{ "slug": "what-is-a-prolapsed-hemorrhoid", "question": "What is a prolapsed hemorrhoid, and how do you treat it?", "shortTitle": "Prolapsed Hemorrhoid Treatment", "clinicalQuestion": "In adults with grade III–IV internal hemorrhoids that protrude through the anus, what defines a prolapsed hemorrhoid, and which treatments (manual reduction, rubber band ligation, excisional hemorrhoidectomy, stapled hemorrhoidopexy, or conservative care) resolve the prolapse and prevent recurrence?", "pico": { "population": "Adults with prolapsed internal hemorrhoids (grade III or IV hemorrhoidal disease)", "intervention": "Treatments for prolapsed hemorrhoids, including manual reduction, rubber band ligation, excisional hemorrhoidectomy, and stapled hemorrhoidopexy", "comparator": "No treatment, conservative management, or an alternative procedural treatment", "outcomes": [ "resolution or reduction of prolapse", "symptom score (pain, bleeding, itching, soiling)", "recurrence rate at 12 months", "complication rate", "time to return to normal activity", "need for repeat or escalated intervention" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "rectal-prolapse", "anal-fissure" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "A prolapsed hemorrhoid is internal hemorrhoid tissue that has slipped down and bulges out of the anus; a well-conducted analysis of randomized trials found that stapling it back in place lets it prolapse again more often than cutting it out, though stapling causes less pain at first.", "detail": "This comes from a pooled analysis of 17 randomized trials comparing stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy, which found a higher rate of prolapse returning after stapling, especially prolapse-specific recurrence, with no difference in needing further surgery, anal function, or quality of life. Other approaches such as rubber band ligation have also been compared with cutting the hemorrhoid out in smaller trials, with results that point the same direction but are less consistent, so the overall picture is only moderately certain.", "studyIds": [ "pmid:41535511", "pmid:40125221", "pmid:39952268", "pmid:42478482" ] }, "strength": { "level": "moderate", "why": "8 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": "A well-conducted study in people reported harm.", "override": null }, "counts": { "recordsRetrieved": 1242, "recordsScreened": 196, "included": 177, "rcts": 29, "systematicReviews": 14, "observational": 81, "participants": 46835, "yearFrom": 2023, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Resolution or reduction of prolapse", "status": "improvement", "note": "Across many single-arm and comparative studies, most people had the visible prolapse shrink or disappear after banding, laser, or surgical treatment, though few studies compared treatment with doing nothing at all.", "studyIds": [ "pmid:42791481", "pmid:42573173", "pmid:42323500", "pmid:41958563", "pmid:40979427", "pmid:40922264", "pmid:39183158" ] }, { "name": "Symptom score (pain, bleeding, itching, soiling)", "status": "improvement", "note": "Pain, bleeding, itching, and soiling scores dropped after most treatments studied, including surgery, banding, laser, and sclerotherapy, in the weeks to months after treatment.", "studyIds": [ "pmid:42478482", "pmid:42442141", "pmid:41018464", "pmid:40824576", "pmid:39183158" ] }, { "name": "Recurrence rate at 12 months", "status": "possible-harm", "note": "Several trials and a pooled analysis found that stapled hemorrhoidopexy, banding, and other less invasive techniques come back more often than standard excisional surgery, sometimes by a wide margin (for example, 47.5% vs 6.1% in one trial).", "studyIds": [ "pmid:41535511", "pmid:39952268", "pmid:42478482", "pmid:40949368", "pmid:37616177", "pmid:37020091", "pmid:40125221" ] }, { "name": "Complication rate", "status": "insufficient", "note": "Complication rates varied widely by technique and were reported inconsistently across studies; case reports describe rare but serious events like bowel perforation, sepsis, and abscess, but how often these actually occur isn't established.", "studyIds": [ "pmid:42359159", "pmid:40661710", "pmid:40385836", "pmid:38283447", "pmid:37064065", "pmid:40303913" ] }, { "name": "Time to return to normal activity", "status": "improvement", "note": "Less invasive options — laser, LigaSure, and stapled surgery — generally let people return to normal activity sooner than traditional cutting surgery (excisional hemorrhoidectomy).", "studyIds": [ "pmid:42816945", "pmid:42802752", "pmid:41914085", "pmid:41603644", "pmid:40125221" ] }, { "name": "Need for repeat or escalated intervention", "status": "possible-harm", "note": "In separate trials, both rubber band ligation and hemorrhoidal artery ligation had higher rates of prolapse recurrence than excisional surgery, which can mean further treatment is eventually needed: one trial found 47.5% recurrence with banding versus 6.1% with surgery at 12 months, and another found higher recurrence with artery ligation than with excisional surgery at 24 months.", "studyIds": [ "pmid:39952268", "pmid:37616177" ] } ], "benefits": [ { "text": "In randomized and large retrospective studies, standard surgical removal (excisional hemorrhoidectomy) had a lower rate of prolapse returning than rubber band ligation, stapled hemorrhoidopexy, or hemorrhoidal artery ligation, though one smaller randomized trial found no statistically significant difference between excisional surgery, laser treatment, and mucopexy at 5 years.", "studyIds": [ "pmid:39952268", "pmid:41535511", "pmid:40125221", "pmid:37616177", "pmid:42478482" ] }, { "text": "Rubber band ligation can control prolapse and bleeding without surgery for many people with grade III disease, though trials show it fails more often than surgery does.", "studyIds": [ "pmid:39952268", "pmid:42067175", "pmid:40492557" ] }, { "text": "Newer techniques like laser hemorrhoidoplasty, LigaSure, and stapled hemorrhoidopexy cause less pain and let people return to normal activity sooner than traditional cutting surgery.", "studyIds": [ "pmid:42816945", "pmid:42802752", "pmid:41914085", "pmid:40125221" ] } ], "limitations": [ { "text": "Most of the studies compared one surgical technique with another, not treatment with doing nothing, so it's often unclear how much better any option is than leaving the hemorrhoid untreated.", "studyIds": [ "pmid:42816945", "pmid:42715146", "pmid:42393699", "pmid:41553737" ] }, { "text": "Many studies were small, retrospective (looking back at records rather than randomly assigning treatment), or from a single hospital, which makes it hard to know if results would hold up elsewhere.", "studyIds": [ "pmid:42802752", "pmid:42337174", "pmid:42313087", "pmid:41091564", "pmid:37692631" ] }, { "text": "The randomized trials in this body of evidence don't agree with each other — some show stapled surgery working as well as cutting surgery, others show it failing more often — which is why overall certainty is moderate rather than high.", "studyIds": [ "pmid:42715146", "pmid:42478482", "pmid:41535511", "pmid:40125221", "pmid:39009485" ] } ], "risks": [ { "text": "A well-conducted analysis of randomized trials found stapled hemorrhoidopexy had a higher rate of long-term prolapse recurrence than standard excisional surgery. Isolated case reports also describe rare but serious complications after various minimally invasive hemorrhoid procedures, including rectal perforation, sepsis, and abscess, but these come from single patients and don't show how often such problems occur or whether they are specific to any one technique.", "studyIds": [ "pmid:41535511", "pmid:40661710", "pmid:37064065", "pmid:38283447", "pmid:42359159", "pmid:40385836" ], "severity": "serious" }, { "text": "Stapled procedures for hemorrhoids (stapled hemorrhoidopexy, also called PPH) carry a risk of the anal canal narrowing (stenosis or stricture) at the staple site; one large study found a 16.0% stricture rate with the standard technique, falling to 2.9% with a modified injection technique, and another study found this narrowing happened more often after stapled surgery than after conventional hemorrhoidectomy.", "studyIds": [ "pmid:42266125", "pmid:39734464", "pmid:39351563", "pmid:38542515" ], "severity": "serious" }, { "text": "Patients who have had hemorrhoidectomy report complications that can include pain, bleeding, itching, and difficulty controlling stool; in one study following recovery after Milligan-Morgan surgery, pain gradually lessened over time and had resolved completely in all patients by 28 days.", "studyIds": [ "pmid:40303913", "pmid:38577073" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "A visible, painful lump makes people want an immediate fix." }, { "text": "Fear of surgery and its recovery time pushes people toward banding, creams, or laser treatments first." }, { "text": "Marketing of 'minimally invasive' or laser procedures makes them sound like an easy cure." }, { "text": "Embarrassment about the problem leads people to try home remedies before seeing a doctor." } ], "keyStudies": [ "pmid:41535511", "pmid:39952268", "pmid:42478482", "pmid:40125221", "pmid:37616177", "pmid:42067175", "pmid:40824576", "pmid:41553737" ], "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 with grade IV hemorrhoids undergoing surgery", "intervention": "LigaSure (energy-based) hemorrhoidectomy", "comparator": "conventional excisional hemorrhoidectomy", "primaryOutcome": "postoperative pain and other surgical recovery outcomes", "result": "LigaSure caused less early pain, less bleeding, and faster recovery, but no difference in recurrence or other longer-term outcomes", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It combines 43 randomized trials with over 3000 patients, but the authors note real uncertainty remains for several outcomes including recurrence.", "directness": "direct", "limitations": "Uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited.", "followUp": "", "plainFinding": "Less pain, faster recovery with LigaSure", "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": "Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids" }, { "field": "intervention", "quote": "although energy-based devices may reduce postoperative pain" }, { "field": "comparator", "quote": "Randomised controlled trials comparing LigaSure with conventional techniques were included." }, { "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:42802752", "pmid": "42802752", "doi": "10.7759/cureus.115337", "nctId": null, "pmcid": "PMC13616098", "title": "Comparative Study of Postoperative Outcomes and Morbidity Among Laser, Open, and Stapled Hemorrhoidectomy for the Treatment of Grade III and Grade IV Hemorrhoids", "firstAuthor": "Parkhi", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "prospective-cohort", "n": 180, "nField": "reported", "population": "adults aged 18-60 with grade III-IV hemorrhoids at a tertiary care center", "intervention": "laser hemorrhoidoplasty", "comparator": "open hemorrhoidectomy (Milligan-Morgan technique) and stapled hemorrhoidopexy", "primaryOutcome": "pain on postoperative day 1 (VAS score)", "result": "Laser surgery caused less pain on day 1, shorter operations, shorter hospital stays, faster recovery, and higher satisfaction than open or stapled surgery, with similar recurrence and only mild complications across all groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Patients were not randomly assigned to treatments, so the groups could differ in ways that affect the results.", "directness": "direct", "limitations": "Allocation was non-random, determined by clinical suitability, device availability, affordability, and patient preference; short three-month follow-up.", "followUp": "three months", "plainFinding": "Laser caused less pain, faster recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42802752/", "sourceText": "Background Hemorrhoidal disease is a highly prevalent anorectal condition that impairs quality of life. Grade III and Grade IV disease may be treated by open hemorrhoidectomy (Milligan-Morgan technique), stapled hemorrhoidopexy, or laser hemorrhoidoplasty (LHP), which differ in postoperative pain, recovery, morbidity, and satisfaction. The primary outcome was pain on the Visual Analogue Scale (VAS) at postoperative day 1 (POD1). Secondary outcomes were VAS at day 7 (postoperative day 7), operative time, hospital stay, recovery time, complications graded by the Clavien-Dindo classification, bleeding, continence (Cleveland Clinic Florida Fecal Incontinence Score (Wexner Score)), three-month recurrence, and satisfaction. Methods In this prospective observational study at a tertiary care center, 180 patients aged 18-60 years with Grade III-IV hemorrhoids were enrolled over six months by consecutive sampling into three groups of 60: open hemorrhoidectomy, LHP, and stapled hemorrhoidopexy, each followed for three months. Allocation was non-random, determined by clinical suitability, device availability, affordability, and patient preference. Anesthesia, analgesia, and pain-assessment timing were standardized. Longitudinal VAS data were analyzed with a linear mixed-effects model with Bonferroni-adjusted pairwise contrasts, reported as mean differences with 95% CIs. Categorical outcomes used the chi-square or Fisher's exact test. Multivariable regression adjusted for age, sex, BMI, hemorrhoid grade, and socioeconomic status, with a propensity-score sensitivity analysis. Fifty-six patients per group gave 80% power to detect a mean VAS difference of 1.5 (SD 2.5) at alpha 0.05; 60 were enrolled per group. A two-sided p < 0.05 was significant. Results Measured baseline characteristics were similar (mean age 39.1 ± 7.2, 38.2 ± 6.8, and 38.5 ± 7.0 years for laser, open, and stapled; p = 0.890). LHP showed lower VAS at POD1 (4.04 ± 1.36) than open (7.53 ± 1.28; mean difference -3.49, 95% CI -3.97 to -3.01) and stapled (5.12 ± 1.10; -1.08, 95% CI -1.53 to -0.63) procedures (p < 0.001). Operative time (22.4 ± 4.5 vs. 29.1 ± 5.2 and 39.6 ± 6.8 minutes) and hospital stay (1.2 ± 0.4 vs. 1.8 ± 0.6 and 2.7 ± 0.8 days) were shortest after laser surgery (both p < 0.001). Recovery was fastest after laser surgery (10.72 ± 3.10 days) vs. stapled (13.85 ± 3.50) and open (20.40 ± 4.20) (p < 0.001). Urinary retention was least frequent after laser treatment (3.3% vs. 15.0% and 13.3%; p = 0.080), reaching significance after adjustment (adjusted OR 0.22, 95% CI 0.04-0.86). Good or excellent satisfaction at three months was highest after laser surgery (88.3%) vs. stapled (80.0%) and open (60.0%) (p < 0.001). All complications were Clavien-Dindo grade I-II, and three-month recurrence did not differ between groups (p = 0.548). Conclusions All three modalities were safe and effective in the short term, with no complication exceeding Clavien-Dindo grade II and no mortality. LHP produced the shortest operative time, shortest hospital stay, least early pain, fastest return to activity, and highest three-month satisfaction, with stapled hemorrhoidopexy consistently intermediate and converging with laser by the end of the first postoperative week. These findings support individualized technique selection according to disease morphology, patient priorities, and available resources.", "provenance": [ { "field": "population", "quote": "180 patients aged 18-60 years with Grade III-IV hemorrhoids were enrolled over six months by consecutive sampling" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "Grade III and Grade IV disease may be treated by open hemorrhoidectomy (Milligan-Morgan technique), stapled hemorrhoidopexy, or laser hemorrhoidoplasty (LHP)" }, { "field": "primaryOutcome", "quote": "The primary outcome was pain on the Visual Analogue Scale (VAS) at postoperative day 1 (POD1)." }, { "field": "result", "quote": "LHP showed lower VAS at POD1 (4.04 ± 1.36) than open (7.53 ± 1.28; mean difference -3.49, 95% CI -3.97 to -3.01) and stapled (5.12 ± 1.10; -1.08, 95% CI -1.53 to -0.63) procedures (p < 0.001)." }, { "field": "result", "quote": "Recovery was fastest after laser surgery (10.72 ± 3.10 days) vs. stapled (13.85 ± 3.50) and open (20.40 ± 4.20) (p < 0.001)." }, { "field": "result", "quote": "Good or excellent satisfaction at three months was highest after laser surgery (88.3%) vs. stapled (80.0%) and open (60.0%) (p < 0.001)." }, { "field": "result", "quote": "three-month recurrence did not differ between groups (p = 0.548)" }, { "field": "n", "quote": "180 patients aged 18-60 years with Grade III-IV hemorrhoids were enrolled" }, { "field": "limitations", "quote": "Allocation was non-random, determined by clinical suitability, device availability, affordability, and patient preference." }, { "field": "followUp", "quote": "each followed for three months" } ] }, { "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": "a 51-year-old woman with breast cancer who developed severe low blood counts and sepsis after chemotherapy, with eroded prolapsed hemorrhoids", "intervention": "non-surgical treatment: antibiotics, blood/immune support, and multimodal local wound care including traditional Chinese medicine", "comparator": "no comparison group; single patient case", "primaryOutcome": "resolution of infection and healing of the eroded hemorrhoid", "result": "after 30 days of treatment, fever resolved and the eroded hemorrhoid healed completely", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment works in general.", "directness": "indirect", "limitations": "Single case report with no control group, in a patient with unusual severe immune suppression from chemotherapy, limiting generalizability to typical prolapsed hemorrhoid cases.", "followUp": "30 days", "plainFinding": "Non-surgical care healed eroded hemorrhoid.", "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": "manual reduction of prolapsed hemorrhoids, resulting in an eroded, inflamed perianal mass" }, { "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" }, { "field": "comparator", "quote": "Given the high risk of surgery due to critical thrombocytopenia and neutropenia, a conservative strategy was implemented." }, { "field": "primaryOutcome", "quote": "The eroded hemorrhoid healed entirely, allowing for a successful transfer to a lower-level hospital for continued supportive care." }, { "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" } ] }, { "id": "pmid:42791481", "pmid": "42791481", "doi": "10.1007/s13304-026-02866-6", "nctId": null, "pmcid": null, "title": "Polidocanol foam sclerotherapy for hemorrhoidal disease in a private outpatient setting: a real-world single-center study combining chart review and WhatsApp-delivered patient-reported