "result", "quote": "The primary clinical endpoint showed a higher improvement rate in the LP group (87.8% vs. 70.2%, P = 0.045)." }, { "field": "n", "quote": "A total of 103 participants (51 in the LP group and 52 in the C group) were recruited" } ] }, { "id": "pmid:37616177", "pmid": "37616177", "doi": "10.1097/DCR.0000000000002885", "nctId": null, "pmcid": null, "title": "Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade III Hemorrhoidal Disease: The EMODART3 Multicenter Study", "firstAuthor": "Giuliani", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2023, "design": "retrospective", "n": 1681, "nField": "reported", "population": "adults with grade III hemorrhoids", "intervention": "artery ligation surgery with mucopexy (a less invasive technique)", "comparator": "traditional excisional hemorrhoidectomy surgery", "primaryOutcome": "symptoms, postoperative complications, and recurrence at 24 months", "result": "excisional surgery had more complications, but artery ligation had more recurrences at 24 months", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study pooling self-reported data from multiple centers, not a randomized trial, so it cannot reliably prove one surgery is better than the other.", "directness": "indirect", "limitations": "The retrospective design and the self-reported nature of data from different centers.", "followUp": "24 months", "plainFinding": "Fewer complications but more recurrence with artery ligation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37616177/", "sourceText": "BACKGROUND: Over the past few decades, several surgical approaches have been proposed to treat hemorrhoids. OBJECTIVE: This multicenter study aimed to compare transanal hemorrhoidal artery ligation and conventional excisional hemorrhoidectomy for grade III hemorrhoidal disease. DESIGN: Multicenter retrospective study. SETTINGS: Any center belonging to the Italian Society of Colorectal Surgery in which at least 30 surgical procedures per year for hemorrhoidal disease were performed was able to join the study. PATIENTS: Clinical data from patients with Goligher's grade III hemorrhoidal disease who underwent excisional hemorrhoidectomy or hemorrhoidal artery ligation were retrospectively analyzed after a 24-month follow-up period. MAIN OUTCOME MEASURES: The primary aims were to evaluate the adoption of 2 different surgical techniques and to compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up. RESULTS: Data from 1681 patients were analyzed. The results of both groups were comparable in terms of postoperative clinical score by multiple regression analysis and matched case-control analysis. Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; p = 0.006). A secondary analysis highlighted that excisional hemorrhoidectomy performed with new devices and hemorrhoidal artery ligation reported a significantly lower risk for complications than excisional hemorrhoidectomy performed with traditional monopolar diathermy. At the 24-month follow-up assessment, recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001). A secondary analysis did not show a higher risk of recurrences based on the type of device. LIMITATIONS: The retrospective design and the self-reported nature of data from different centers. CONCLUSIONS: Hemorrhoidal artery ligation is an effective option for grade III hemorrhoidal disease; however, it is burdened by a high risk of recurrences. Excisional hemorrhoidectomy performed with newer devices is competitive in terms of postoperative complications.HEMORROIDECTOMÍA POR ESCISIÓN VERSUS DESARTERIALIZACIÓN CON MUCOPEXIA PARA EL TRATAMIENTO DE LA ENFERMEDAD HEMORROIDAL DE GRADO 3: EL ESTUDIO MULTICÉNTRICO EMODART3ANTECEDENTES:En las últimas décadas se han propuesto varios abordajes quirúrgicos para el tratamiento de las hemorroides.OBJETIVO:Este estudio multicéntrico tiene como objetivo comparar la ligadura de la arteria hemorroidal transanal y la hemorroidectomía por escisión convencional para la enfermedad hemorroidal de grado III.DISEÑO:Estudio retrospectivo multicéntrico.ÁMBITO:Cualquier centro perteneciente a la Sociedad Italiana de Cirugía Colorrectal en el que se realizaron al menos 30 procedimientos quirúrgicos por año para la enfermedad hemorroidal pudo participar en el estudio.PACIENTES:Los datos clínicos de pacientes con enfermedad hemorroidal de grado III de Goligher que se sometieron a hemorroidectomía por escisión o ligadura de arterias hemorroidales se analizaron retrospectivamente después de un período de seguimiento de 24 meses.PRINCIPALES MEDIDAS DE RESULTADO:Los objetivos primarios fueron evaluar la adopción de dos técnicas quirúrgicas diferentes y compararlas en términos de síntomas, eventos adversos posoperatorios y recurrencias a los 24 meses de seguimiento.RESULTADOS:Se analizaron datos de 1681 pacientes. Los 2 grupos resultaron ser comparables en términos de puntuación clínica posoperatoria mediante análisis de regresión múltiple y análisis de casos y controles emparejados. Los pacientes sometidos a hemorroidectomía excisional tuvieron un riesgo significativamente mayor de complicaciones posoperatorias (odds ratio ajustado = 1,58; p = 0,006). Un análisis secundario destacó que la hemorroidectomía por escisión realizada con nuevos dispositivos y la ligadura de la arteria hemorroidal informaron un riesgo significativamente menor de complicaciones que la hemorroidectomía por escisión realizada con diatermia monopolar tradicional. En la evaluación de seguimiento de 24 meses, la recurrencia fue significativamente mayor en el grupo de ligadura de la arteria hemorroidal (razón de probabilidad ajustada = 0,50; p = 0,001). Un análisis secundario no mostró un mayor riesgo de recurrencias según el tipo de dispositivo.LIMITACIONES:El diseño retrospectivo y el carácter autoinformado de los datos de diferentes centros.CONCLUSIÓN:HAL es una opción efectiva para la enfermedad hemorroidal grado III; sin embargo, se ve afectado por un alto riesgo de recurrencias. La hemorroidectomía por escisión realizada con dispositivos más nuevos es competitiva en términos de complicaciones posoperatorias. (Traducción-Dr Yolanda Colorado ).", "provenance": [ { "field": "population", "quote": "patients with Goligher's grade III hemorrhoidal disease" }, { "field": "intervention", "quote": "hemorrhoidal artery ligation" }, { "field": "comparator", "quote": "excisional hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up" }, { "field": "result", "quote": "Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; p = 0.006)." }, { "field": "result", "quote": "recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001)" }, { "field": "n", "quote": "Data from 1681 patients were analyzed." }, { "field": "limitations", "quote": "The retrospective design and the self-reported nature of data from different centers." }, { "field": "followUp", "quote": "24-month follow-up period" } ] }, { "id": "pmid:37530049", "pmid": "37530049", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment of haemorrhoids in pregnancy: A retrospective review", "firstAuthor": "Fiordaliso", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "pregnant women with hemorrhoids", "intervention": "non-surgical treatments like fiber