outcomes", "firstAuthor": "Neola", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "retrospective", "n": 84, "nField": "reported", "population": "adults with symptomatic hemorrhoidal disease treated in a private proctology clinic", "intervention": "polidocanol foam sclerotherapy (an injection treatment for hemorrhoids)", "comparator": "none (single-arm, before-and-after comparison within the same patients)", "primaryOutcome": "patient-reported improvement in hemorrhoid symptoms (bleeding, heaviness/pain, prolapse) and satisfaction", "result": "Among those with prolapse symptoms at baseline, 86.4% reported improvement or resolution after treatment, with similarly high improvement in bleeding (95.8%) and heaviness/pain (97.4%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study with no control group and relied on self-reported surveys with incomplete response and follow-up, so its findings are not strong proof the treatment works.", "directness": "indirect", "limitations": "Retrospective design, no comparator group, survey response rate was 65.5%, chart and survey follow-up used different, non-comparable methods, and the authors note possible ascertainment bias.", "followUp": "", "plainFinding": "Most patients reported improved prolapse symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42791481/", "sourceText": "BACKGROUND: Polidocanol foam sclerotherapy (PFS) is an effective office-based treatment for symptomatic hemorrhoidal disease (HD), but real-world data from private practice and patient-reported outcomes (PROMs) at variable follow-up are scarce. METHODS: We retrospectively reviewed all consecutive patients treated with PFS (3% polidocanol, Tessari method) in a single private proctology office (December 2021-May 2026). Indication was primarily symptom-driven rather than based on Goligher grade. Two data sources were combined: session-level chart review and a structured digital questionnaire (Google Forms) delivered through a personalized WhatsApp invitation, exploring symptoms before and after treatment, post-procedural discomfort and satisfaction. Outcomes were also explored by time since the last session. RESULTS: Eighty-four patients underwent 118 sessions (65.5% single). The survey response rate was 65.5% (55/84; median time from last treatment 64 days, range 1-1,438). Among patients symptomatic at baseline, improvement or resolution was reported by 95.8% (46/48) for bleeding, 97.4% (37/38) for heaviness/pain and 86.4% (38/44) for prolapse (composite 121/130, 93.1%). No or mild post-procedural discomfort was reported by 89.0%, overall satisfaction was 94.5%, and no severe discomfort was reported; no major adverse event was reported or documented. Chart review captured in-office follow-up after 38.1% of sessions, with persistence/recurrence in 63.4% of classifiable encounters. Chart and PROM estimates used different units and are not directly comparable; their discrepancy suggests return-to-clinic ascertainment bias. CONCLUSIONS: Among respondents, PFS achieved high patient-reported symptom control and satisfaction. A WhatsApp-delivered PROM survey was feasible and may reduce the bias of clinic-return-based follow-up.", "provenance": [ { "field": "n", "quote": "Eighty-four patients underwent 118 sessions" }, { "field": "population", "quote": "patients treated with PFS (3% polidocanol, Tessari method) in a single private proctology office" }, { "field": "intervention", "quote": "Polidocanol foam sclerotherapy (PFS) is an effective office-based treatment for symptomatic hemorrhoidal disease (HD)" }, { "field": "comparator", "quote": "We retrospectively reviewed all consecutive patients treated with PFS" }, { "field": "primaryOutcome", "quote": "exploring symptoms before and after treatment, post-procedural discomfort and satisfaction" }, { "field": "result", "quote": "improvement or resolution was reported by 95.8% (46/48) for bleeding, 97.4% (37/38) for heaviness/pain and 86.4% (38/44) for prolapse (composite 121/130, 93.1%)" } ] }, { "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": "", "primaryOutcome": "Pattern of pain severity over 14 days after surgery and factors affecting it", "result": "Patients fell into two pain recovery patterns (fast relief or poor relief); younger age, higher anxiety/depression, lower social support, and more ligations predicted poor pain relief", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective single-center study without a comparison treatment, so it shows pain patterns after this procedure but cannot say if it works better than other options.", "directness": "indirect", "limitations": "Retrospective design, single center, no control group or comparison treatment, so causal conclusions about treatment effectiveness cannot be drawn.", "followUp": "14 days", "plainFinding": "Pain patterns vary; risk factors identified.", "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": "n", "quote": "included 173 patients with mixed hemorrhoids" }, { "field": "primaryOutcome", "quote": "dynamic trajectory of acute pain after elastic band ligation of internal hemorrhoids" }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "visual analog scale (VAS) pain scores on postoperative days 1, 3, 7, and 14" } ] }, { "id": "pmid:42715146", "pmid": "42715146", "doi": "10.1159/dsu/acoag005", "nctId": null, "pmcid": null, "title": "HARMONIC SCALPEL HEMORRHOIDECTOMY VERSUS STAPLED HEMORRHOIDOPEXY IN GRADE III / IV HEMORRHOIDS: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS", "firstAuthor": "de Oliveira", "multipleAuthors": true, "journal": "Dig Surg", "year": 2026, "design": "meta-analysis", "n": 375, "nField": "reported", "population": "patients with grade III or IV prolapsed hemorrhoids needing surgery", "intervention": "harmonic scalpel hemorrhoidectomy", "comparator": "stapled hemorrhoidopexy", "primaryOutcome": "recurrence, pain, bleeding, incontinence, operative time, hospital stay, urinary retention", "result": "harmonic scalpel surgery had lower recurrence but more pain; stapled surgery had less pain but no difference in other outcomes", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools six randomized trials but only 375 patients total, so results could still be imprecise", "directness": "direct", "limitations": "small number of trials and patients pooled together", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42715146/", "sourceText": "BACKGROUND: Third- and IV-degree hemorrhoids often require surgery due to prolapse, bleeding and discomfort. Among the available procedures, there is no consensus on which surgical technique offers better results. This systematic review with meta-analysis aims to compare harmonic scalpel hemorrhoidectomy (HSH) versus stapled hemorrhoidopexy (SH). METHODS: A search was conducted in the PubMed, Scopus, and Cochrane Library databases. Inclusion criteria were (a) randomized controlled trials, (b) comparing HSH and SH, (c) in patients with grade III/IV hemorrhoids, and (d) reporting at least one outcome of interest. Statistical analyses were performed in Review Manager 5.4.1 and RStudio, using a random-effects model to calculate the risk ratio (RR) and mean differences (MD) with 95% confidence intervals (CIs). RESULTS: We included six randomized controlled trials with a total of 375 patients. HSH was associated with a lower recurrence compared to SH. However, there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay and urinary retention. SH group was associated with less postoperative severe pain and overall pain. CONCLUSION: HSH and SH are comparable in the treatment of grade III/IV hemorrhoids, analyzing postoperative bleeding, fecal incontinence, operative time, hospital stay and urinary retention. However, SH presented less severe and overall pain, showing better results in the short term and HSH presented lower recurrence, highlighting as a better outcome in the long term.", "provenance": [ { "field": "n", "quote": "We included six randomized controlled trials with a total of 375 patients." }, { "field": "population", "quote": "patients with grade III/IV hemorrhoids" }, { "field": "intervention", "quote": "harmonic scalpel hemorrhoidectomy (HSH)" }, { "field": "comparator", "quote": "stapled hemorrhoidopexy (SH)" }, { "field": "primaryOutcome", "quote": "there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay and urinary retention" }, { "field": "result", "quote": "HSH was associated with a lower recurrence compared to SH" }, { "field": "result", "quote": "SH group was associated with less postoperative severe pain and overall pain" } ] }, { "id": "pmid:42698285", "pmid": "42698285", "doi": "10.1177/08465371261484425", "nctId": null, "pmcid": null, "title": "CT-Guided Inferior Rectal Nerve Block for Postoperative Pain Management After Hemorrhoidectomy", "firstAuthor": "Chang", "multipleAuthors": true, "journal": "Can Assoc Radiol J", "year": 2026, "design": "retrospective", "n": 69, "nField": "reported", "population": "patients with grade III or IV mixed hemorrhoids who had hemorrhoid removal surgery", "intervention": "CT-guided nerve block near the rectum given the day after surgery, using numbing medicine and steroid", "comparator": "standard pain medicine after surgery (no nerve block)", "primaryOutcome": "pain intensity after surgery, measured on a 0-10 pain scale", "result": "patients who got the nerve block had lower pain scores than those on standard pain medicine, especially in the first two weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "patients chose their own group rather than being randomly assigned, and the study only looked back at records from one hospital.", "directness": "indirect", "limitations": "patients self-selected into groups rather than being randomized, it is a retrospective review, and it addresses pain control after surgery rather than how prolapsed hemorrhoids themselves should be treated", "followUp": "28", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42698285/", "sourceText": "INTRODUCTION: Hemorrhoidectomy is among the most painful procedures in colorectal surgery. Effective postoperative pain management remains an unmet clinical need. To evaluate the efficacy, duration of analgesia, and safety of CT-guided inferior rectal nerve block (IRNB) for postoperative pain management following hemorrhoidectomy. METHODS: This retrospective study enrolled 69 patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy between April 2024 and March 2026. Patients who elected to receive IRNB were assigned to Group 1 (n = 38); those who declined formed Group 2 (n = 31, standard analgesia). Group 1 received bilateral CT-guided IRNB on postoperative day 1 using a mixture of triamcinolone acetonide, 0.5% bupivacaine HCl, normal saline, and epinephrine. Pain intensity was assessed using the Numerical Rating Scale (NRS, 0-10) at baseline and on postoperative days 1 to 10, 14, and 28. Analgesic use and complications were also recorded. RESULTS: Group 1 showed significantly lower median NRS scores than Group 2 on postoperative day 1 (2 [1-5] vs 5 [4-7]; P < .001), with sustained superiority through day 14 (1 [0-1] vs 2 [0-3]; P < .05). A secondary pain peak occurred in Group 1 on day 4 (4 [2-5]), consider pharmacological attrition and pain rebound. Both groups reached near-complete pain resolution by day 28. Complication rates did not differ significantly between groups. CONCLUSIONS: CT-guided IRNB may provides effective and safe postoperative analgesia following hemorrhoidectomy, with significant pain control over the first 2 postoperative weeks.", "provenance": [ { "field": "n", "quote": "This retrospective study enrolled 69 patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy between April 2024 and March 2026." }, { "field": "population", "quote": "patients with grade III or IV mixed hemorrhoids undergoing hemorrhoidectomy" }, { "field": "intervention", "quote": "Group 1 received bilateral CT-guided IRNB on postoperative day 1 using a mixture of triamcinolone acetonide, 0.5% bupivacaine HCl, normal saline, and epinephrine." }, { "field": "comparator", "quote": "those who declined formed Group 2 (n = 31, standard analgesia)" }, { "field": "primaryOutcome", "quote": "Pain intensity was assessed using the Numerical Rating Scale (NRS, 0-10) at baseline and on postoperative days 1 to 10, 14, and 28." }, { "field": "result", "quote": "Group 1 showed significantly lower median NRS scores than Group 2 on postoperative day 1 (2 [1-5] vs 5 [4-7]; P < .001), with sustained superiority through day 14 (1 [0-1] vs 2 [0-3]; P < .05)." } ] }, { "id": "pmid:42577337", "pmid": "42577337", "doi": "10.7759/cureus.112426", "nctId": null, "pmcid": "PMC13453973", "title": "Comparing Outcomes of Conventional Hemorrhoidectomy With Hemorrhoidectomy Using the Harmonic Scalpel", "firstAuthor": "Vignesh", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "prospective-cohort", "n": 112, "nField": "reported", "population": "patients with grade III and IV hemorrhoids", "intervention": "hemorrhoidectomy using the harmonic scalpel", "comparator": "conventional hemorrhoidectomy", "primaryOutcome": "intraoperative bleeding, operating time, and postoperative pain", "result": "significant reduction in operating time, blood loss, postoperative pain, urinary catheterization, and hospital stay with harmonic scalpel", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a non-randomized observational study comparing two surgical techniques, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Observational study design, not randomized, single-center.", "followUp": "", "plainFinding": "Less pain, faster surgery, quicker recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42577337/", "sourceText": "Background Hemorrhoidal disease is one of the most common benign anorectal disorders encountered in surgical practice. Although various surgical modalities are available for grade III and IV hemorrhoids, Milligan-Morgan hemorrhoidectomy remains the gold standard treatment. However, postoperative pain is a major complication associated with this procedure. Therefore, hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain. Methods This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53) at a tertiary teaching hospital between December 2024 and May 2026. Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (approval number: CSP-MED/24/OCT/110/327), and written informed consent was obtained from all the participants. The study aimed to compare the efficacy of hemorrhoidectomy using the harmonic scalpel with the conventional technique in terms of perioperative outcomes. The primary outcomes included intraoperative bleeding, operating time, and postoperative pain, whereas secondary outcomes included the duration of hospital stay and postoperative urinary retention. Statistical analysis was performed, and a p-value of <0.05 was considered statistically significant. Results A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group. Conclusion Patients undergoing hemorrhoidectomy using the harmonic scalpel demonstrated a significant reduction in intra- and postoperative complications compared with the conventional group, suggesting greater efficacy in the management of grade III and IV hemorrhoids.", "provenance": [ { "field": "population", "quote": "This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain" }, { "field": "comparator", "quote": "who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53)" }, { "field": "primaryOutcome", "quote": "The primary outcomes included intraoperative bleeding, operating time, and postoperative pain" }, { "field": "result", "quote": "A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group." }, { "field": "n", "quote": "This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids" } ] }, { "id": "pmid:42573173", "pmid": "42573173", "doi": "10.1111/1754-9485.70165", "nctId": null, "pmcid": null, "title": "Short- and Medium-Term Efficacy of Super-Selective Haemorrhoidal Artery Embolisation for Internal Haemorrhoids and Its Relationship With Severity Grading: A Single-Centre Retrospective Study", "firstAuthor": "Cai", "multipleAuthors": true, "journal": "J Med Imaging Radiat Oncol", "year": 2026, "design": "retrospective", "n": 32, "nField": "reported", "population": "adults with internal hemorrhoids (various severity grades I-IV)", "intervention": "super-selective hemorrhoidal artery embolisation (a minimally invasive procedure blocking blood flow to hemorrhoids)", "comparator": "none; outcomes compared to patients' own pre-treatment scores", "primaryOutcome": "symptom relief (bleeding and pain scores) and clinical success rate over 12 months", "result": "symptom relief was high at 1 month (87.5%) but declined over time to 56.2% at 12 months, with success rates falling as hemorrhoid grade increased (100% for Grade I down to 40% for Grade IV)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small, single-center retrospective study with no comparison group, so its findings can't reliably show whether the treatment truly works better than other options.", "directness": "indirect", "limitations": "retrospective design, small sample size, no control group, and declining efficacy over time not fully explained", "followUp": "12 months", "plainFinding": "Early relief fades, worse in severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42573173/", "sourceText": "OBJECTIVE: To evaluate the 12-month symptom relief rate of super-selective haemorrhoidal artery embolisation (HAE) for Grade I-IV internal haemorrhoids and analyse the impact of haemorrhoid grading and embolisation site on treatment efficacy. METHODS: A retrospective analysis was conducted on 32 patients with internal haemorrhoids who underwent HAE at the Interventional Radiology Department of The Second Affiliated Hospital of Soochow University between April 2020 and January 2025. Efficacy was assessed using Visual Analogue Scale (VAS) and French Bleeding Scale (FBS) scores at 1, 3, 6, and 12 months postoperatively. RESULTS: The clinical success rate at 1 month post-procedure (defined as clinical success: ≥ 50% reduction in VAS or FBS from baseline without requiring any reintervention during follow-up) was 87.5% (28/32). The rates at 3 months, 6 months, and 12 months were 68.8% (22/32), 59.4% (19/32), and 56.2% (18/32). The VAS score decreased from 4.25 ± 1.08 preoperatively to 3.53 ± 1.39 at 1 month postoperatively (p < 0.001), rising to 3.72 ± 1.46 at 12 months postoperatively (p < 0.001). The FBS score decreased from 6.09 ± 1.84 preoperatively to 2.06 ± 1.41 at 1 month postoperatively (p < 0.001), and rebounded to 3.84 ± 2.10 at 12 months postoperatively (p < 0.001). The 12-month efficacy rate remained at 100% for Grade I haemorrhoids, 54.5% for Grade II, 50% for Grade III, and 40% for Grade IV. Minor complications occurred in 9.4% of patients, all resolving without intervention. CONCLUSION: HAE demonstrates reliable short-term efficacy for bleeding from Grade I-III internal haemorrhoids. As follow-up duration increases and severity grades rise, symptom relief rates gradually decline. The procedure is safe and reproducible, serving as an alternative minimally invasive option for patients unwilling or unable to undergo excision for Grade I-III internal haemorrhoids. However, patients should be informed of the recurrence risk, and long-term efficacy requires further investigation.", "provenance": [ { "field": "population", "quote": "32 patients with internal haemorrhoids" }, { "field": "intervention", "quote": "super-selective haemorrhoidal artery embolisation (HAE)" }, { "field": "comparator", "quote": "Efficacy was assessed using Visual Analogue Scale (VAS) and French Bleeding Scale (FBS) scores at 1, 3, 6, and 12 months postoperatively." }, { "field": "primaryOutcome", "quote": "To evaluate the 12-month symptom relief rate of super-selective haemorrhoidal artery embolisation (HAE) for Grade I-IV internal haemorrhoids" }, { "field": "result", "quote": "The rates at 3 months, 6 months, and 12 months were 68.8% (22/32), 59.4% (19/32), and 56.2% (18/32)." }, { "field": "result", "quote": "The 12-month efficacy rate remained at 100% for Grade I haemorrhoids, 54.5% for Grade II, 50% for Grade III, and 40% for Grade IV." }, { "field": "n", "quote": "A retrospective analysis was conducted on 32 patients with internal haemorrhoids who underwent HAE" } ] }, { "id": "pmid:42572365", "pmid": "42572365", "doi": "10.1177/00031348261474195", "nctId": null, "pmcid": null, "title": "Suture Reinforcement of Rubber Band Ligation for Internal Hemorrhoids: A Technical Modification to Reduce Delayed Massive Bleeding", "firstAuthor": "Wu", "multipleAuthors": true, "journal": "Am Surg", "year": 2026, "design": "retrospective", "n": 530, "nField": "reported", "population": "adults with grade II or III internal hemorrhoids", "intervention": "rubber band ligation plus an added absorbable stitch", "comparator": "rubber band ligation alone", "primaryOutcome": "rate of delayed heavy bleeding and hemorrhoid recurrence after treatment", "result": "adding a stitch led to fewer delayed heavy bleeding events (1 vs 7) but no significant difference in recurrence or other symptoms", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a non-randomized, single-center look-back study with very few bleeding events, so the result could easily be due to chance or bias.", "directness": "direct", "limitations": "Retrospective, nonrandomized design with sequential (not randomized) allocation, small number of bleeding events, wide confidence intervals, single center.", "followUp": "", "plainFinding": "Added stitches reduced bleeding risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42572365/", "sourceText": "BackgroundRubber band ligation (RBL) is a widely accepted treatment for Grade II-III internal hemorrhoids. However, postoperative bleeding, particularly delayed massive bleeding (DMB), remains a serious complication. This study aims to compare the outcomes of RBL alone vs RBL combined with absorbable suture ligation (RBL-SL), with a primary focus on postoperative DMB events.MethodsWe retrospectively enrolled patients with grade II/III internal hemorrhoids who were treated with RBL from May 2024 to December 2024 and RBL combined with suture ligation from January 2025 to July 2025 at the General Hospital of Central Theater Command. The incidence of DMB and hemorrhoids recurrence were evaluated as the primary outcomes. The secondary outcomes assessed were the degree of postoperative pain, anal edema, and sensation of prolapse. The Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale for HD (SHS-HD) were documented during long-term follow-up.ResultsA total of 530 patients were enrolled, including 263 patients received RBL combined with suture ligation and 267 patients underwent RBL alone. There was no statistically significant difference in most baseline characteristics except age and body mass index (BMI) between the two groups (P > 0.05). Compared with one patient who underwent DMB in the RBL-SL group, seven cases of DMB were observed in the RBL group. The difference was statistically significant (P < 0.05). Although the number of hemorrhoid recurrence cases in the RBL-SL group was lower than the RBL group, there was no statistically significant difference in the recurrence rate between the two groups (8.0% vs 12.7%, P > 0.05). On the third and seventh days after surgery, there were no statistically significant differences in minor complications (pain score, anal edema, and prolapse sensation) between the two groups(P > 0.05). There were also no significant differences in HDSS and SHS scores between the two groups after surgery (P > 0.05).ConclusionIn this single-center, nonrandomized study, adjunctive absorbable suture ligation was associated with a signal toward reduced DMB after RBL for internal hemorrhoids. However, due to the small number of events, wide confidence intervals, and potential for bias from sequential allocation, these findings are hypothesis-generating only. Further prospective, randomized evaluation is required before considering this technique as a new standard of care.", "provenance": [ { "field": "population", "quote": "patients with grade II/III internal hemorrhoids who were treated with RBL" }, { "field": "intervention", "quote": "RBL combined with absorbable suture ligation (RBL-SL)" }, { "field": "comparator", "quote": "RBL alone" }, { "field": "primaryOutcome", "quote": "The incidence of DMB and hemorrhoids recurrence were evaluated as the primary outcomes." }, { "field": "result", "quote": "Compared with one patient who underwent DMB in the RBL-SL group, seven cases of DMB were observed in the RBL group. The difference was statistically significant (P < 0.05)." }, { "field": "result", "quote": "there was no statistically significant difference in the recurrence rate between the two groups (8.0% vs 12.7%, P > 0.05)" }, { "field": "n", "quote": "A total of 530 patients were enrolled, including 263 patients received RBL combined with suture ligation and 267 patients underwent RBL alone." } ] }, { "id": "pmid:42535235", "pmid": "42535235", "doi": "10.23922/jarc.2025-126", "nctId": null, "pmcid": "PMC13423449", "title": "Comparative Outcomes of Hemorrhoidectomy under Spinal Anesthesia between Older and Super-old Patients", "firstAuthor": "Yeo", "multipleAuthors": true, "journal": "J Anus Rectum Colon", "year": 2026, "design": "retrospective", "n": 761, "nField": "reported", "population": "adult patients who had surgery to remove hemorrhoids, divided into older (65-79) and very old (80+) age groups", "intervention": "open hemorrhoidectomy under spinal anesthesia in very old patients (age 80 and above)", "comparator": "open hemorrhoidectomy under spinal anesthesia in older patients (age 65-79)", "primaryOutcome": "complications within 6 months after surgery, and need for urinary catheter or extra pain medication", "result": "no significant difference in early complications between age groups, but very old patients needed a urinary catheter more often", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a single retrospective study at one hospital with very unequal group sizes, so it cannot prove the surgery is equally safe for everyone.", "directness": "indirect", "limitations": "Retrospective design, single center, much smaller very-old group (68 vs 693), and only looked at surgery safety by age rather than comparing surgery to other treatments for prolapsed hemorrhoids.", "followUp": "6 months", "plainFinding": "Surgery equally safe in very old patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42535235/", "sourceText": "OBJECTIVES: With increasing life expectancy, the number of older and very old patients undergoing anorectal surgery is rising. However, concerns remain regarding the safety of hemorrhoidectomy among those aged ≥80 years. In this study, we compared postoperative outcomes between older (age 65-79 years) and very old (age ≥80 years) patients undergoing open hemorrhoidectomy under spinal anesthesia. METHODS: This single-center retrospective cohort study included consecutive adult patients who underwent excisional hemorrhoidectomy between April 2024 and May 2025. Patients were stratified into older (65-79 years) and very old (≥80 years) groups. Baseline characteristics, perioperative factors, and postoperative outcomes, including 6-month complications, and predictors of Foley catheter insertion or additional analgesic injections were assessed. RESULTS: Overall, 693 older patients and 68 very old patients were included. The incidence of early (≤6 months) postoperative complications, including constipation, bleeding, and recurrence, did not differ significantly between the two groups. Foley catheter insertion occurred more frequently in the very old group than in the older group (45.6% vs 31.0%, p = 0.021). No Clavien-Dindo grade III or higher complications occurred in the very old group. In the multivariable analysis, intravenous patient-controlled analgesia was associated with a reduced likelihood of needing additional analgesic injections (odds ratio, 0.39; 95% confidence interval, 0.22-0.69). CONCLUSIONS: Hemorrhoidectomy under spinal anesthesia led to comparable short-term postoperative outcomes in older and very old patients without severe systemic disease.", "provenance": [ { "field": "population", "quote": "Patients were stratified into older (65-79 years) and very old (≥80 years) groups." }, { "field": "n", "quote": "Overall, 693 older patients and 68 very old patients were included." }, { "field": "intervention", "quote": "open hemorrhoidectomy under spinal anesthesia" }, { "field": "comparator", "quote": "compared postoperative outcomes between older (age 65-79 years) and very old (age ≥80 years) patients undergoing open hemorrhoidectomy under spinal anesthesia" }, { "field": "primaryOutcome", "quote": "postoperative outcomes, including 6-month complications, and predictors of Foley catheter insertion or additional analgesic injections were assessed" }, { "field": "result", "quote": "The incidence of early (≤6 months) postoperative complications, including constipation, bleeding, and recurrence, did not differ significantly between the two groups. Foley catheter insertion occurred more frequently in the very old group than in the older group (45.6% vs 31.0%, p = 0.021)." } ] }, { "id": "pmid:42478482", "pmid": "42478482", "doi": "10.1097/DCR.0000000000004372", "nctId": null, "pmcid": "PMC13585168", "title": "Five-Year Follow-up of the Double-Blinded Randomized Controlled Trial Comparing Laser Hemorrhoidoplasty With Sutured Mucopexy and Excisional Hemorrhoidectomy", "firstAuthor": "Makunaite", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2026, "design": "rct", "n": 102, "nField": "reported", "population": "patients with symptomatic second- or third-degree hemorrhoids", "intervention": "laser hemorrhoidoplasty or sutured mucopexy", "comparator": "excisional hemorrhoidectomy", "primaryOutcome": "return of hemorrhoid symptoms over 5 years", "result": "symptom recurrence at 5 years was 24% after excisional hemorrhoidectomy, 29% after laser hemorrhoidoplasty, and 44% after sutured mucopexy, a difference that was not statistically significant", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "this was a randomized, double-blinded trial but from a single small center, so the long-term differences between treatments could not be shown with confidence.", "directness": "direct", "limitations": "single-center study with a relatively small sample size", "followUp": "5 years", "plainFinding": "Similar long-term recurrence across treatments.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42478482/", "sourceText": "BACKGROUND: Patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery. OBJECTIVE: The aim of this study was to compare the long-term results of laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy. DESIGN: A follow-up of randomized, parallel-group, double-blinded, single-center prospective study. SETTINGS: Treatment was provided between April 2016 and April 2017 at a single center. PATIENTS: Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery were interviewed via telephone or online questionnaire. MAIN OUTCOME MEASURES: Recurrence of symptoms was the primary outcome; patients' quality of life, fecal incontinence, and patients' evaluation of treatment were secondary outcomes. RESULTS: A total of 102 patients were evaluated at 5 years (34 per group). Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076). Although recurrence-free probability was numerically higher in the excisional hemorrhoidectomy and laser hemorrhoidoplasty groups, the timing of events varied across cohorts. Specific recurrences included bleeding in 18% (excisional hemorrhoidectomy), 31% (sutured mucopexy), and 31% (laser hemorrhoidoplasty) and prolapse in 12% (excisional hemorrhoidectomy), 23% (laser hemorrhoidoplasty), and 34% (sutured mucopexy). General health evaluation scores were highest in the laser hemorrhoidoplasty group. A mixed-effect model for repeated measures analysis showed a continued trend of improvement in physical and social activity between 1 and 5 years across all groups ( p = 0.021). Decision regret was lowest in the sutured mucopexy group (mean score 1.33). LIMITATIONS: This is a single-center study with a relatively small sample size. CONCLUSIONS: Patients who underwent excisional hemorrhoidectomy reported the best outcomes; however, laser hemorrhoidoplasty produced only slightly worse results with a significantly shorter and less painful postoperative course. See Video Abstract . SEGUIMIENTO A CINCO AOS DEL ENSAYO CLNICO ALEATORIZADO DOBLE CIEGO QUE COMPARA LA HEMORROIDOPLASTIA LSER CON LA MUCOPEXIA SUTURADA Y LA HEMORROIDECTOMA POR ESCISIN: ANTECEDENTES:Se realizó un seguimiento a pacientes, asignados aleatoriamente a hemorroidoplastia láser, hemorroidectomía por escisión y mucopexia suturada, a los 5 años de la cirugía.OBJETIVO:El objetivo de este estudio fue comparar los resultados a largo plazo de la hemorroidoplastia láser, la hemorroidectomía por escisión y la mucopexia suturada.DISEÑO:Estudio prospectivo, unicéntrico, doble ciego, aleatorizado, de seguimiento y con grupos paralelos.ÁMBITO:Entre abril de 2016 y abril de 2017, se incluyeron 121 pacientes en el estudio.PACIENTES:Se entrevistó telefónicamente o mediante cuestionario en línea a pacientes con hemorroides sintomáticas de segundo o tercer grado, 5 años después de la cirugía.PRINCIPALES MEDIDAS DE RESULTADO:La recurrencia de los síntomas fue el resultado primario; la calidad de vida de los pacientes, la incontinencia fecal y la evaluación del tratamiento por parte de los pacientes fueron resultados secundarios.RESULTADOS:Se evaluó a un total de 102 pacientes a los 5 años (34 por grupo). Las estimaciones de Kaplan-Meier de la recurrencia de los síntomas a los 5 años fueron del 24% para la hemorroidectomía por escisión, del 29% para la hemorroidoplastia láser y del 44% para la mucopexia suturada; estas diferencias no alcanzaron significación estadística (log-rank p = 0,076). Si bien la probabilidad de ausencia de recurrencia fue numéricamente mayor en los grupos de hemorroidectomía por escisión y hemorroidoplastia láser, el momento de los eventos varió entre las cohortes. Las recurrencias específicas incluyeron sangrado en el 18% (hemorroidectomía por escisión), 31% (mucopexia suturada) y 31% (hemorroidectomía láser), y prolapso en el 12% (hemorroidectomía por escisión), 23% (hemorroidectomía láser) y 34% (mucopexia suturada). Las puntuaciones de evaluación de salud general fueron más altas en el grupo de hemorroidoplastia láser. El modelo de efectos mixtos para el análisis de medidas repetidas mostró una tendencia continua de mejora en la actividad física y social entre 1 y 5 años en todos los grupos (p = 0,021). El arrepentimiento por la decisión tomada fue menor en el grupo de mucopexia suturada (puntuación media de 1,33).LIMITACIONES:Este es un estudio unicéntrico, con un tamaño de muestra relativamente pequeño.CONCLUSIONES:Los pacientes sometidos a hemorroidectomía por escisión reportan los mejores resultados; sin embargo, la hemorroidoplastia láser produce resultados solo ligeramente peores, con un postoperatorio significativamente más corto y menos doloroso. (AI-generated translation ).", "provenance": [ { "field": "n", "quote": "A total of 102 patients were evaluated at 5 years (34 per group)." }, { "field": "population", "quote": "Patients with symptomatic second- or third-degree hemorrhoids 5 years after surgery were interviewed via telephone or online questionnaire." }, { "field": "intervention", "quote": "Patients randomly assigned to laser hemorrhoidoplasty, excisional hemorrhoidectomy, and sutured mucopexy were followed up at 5 years after surgery." }, { "field": "comparator", "quote": "excisional hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Recurrence of symptoms was the primary outcome" }, { "field": "result", "quote": "Kaplan-Meier estimates of 5-year symptom recurrence were 24% for excisional hemorrhoidectomy, 29% for laser hemorrhoidoplasty, and 44% for sutured mucopexy; these differences did not reach statistical significance (log-rank p = 0.076)." }, { "field": "limitations", "quote": "This is a single-center study with a relatively small sample size." }, { "field": "followUp", "quote": "A total of 102 patients were evaluated at 5 years (34 per group)." } ] }, { "id": "pmid:42460166", "pmid": "42460166", "doi": "10.7759/cureus.110895", "nctId": null, "pmcid": "PMC13371875", "title": "LigaSure™ Hemorrhoidectomy for Complex Grade III Hemorrhoidal Disease: A Prospective, Single-Center, Cohort Study", "firstAuthor": "Al Hakkak", "multipleAuthors": false, "journal": "Cureus", "year": 2026, "design": "prospective-cohort", "n": 316, "nField": "reported", "population": "adults with grade III hemorrhoids with large or circumferential prolapse, some after failed prior treatment", "intervention": "LigaSure hemorrhoidectomy (a device that seals and cuts tissue during surgical removal of hemorrhoids)", "comparator": "none; all patients received the same surgery (spinal vs general anesthesia compared as a secondary analysis)", "primaryOutcome": "how long surgery took and complications within 30 days (severe pain, urinary retention, bleeding, infection, narrowing, loss of bowel control)", "result": "Surgery was quick, severe pain and major complications were rare, and no patients needed repeat surgery within a year, though urinary retention was more common with spinal anesthesia", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study at one hospital with no comparison treatment, so it can't show whether this surgery works better than other options.", "directness": "direct", "limitations": "No comparator group, single-center design, and about 8.5% of patients were lost to one-year follow-up.", "followUp": "one-year", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42460166/", "sourceText": "BACKGROUND: Grade III hemorrhoidal disease (HD) with large-volume or circumferential prolapse is poorly managed with less invasive treatments. This study evaluates LigaSure™ (Covidien plc, Dublin, Ireland; now acquired by Medtronic plc, Galway, Ireland) hemorrhoidectomy outcomes in this subset. METHODS: This was a prospective single-center cohort study conducted in Najaf Province, Iraq, which enrolled 316 adults with Grade III HD and at least one \"special\" feature (large solitary prolapse ≥3 cm or ≥1 quadrant, circumferential prolapse ≥3 quadrants, perianal fibrosis/edema, or prior failed rubber band ligation (RBL)/dearterialization (DEART)/stapled hemorrhoidopexy (SH)), from February 2023 to October 2024, with a follow-up to October 2025. Primary endpoints included operative time and 30-day complications (visual analog scale ≥7 pain, urinary retention, bleeding, infection, stenosis, incontinence). Secondary outcomes included length of stay (LOS), recovery time, and one-year recurrence. RESULTS: Median age of participants was 30 years (range 18-55). Of the total participants, 62.7% were male, and 48.1% had prior failed therapy. Mean operative time was 28.0 ± 6.0 minutes. Severe pain was recorded in 6.9% (95% CI 4.4-10.3), urinary retention in 17.1% (95% CI 13.1-21.7); the rate of postoperative urinary retention was higher with spinal (19.6%, n=240) versus general anesthesia (9.2%, n=76). The risk difference was 12.5% (95% CI 3.2-21.8). No bleeding, infection, stenosis, or incontinence was seen. Median LOS was one day (IQR 1, 1), and median recovery duration was seven days (IQR 6, 9). The one-year follow-up rate was achieved in 91.5% (289/316) of the patients. There were no patients with reoperation, and 11.8% had minor bleeding (95% CI 8.3-16.1). Outcomes were similar regardless of prior treatment failure. CONCLUSION: Standardized LigaSure hemorrhoidectomy for complex Grade III HD demonstrated rapid operative times, low severe pain, acceptable urinary retention (higher with spinal anesthesia), and zero one-year reoperations, supporting early excisional surgery in this anatomical subset.", "provenance": [ { "field": "n", "quote": "enrolled 316 adults with Grade III HD" }, { "field": "population", "quote": "Grade III hemorrhoidal disease (HD) with large-volume or circumferential prolapse" }, { "field": "intervention", "quote": "LigaSure™ (Covidien plc, Dublin, Ireland; now acquired by Medtronic plc, Galway, Ireland) hemorrhoidectomy" }, { "field": "comparator", "quote": "the rate of postoperative urinary retention was higher with spinal (19.6%, n=240) versus general anesthesia (9.2%, n=76)" }, { "field": "primaryOutcome", "quote": "Primary endpoints included operative time and 30-day complications (visual analog scale ≥7 pain, urinary retention, bleeding, infection, stenosis, incontinence)." }, { "field": "result", "quote": "Mean operative time was 28.0 ± 6.0 minutes. Severe pain was recorded in 6.9% (95% CI 4.4-10.3), urinary retention in 17.1% (95% CI 13.1-21.7)" }, { "field": "result", "quote": "There were no patients with reoperation" }, { "field": "followUp", "quote": "with a follow-up to October 2025" }, { "field": "followUp", "quote": "The one-year follow-up rate was achieved in 91.5% (289/316) of the patients." } ] }, { "id": "pmid:42442141", "pmid": "42442141", "doi": "10.1016/j.surg.2026.110402", "nctId": null, "pmcid": null, "title": "Use of mesoglycan in the acute phase of hemorrhoidal disease, the aCute HaemORrhoidal MEsoglycan Study (CHORMES): A double-blind, randomized controlled trial", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Surgery", "year": 2026, "design": "rct", "n": 52, "nField": "reported", "population": "adults with symptomatic grade II to III hemorrhoid disease", "intervention": "oral mesoglycan taken for 40 days", "comparator": "placebo", "primaryOutcome": "change in hemorrhoid symptom score (itching, pain, bleeding, swelling/prolapse) from baseline to day 40", "result": "mesoglycan reduced hemorrhoid symptom score more than placebo, including swelling/prolapse scores", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small phase 2 trial with only 52 patients, so results need confirmation in larger studies.", "directness": "indirect", "limitations": "small sample size (52 patients), phase 2 study, grade II-III disease pooled together rather than focused on prolapse specifically", "followUp": "40 days treatment plus 30-day telephone follow-up", "plainFinding": "Fewer symptoms including prolapse/swelling.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42442141/", "sourceText": "BACKGROUND: Hemorrhoidal disease is a common condition with significant clinical and socioeconomic impact. Mesoglycan, with endothelial-protective, antithrombotic, and profibrinolytic properties, has shown potential benefits in postoperative hemorrhoidal disease management. The aCute HaemORrhoidal MEsoglycan Study trial was designed to evaluate the efficacy and safety of mesoglycan in the acute phase of hemorrhoidal disease. METHODS: This multicenter, randomized, double-blind, placebo-controlled phase 2 trial enrolled adults with symptomatic grade II to III hemorrhoidal disease. Participants were randomly assigned (1:1) to receive oral mesoglycan or placebo for 40 days, followed by a 30-day telephone follow-up. The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40. Analyses were performed on modified intention-to-treat and modified per-protocol populations. RESULTS: Fifty-two patients were randomized (26 mesoglycan, 26 placebo), and 48 completed the study. In the modified intention-to-treat population (n = 47), mesoglycan resulted in a significantly greater reduction in Hemorrhoidal Disease Symptom Score compared with placebo (-7.5 ± 5.9 vs -3.9 ± 5.4; P = .027). Improvements were consistent across sensitivity analyses and more pronounced in patients with grade III hemorrhoidal disease (P = .042). Symptom-specific analysis showed significant reductions in itching (P = .0048), pain (P = .0246), and swelling/prolapse (P = .0418) in the mesoglycan group. Pain relief (visual analog scale) was sustained only in the mesoglycan arm. Bleeding improved significantly in the grade III subgroup (P = .03). Treatment adherence exceeded 97% in both arms. No treatment-related serious adverse events were observed. CONCLUSION: Mesoglycan demonstrated clinically meaningful and statistically significant improvements in acute hemorrhoidal disease symptoms, with a favorable safety profile and excellent adherence. Its mechanism of action allows for sustained benefits beyond mere symptomatic relief.", "provenance": [ { "field": "n", "quote": "Fifty-two patients were randomized (26 mesoglycan, 26 placebo)" }, { "field": "population", "quote": "adults with symptomatic grade II to III hemorrhoidal disease" }, { "field": "intervention", "quote": "oral mesoglycan or placebo for 40 days" }, { "field": "comparator", "quote": "oral mesoglycan or placebo for 40 days" }, { "field": "primaryOutcome", "quote": "The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40" }, { "field": "result", "quote": "mesoglycan resulted in a significantly greater reduction in Hemorrhoidal Disease Symptom Score compared with placebo (-7.5 ± 5.9 vs -3.9 ± 5.4; P = .027)" }, { "field": "result", "quote": "Symptom-specific analysis showed significant reductions in itching (P = .0048), pain (P = .0246), and swelling/prolapse (P = .0418) in the mesoglycan group" } ] }, { "id": "pmid:42439421", "pmid": "42439421", "doi": "10.17235/reed.2026.12090/2026", "nctId": null, "pmcid": null, "title": "Hemorrhoids or not? Inflammatory cloacogenic polyps mimicking prolapsed hemorrhoids: a 10-year case series of 56 patients", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Rev Esp Enferm Dig", "year": 2026, "design": "case-series", "n": 56, "nField": "reported", "population": "patients diagnosed with hemorrhoids before surgery who turned out to have a different condition (inflammatory cloacogenic polyp)", "intervention": "surgical excision performed during hemorrhoid treatment", "comparator": "none", "primaryOutcome": "whether the removed tissue was confirmed as hemorrhoids or actually a different lesion (ICP) on pathology", "result": "all 56 had a prolapsing anal mass and most had bleeding; excision allowed correct diagnosis as ICP rather than hemorrhoids", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective case series without a comparison group, so it cannot show whether any treatment works better than another.", "directness": "indirect", "limitations": "Retrospective design, no control group, and the abstract focuses on a rare mimicking condition rather than true hemorrhoid treatment outcomes.", "followUp": "", "plainFinding": "Some 'hemorrhoids' are actually a different lesion.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42439421/", "sourceText": "BACKGROUND: Inflammatory cloacogenic polyp (ICP) is a rare benign lesion that closely mimics hemorrhoids, frequently leading to clinical misdiagnosis. METHODS: We retrospectively reviewed patients who were preoperatively diagnosed with hemorrhoids and subsequently found to have ICP on histopathological examination, between April 2016 and April 2026. RESULTS: Among 19364 patients treated for hemorrhoids, 56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP. All 56 patients presented with a prolapsing anal mass, and 51 (91.1%) also had hematochezia. The median symptom duration was 5 years (range 0.25-50). Lesions detected on digital rectal examination or anoscopy were completely excised during hemorrhoid treatment and confirmed as ICP. CONCLUSIONS: ICP should be suspected in any chronic prolapsing anorectal mass presumed to be hemorrhoidal. Complete excision and routine histopathological evaluation are essential to avoid misdiagnosis.", "provenance": [ { "field": "n", "quote": "56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP" }, { "field": "population", "quote": "patients who were preoperatively diagnosed with hemorrhoids and subsequently found to have ICP on histopathological examination" }, { "field": "intervention", "quote": "Lesions detected on digital rectal examination or anoscopy were completely excised during hemorrhoid treatment and confirmed as ICP" }, { "field": "primaryOutcome", "quote": "subsequently found to have ICP on histopathological examination" }, { "field": "result", "quote": "All 56 patients presented with a prolapsing anal mass, and 51 (91.1%) also had hematochezia" }, { "field": "comparator", "quote": "Among 19364 patients treated for hemorrhoids, 56 (0.29%;12 males, 44 females; median age 56.5 years, range 18-81) were histopathologically confirmed to have ICP" } ] }, { "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 (which can include prolapsed hemorrhoids)", "intervention": "low excision and high suspension hemorrhoidectomy (LEHS), a tissue-preserving surgical technique", "comparator": "standard Milligan-Morgan hemorrhoidectomy (MM), the traditional surgical removal method", "primaryOutcome": "rate of successful treatment at 12 weeks and rate of hemorrhoid recurrence at 12 months", "result": "LEHS was as effective as MM in healing and preventing recurrence, with less pain, fewer complications, and better preserved anal function", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized, blinded trial but came from a single hospital with a modest number of patients and a short follow-up window for recurrence.", "directness": "indirect", "limitations": "Single-center study, trial registered retrospectively after the study period, and results may not generalize to other settings or hemorrhoid types.", "followUp": "12 months", "plainFinding": "Similar healing, less pain, fewer complications.", "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 (all P < 0.001), with higher patient satisfaction." } ] }, { "id": "pmid:42376216", "pmid": "42376216", "doi": "10.3389/fsurg.2026.1846705", "nctId": null, "pmcid": "PMC13311046", "title": "Multidisciplinary management of Grade III circumferential mixed hemorrhoids in a patient with Marfan syndrome receiving long-term anticoagulation: a case report", "firstAuthor": "Wei", "multipleAuthors": true, "journal": "Front Surg", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 33-year-old man with Marfan syndrome on long-term warfarin, with severe prolapsed hemorrhoids not helped by non-surgical treatment", "intervention": "surgery combining external hemorrhoid removal, internal ligation, and sclerotherapy injection, managed with a careful multi-specialty plan for blood thinners", "comparator": "no comparison group; single patient case report", "primaryOutcome": "healing of hemorrhoids and bleeding complications after surgery", "result": "wounds healed well with no recurrent prolapse or serious bleeding at long-term follow-up, after a brief episode of minor self-limiting bleeding after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment works better than other options in general.", "directness": "indirect", "limitations": "Only one patient was studied, there is no comparison group, and the patient had unusual medical complexity (Marfan syndrome and anticoagulation) that limits how well this applies to typical patients with prolapsed hemorrhoids.", "followUp": "41 months", "plainFinding": "Surgery healed hemorrhoids safely in this case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42376216/", "sourceText": "Management of advanced hemorrhoidal disease in patients with Marfan syndrome (MFS) who require lifelong anticoagulation is clinically complex because perioperative care must balance prosthetic valve thrombosis against postoperative anorectal bleeding. We report the case of a 33-year-old male with MFS, status post-aortic dissection repair (Sun's procedure and Bentall operation) on continuous warfarin therapy, who presented with persistent Grade III circumferential mixed hemorrhoids that had not responded adequately to prior conservative outpatient management. Physical examination confirmed characteristic MFS musculoskeletal signs and severe hemorrhoidal prolapse. A structured multidisciplinary team (MDT) pathway involving colorectal surgery, cardiovascular medicine, vascular surgery, anesthesia, pharmacy, and nutrition was used to individualize perioperative management. After cardiology consultation, and based on the patient's high thromboembolic risk, preoperative warfarin interruption was shortened to 3 days with enoxaparin bridging, and the INR decreased to 1.01 on the day before surgery. Rubber band ligation was avoided because of concern for delayed bleeding after sloughing in an anticoagulated patient. Because the disease involved circumferential mixed hemorrhoids with a prominent external component and prolapse, repeated sclerotherapy alone was considered unlikely to provide adequate definitive control. The patient therefore underwent external dissection and internal ligation combined with liquid polidocanol injection sclerotherapy, with minimal intraoperative blood loss. Postoperatively, a 25-day inpatient observation period enabled close INR titration during warfarin reinitiation, controlled bowel management, staged low-residue enteral nutrition, avoidance of rectal suppositories, and direct monitoring for delayed bleeding. Following minor self-limiting hematochezia, the patient was discharged with an INR of 1.8 as a pragmatic compromise between bleeding and thrombotic risks. At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications. This case suggests that surgical intervention for advanced hemorrhoids in anticoagulated MFS patients may be feasible when embedded within a structured, individualized multidisciplinary pathway. The anticoagulation, nutritional, and inpatient-monitoring strategies described here should be interpreted as patient-specific measures requiring further validation.", "provenance": [ { "field": "n", "quote": "We report the case of a 33-year-old male with MFS" }, { "field": "population", "quote": "a 33-year-old male with MFS, status post-aortic dissection repair (Sun's procedure and Bentall operation) on continuous warfarin therapy, who presented with persistent Grade III circumferential mixed hemorrhoids that had not responded adequately to prior conservative outpatient management" }, { "field": "intervention", "quote": "underwent external dissection and internal ligation combined with liquid polidocanol injection sclerotherapy" }, { "field": "comparator", "quote": "We report the case of a 33-year-old male" }, { "field": "primaryOutcome", "quote": "At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications." }, { "field": "result", "quote": "At 41 months of follow-up, the wounds remained well healed, with no recurrent prolapse or severe hemorrhagic complications." }, { "field": "followUp", "quote": "At 41 months of follow-up" } ] }, { "id": "pmid:42369632", "pmid": "42369632", "doi": "10.3389/fsurg.2026.1825956", "nctId": null, "pmcid": "PMC13294052", "title": "Benign lesions prolapsing through the anus: a differential diagnostic algorithm and evidence-based surgical management-a narrative review", "firstAuthor": "Vergara Torrente", "multipleAuthors": true, "journal": "Front Surg", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with a mass or lump coming out of the anus", "intervention": "clinical exam-based diagnosis and surgical treatment approaches for benign prolapsing anal conditions (including hemorrhoids)", "comparator": "no single comparator; different diagnoses and treatments compared against each other", "primaryOutcome": "a diagnostic algorithm to tell apart benign causes of anal prolapse and guide treatment choice", "result": "The review describes seven benign conditions that can prolapse through the anus, including internal and thrombosed hemorrhoids, and proposes a clinical algorithm using fold pattern, texture, mobility and location to tell them apart and guide surgical decisions, while flagging signs that need cancer or emergency work-up", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review summarizing existing evidence and expert opinion rather than new patient data, so it cannot show how well any treatment actually works.", "directness": "indirect", "limitations": "Narrative (non-systematic) review covering multiple different conditions, not focused specifically on prolapsed hemorrhoid outcomes; no original patient data or quantitative results given.", "followUp": "", "plainFinding": "Describes diagnosis, not treatment effectiveness.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42369632/", "sourceText": "Masses prolapsing through the anus represent a frequent diagnostic challenge in coloproctological practice. Misidentification may delay the management of malignant disease or surgical emergencies. This narrative review integrates current evidence on seven benign entities that may prolapse through the anus-complete rectal prolapse, mucosal rectal prolapse, internal hemorrhoids, thrombosed hemorrhoids, anal condylomas, hypertrophied anal papilla, and anal canal polyps-and proposes a clinical decision algorithm based on findings from physical examination. Particular emphasis is placed on the identification of red flags that require exclusion of malignancy or surgical emergency. The evidence supporting the different therapeutic options is critically analyzed. The proposed algorithm prioritizes objective clinical characteristics-fold pattern, texture, mobility, and anatomical location-to guide differential diagnosis and the sequence of complementary studies, optimizing surgical decision-making.", "provenance": [ { "field": "population", "quote": "Masses prolapsing through the anus represent a frequent diagnostic challenge in coloproctological practice." }, { "field": "intervention", "quote": "proposes a clinical decision algorithm based on findings from physical examination" }, { "field": "comparator", "quote": "seven benign entities that may prolapse through the anus-complete rectal prolapse, mucosal rectal prolapse, internal hemorrhoids, thrombosed hemorrhoids, anal condylomas, hypertrophied anal papilla, and anal canal polyps" }, { "field": "primaryOutcome", "quote": "proposes a clinical decision algorithm based on findings from physical examination" }, { "field": "result", "quote": "The proposed algorithm prioritizes objective clinical characteristics-fold pattern, texture, mobility, and anatomical location-to guide differential diagnosis and the sequence of complementary studies, optimizing surgical decision-making." } ] }, { "id": "pmid:42359159", "pmid": "42359159", "doi": "10.1093/jscr/rjag453", "nctId": null, "pmcid": "PMC13291813", "title": "Proximal sigmoid fecaloma after stapled hemorrhoidopexy: a diagnostic pitfall and stepwise nonoperative management", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "49-year-old woman with prolapsing hemorrhoids after stapled surgery", "intervention": "stapled hemorrhoidopexy for prolapsing hemorrhoids", "comparator": "none", "primaryOutcome": "development and management of proximal sigmoid fecaloma (severe constipation complication)", "result": "Patient developed severe abdominal pain and constipation from a fecaloma above the staple line, which was treated successfully without surgery using enemas and bowel irrigation", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report describing a complication, so it cannot show how well the surgery works overall.", "directness": "indirect", "limitations": "Single case report; no comparison group; cannot establish how common this complication is or how well the original hemorrhoid surgery worked.", "followUp": "14 days", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42359159/", "sourceText": "Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids and is associated with less short-term postoperative pain. While constipation is common after SH, proximal sigmoid fecaloma is rarely reported. We report a 49-year-old woman who presented with severe abdominal pain and obstipation 14 days after SH. Although digital rectal examination revealed an empty rectum, computed tomography (CT) demonstrated a large fecaloma in the proximal sigmoid colon, 15 cm proximal to the intact staple line. A rectal tube enema failed, but a targeted high enema via flexible sigmoidoscopy achieved partial softening, followed by successful evacuation with nasogastric polyethylene glycol irrigation. This case highlights that an empty rectum on digital examination does not exclude proximal fecal impaction after SH. Early CT may help differentiate proximal fecaloma from staple-line complications and support stepwise nonoperative management in selected stable patients.", "provenance": [ { "field": "population", "quote": "a 49-year-old woman who presented with severe abdominal pain and obstipation 14 days after SH" }, { "field": "intervention", "quote": "Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids" }, { "field": "comparator", "quote": "Stapled hemorrhoidopexy (SH) is used for prolapsing hemorrhoids and is associated with less short-term postoperative pain." }, { "field": "primaryOutcome", "quote": "proximal sigmoid fecaloma is rarely reported" }, { "field": "result", "quote": "computed tomography (CT) demonstrated a large fecaloma in the proximal sigmoid colon, 15 cm proximal to the intact staple line" }, { "field": "result", "quote": "successful evacuation with nasogastric polyethylene glycol irrigation" }, { "field": "n", "quote": "We report a 49-year-old woman" }, { "field": "followUp", "quote": "14 days after SH" } ] }, { "id": "pmid:42355550", "pmid": "42355550", "doi": "10.3390/life16061025", "nctId": null, "pmcid": "PMC13301189", "title": "Radiofrequency Ablation for Hemorrhoidal Disease", "firstAuthor": "Spiridon", "multipleAuthors": true, "journal": "Life (Basel)", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with internal hemorrhoids, especially grade II-III", "intervention": "radiofrequency ablation (RFA, including the Rafaelo procedure)", "comparator": "conventional hemorrhoidectomy", "primaryOutcome": "pain, recovery and symptom control after treatment", "result": "RFA may cause less pain, fewer painkillers needed, shorter hospital stay and faster return to normal life, with acceptable symptom control in the short and medium term, compared to surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a narrative review of studies that the authors themselves describe as varied in design, technique and follow-up, with no pooled statistics and a call for more randomized trials.", "directness": "indirect", "limitations": "Studies reviewed are heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration; long-term recurrence and cost-effectiveness data are lacking.", "followUp": "short- and mid-term", "plainFinding": "Less pain than surgery, similar relief.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42355550/", "sourceText": "Hemorrhoidal disease is a common anorectal condition that may require treatment when bleeding, prolapse or persistent symptoms fail to respond to conservative or office-based therapy. Radiofrequency ablation (RFA) has emerged as a minimally invasive, tissue-sparing technique for symptomatic internal hemorrhoids, based on controlled delivery of high-frequency energy into hemorrhoidal tissue. The resulting thermal effect induces coagulative necrosis, fibrosis, mucosal fixation and progressive reduction in hemorrhoidal volume, without excisional removal of anoderm or rectal mucosa. This narrative review summarizes the mechanism, technical principles, clinical advantages, comparative evidence and remaining uncertainties surrounding RFA, with particular attention to the Rafaelo procedure and related radiofrequency-based approaches. Current evidence suggests that RFA may reduce postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity compared with conventional hemorrhoidectomy, while maintaining acceptable short- and mid-term symptom control in selected patients, especially those with grade II-III internal hemorrhoids. However, available studies remain heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration. The relationship between modern probe-based RFA and earlier radiofrequency-based approaches, including Ellman surface coagulation, Celon bipolar radiofrequency-induced thermotherapy and radiofrequency-assisted hemorrhoidectomy, remains insufficiently standardized in the literature. Further randomized trials, standardized outcome reporting, long-term recurrence data and cost-effectiveness analyses are required to define the optimal indications and therapeutic position of RFA.", "provenance": [ { "field": "population", "quote": "especially those with grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "Radiofrequency ablation (RFA) has emerged as a minimally invasive, tissue-sparing technique for symptomatic internal hemorrhoids" }, { "field": "comparator", "quote": "compared with conventional hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity" }, { "field": "result", "quote": "Current evidence suggests that RFA may reduce postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity compared with conventional hemorrhoidectomy, while maintaining acceptable short- and mid-term symptom control in selected patients, especially those with grade II-III internal hemorrhoids." }, { "field": "limitations", "quote": "available studies remain heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration" }, { "field": "followUp", "quote": "acceptable short- and mid-term symptom control" } ] }, { "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 with symptomatic hemorrhoids grade 2 to 4, mostly advanced (grade III/IV) with minimal to moderate prolapse", "intervention": "laser hemorrhoidoplasty", "comparator": "", "primaryOutcome": "symptom resolution, recurrence, pain, complications, and patient satisfaction after surgery", "result": "over 90% had full symptom relief at 1 year, 9.1% recurrence, low pain, and high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single-group study without a comparison treatment, and fewer than half of patients were followed up at 2 years, so it cannot show how laser treatment compares to other options.", "directness": "direct", "limitations": "only 33.8% of patients followed at 2 years, and the abstract title describes it as retrospective and observational with no comparison group", "followUp": "2 years", "plainFinding": "Good symptom relief, low pain, high satisfaction.", "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": "symptomatic haemorrhoids of grade 2 to 4 with minimal to moderate prolapse" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "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." } ] }, { "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": "adults with bleeding-predominant grade III internal hemorrhoids", "intervention": "cap-assisted endoscopic sclerotherapy (CAES) with polidocanol injection via long needle", "comparator": "none (single-arm, before-after comparison)", "primaryOutcome": "improvement in hemorrhoid symptoms (bleeding and prolapse) measured by severity scores", "result": "96.3% effective for bleeding but only 58.2% effective for prolapse, with 25.3% bleeding recurrence over 24 months", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study of one group of patients with no comparison group, so it can't prove the treatment caused the improvement.", "directness": "indirect", "limitations": "Single-arm retrospective design, patients selected specifically for bleeding-predominant symptoms, no control group.", "followUp": "24 months", "plainFinding": "Good for bleeding, less for prolapse.", "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 who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle." }, { "field": "population", "quote": "This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs" }, { "field": "intervention", "quote": "the injection of liquid polidocanol via a long needle" }, { "field": "comparator", "quote": "This single-arm retrospective observational study" }, { "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) and the score of the intensity dimension of the bleeding symptom." }, { "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": "the bleeding recurrence rate was 25.3% (20/79)" }, { "field": "followUp", "quote": "During a follow-up of 24 months" } ] }, { "id": "pmid:42313087", "pmid": "42313087", "doi": "10.17235/reed.2026.11898/2026", "nctId": null, "pmcid": null, "title": "Outcomes of laser hemorrhoidoplasty in grade II-IV hemorrhoidal disease: a four-year, single center experience", "firstAuthor": "Heynderickx", "multipleAuthors": true, "journal": "Rev Esp Enferm Dig", "year": 2026, "design": "retrospective", "n": 132, "nField": "reported", "population": "adults with grade II-IV hemorrhoids (some prolapsed)", "intervention": "laser hemorrhoidoplasty (minimally invasive laser procedure)", "comparator": "no comparison group (single-arm outcomes)", "primaryOutcome": "postoperative pain, complications, satisfaction, and recurrence", "result": "Low pain scores, 95.5% satisfaction, 9.1% complications, 9.8% recurrence overall; grade IV disease linked to higher recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective single-center study without a comparison group, so results could be biased or not generalizable.", "directness": "direct", "limitations": "Retrospective design, no control/comparison group, single center, authors call for prospective studies with larger samples and longer follow-up.", "followUp": "one month", "plainFinding": "Low pain, good satisfaction, more recurrence in severe cases", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42313087/", "sourceText": "BACKGROUND: Open hemorrhoidectomy remains the gold standard for the surgical treatment of hemorrhoidal disease but is associated with substantial postoperative pain and complications. In contrast, Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative. This study aimed to evaluate the clinical outcomes, complication and recurrence rates of LHP in a single-center cohort. METHODS: This retrospective study included 132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease who underwent Laser Hemorrhoidoplasty in our center between January 2021 and June 2025. Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed. Univariable and multivariable logistic regression analyses were performed to identify associations with recurrence and complications. RESULTS: Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month. Most patients (94.7 %) were discharged on the day of surgery, and 95.5 % reported satisfaction with the postoperative outcome. Postoperative complications occurred in twelve patients (9.1 %), including three readmissions (2.3 %) and one reintervention (0.8 %). Overall recurrence occurred in thirteen patients (9.8 %), while five patients (3.8 %) required surgical treatment. Higher hemorrhoidal grade was significantly associated with recurrence, whereas no association was observed with postoperative complications. In multivariable analysis, grade IV hemorrhoids were independently associated with increased odds of recurrence after adjustment for age and previous treatment. CONCLUSION: Within this cohort, LHP may represent a safe and minimally invasive treatment option for hemorrhoidal disease associated with generally low postoperative pain, favorable patient satisfaction and relatively short hospital stay. Complication and readmission rates were low. However, grade IV disease was independently associated with increased recurrence after adjustment for age and previous treatment, indicating that caution is warranted in this subgroup. Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed to better define the role of LHP in advanced hemorrhoidal disease.", "provenance": [ { "field": "n", "quote": "This retrospective study included 132 patients" }, { "field": "population", "quote": "132 patients (72 % male, mean age 52.8 years) with grade II-IV hemorrhoidal disease" }, { "field": "intervention", "quote": "Laser Hemorrhoidoplasty (LHP) has emerged as a minimally invasive alternative" }, { "field": "comparator", "quote": "Further prospective studies with larger sample sizes, comparison group and longer follow-up are needed" }, { "field": "primaryOutcome", "quote": "Postoperative pain, complications, patient satisfaction, and recurrence rates were analyzed." }, { "field": "result", "quote": "Postoperative pain scores were low, with a median Visual Analogue Scale (VAS) score of zero at discharge, after one week and after one month." }, { "field": "result", "quote": "Postoperative complications occurred in twelve patients (9.1 %)" }, { "field": "result", "quote": "Overall recurrence occurred in thirteen patients (9.8 %)" }, { "field": "result", "quote": "Higher hemorrhoidal grade was significantly associated with recurrence" }, { "field": "followUp", "quote": "after one week and after one month" } ] }, { "id": "pmid:42266125", "pmid": "42266125", "doi": "10.3393/ac.2025.01088.0155", "nctId": null, "pmcid": "PMC13261178", "title": "Efficacy and safety of low-dose triamcinolone acetonide injections in reducing stricture at stapled hemorrhoidopexy sites", "firstAuthor": "Youn", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2026, "design": "retrospective", "n": 1023, "nField": "reported", "population": "patients who had surgery (stapled hemorrhoidopexy) for severe internal hemorrhoids with prolapse", "intervention": "low-dose triamcinolone acetonide (steroid) injection at the surgical staple site", "comparator": "conventional epinephrine injection at the staple site", "primaryOutcome": "rate of stricture (narrowing) at the surgical site and need for reoperation", "result": "stricture rate was 2.9% with steroid injection versus 16.0% with epinephrine, and reoperation rate was 5.9% versus 14.4%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized comparison using statistical matching rather than a randomized trial, so bias cannot be ruled out.", "directness": "indirect", "limitations": "not randomized; relies on propensity score matching to balance groups; single intervention variant (dose/technique) so may not generalize to other stricture-prevention methods", "followUp": "", "plainFinding": "Fewer strictures, fewer reoperations.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42266125/", "sourceText": "PURPOSE: Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids. A common complication of SH is SH site stricture (SHsS), which negatively affects quality of life. This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS. METHODS: Between 2020 and 2023, 1,023 patients underwent SH, with an average of 3.3 external hemorrhoids being excised per patient. The fluid mixture contained 40 mg of TA per 100 mL (0.4 mg/mL), with 5 mL (2 mg of TA) injected at the SH site and 2-3 mL (1.2 mg of TA) at each excisional hemorrhoidectomy site. The TA group (n=554; propensity score matching [PSM]-adjusted, n=375) received TA injections, whereas the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections. PSM was adjusted for age, sex, concurrent surgeries, botulinum toxin injection, and excisional hemorrhoidectomy frequency. Logistic regression models were used to analyze SHsS and reoperation rates. RESULTS: SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%). CONCLUSION: Low-dose TA injections effectively prevent SHsS and reduce reoperation rates without increasing the risk of infection, providing a safe, cost-effective approach to improving surgical outcomes.", "provenance": [ { "field": "n", "quote": "Between 2020 and 2023, 1,023 patients underwent SH" }, { "field": "population", "quote": "Stapled hemorrhoidopexy (SH) is commonly used to treat severe internal hemorrhoids and rectal mucosal prolapse associated with prolapsing hemorrhoids." }, { "field": "intervention", "quote": "with 5 mL (2 mg of TA) injected at the SH site" }, { "field": "comparator", "quote": "the non-TA group (n=469; after PSM, n=375) received conventional epinephrine injections" }, { "field": "primaryOutcome", "quote": "This study evaluated the efficacy and safety of low-dose triamcinolone acetonide (TA) injection at the SH site for the prevention of SHsS." }, { "field": "result", "quote": "SHsS rate was significantly lower in the TA group (2.9%) than in the non-TA group (16.0%). Furthermore, the reoperation rate was lower in the TA group (5.9%) than in the non-TA group (14.4%)." } ] }, { "id": "pmid:42159773", "pmid": "42159773", "doi": "10.1007/s00384-026-05151-5", "nctId": null, "pmcid": "PMC13364931", "title": "Defining proficiency in THD-Anolift: a CUSUM analysis of the learning curve in 51 consecutive cases", "firstAuthor": "Galli", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2026, "design": "case-series", "n": 51, "nField": "reported", "population": "patients with hemorrhoidal disease (mostly grade III) undergoing a minimally invasive hemorrhoid procedure", "intervention": "transanal hemorrhoidal dearterialization with Anolift mucopexy (THD-Anolift), performed by one surgeon learning the technique", "comparator": "the surgeon's own earlier cases (first 23) compared to later cases (after case 23) as experience increased", "primaryOutcome": "a combined measure of recurrence and/or complications, and operating time, used to find the point where the surgeon became proficient", "result": "Operating time fell significantly as the surgeon gained experience (from about 27 to 20 minutes), and the complication/recurrence rate also fell (from 52% to 25%) but this drop was not statistically significant", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a single surgeon's retrospective case series with no comparison group and too few patients to reliably show whether complications truly improved.", "directness": "indirect", "limitations": "Retrospective, single-surgeon, single-center design; 9 patients excluded for incomplete data; the complication/recurrence improvement did not reach statistical significance (p = 0.080).", "followUp": "Median follow-up was 12 months (range 3-33)", "plainFinding": "Faster surgery with experience; complication benefit unclear", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42159773/", "sourceText": "BACKGROUND: Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy is a validated non-excisional procedure for hemorrhoidal disease. Although surgeon experience is acknowledged as a determinant of THD outcomes, no formal learning curve analysis exists. This study aimed to characterize the learning curve of a single surgeon adopting THD-Anolift. METHODS: Retrospective analysis of 60 consecutive THD-Anolift cases (May 2023-February 2026). Nine patients with incomplete outcome data were excluded, leaving 51 for analysis. Median follow-up was 12 months (range 3-33). Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time. The proficiency point was identified at the CUSUM inflection. Sensitivity analyses included CUSUM on recurrence alone, CUSUM restricted to recurrence and Clavien-Dindo ≥ II complications, best-case/worst-case imputation for excluded patients, and risk-adjusted CUSUM controlling for hemorrhoid grade and previous procedures. RESULTS: Median age was 53 years; 72.5% were male; 80.4% had grade III hemorrhoids. The overall composite failure rate was 37.3% (19/51) and the recurrence rate 15.7% (8/51). Mean operative time was 23.5 ± 7.4 min. The composite outcome CUSUM identified a proficiency point at case 23: the failure rate decreased from 52.2% in Phase 1 (cases 1-23) to 25.0% in Phase 2 (cases 24-51; p = 0.080, not statistically significant at the conventional threshold). Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0 min (p < 0.001). On sensitivity analysis, both the recurrence-only CUSUM and the risk-adjusted CUSUM confirmed an identical proficiency point at case 23, and worst-case/best-case imputation for excluded patients moved the inflection only to cases 25 and 22 respectively, indicating that the finding was robust to endpoint definition and case-mix variation, as well as to plausible patterns of missing data. CONCLUSIONS: CUSUM analysis identified an inflection at approximately 23 cases, with a statistically significant reduction in operative time and a clinically relevant but underpowered reduction in composite failure that did not reach the conventional threshold for statistical significance. Rather than a fixed competency threshold, these findings provide an initial benchmark to help structure supervised adoption-suggesting that the 10 mentored cases conventionally proposed in industry-sponsored teaching may be insufficient- and to inform future multicenter validation.", "provenance": [ { "field": "n", "quote": "leaving 51 for analysis" }, { "field": "population", "quote": "80.4% had grade III hemorrhoids" }, { "field": "intervention", "quote": "Transanal hemorrhoidal dearterialization (THD) with Anolift mucopexy" }, { "field": "comparator", "quote": "the failure rate decreased from 52.2% in Phase 1 (cases 1-23) to 25.0% in Phase 2 (cases 24-51" }, { "field": "primaryOutcome", "quote": "Cumulative sum (CUSUM) charts were constructed for a composite failure endpoint (recurrence and/or any complication) and for operative time." }, { "field": "result", "quote": "Operative time decreased from 27.1 ± 7.4 to 20.4 ± 6.0 min (p < 0.001)." }, { "field": "result", "quote": "the failure rate decreased from 52.2% in Phase 1 (cases 1-23) to 25.0% in Phase 2 (cases 24-51; p = 0.080, not statistically significant at the conventional threshold)" }, { "field": "followUp", "quote": "Median follow-up was 12 months (range 3-33)." } ] }, { "id": "pmid:42143115", "pmid": "42143115", "doi": "10.1038/s41598-026-53489-1", "nctId": null, "pmcid": "PMC13369158", "title": "Effect of intrasphincteric botulinum toxin on postoperative urinary retention following stapled hemorrhoidopexy: a randomized, double-blind, placebo-controlled trial", "firstAuthor": "Alvandipour", "multipleAuthors": true, "journal": "Sci Rep", "year": 2026, "design": "rct", "n": 68, "nField": "reported", "population": "adults with grade III-IV hemorrhoids having stapled hemorrhoidopexy surgery", "intervention": "botulinum toxin injected into the anal sphincter muscle during surgery", "comparator": "placebo injection into the anal sphincter during surgery", "primaryOutcome": "inability to urinate after surgery requiring a catheter", "result": "botulinum toxin lowered the rate of urinary retention compared to placebo", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized placebo-controlled trial but with a modest number of patients and was a secondary analysis of a trial designed for a different purpose.", "directness": "indirect", "limitations": "this was a secondary analysis of a trial originally designed to study pain, not hemorrhoid prolapse treatment itself, and focused on a surgical complication rather than hemorrhoid outcomes", "followUp": "", "plainFinding": "Less urinary retention after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42143115/", "sourceText": "Postoperative urinary retention (POUR) is a frequent and clinically significant complication following stapled hemorrhoidopexy, often resulting in catheterization, prolonged hospitalization, and patient discomfort. Strategies to reduce POUR remain limited. Intrasphincteric botulinum toxin (BTX) injection may decrease internal anal sphincter tone and indirectly reduce urinary dysfunction. To evaluate the effect of intrasphincteric BTX type A injection on the incidence of POUR following stapled hemorrhoidopexy in a secondary analysis of a prospective randomized controlled trial originally designed to assess postoperative pain outcomes. In this double-blind, placebo-controlled trial, 68 adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy at two tertiary hospitals were randomized (1:1) to receive either 50 units of BTX A or placebo injected into the internal anal sphincter intraoperatively. The primary outcome was POUR, defined as failure to void within six hours postoperatively with a bladder volume > 400 mL on ultrasound requiring catheterization. Secondary outcomes included postoperative pain, gas incontinence, bleeding, and anal stenosis. POUR occurred in 30 patients (44.1%). The incidence was significantly lower in the BTX group compared with placebo (20.6% vs. 67.6%, P < 0.001). In multivariable logistic regression adjusted for age and sex, placebo treatment was independently associated with higher odds of POUR (adjusted OR 8.87, 95% CI 2.82-27.95; P < 0.001). No significant differences were observed in postoperative bleeding or gas incontinence. Intrasphincteric BTX injection significantly reduces postoperative urinary retention following stapled hemorrhoidopexy and may represent an effective perioperative strategy to improve surgical.Registration: IRCT20130826014483N12; Registered 25 June 2025 (Retrospectively registered).", "provenance": [ { "field": "n", "quote": "68 adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy" }, { "field": "population", "quote": "adult patients with grade III-IV hemorrhoids undergoing stapled hemorrhoidopexy at two tertiary hospitals" }, { "field": "intervention", "quote": "50 units of BTX A" }, { "field": "comparator", "quote": "placebo injected into the internal anal sphincter intraoperatively" }, { "field": "primaryOutcome", "quote": "The primary outcome was POUR, defined as failure to void within six hours postoperatively with a bladder volume > 400 mL on ultrasound requiring catheterization." }, { "field": "result", "quote": "The incidence was significantly lower in the BTX group compared with placebo (20.6% vs. 67.6%, P < 0.001)." } ] }, { "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 underwent hemorrhoid removal surgery", "intervention": "having anemia before surgery", "comparator": "not having anemia before surgery", "primaryOutcome": "pain, complications, healing time, and recurrence after hemorrhoid surgery", "result": "patients who were anemic before surgery had more pain and worse sleep in the first week after surgery, but no difference in bleeding, infection, swelling, urinary retention, healing time, or hemorrhoid recurrence within 12 months", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective study comparing two groups without randomization, and the authors themselves say the findings need confirmation in larger, better-designed studies.", "directness": "indirect", "limitations": "retrospective observational design, exploratory analysis, no multivariable adjustment, authors say findings should be interpreted with caution", "followUp": "12 months", "plainFinding": "Anemia linked to more pain, not recurrence", "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": "127 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": "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." }, { "field": "qualityWhy", "quote": "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." } ] }, { "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, including those with prolapse", "intervention": "rubber band ligation or infrared coagulation (with diet/lifestyle and topical treatments)", "comparator": "other treatments or no treatment", "primaryOutcome": "control of symptoms like prolapse and bleeding", "result": "banding and infrared coagulation are safe and effective, with banding giving longer-term control of prolapse and bleeding than infrared coagulation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an expert consensus guideline based on opinion and literature review without systematic review or formal evidence ratings.", "directness": "direct", "limitations": "No systematic review was performed and statements are not formally graded for evidence quality.", "followUp": "", "plainFinding": "Banding works better long-term for prolapse.", "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": "intervention", "quote": "Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting." }, { "field": "comparator", "quote": "Infrared coagulation and rubber band ligation have similar benefits in the short term." }, { "field": "result", "quote": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding." }, { "field": "primaryOutcome", "quote": "Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse." }, { "field": "population", "quote": "Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids." }, { "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: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": "adults with symptomatic grade III prolapsing hemorrhoids", "intervention": "surgery combining tissue removal (Milligan-Morgan hemorrhoidectomy) and/or stitching the prolapsed tissue back up (mucopexy), in different combinations", "comparator": "different groups compared against each other: hemorrhoidectomy alone, mucopexy alone, or a mix of both", "primaryOutcome": "hemorrhoid recurrence and patient-reported pain/satisfaction scores", "result": "mucopexy alone caused less pain and better scores soon after surgery, but had a much higher recurrence rate (14.5%) than hemorrhoidectomy alone (4.2%), which had the best long-term results", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it looked back at past patient records rather than randomly assigning treatments, so differences between groups could be due to other factors.", "directness": "direct", "limitations": "Retrospective analysis.", "followUp": "2 years", "plainFinding": "Less pain but more recurrence with mucopexy.", "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": "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": "group 1 included patients treated with MM alone" }, { "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." }, { "field": "limitations", "quote": "Retrospective analysis." } ] }, { "id": "pmid:42022142", "pmid": "42022142", "doi": "10.3389/fgstr.2026.1681972", "nctId": null, "pmcid": "PMC13095556", "title": "Case Report: Endoscopic anal papillectomy combined with ligation: a new approach for the treatment of grade IV hemorrhoids (with video)", "firstAuthor": "Lv", "multipleAuthors": true, "journal": "Front Gastroenterol (Lausanne)", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a woman with grade IV prolapsed hemorrhoids for three years", "intervention": "endoscopic removal of the prolapsed hemorrhoid and papillae with snare, plus ligation of loose mucosa", "comparator": "none (no comparison group)", "primaryOutcome": "bleeding, pain, recovery time, and complications like anal narrowing or recurrence", "result": "minimal bleeding, less pain, faster recovery, and no complications over 8 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no comparison group, so it cannot show whether this works better than other treatments.", "directness": "direct", "limitations": "Only one patient, no control group, and follow-up was limited to 8 months; abstract calls for larger comparative studies.", "followUp": "8-month follow-up", "plainFinding": "New scope technique, good early results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42022142/", "sourceText": "BACKGROUND AND AIMS: Hemorrhoids represent the most prevalent anorectal disorder globally. They are categorized into three types based on location: internal, external, and mixed hemorrhoids. Furthermore, internal hemorrhoids are classified from I to IV, depending on their appearance and degree of prolapse. Surgical intervention is frequently required for Grade III-IV and mixed hemorrhoids, which exhibit complex and severe symptoms. The challenges of these surgical procedures include extensive incisions, substantial intraoperative bleeding, intense postoperative pain, and a heightened risk of complications. Consequently, the exploration of alternative therapies continues. METHODS: This report introduces an innovative endoscopic technique employed to treat a female patient suffering from Grade IV hemorrhoids for three years. Utilizing an endoscope, the prolapsed hemorrhoid and hypertrophic anal papillae were progressively excised with a snare, followed by the application of a ligator to ligate the lax mucosa above the dentate line at multiple sites, thereby preventing future prolapse. RESULTS: The procedure resulted in minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up. CONCLUSION: This technique is particularly innovative as endoscope facilitates a clearer surgical view and more precise manipulation, thus minimizing damage to the rectal mucosa and anal skin. Furthermore, this technique can be utilized to concurrently remove hemorrhoids during gastrointestinal endoscopy, which will alleviate the patient's multiple suffering and save money and time. This method offers a new direction for treating Grade IV hemorrhoids. Longer follow-up periods and larger sample size comparative studies are needed in the future to verify its safety and efficacy.", "provenance": [ { "field": "population", "quote": "a female patient suffering from Grade IV hemorrhoids for three years" }, { "field": "intervention", "quote": "the prolapsed hemorrhoid and hypertrophic anal papillae were progressively excised with a snare, followed by the application of a ligator to ligate the lax mucosa above the dentate line at multiple sites" }, { "field": "comparator", "quote": "This report introduces an innovative endoscopic technique employed to treat a female patient" }, { "field": "primaryOutcome", "quote": "minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up" }, { "field": "result", "quote": "The procedure resulted in minimal bleeding, reduced postoperative pain, a shorter recovery period, and the patient experienced no complications such as anal stenosis or recurrent prolapse during the 8-month follow-up." }, { "field": "n", "quote": "a female patient suffering from Grade IV hemorrhoids for three years" } ] }, { "id": "pmid:41992176", "pmid": "41992176", "doi": "10.1186/s12893-026-03714-5", "nctId": null, "pmcid": "PMC13220486", "title": "Open haemorrhoidectomy combined with lateral internal sphincterotomy versus conventional haemorrhoidectomy: a prospective randomized comparative study", "firstAuthor": "Alsalaumy", "multipleAuthors": false, "journal": "BMC Surg", "year": 2026, "design": "rct", "n": 120, "nField": "reported", "population": "adults with grade III or IV prolapsed hemorrhoids", "intervention": "open hemorrhoidectomy surgery plus a cut in the anal sphincter muscle (lateral internal sphincterotomy)", "comparator": "open hemorrhoidectomy surgery alone", "primaryOutcome": "pain and bleeding after surgery over the first two weeks", "result": "adding the sphincterotomy led to much less pain and less early bleeding than hemorrhoidectomy alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was randomized but came from a single hospital, was not blinded given the surgical difference, and the trial was registered only after the study had already been completed, raising concern about selective reporting.", "directness": "direct", "limitations": "single-center study, likely no blinding of patients or assessors to which surgery they had, and retrospective trial registration after the study period ended", "followUp": "two weeks", "plainFinding": "Less pain and bleeding with sphincterotomy added.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41992176/", "sourceText": "BACKGROUND: Open haemorrhoidectomy is an effective treatment for haemorrhoidal disease, but it is associated with significant postoperative pain and early bleeding. Lateral internal sphincterotomy (LIS) has been recommended as an adjunctive procedure to reduce sphincter spasm and facilitate post-operative healing. This study was designed to compare postoperative pain and bleeding in patients treated with an open haemorrhoidectomy with or without a lateral internal sphincterotomy. METHODS: This prospective, randomized, comparative study was conducted at Baghdad Teaching Hospital from March 2024 to July 2025. A total of 120 patients with Grade III or IV haemorrhoids were randomly divided into two groups: the group of open haemorrhoidectomy with lateral internal sphincterotomy (Group A, n = 60) or the group of open haemorrhoidectomy alone (Group B, n = 60). Allocation was made by means of sealed, opaque envelopes. Pain and postoperative bleeding were compared during the first 24 h, 48 h, one week and two weeks thereafter. Statistical analysis was carried out using the chi-square test or Fisher’s exact test, with p < 0.05 considered statistically significant. RESULTS: Postoperatively, patients who underwent haemorrhoidectomy and lateral internal sphincterotomy had significantly less pain during all assessed time points. At 1 week, 81.6% of patients in Group A were pain-free compared to none in Group B (risk difference 81.7%, 95% CI 71.9%–91.5%; p < 0.001). At 2 weeks, 94.2% in Group A were pain-free vs. 3.5% in Group B (risk difference 90.7%, 95% CI 82.8%–98.7%; p < 0.001). Bleeding occurred in 5% of patients in Group A compared to 41.6% in Group B at 24 h (p < 0.001), and in 5% versus 35% at 48 h (p < 0.001). No further bleeding episodes were observed in Group A beyond the first postoperative week. CONCLUSIONS: Inclusion of lateral internal sphincterotomy in the standard open haemorrhoidectomy decreases both postoperative pain and early bleeding, which leads to improved short-term recovery. This combination method seems to be a safe and efficacious modification of conventional haemorrhoidectomy. TRIAL REGISTRATION: This study was retrospectively registered at ClinicalTrials.gov on 13th January 2026. Identifier NCT07360912.", "provenance": [ { "field": "population", "quote": "120 patients with Grade III or IV haemorrhoids" }, { "field": "intervention", "quote": "open haemorrhoidectomy with lateral internal sphincterotomy" }, { "field": "comparator", "quote": "open haemorrhoidectomy alone" }, { "field": "primaryOutcome", "quote": "Pain and postoperative bleeding were compared during the first 24 h, 48 h, one week and two weeks thereafter" }, { "field": "result", "quote": "At 1 week, 81.6% of patients in Group A were pain-free compared to none in Group B (risk difference 81.7%, 95% CI 71.9%–91.5%; p < 0.001)" }, { "field": "result", "quote": "Bleeding occurred in 5% of patients in Group A compared to 41.6% in Group B at 24 h (p < 0.001)" }, { "field": "n", "quote": "A total of 120 patients with Grade III or IV haemorrhoids were randomly divided into two groups" } ] }, { "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)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH) surgery", "primaryOutcome": "cure rate, operative time, hospital stay, pain scores, and complications", "result": "similar cure rates but shorter surgery, shorter hospital stay, less pain, and fewer urinary retention complications with ESHB", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study comparing two groups without randomization, so other differences between patients could explain the results.", "directness": "direct", "limitations": "Retrospective design, no randomization, and only short-term follow-up with long-term efficacy not yet validated.", "followUp": "", "plainFinding": "Similar cure, faster recovery, 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": "n", "quote": "245 patients underwent Milligan-Morgan hemorrhoidectomy (MMH) and 235 patients underwent ESHB." }, { "field": "population", "quote": "patients with mixed hemorrhoids treated in our hospital from June 2021 to June 2024" }, { "field": "intervention", "quote": "Endoscopic Super-hemorrhoidal Banding (ESHB)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH) as the control group" }, { "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." }, { "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). 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)." } ] }, { "id": "pmid:41985960", "pmid": "41985960", "doi": "10.1136/bmjopen-2025-113469", "nctId": null, "pmcid": "PMC13084786", "title": "Comparing the effectiveness and safety of different surgical procedures for haemorrhoids: a protocol for systematic evaluation and network meta-analysis of randomised controlled trials", "firstAuthor": "Li", "multipleAuthors": true, "journal": "BMJ Open", "year": 2026, "design": "registered-trial-no-results", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids needing surgery", "intervention": "various surgical and office-based hemorrhoid procedures", "comparator": "different hemorrhoid procedures compared to each other", "primaryOutcome": "cure rate, recurrence, complications, pain, healing time, anal function", "result": "This is a study protocol; no results are reported yet", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is only a plan for future research, not an actual study with findings.", "directness": "indirect", "limitations": "No results are available yet; this describes planned methods only.", "followUp": "", "plainFinding": "No results yet; protocol only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41985960/", "sourceText": "INTRODUCTION: Haemorrhoidal disease affects 25-40% of adults worldwide and constitutes a primary reason for outpatient colorectal consultations. Surgical management is essential for grade III-IV or treatment-refractory cases. Numerous procedures have emerged, including Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty. However, randomised controlled trials and conventional meta-analyses report conflicting results on efficacy, postoperative pain, recurrence rates and complications such as bleeding, stenosis and incontinence. Although network meta-analyses exist, an updated synthesis is needed because outcomes and follow-up vary across trials. This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis, providing evidence-based guidance for clinical practice and guideline development. METHODS AND ANALYSIS: The Cochrane Library, Web of Science, MEDLINE, Embase, China National Knowledge Infrastructure, VIP, SinoMed and Wanfang databases will be searched from inception to January 2025, limited to English or Chinese publications. Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included, with outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration. Risk of bias will be assessed using RoB 2. Pairwise meta-analyses will be conducted in RevMan; network meta-analysis will employ Bayesian frameworks in GeMTC or R, incorporating consistency evaluation, node-splitting and surface under the cumulative ranking curve for treatment ranking. Subgroup analyses (haemorrhoid grade, follow-up duration), sensitivity analyses and publication bias assessments will be performed. Evidence certainty will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and the Confidence in Network Meta-Analysis (CINeMA) framework. ETHICS AND DISSEMINATION: As only published data will be used, ethical approval is not required. Results will be disseminated via peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD420251053697.", "provenance": [ { "field": "population", "quote": "Haemorrhoidal disease affects 25-40% of adults worldwide" }, { "field": "intervention", "quote": "Milligan-Morgan open haemorrhoidectomy, Ferguson closed haemorrhoidectomy, stapled haemorrhoidopexy, Doppler-guided haemorrhoidal artery ligation, transanal haemorrhoidal dearterialisation and laser haemorrhoidoplasty" }, { "field": "comparator", "quote": "Randomised controlled trials evaluating haemorrhoid interventions/procedures for haemorrhoidal disease will be included" }, { "field": "primaryOutcome", "quote": "outcomes encompassing cure rate, recurrence, complications, postoperative pain, wound-healing time, anal function and operative duration" }, { "field": "result", "quote": "This protocol aims to determine the most effective and safest haemorrhoid interventions (office-based and operative) through systematic review and network meta-analysis" } ] }, { "id": "pmid:41981341", "pmid": "41981341", "doi": "10.1007/s00423-026-04030-5", "nctId": null, "pmcid": "PMC13186793", "title": "Determinants influencing decision-making for operative and perioperative management of grade III and IV hemorrhoidal disease: secondary analysis of a multicenter nationwide prospective cohort study", "firstAuthor": "Kement", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2026, "design": "prospective-cohort", "n": 315, "nField": "reported", "population": "patients with grade III and IV hemorrhoid disease", "intervention": "choice of surgical technique and perioperative management (e.g., excisional vs non-excisional surgery, anesthesia, analgesia, outpatient care)", "comparator": "patient and disease-related factors such as thrombosis, disease grade, and hospital type", "primaryOutcome": "which factors influenced the choice of surgical technique, anesthesia type, analgesia use, and outpatient management", "result": "Thrombosis and hospital category were the strongest factors influencing which surgery and perioperative care patients received, with significant variation between hospitals", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "It is a reasonably large multicenter study, but it only looks at what drives doctors' treatment choices, not whether those treatments actually work better.", "directness": "indirect", "limitations": "This is a secondary analysis of a cohort study focused on decision-making factors, not on comparing treatment outcomes or effectiveness.", "followUp": "", "plainFinding": "Treatment choice varies by hospital and thrombosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41981341/", "sourceText": "PURPOSE: With multiple treatment options available for hemorrhoidal disease (HD), identifying factors that influence surgical and perioperative management decisions is essential, particularly in advanced cases. This study aimed to determine the patient and disease-related determinants affecting the choice of surgical technique and perioperative management in patients with Grade III and IV HD, thereby addressing inter-institutional variations in treatment approaches. METHODS: A secondary analysis was performed on data from a nationwide, multicenter prospective cohort study. The study included 315 patients diagnosed with Grade III (72%) and Grade IV (28%) HD, with a mean age of 43.7 ± 11.4 years and a male predominance (76.7%). Preoperative data, including patient demographics, comorbidities (ASA scores), symptom severity, and clinical findings, were collected at participating governmental and private hospitals. Surgical techniques were classified as excisional or non-excisional, while anesthesia type, use of perianal or pudendal analgesia, and hospitalization duration were determined by the surgical teams. Hospital type was also recorded. Multivariable analyses were conducted to identify factors influencing the choice of surgical techniques, anesthesia, analgesia application, and the decision for outpatient procedures. RESULTS: Multivariate analysis revealed that the presence of thrombosis significantly influenced the choice of surgical technique (OR: 7.2, CI: 2.8-12.7, p = 0.001), while hospital category also played an important role (OR: 5.1, CI: 2.7-9.7, p = 0.001). For anesthesia type, factors such as disease grade (OR: 3.3, CI: 1.6-6.7, p = 0.001), hospital category (OR: 9, CI: 4.1-19.9, p < 0.001), and surgical technique (OR: 6.8, CI: 3-15.3, p < 0.001) were significant determinants. The decision to use perianal or pudendal analgesia was influenced by hospital category (OR: 27.1, CI: 11.7-62.6, p < 0.001) and the presence of incontinence (OR: 0.2, CI: 0.04-0.93, p = 0.04). Outpatient management was associated with disease grade (OR: 2.3, CI: 1.1-4.8, p = 0.023), hospital category (OR: 2, CI: 1.2-3.2, p = 0.011), higher comorbidity (ASA ≥ 3, OR: 3.3, CI: 1.8-3.2, p = 0.007), and the selected surgical technique (OR: 3.1, CI: 1.6-5.8, p = 0.001). CONCLUSION: Significant inter-institutional variations exist in the management of advanced HD. Among various factors, the presence of thrombosis emerges as the predominant determinant in surgical decision-making, providing valuable insights for standardizing treatment protocols and reducing practice variability.", "provenance": [ { "field": "n", "quote": "The study included 315 patients diagnosed with Grade III (72%) and Grade IV (28%) HD" }, { "field": "population", "quote": "patients with Grade III and IV HD" }, { "field": "intervention", "quote": "Surgical techniques were classified as excisional or non-excisional, while anesthesia type, use of perianal or pudendal analgesia, and hospitalization duration were determined by the surgical teams." }, { "field": "comparator", "quote": "Multivariable analyses were conducted to identify factors influencing the choice of surgical techniques, anesthesia, analgesia application, and the decision for outpatient procedures." }, { "field": "primaryOutcome", "quote": "identifying factors that influence surgical and perioperative management decisions is essential, particularly in advanced cases" }, { "field": "result", "quote": "the presence of thrombosis significantly influenced the choice of surgical technique (OR: 7.2, CI: 2.8-12.7, p = 0.001), while hospital category also played an important role (OR: 5.1, CI: 2.7-9.7, p = 0.001)" } ] }, { "id": "pmid:41958563", "pmid": "41958563", "doi": "10.3389/fmed.2026.1755971", "nctId": null, "pmcid": "PMC13056619", "title": "Efficacy and safety of combined endoscopic rubber band ligation in the treatment of grade II-III prolapsed hemorrhoids: a retrospective study (with video)", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Front Med (Lausanne)", "year": 2026, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with grade II-III prolapsed internal hemorrhoids", "intervention": "combined endoscopic rubber band ligation (ERBL)", "comparator": "ligating two hemorrhoids versus ligating three hemorrhoids", "primaryOutcome": "resolution of hemorrhoids (complete, partial, or recurrence) and safety complications", "result": "Complete resolution occurred in 91.85% of cases, partial resolution in 5.19%, and recurrence in 2.96%; ligating three hemorrhoids caused more pain than ligating two, but long-term success was similar between the two groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group other than itself, so it can't prove the treatment works better than doing nothing or another method.", "directness": "direct", "limitations": "Retrospective design, no control group, and reliance on complications and male sex as the only identified risk factors for incomplete resolution.", "followUp": "", "plainFinding": "High success treating prolapsed hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41958563/", "sourceText": "BACKGROUND: Hemorrhoids is one of the most common anorectal diseases. In recent years, the incidence rate of hemorrhoids has been rising. AIMS: To investigate the efficacy and safety of combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids. METHODS: Patients with grade II-III prolapsed internal hemorrhoids treated from January 2019 to June 2023 were reviewed. RESULTS: Complete resolution was achieved in 124 cases (91.85%), partial resolution in 7 cases (5.19%), and recurrence in 4 cases (2.96%). 34 (25.19%) cases experienced anal pain after procedure, with a median visual analog scale (VAS) score of 0 (0-3). Postoperative bleeding occurred in 18 (13.33%) cases. Anal swelling was observed in 19 (14.07%) cases, and urinary retention occurred in 4 cases (2.96%). The incidence of postoperative pain (30.43% vs. 11.6%, P = 0.018) and VAS scores (0 vs. 0, P = 0.003) in the ligate three hemorrhoids group were significantly higher compared to the ligate two hemorrhoids group. There was no significant difference in long-term efficacy between the two groups. Male [odds ratio (OR) 5.654, 95% confidence interval (CI) 1.222-26.159; P = 0.027] and postoperative complications (OR 4.914, 95% CI 1.080-22.345; P = 0.039) were independent risk factors that were incomplete resolution. CONCLUSIONS: Combined ERBL is an efficient and safe method for grade II-III prolapsed internal hemorrhoids. The number of hemorrhoids ligated had no significant effect on the long-term outcome, but the ligation of three hemorrhoids was associated with an increased incidence of postoperative pain. Male and postoperative complications are risk factors for incomplete resolution.", "provenance": [ { "field": "population", "quote": "Patients with grade II-III prolapsed internal hemorrhoids treated from January 2019 to June 2023 were reviewed." }, { "field": "intervention", "quote": "combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids" }, { "field": "comparator", "quote": "the ligate three hemorrhoids group were significantly higher compared to the ligate two hemorrhoids group" }, { "field": "primaryOutcome", "quote": "Complete resolution was achieved in 124 cases (91.85%), partial resolution in 7 cases (5.19%), and recurrence in 4 cases (2.96%)." }, { "field": "result", "quote": "There was no significant difference in long-term efficacy between the two groups." } ] }, { "id": "pmid:41914085", "pmid": "41914085", "doi": null, "nctId": null, "pmcid": null, "title": "Perioperative and Postoperative Complications Associated with Stapled Hemorrhoidopexy", "firstAuthor": "Alam", "multipleAuthors": true, "journal": "Mymensingh Med J", "year": 2026, "design": "prospective-cohort", "n": 130, "nField": "reported", "population": "Adults in Bangladesh with Grade III and IV hemorrhoids", "intervention": "Stapled hemorrhoidopexy surgery", "comparator": "Open hemorrhoidectomy surgery", "primaryOutcome": "Postoperative pain, complications, hospital stay, return to work and cost", "result": "Stapled hemorrhoidopexy caused less pain, fewer urinary retention cases, shorter hospital stay, faster return to work, and no reactionary bleeding, but cost much more than open hemorrhoidectomy", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a prospective comparison, not a randomized trial, so differences between groups could be due to other factors besides the surgery type.", "directness": "direct", "limitations": "Not randomized; abstract does not report blinding or long-term follow-up beyond return to work and short-term complications.", "followUp": "", "plainFinding": "Less pain, faster recovery, costs more.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41914085/", "sourceText": "Stapled hemorrhoidopexy (SH) has been proposed as a less invasive alternative to open hemorrhoidectomy (OH) for advanced hemorrhoidal disease. This study compared perioperative and short-term postoperative outcomes between SH and OH in a Bangladeshi population. A prospective comparative study was conducted among 130 patients (65 per group) with Grade III and IV hemorrhoids. Baseline characteristics, perioperative blood loss, postoperative pain (VAS), complications, hospital stay, return to work and treatment cost were analyzed using appropriate statistical tests. Baseline age, gender and hemorrhoid grade distributions were comparable between groups (p>0.05). SH was associated with lower postoperative pain (80.0% mild; no severe cases), reduced urinary retention (13.8% vs. 40.0%, p=0.001) and shorter hospital stays (mean 2.89 vs. 7.12 days, p<0.001). Return to work was faster in SH (mean 7.72 vs. 14.29 days, p<0.001). Reactionary hemorrhage occurred only in OH (6.2%, p=0.042). Perioperative blood loss differences were not statistically significant (p=0.149). SH incurred significantly higher costs (mean Tk. 18,876.92 vs. Tk. 6,690.77, p<0.001). SH offers significant short-term clinical benefits over OH, including reduced pain, faster recovery and fewer complications. However, higher costs may limit its feasibility in resource-constrained healthcare systems. Cost-effectiveness evaluation is essential before widespread adoption.", "provenance": [ { "field": "n", "quote": "130 patients (65 per group)" }, { "field": "population", "quote": "A prospective comparative study was conducted among 130 patients (65 per group) with Grade III and IV hemorrhoids." }, { "field": "intervention", "quote": "Stapled hemorrhoidopexy (SH)" }, { "field": "comparator", "quote": "open hemorrhoidectomy (OH)" }, { "field": "primaryOutcome", "quote": "postoperative pain (VAS), complications, hospital stay, return to work and treatment cost" }, { "field": "result", "quote": "SH was associated with lower postoperative pain (80.0% mild; no severe cases), reduced urinary retention (13.8% vs. 40.0%, p=0.001) and shorter hospital stays (mean 2.89 vs. 7.12 days, p<0.001)" }, { "field": "result", "quote": "SH incurred significantly higher costs (mean Tk. 18,876.92 vs. Tk. 6,690.77, p<0.001)" } ] }, { "id": "pmid:41909274", "pmid": "41909274", "doi": "10.7759/cureus.104155", "nctId": null, "pmcid": "PMC13018720", "title": "Spectrum and Management of Anorectal Disorders: A Retrospective Analysis From the United Arab Emirates", "firstAuthor": "Prince", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "retrospective", "n": 176, "nField": "reported", "population": "176 patients diagnosed with anorectal disorders at a tertiary hospital in the UAE", "intervention": "various treatments used for hemorrhoids and other anorectal disorders, including hemorrhoidectomy and conservative care", "comparator": "no direct comparison between treatments; this is a descriptive review of what was done", "primaryOutcome": "how common different anorectal disorders were and what treatments patients received", "result": "Hemorrhoids were the most common problem, with many patients having advanced (grade III or IV) disease, and surgery (hemorrhoidectomy) was used more often than conservative treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single-center, retrospective chart review describing patterns of care without comparing treatment outcomes, so it cannot show whether one treatment works better than another", "directness": "indirect", "limitations": "Retrospective design, single tertiary center, no comparison of treatment outcomes or follow-up data on symptom resolution reported", "followUp": "", "plainFinding": "Surgery more common than conservative care.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41909274/", "sourceText": "BACKGROUND: Anorectal disorders, including hemorrhoids, anal fissures, and anal fistulas, are common conditions that can significantly impact quality of life. Data on their prevalence, clinical presentation, and management in the United Arab Emirates (UAE) are limited. This study aimed to evaluate the distribution, symptoms, and treatment patterns of anorectal disorders in a tertiary care setting in the UAE. METHODS: A retrospective review of medical records was conducted for 176 patients diagnosed with anorectal disorders at a tertiary hospital in the UAE, between January 2024 and January 2025. Sociodemographic data, clinical presentation, and management modalities were extracted using a structured proforma. Descriptive statistics were performed using SPSS version 29 (IBM Corp., Armonk, NY). RESULTS: A total of 176 patients were included, with a predominance of males (153, 86.9%) and individuals aged ≥35 years (97, 55.1%). Patients of Asian nationality accounted for 137 (77.8%), and 122 (69.4%) were overweight or obese. Hemorrhoids were the most common disorder, with 71 (40.8%) patients presenting with grade III and 26 (14.8%) with grade IV disease, followed by anal fissures in 49 (27.3%) patients and anal fistulas in 11 (6.3%) patients. The most frequent presenting complaint was a combination of pain and bleeding seen in 94 patients (53.4%), followed by bleeding alone in 62 patients (35.2%) and pain alone in 20 patients (11.4%). Surgical intervention was more common than conservative management, with hemorrhoidectomy performed in 75 (42.6%) cases, conservative treatment in 69 (39.2%), fissurectomy in 25 (14.2%), and fistulectomy in 7 (4.0%). CONCLUSIONS: Hemorrhoids and anal fissures are the most prevalent anorectal disorders in this UAE tertiary care population, frequently presenting with pain and bleeding. Surgical intervention predominates, likely due to delayed presentation and advanced disease. Early detection, conservative management, and targeted public health strategies could reduce progression to severe disease and minimize the need for surgery. Training primary care providers to recognize anorectal disorders promptly may further improve patient outcomes.", "provenance": [ { "field": "n", "quote": "A total of 176 patients were included" }, { "field": "population", "quote": "176 patients diagnosed with anorectal disorders at a tertiary hospital in the UAE" }, { "field": "intervention", "quote": "hemorrhoidectomy performed in 75 (42.6%) cases, conservative treatment in 69 (39.2%), fissurectomy in 25 (14.2%), and fistulectomy in 7 (4.0%)" }, { "field": "comparator", "quote": "Surgical intervention was more common than conservative management" }, { "field": "primaryOutcome", "quote": "This study aimed to evaluate the distribution, symptoms, and treatment patterns of anorectal disorders in a tertiary care setting in the UAE" }, { "field": "result", "quote": "Hemorrhoids were the most common disorder, with 71 (40.8%) patients presenting with grade III and 26 (14.8%) with grade IV disease" } ] }, { "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 (grade IV being prolapsed and not reducible) who had a type of hemorrhoid surgery", "intervention": "arterial detection ligation (ADL)-mucopexy surgery for grade IV (prolapsed) hemorrhoids", "comparator": "same ADL-mucopexy surgery performed for less severe grade II/III hemorrhoids", "primaryOutcome": "pain after surgery and hemorrhoid recurrence", "result": "both groups had similar recurrence and satisfaction, but grade IV patients had more pain, needed more painkillers, and recovered bowel function more slowly in the first week", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small retrospective study with only 24 patients in the prolapsed (grade IV) group, so the findings are not very reliable.", "directness": "direct", "limitations": "retrospective design, small number of patients especially in the grade IV group, short follow-up", "followUp": "1 month", "plainFinding": "Similar success, more early pain if prolapsed.", "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 may be considered a potential minimally invasive surgical option in carefully selected patients with grade IV HD." }, { "field": "comparator", "quote": "This study 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": "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." }, { "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:41835152", "pmid": "41835152", "doi": "10.3389/fphys.2026.1762846", "nctId": null, "pmcid": "PMC12980089", "title": "Endoscopic excision for internal and mixed hemorrhoids: a retrospective case series of short-term outcomes", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Front Physiol", "year": 2026, "design": "case-series", "n": 20, "nField": "reported", "population": "patients with Grade II to IV internal or mixed hemorrhoids", "intervention": "endoscopic excision surgery for hemorrhoids", "comparator": "none (no comparison group)", "primaryOutcome": "treatment effectiveness, patient satisfaction and complications after surgery", "result": "all patients showed treatment success and satisfaction with no serious complications, though some had mild pain or temporary issues", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series of only 20 patients with no comparison group, so it cannot show whether this treatment works better than alternatives.", "directness": "direct", "limitations": "Retrospective, no control group, small sample size, short follow-up.", "followUp": "6 months", "plainFinding": "Surgery relieved symptoms, high satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41835152/", "sourceText": "OBJECTIVE: This study aimed to investigate the short-term clinical outcomes and safety of endoscopic excision for the management of internal and mixed hemorrhoids. METHODS: A retrospective analysis was conducted on 20 patients with Grade II to Grade IV internal or mixed hemorrhoids who underwent endoscopic excision at Zhoushan Hospital between January 2024 and December 2024. All patients had complete follow-up data. RESULTS: At 3 and 6 months after surgery, the treatment effectiveness rate was 100%, and both postoperative satisfaction and acceptance rates were 100%. No severe postoperative complications occurred, and no bleeding or infection was observed. Mild pain developed in three patients, a transient sensation of anal heaviness and distension occurred in one patient, and temporary urinary retention occurred in one patient, which resolved after local hot compress therapy. Postoperative pathological examinations confirmed that the resected anorectal masses demonstrated changes consistent with hemorrhoidal tissue. CONCLUSION: Endoscopic excision for internal and mixed hemorrhoids is a safe and effective therapeutic approach. It provides significant symptom relief, yields high postoperative satisfaction and acceptance among patients, and allows for definitive pathological confirmation of the nature of the resected anorectal tissue.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 20 patients" }, { "field": "population", "quote": "20 patients with Grade II to Grade IV internal or mixed hemorrhoids who underwent endoscopic excision" }, { "field": "intervention", "quote": "endoscopic excision for the management of internal and mixed hemorrhoids" }, { "field": "comparator", "quote": "RESULTS: At 3 and 6 months after surgery, the treatment effectiveness rate was 100%" }, { "field": "primaryOutcome", "quote": "the treatment effectiveness rate was 100%, and both postoperative satisfaction and acceptance rates were 100%" }, { "field": "result", "quote": "No severe postoperative complications occurred, and no bleeding or infection was observed. Mild pain developed in three patients, a transient sensation of anal heaviness and distension occurred in one patient, and temporary urinary retention occurred in one patient" } ] }, { "id": "pmid:41804964", "pmid": "41804964", "doi": "10.23736/S2724-5691.26.11077-6", "nctId": null, "pmcid": null, "title": "Ligasure versus voyant hemorrhoidectomy: comparison of 30-day postoperative complications", "firstAuthor": "Marino", "multipleAuthors": true, "journal": "Minerva Surg", "year": 2026, "design": "prospective-cohort", "n": 123, "nField": "reported", "population": "patients with grade III and IV hemorrhoids", "intervention": "LigaSure radiofrequency hemorrhoid surgery", "comparator": "Voyant radiofrequency hemorrhoid surgery", "primaryOutcome": "bleeding, urinary retention, and anal narrowing within 30 days after surgery", "result": "no significant difference in bleeding, urinary retention, or anal stenosis between the two devices", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was a non-randomized observational comparison of two surgical devices without blinding, limiting confidence in the equivalence finding.", "directness": "indirect", "limitations": "not randomized; observational design; excluded patients with other anal disorders or prior anal surgery", "followUp": "30-day follow-up", "plainFinding": "Similar complication rates, Voyant cheaper.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41804964/", "sourceText": "BACKGROUND: Radiofrequency (RF) hemorrhoidectomy features shorter operating times, less intraoperative bleeding, less postoperative pain, and a quicker return to work compared to conventional hemorrhoidectomy. Numerous RF devices are available at varying costs. The purpose of our study was to compare the 30-day postoperative outcomes of LigaSure hemorrhoidectomy versus Voyant hemorrhoidectomy for grade III and IV hemorrhoids in terms of bleeding, urinary retention, and anal stenosis. METHODS: A prospective observational study was conducted from May 2017 to March 2023. Patients with concomitant anal disorders and patients who had undergone previous anal surgery were excluded from the study. Patient data collected during hospitalization and subsequent 30-day follow-up were entered into an electronic database. Data was analysed using Stata version 18 (StataCorp LLC, TX, USA). RESULTS: In total, 123 patients were enrolled (61 in group A and 62 in group B). Patient demographics and clinical characteristics (age, gender, ASA score, hemorrhoid grade) and the number of resected piles were similar in the two groups. There were three cases of hemorrhage in group A (one requiring blood transfusion and reoperation) and four cases in group B (one requiring blood transfusion). In each group, two cases of anal (sub)stenosis occurred, all resolved with self mechanical anal dilatation. There were two cases of urinary retention in group A and one case in group B. No statistical differences were observed between the two groups in terms of postoperative bleeding, urinary retention, and anal stenosis. CONCLUSIONS: The LigaSure and Voyant devices show comparable results in terms of postoperative complications in the treatment of grade III and IV hemorrhoids. However, the Voyant device is much less expensive.", "provenance": [ { "field": "n", "quote": "In total, 123 patients were enrolled (61 in group A and 62 in group B)." }, { "field": "population", "quote": "grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "LigaSure hemorrhoidectomy" }, { "field": "comparator", "quote": "Voyant hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "bleeding, urinary retention, and anal stenosis" }, { "field": "result", "quote": "No statistical differences were observed between the two groups in terms of postoperative bleeding, urinary retention, and anal stenosis." } ] }, { "id": "pmid:41804401", "pmid": "41804401", "doi": "10.7759/cureus.103075", "nctId": null, "pmcid": "PMC12967802", "title": "Pedicle Ligation Prior to Milligan-Morgan Hemorrhoidectomy for Advanced Grade IV Hemorrhoids: An Experience From a Specialized Proctology Unit", "firstAuthor": "Hamada", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 32-year-old man with severe (grade IV) prolapsed hemorrhoids that would not go back in and had not improved with non-surgical treatment", "intervention": "tying off the hemorrhoid's blood vessel stalk before surgically removing it (Milligan-Morgan hemorrhoidectomy)", "comparator": "no comparison group; single case only", "primaryOutcome": "whether surgery was safe and recovery went well", "result": "surgery completed with no complications during the operation and a smooth recovery afterward", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether the technique works better than other approaches.", "directness": "direct", "limitations": "only one patient was described, with no control group or comparison technique.", "followUp": "", "plainFinding": "Safe surgery, smooth recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41804401/", "sourceText": "Grade IV hemorrhoidal disease represents the most advanced form of hemorrhoids and is frequently associated with severe prolapse, chronic inflammation, and a high risk of bleeding. Although minimally invasive techniques