supplements, stool softeners, laxatives, topical medication or oral phlebotonics", "comparator": "surgery (hemorrhoidectomy)", "primaryOutcome": "appropriate management approach for hemorrhoids in pregnancy", "result": "conservative measures are generally safe; surgery reserved for severe complications like strangulation, thrombosis or intractable bleeding", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative literature review without systematic methodology or pooled data, so it cannot reliably establish whether one treatment works better than another.", "directness": "direct", "limitations": "The abstract does not describe systematic review methodology, quality assessment of included studies, or report on study selection criteria beyond search terms used.", "followUp": "", "plainFinding": "Non-surgical care usually enough; surgery for severe cases only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37530049/", "sourceText": "AIM: Haemorrhoids are varicose veins of the rectum covered by mucosa at or near the anal canal. They are normally asymptomatic, can occur at any age and affect both males and females. Haemorrhoids are common in young women and commoner during pregnancy and the puerperium. In this review, we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management. This is significant because there are currently no recommendations for pregnant patients with hemorrhoids. METHODS: The literature search comprised all the inherent published original papers; also abstract were included. No language selection was done. Search terms used were: \"hemorrhoid\", \"hemorrhoid therapy\", \"hemorrhoid in pregnancy\", \"hemorrhoid complication\". Data research was conducted using MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. gov, OVID and Cochrane Library querying for all articles related to treatment of hemorrhoidis in pregnancy. RESULTS: Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking. In case of massive bleeding, anal packing could be a simple and useful maneuver. Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding. KEY WORDS: Hemorrhoid, Hemorrhoid Therapy, Hemorrhoid in Pregnancy, Hemorrhoid Complication.", "provenance": [ { "field": "population", "quote": "Haemorrhoids are common in young women and commoner during pregnancy and the puerperium." }, { "field": "intervention", "quote": "Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women." }, { "field": "comparator", "quote": "Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding." }, { "field": "primaryOutcome", "quote": "we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management" }, { "field": "result", "quote": "Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking." }, { "field": "result", "quote": "Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding." } ] }, { "id": "pmid:37438655", "pmid": "37438655", "doi": "10.1007/s13304-023-01578-5", "nctId": null, "pmcid": null, "title": "Laser technology in proctological diseases: is it really the wave of the future?", "firstAuthor": "Solari", "multipleAuthors": true, "journal": "Updates Surg", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids", "intervention": "laser treatment for hemorrhoids", "comparator": "conventional hemorrhoidectomy", "primaryOutcome": "operative time, postoperative pain, bleeding, and cost", "result": "Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive.", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a scoping review with highly varied studies and only three randomized trials, so the findings are not very reliable.", "directness": "direct", "limitations": "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.", "followUp": "", "plainFinding": "Less pain than surgery, but costly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37438655/", "sourceText": "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.", "provenance": [ { "field": "n", "quote": "55 studies were included for the final revision." }, { "field": "result", "quote": "Laser treatments for hemorrhoids require a shorter operative time and show less postoperative pain and bleeding compared to conventional hemorrhoidectomy, but are more expensive." }, { "field": "primaryOutcome", "quote": "require a shorter operative time and show less postoperative pain and bleeding" }, { "field": "intervention", "quote": "Laser treatments for hemorrhoids" }, { "field": "comparator", "quote": "compared to conventional hemorrhoidectomy" }, { "field": "population", "quote": "Laser treatments for hemorrhoids" } ] }, { "id": "pmid:37389425", "pmid": "37389425", "doi": "10.1097/MOG.0000000000000960", "nctId": null, "pmcid": null, "title": "Endoscopic approaches to the management of hemorrhoids", "firstAuthor": "Kodilinye", "multipleAuthors": true, "journal": "Curr Opin Gastroenterol", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with internal hemorrhoids", "intervention": "endoscopic treatments such as rubber band ligation, sclerotherapy, and coagulation", "comparator": "different endoscopic techniques compared to each other", "primaryOutcome": "effectiveness and complications of endoscopic treatment for hemorrhoids", "result": "Endoscopic rubber band ligation works reasonably well but causes mild complications; other techniques are understudied and direct comparisons are lacking", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review of varied studies without pooled data, standardized comparisons, or patient numbers reported.", "directness": "direct", "limitations": "Abstract notes lack of standardization of clinical trials, variation in techniques and hemorrhoid grading, and insufficient head-to-head comparisons.", "followUp": "", "plainFinding": "Nonsurgical options show promise but need more study.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37389425/", "sourceText": "PURPOSE OF REVIEW: To review the literature within the last 5 years on the current status and future perspectives of the endoscopic management of internal hemorrhoids. RECENT FINDINGS: Despite the large burden of hemorrhoidal diseases, research in this area, particularly on endoscopic approaches for treatment, has been slow. Within the last 5 years, data has been published on the novel cap-assisted endoscopic sclerotherapy (CAES), which will continue to gain attention in the future. Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL), demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common. Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES. Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting. Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods, differences in the grading of hemorrhoids, and lack of standardization of clinical trials. The Goligher classification alone is inadequate for determining the management of symptomatic hemorrhoids and this warrants revision. SUMMARY: Gastroenterologists are poised to assume a greater role in the management of internal hemorrhoids with flexible endoscopy. Current endoscopic treatment options require further study.", "provenance": [ { "field": "population", "quote": "the endoscopic management of internal hemorrhoids" }, { "field": "intervention", "quote": "cap-assisted endoscopic sclerotherapy (CAES)" }, { "field": "intervention", "quote": "Rubber band ligation has been adopted by the endoscopist as endoscopic rubber band ligation (ERBL)" }, { "field": "comparator", "quote": "Data is needed on head-to-head comparisons between ERBL, endoscopic sclerotherapy, and CAES." }, { "field": "primaryOutcome", "quote": "current status and future perspectives of the endoscopic management of internal hemorrhoids" }, { "field": "result", "quote": "demonstrating satisfactory results in treating symptomatic hemorrhoids, although mild postprocedure complications are common" }, { "field": "result", "quote": "Other methods, such as coagulation, are understudied and should be explored further in the endoscopic setting." }, { "field": "result", "quote": "Meaningful comparisons between treatment methods for internal hemorrhoids have been difficult because of variations in interventional techniques and methods" } ] }, { "id": "pmid:37349572", "pmid": "37349572", "doi": "10.1007/s00423-023-02990-6", "nctId": null, "pmcid": null, "title": "Quality of life and outcomes after rubber band ligation for haemorrhoidal disease", "firstAuthor": "Pastor Peinado", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2023, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "adults with symptomatic grade II-III hemorrhoids that did not improve after 6 months of non-surgical treatment", "intervention": "rubber band ligation (RBL) of hemorrhoids", "comparator": "no comparison group; scores measured before and after treatment in the same patients", "primaryOutcome": "change in quality of life using symptom and health scores (HDSS and SHS)", "result": "significant reduction in symptom and health scale scores, with 89% overall success and 76% patient satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison treatment, so it cannot show whether banding worked better than no treatment or surgery.", "directness": "direct", "limitations": "No control group was used, so improvements cannot be directly attributed to the procedure alone; some patients needed repeat procedures and 12% had complications.", "followUp": "6 months", "plainFinding": "Less pain and improved symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37349572/", "sourceText": "PURPOSE: The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. METHODS: This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. RBL was offered as first-line treatment in this group. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale).Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. RESULTS: A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (p < 0.001). The main improvement was found in the first month and it was maintained until the sixth month. A high degree of satisfaction with the procedure was reported by 76% of patients. The overall success rate of banding was 89%. A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%). CONCLUSION: Rubber band ligation, as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment, leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients.", "provenance": [ { "field": "n", "quote": "A total of 100 patients were finally included." }, { "field": "population", "quote": "patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment" }, { "field": "intervention", "quote": "rubber band ligation (RBL)" }, { "field": "comparator", "quote": "RBL was offered as first-line treatment in this group." }, { "field": "primaryOutcome", "quote": "Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale)." }, { "field": "result", "quote": "a significant reduction was found in the HDSS and SHS scores (p < 0.001)" }, { "field": "result", "quote": "The overall success rate of banding was 89%." }, { "field": "result", "quote": "A high degree of satisfaction with the procedure was reported by 76% of patients." } ] }, { "id": "pmid:37325897", "pmid": "37325897", "doi": "10.1097/SLA.0000000000005961", "nctId": null, "pmcid": null, "title": "Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Ferguson Hemorrhoidectomy for Prolapsed Internal Hemorrhoids: A Multicenter Prospective Study", "firstAuthor": "Gachabayov", "multipleAuthors": true, "journal": "Ann Surg", "year": 2023, "design": "prospective-cohort", "n": 197, "nField": "reported", "population": "patients with prolapsed internal hemorrhoids in at least 3 columns", "intervention": "transanal hemorrhoidal dearterialization (THD) with mucopexy, a surgical technique", "comparator": "Ferguson hemorrhoidectomy, a traditional surgical removal of hemorrhoids", "primaryOutcome": "rate of hemorrhoid prolapse coming back after surgery", "result": "recurrence rates were similar between the two surgeries, but the newer technique caused less pain and higher patient satisfaction in the first weeks and months", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it followed many patients over several years across multiple centers, but surgeons chose which operation to perform rather than patients being randomly assigned, which could bias results", "directness": "indirect", "limitations": "Surgeons performed the operation they knew best rather than being randomly assigned, so the comparison is affected by surgeon experience and preference rather than a controlled randomization.", "followUp": "3.1 (1.0-5.5) years", "plainFinding": "Less pain, similar recurrence between two surgeries.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37325897/", "sourceText": "OBJECTIVE: To compare transanal hemorrhoidal dearterialization (THD) with mucopexy to Ferguson hemorrhoidectomy in terms of recurrence rates and quality of life. BACKGROUND: There is uncertainty regarding the durability of the therapeutic effect of THD with mucopexy compared with Ferguson hemorrhoidectomy in terms of recurrence rates. METHODS: This was a multicenter prospective study. Participating surgeons performed the operation they knew best enrolling 10 patients each. Surgeons' unedited videos were reviewed by an independent expert. Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible. The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids. Patient-reported outcomes and satisfaction were evaluated with Pain Scale and Brief Pain Inventory, Fecal Incontinence Quality Of Life (FIQOL), Cleveland Clinic Incontinence, Constipation, Short-Form 12 scores, and Patient satisfaction (4-point Likert) scale. RESULTS: Twenty surgeons enrolled 197 patients. THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P =0.047), POD7 (4.5 vs 7.7, P =0.021), POD14 (2.8 vs 5.3, P <0.001), and medication use at POD14 (23% vs 58%, P <0.001). Median follow-up was 3.1 (1.0-5.5) years. Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P =0.253). Patient satisfaction rate was higher after THD at POD14 (76.4% vs 52.5%, P =0.031) and 3 months (95.1% vs 63.3%, P =0.029), but did not differ at 6 months (91.7% vs 88%, P =0.228) and 1 year (94.2% vs 88%, P =0.836). CONCLUSION: THD with mucopexy was associated with improved patient-reported outcomes and quality of life as compared with Ferguson hemorrhoidectomy with nonsignificantly different recurrence rates.", "provenance": [ { "field": "n", "quote": "Twenty surgeons enrolled 197 patients." }, { "field": "population", "quote": "Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible." }, { "field": "intervention", "quote": "transanal hemorrhoidal dearterialization (THD) with mucopexy" }, { "field": "comparator", "quote": "Ferguson hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids." }, { "field": "result", "quote": "Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P =0.253)." }, { "field": "result", "quote": "THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P =0.047), POD7 (4.5 vs 7.7, P =0.021), POD14 (2.8 vs 5.3, P <0.001)" }, { "field": "followUp", "quote": "Median follow-up was 3.1 (1.0-5.5) years." }, { "field": "limitations", "quote": "Participating surgeons performed the operation they knew best enrolling 10 patients each." } ] }, { "id": "pmid:37270601", "pmid": "37270601", "doi": "10.1186/s13063-023-07400-2", "nctId": null, "pmcid": "PMC10239572", "title": "Treatment of haemorrhoids: rubber band ligation or sclerotherapy (THROS)? Study protocol for a multicentre, non-inferiority, randomised controlled trial", "firstAuthor": "van Oostendorp", "multipleAuthors": true, "journal": "Trials", "year": 2023, "design": "registered-trial-no-results", "n": null, "nField": "not-reported", "population": "adults with mild (grade 1-2) hemorrhoids", "intervention": "rubber band ligation", "comparator": "sclerotherapy injection", "primaryOutcome": "symptom reduction, recurrence and complications", "result": "No results reported; this is a study protocol for a planned trial", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is only a trial protocol with no outcome data yet, so it cannot show whether either treatment works.", "directness": "direct", "limitations": "The abstract describes planned methodology only; no results, sample size outcomes, or follow-up data are yet available.", "followUp": "", "plainFinding": "No results yet; trial planned.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37270601/", "sourceText": "INTRODUCTION: Haemorrhoidal disease (HD) is a common condition with significant epidemiologic and economic implications. While it is possible to treat symptomatic grade 1-2 haemorrhoids with rubber band ligation (RBL) or sclerotherapy (SCL), the effectiveness of these treatments compatible with current standards has not yet been investigated with a randomised controlled trial. The hypothesis is that SCL is not inferior to RBL in terms of symptom reduction (patient-related outcome measures (PROMs)), patient experience, complications or recurrence rate. METHODS AND ANALYSIS: This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy for symptomatic grade 1-2 haemorrhoids in adults (> 18 years). Patients are preferably randomised between the two treatment arms. However, patients with a strong preference for one of the treatments and refuse randomisation are eligible for the registration arm. Patients either receive 4 cc Aethoxysklerol 3% SCL or 3 × RBL. The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates. Secondary outcome measures are patient experience, number of treatments and days of sick leave from work. Data are collected at 4 different time points. DISCUSSION: The THROS trial is the first large multicentre randomised trial to study the difference in effectivity between RBL and SCL for the treatment of grade 1-2 HD. It will provide information as to which treatment method (RBL or SCL) is the most effective, gives fewer complications and is experienced by the patient as the best option. ETHICS AND DISSEMINATION: The study protocol has been approved by the Medical Ethics Review Committee of the Amsterdam University Medical Centers, location AMC (nr. 2020_053). The gathered data and results will be submitted for publication in peer-reviewed journals and spread to coloproctological associations and guidelines. TRIAL REGISTRATION: Dutch Trial Register NL8377 . Registered on 12-02-2020.", "provenance": [ { "field": "population", "quote": "symptomatic grade 1-2 haemorrhoids in adults (> 18 years)" }, { "field": "intervention", "quote": "rubber band ligation (RBL)" }, { "field": "comparator", "quote": "sclerotherapy (SCL)" }, { "field": "primaryOutcome", "quote": "The primary outcome measures are symptom reduction by means of PROMs, recurrence and complication rates." }, { "field": "result", "quote": "This protocol describes the methodology of a non-inferiority, multicentre, randomised controlled trial comparing rubber band ligation and sclerotherapy" } ] }, { "id": "pmid:37267978", "pmid": "37267978", "doi": "10.1055/a-2068-4409", "nctId": null, "pmcid": null, "title": "[Hemorroids Therapy: a Tailored Approch]", "firstAuthor": "Pfeil", "multipleAuthors": true, "journal": "Zentralbl Chir", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with symptomatic hemorrhoids", "intervention": "non-surgical treatments (conservative care and sclerotherapy)", "comparator": "surgical treatments (various operations)", "primaryOutcome": "symptom control and quality of life", "result": "Most patients improve with non-surgical treatment; surgery is reserved for cases where conservative treatment fails, with rare complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative opinion-style review without study data, numbers, or methods, so it cannot reliably establish what works.", "directness": "direct", "limitations": "No study design, sample size, or data are reported; this is a narrative summary of clinical practice.", "followUp": "", "plainFinding": "Most cases improve without surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37267978/", "sourceText": "One of the most common reasons to consult a coloproctologist is symptomatic haemorrhoids. Typical signs and symptoms as well as a specialised examination, including proctoscopy, are essential for the correct diagnosis. The vast majority of patients can be treated conservatively with excellent results in terms of quality of life. Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease. If conservative treatment fails, there are various surgical options. A tailored approach is mandatory. Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA. Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.", "provenance": [ { "field": "population", "quote": "symptomatic haemorrhoids" }, { "field": "intervention", "quote": "The vast majority of patients can be treated conservatively with excellent results in terms of quality of life." }, { "field": "comparator", "quote": "If conservative treatment fails, there are various surgical options." }, { "field": "primaryOutcome", "quote": "excellent results in terms of quality of life" }, { "field": "result", "quote": "Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease." }, { "field": "result", "quote": "Postoperative bleeding, pain and faecal incontinence are rare complications after surgery." } ] }, { "id": "pmid:37188908", "pmid": "37188908", "doi": "10.1007/s00464-023-10108-8", "nctId": null, "pmcid": null, "title": "Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial", "firstAuthor": "Tian", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2023, "design": "rct", "n": 70, "nField": "reported", "population": "patients with symptomatic grade I to III hemorrhoids", "intervention": "rubber band ligation of hemorrhoids alone", "comparator": "combined ligation (hemorrhoids plus proximal normal mucosa)", "primaryOutcome": "overall therapeutic success rate (complete and partial resolution)", "result": "No significant difference in overall efficacy or recurrence between the two banding methods, but combined ligation caused more post-procedure pain", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a small, open-label randomized trial comparing two non-surgical techniques rather than against surgery itself, so results may not fully generalize.", "directness": "direct", "limitations": "Open-label design, modest sample size, and only 62 of 70 patients completed 12-month follow-up.", "followUp": "12 months", "plainFinding": "Banding works well, no surgery needed.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37188908/", "sourceText": "BACKGROUND: Endoscopic rubber band ligation (ERBL) is considered an effective nonsurgical treatment for symptomatic grade I to III hemorrhoids; however, it is unclear whether ligation of hemorrhoids or simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation) is safer and more effective. This controlled, open-label, and prospective study aimed to evaluate the efficacy and safety of both methods for symptomatic grade I to III hemorrhoids. METHODS: Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group). Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence. The primary outcome was overall therapeutic success rate (complete resolution and partial resolution rates). The secondary outcomes included recurrence rate and efficacy for each symptom. Complications and patient satisfaction were also assessed. RESULTS: Sixty-two patients (31 in each group) completed the 12-month follow-up; 42 (67.8%) experienced complete resolution, 17 (27.4%) experienced partial resolution, and 3 (4.8%) experienced no change in overall efficacy. The rates of complete resolution, partial resolution, and no change in the hemorrhoid ligation and combined ligation groups were 71.0 and 64.5%, 22.6 and 32.3%, and 6.5 and 3.2%, respectively. No significant differences in overall efficacy, recurrence rate, or efficacy for each symptom (including bleeding, prolapse, pain, anal swelling, itching, soiling, and constipation) were observed between groups. No life-threatening events requiring surgical intervention occurred. The incidence of postoperative pain was higher in the combined ligation group (74.2% vs. 45.2%, P = 0.02). No significant differences between groups in terms of incidences of other complications or patient satisfaction were observed. CONCLUSION: Both methods achieved satisfactory therapeutic effects. No significant differences in efficacy and safety of the two ligation methods were observed; however, combined ligation resulted in a higher incidence of postprocedural pain.", "provenance": [ { "field": "n", "quote": "Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group)." }, { "field": "population", "quote": "symptomatic grade I to III hemorrhoids" }, { "field": "intervention", "quote": "ligation of hemorrhoids" }, { "field": "comparator", "quote": "simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation)" }, { "field": "primaryOutcome", "quote": "The primary outcome was overall therapeutic success rate (complete resolution and partial resolution rates)." }, { "field": "result", "quote": "No significant differences in overall efficacy, recurrence rate, or efficacy for each symptom (including bleeding, prolapse, pain, anal swelling, itching, soiling, and constipation) were observed between groups." }, { "field": "result", "quote": "The incidence of postoperative pain was higher in the combined ligation group (74.2% vs. 45.2%, P = 0.02)." }, { "field": "followUp", "quote": "Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence." } ] }, { "id": "pmid:37133577", "pmid": "37133577", "doi": "10.1007/s00384-023-04394-w", "nctId": null, "pmcid": null, "title": "HEmoRhoidal disease management with Band ligation versus polidocanol Sclerotherapy: a systematic review and meta-analysis (the HerBS Review)", "firstAuthor": "Patel", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "adults with grade I-III symptomatic internal hemorrhoids", "intervention": "polidocanol sclerotherapy (injection treatment)", "comparator": "rubber band ligation", "primaryOutcome": "treatment success and complications after the procedure", "result": "Sclerotherapy had a higher success rate (93%) than banding (75%); complication rates were not significantly different (8% vs 18%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Most included studies were small, single-arm, or non-randomized, so the comparison between treatments is not very reliable.", "directness": "direct", "limitations": "Only 3 of the included studies directly compared the two treatments; most were single-arm studies, and the abstract calls for randomized trials to confirm findings.", "followUp": "", "plainFinding": "Sclerotherapy may work better than banding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37133577/", "sourceText": "PURPOSE: Symptomatic internal hemorrhoids affect up to 40% of people in Western society. Patients with grade I-III hemorrhoids, who fail lifestyle and medical management, may benefit from office-based procedures. As per the American Society of Colon and Rectum Surgeons (ASCRS), rubber band ligation (RBL) is the first-line office-based treatment. Polidocanol sclerotherapy is a relatively new approach for these patients. The aim of this systematic review is to compare the efficacy of RBL and polidocanol sclerotherapy with the treatment of symptomatic grade I-III internal hemorrhoids. METHODS: The systematic review was completed by searching MEDLINE, Embase, and CENTRAL databases from inception to August 2022 for prospective studies comparing RBL and polidocanol sclerotherapy or evaluating the efficacy of polidocanol sclerotherapy alone for adult (> 18 years) patients with grade I-III internal hemorrhoids. Treatments were evaluated for therapeutic success and post-procedure morbidity. RESULTS: Of 155 citations obtained, 10 studies (3 comparative and 7 single-arm studies) and 4 abstracts (2 comparative and 2 single arm) were included in the study. The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31). CONCLUSION: This study highlights that polidocanol sclerotherapy may be associated with higher therapeutic success in patients with symptomatic grade I-III internal hemorrhoids. Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy.", "provenance": [ { "field": "population", "quote": "adult (> 18 years) patients with grade I-III internal hemorrhoids" }, { "field": "intervention", "quote": "polidocanol sclerotherapy" }, { "field": "comparator", "quote": "rubber band ligation (RBL)" }, { "field": "primaryOutcome", "quote": "Treatments were evaluated for therapeutic success and post-procedure morbidity." }, { "field": "result", "quote": "The patients undergoing sclerotherapy had a 93% (151/163) therapeutic success rate compared to 75% (68/91) in the RBL group (OR 3.39, 95% CI 1.48-7.74, p < 0.01). The post-procedure morbidity was 8% (17/200) in the sclerotherapy group and 18% (23/128) in the RBL group (OR 0.53, 95% CI 0.15-1.82, p = 0.31)." }, { "field": "limitations", "quote": "Further evaluations in the form of randomized trials are required to evaluate patient populations, which may benefit more from sclerotherapy." } ] }, { "id": "pmid:37117040", "pmid": "37117040", "doi": "10.1136/pmj-2022-141941", "nctId": null, "pmcid": null, "title": "Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials", "firstAuthor": "Ding", "multipleAuthors": true, "journal": "Postgrad Med J", "year": 2023, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "patients with haemorrhoids", "intervention": "rubber band ligation (a non-surgical treatment)", "comparator": "coagulation therapy (a non-surgical treatment)", "primaryOutcome": "treatment success, prolapse, recurrence, pain, bleeding and urine retention rates", "result": "No significant difference in efficacy, prolapse, recurrence or urine retention; rubber band ligation had more pain but less bleeding than coagulation", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools nine randomized trials, but all were rated only moderate quality so the findings are not fully certain.", "directness": "direct", "limitations": "All trials were of moderate methodological quality.", "followUp": "", "plainFinding": "Both work similarly; banding hurts more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37117040/", "sourceText": "Non-surgical therapies have the advantage of lower postoperative pain and complication rates compared with surgical therapies. Rubber band ligation and coagulation are two kinds of non-surgical therapies. The aim of this study is to compare the clinical outcomes of rubber band ligation and coagulation. A systematic review was conducted to identify randomised clinical trials that compare rubber band ligation and coagulation treatments for haemorrhoids. PubMed and Web of Science were searched, from inception to April 30th,2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Fifty-nine studies were identified. Nine trials met the inclusion criteria. All trials were of moderate methodological quality. No significant difference was found between rubber band ligation and coagulation in terms of efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate after treatment. Patients undergoing rubber band ligation had higher postoperative pain rate and lower postoperative bleeding rate than patients undergoing coagulation. The subgroup analysis showed that there was no significant difference between rubber band ligation and infrared coagulation or non-infrared coagulation in terms of efficacy rate, postoperative bleeding and postoperative urine retention rate after treatment. Patients undergoing rubber band ligation had a higher postoperative pain rate than patients undergoing infrared coagulation or non-infrared coagulation. We believe that coagulation for haemorrhoids still has a good future. PROSPERO registration number CRD42022311281.", "provenance": [ { "field": "population", "quote": "compare rubber band ligation and coagulation treatments for haemorrhoids" }, { "field": "intervention", "quote": "Rubber band ligation" }, { "field": "comparator", "quote": "coagulation" }, { "field": "primaryOutcome", "quote": "efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate" }, { "field": "result", "quote": "No significant difference was found between rubber band ligation and coagulation in terms of efficacy rate, postoperative prolapse rate, recurrence rate and postoperative urine retention rate after treatment. Patients undergoing rubber band ligation had higher postoperative pain rate and lower postoperative bleeding rate than patients undergoing coagulation." }, { "field": "qualityWhy", "quote": "All trials were of moderate methodological quality." } ] }, { "id": "pmid:37106517", "pmid": "37106517", "doi": "10.2174/1871526523666230427115436", "nctId": null, "pmcid": null, "title": "Hemorrhoid Disease: A Review on Treatment, Clinical Research and Patent Data", "firstAuthor": "Devi", "multipleAuthors": true, "journal": "Infect Disord Drug Targets", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "various hemorrhoid treatments and newer drug molecules", "comparator": "not specified", "primaryOutcome": "safety and clinical efficacy of treatments", "result": "The review discusses the need for new molecules but does not report specific outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing literature without presenting specific study results, data, or methodology for pooling evidence.", "directness": "indirect", "limitations": "No specific study results, patient numbers, or outcome data are reported; it is a general literature summary.", "followUp": "", "plainFinding": "No specific finding reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37106517/", "sourceText": "BACKGROUND: Hemorrhoid disease (HD) is an anal-rectal ailment that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue. It is generally associated with bleeding, prolapse, pruritus, and discomfort, which results in a diminished quality of life and well-being. OBJECTIVE: To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids. METHOD: Reported literature available on Scopus, PubMed, Science Direct, Clinicaltrails.gov, and from many reputed foundations has been studied to summarize the recent development and clinical studies for the management of hemorrhoids. RESULTS AND CONCLUSION: The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed. This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.", "provenance": [ { "field": "population", "quote": "Hemorrhoid disease (HD) is an anal-rectal ailment" }, { "field": "intervention", "quote": "newer molecules to overcome hemorrhoids" }, { "field": "primaryOutcome", "quote": "safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids" }, { "field": "result", "quote": "The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed." }, { "field": "comparator", "quote": "various studies carried out in the past" } ] }, { "id": "pmid:37084307", "pmid": "37084307", "doi": "10.24875/CIRU.22000287", "nctId": null, "pmcid": null, "title": "Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease", "firstAuthor": "Dursun", "multipleAuthors": true, "journal": "Cir Cir", "year": 2023, "design": "retrospective", "n": 103, "nField": "reported", "population": "adults with grade 2, 3, or 4 internal hemorrhoids", "intervention": "laser hemorrhoidoplasty (a minimally invasive laser procedure)", "comparator": "no comparison group; results tracked within the same patients over time", "primaryOutcome": "symptom recovery, recurrence, pain, and complications after treatment", "result": "recurrence occurred in 17.6% of grade 2/3 patients and 50% of grade 4 patients, with minor complications in 2.9% and quick return to daily activity", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a retrospective study of one clinic's patients with no comparison group, so it cannot show whether laser treatment works better or worse than surgery or no treatment.", "directness": "indirect", "limitations": "retrospective design, no control or comparator group, single center, higher recurrence in more severe (grade 4) disease", "followUp": "6 months, 1 year, and 2 years", "plainFinding": "Low complications, but recurrence worse in severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37084307/", "sourceText": "INTRODUCTION: Minimally invasive techniques still continue to maintain their popularity in hemorrhoidal disease. In this study, we aimed to present the symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates of patients treated with the laser hemorrhoidoplasty (LHP) method in our clinic. METHODS: The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively. The patients enrolled in the study were followed for at least 6 months (6 months, 1 year, and 2 years) and their results were analyzed. RESULTS: A total of 103 patients were included in the study. Seventy-five (72.8%) of them were male and the mean age was 41.6 ± 13.6 years. The mean operation time was 17.9 ± 5.2 min and minor complications developed in 3 (2.9%) patients postoperatively. Mean time to return to normal daily life was 2.17 (1-11) days. Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019). CONCLUSION: LHP is a popular procedure which is effective in selected patient groups with acceptable recurrence rates.", "provenance": [ { "field": "population", "quote": "patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty (LHP) method" }, { "field": "comparator", "quote": "The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively." }, { "field": "primaryOutcome", "quote": "symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates" }, { "field": "result", "quote": "Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019)." }, { "field": "n", "quote": "A total of 103 patients were included in the study." }, { "field": "followUp", "quote": "followed for at least 6 months (6 months, 1 year, and 2 years)" } ] }, { "id": "pmid:37059872", "pmid": "37059872", "doi": "10.1007/s11845-023-03367-w", "nctId": null, "pmcid": null, "title": "Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids", "firstAuthor": "Xiong", "multipleAuthors": true, "journal": "Ir J Med Sci", "year": 2023, "design": "case-series", "n": 120, "nField": "reported", "population": "adults with internal hemorrhoids", "intervention": "endoscopic rubber band ligation (bands placed in a single session)", "comparator": "different hemorrhoid grades (II vs III) and different numbers of bands used", "primaryOutcome": "no hemorrhoid symptoms 6 weeks after treatment", "result": "78.8% of patients had no symptoms at 6 weeks; grade II hemorrhoids responded better than grade III (87.8% vs 69.2%), and recurrence occurred in 25% overall, higher for grade III", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study without a comparison group or randomization, so it can't show whether banding is better than surgery or no treatment.", "directness": "direct", "limitations": "No control group, no randomization, and follow-up time varied widely between patients.", "followUp": "14.3 ± 7.9 (1.3-30.9) months", "plainFinding": "Band ligation relieved most hemorrhoid symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37059872/", "sourceText": "BACKGROUND: There is no consensus on the number of ligation bands for varying grades of internal hemorrhoids (IH) in a single session of endoscopic rubber band ligation (ERBL). AIMS: The aims of this study were to investigate this issue. METHODS: Patients with IH were treated with ERBL. The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL. The secondary endpoints were postoperative complications and recurrence. RESULTS: One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded. The average bands were 3.9 ± 1.1, and grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000). 78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%). The incidence of postoperative complications was not significantly correlated with the grade of hemorrhoids (P = 0.201) and the number of bands (P = 0.886). The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months. The overall recurrence rate was 25.0%, with grade III significantly higher than grade I-II (32.8% vs 14.6%, P = 0.027). For grade III hemorrhoids, the recurrence rate was lower with more than 4 bands of ligation than with less than 4 bands (26.5% vs 53.3%). CONCLUSIONS: The average ERBL treatment of IH requires nearly four bands, and grade II hemorrhoids require less banding than grade III hemorrhoids, while the efficacy was better. Increasing the number of bands improves the treatment efficacy for grade III IH, which could be a strategy to reduce the recurrence rate without increasing postoperative complications.", "provenance": [ { "field": "n", "quote": "One hundred twenty-three eligible patients met the inclusion criteria, and 3 patients were excluded." }, { "field": "population", "quote": "Patients with IH were treated with ERBL." }, { "field": "intervention", "quote": "in a single session of endoscopic rubber band ligation (ERBL)" }, { "field": "comparator", "quote": "grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids" }, { "field": "primaryOutcome", "quote": "The primary endpoint was no hemorrhoid symptoms 6 weeks after ERBL." }, { "field": "result", "quote": "78.8% of patients achieved the primary endpoint. The efficacy of grade II hemorrhoids was higher than that of grade III hemorrhoids (87.8% vs 69.2%)." }, { "field": "followUp", "quote": "The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months." } ] }, { "id": "pmid:37020091", "pmid": "37020091", "doi": "10.1007/s00423-023-02879-4", "nctId": null, "pmcid": "PMC10076349", "title": "Mid-term efficacy and postoperative wound management of laser hemorrhoidoplasty (LHP) vs conventional excisional hemorrhoidectomy in grade III hemorrhoidal disease: the twisting trend", "firstAuthor": "Gambardella", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2023, "design": "retrospective", "n": 174, "nField": "reported", "population": "patients with grade III symptomatic hemorrhoidal disease", "intervention": "laser hemorrhoidoplasty (diode laser shrinkage of hemorrhoids)", "comparator": "conventional Milligan-Morgan excisional hemorrhoidectomy", "primaryOutcome": "postoperative pain, wound healing, symptom recurrence and quality of life", "result": "Laser treatment caused less pain and easier wound care but a higher rate of symptom recurrence than conventional surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison of two surgical techniques, so differences could be due to patient selection rather than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design without randomization; abstract states larger comparative studies are needed.", "followUp": "25 ± 8 months", "plainFinding": "Less pain, but more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37020091/", "sourceText": "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.", "provenance": [ { "field": "n", "quote": "93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment" }, { "field": "population", "quote": "grade III symptomatic HD patients undergoing LHP vs MM" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty treatment using a 1470-nm diode laser" }, { "field": "comparator", "quote": "conventional Milligan Morgan as control group" }, { "field": "primaryOutcome", "quote": "Postoperative pain, wound care management, symptoms' resolution, patients' quality of life, and length of return to daily activity" }, { "field": "result", "quote": "Laser hemorrhoidoplasty patients experienced lower postoperative pain score (p < 0.0001) and smoother wound management" }, { "field": "result", "quote": "the recurrence of symptoms occurred in 8.1% after Milligan-Morgan and 21.6% after laser hemorrhoidoplasty (p < 0.05)" }, { "field": "followUp", "quote": "After 25 ± 8 months follow-up" } ] }, { "id": "pmid:37005961", "pmid": "37005961", "doi": "10.1007/s10151-023-02787-1", "nctId": null, "pmcid": "PMC10485119", "title": "French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease", "firstAuthor": "Laurain", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "prospective-cohort", "n": 129, "nField": "reported", "population": "adults with grade II-III hemorrhoids", "intervention": "radiofrequency ablation (RFA) of hemorrhoids", "comparator": "no comparison group (before-and-after same patients)", "primaryOutcome": "quality of life score related to hemorrhoid disease at 3 months", "result": "quality of life score improved significantly and symptoms like bleeding and prolapse decreased", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This study had no comparison group, so it can't show if results are better than doing nothing or another treatment.", "directness": "direct", "limitations": "No control group to compare against; some patients needed repeat surgery for relapse or complications.", "followUp": "1 year", "plainFinding": "Fewer symptoms, better quality of life.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37005961/", "sourceText": "PURPOSE: The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. METHOD: This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. RESULTS: A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale). CONCLUSION: RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. CLINICAL TRIAL REGISTRATION AND DATE: Clinical trial NCT04229784 (18/01/2020).", "provenance": [ { "field": "population", "quote": "outpatients with grade II-III haemorrhoids" }, { "field": "intervention", "quote": "RFA (Rafaelo©)" }, { "field": "n", "quote": "A total of 129 patients" }, { "field": "primaryOutcome", "quote": "Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery." }, { "field": "result", "quote": "Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months." }, { "field": "comparator", "quote": "This prospective multicentre study assessed RFA" }, { "field": "followUp", "quote": "1 year's follow-up" } ] } ], "faqs": [ { "q": "Will I definitely need surgery for my hemorrhoids?", "a": "No. Most people, especially with milder hemorrhoids, are managed first with diet changes, creams, or office procedures like banding. Surgery is generally reserved for more severe or grade III-IV disease that hasn't responded to these." }, { "q": "Is rubber band ligation as good as surgery?", "a": "Not for grade III hemorrhoids, based on the trial that tested this directly. Banding caused less pain and let people return to activity sooner, but hemorrhoids came back much more often than after surgery (about 48% vs 6% within a year)." }, { "q": "Should I stop a non-surgical treatment if it isn't working?", "a": "Yes. If office procedures or conservative measures aren't controlling your symptoms, guidance reviewed here suggests moving on to surgery rather than repeating the same approach indefinitely." }, { "q": "What are the risks of non-surgical treatments like banding?", "a": "Most side effects are mild and temporary, but rare serious bleeding has been reported after banding. Tell your doctor right away about any heavy bleeding after the procedure." }, { "q": "What are the risks of surgery?", "a": "Surgery causes more pain and a longer recovery than office procedures. Infection risk is higher in people who carry certain resistant bacteria, and like any surgery it carries a small chance of serious complications." }, { "q": "Are there any safety risks I should watch for after a hemorrhoid procedure?", "a": "Yes. Reported problems include delayed heavy bleeding after rubber band ligation, occurring about two weeks later in one case (32), and a serious bowel wall injury (rectal perforation) after laser hemorrhoidoplasty that required emergency surgery (76). People who carry drug-resistant bacteria in the rectum also had a much higher rate of wound infection after surgical hemorrhoid removal (97). These problems are uncommon, but if you develop new or worsening bleeding, fever, severe pain, or swelling in the days or weeks after any hemorrhoid treatment, contact your doctor or go to an emergency room right away rather than waiting it out. Choosing an experienced provider and asking what warning signs to watch for before your procedure is the best way to catch a problem early." }, { "q": "Are there any serious risks I should know about before choosing a treatment?", "a": "Yes, though they appear to be rare. Case reports describe a woman who had massive rectal bleeding two weeks after rubber-band banding, and another who developed a rectal perforation with sepsis and organ failure after laser hemorrhoidoplasty, needing emergency surgery; a separate study found that patients carrying drug-resistant bacteria had a much higher infection rate after hemorrhoid surgery, and laboratory modeling of laser heating showed how uneven heat could damage the layers of rectal tissue. These reports do not tell us how often such problems happen, but they are a reason to have any hemorrhoid procedure done by an experienced clinician. If you develop heavy bleeding, fever, severe pain, or are unable to pass urine or stool after a procedure, contact a doctor right away instead of waiting it out." } ], "patientTakeaway": "For many people, especially with milder hemorrhoids, office treatments such as banding or diet changes work and surgery isn't needed. For grade III hemorrhoids, the trial evidence here shows surgery keeps hemorrhoids from coming back far more often than banding, even though it hurts more right after and takes longer to recover from. Both approaches have rare but serious risks, so talk with your doctor about which trade-off - less pain now, or fewer repeat procedures later - matters more to you.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Hemorrhoids/surgery\"[Mesh] OR \"Hemorrhoids/therapy\"[Mesh]) AND (\"Hemorrhoidectomy\"[Mesh] OR \"Sclerotherapy\"[Mesh] OR \"Ligation\"[Mesh] OR \"Laser Therapy\"[Mesh] OR nonsurgical[tiab] OR \"non-surgical\"[tiab] OR \"rubber band ligation\"[tiab] OR \"infrared coagulation\"[tiab] OR \"laser hemorrhoidoplasty\"[tiab])" }, "pubmedQueryTranslation": "(\"hemorrhoids/surgery\"[MeSH Terms] OR \"hemorrhoids/therapy\"[MeSH Terms]) AND (\"Hemorrhoidectomy\"[MeSH Terms] OR \"Sclerotherapy\"[MeSH Terms] OR \"Ligation\"[MeSH Terms] OR \"Laser Therapy\"[MeSH Terms] OR \"nonsurgical\"[Title/Abstract] OR \"non-surgical\"[Title/Abstract] OR \"rubber band ligation\"[Title/Abstract] OR \"infrared coagulation\"[Title/Abstract] OR \"laser hemorrhoidoplasty\"[Title/Abstract])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Do Hemorrhoids Need Surgery or Non-Surgical Care?", "description": "15 trials compared surgery and non-surgical hemorrhoid treatments: surgery cuts recurrence but both carry rare, serious risks." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }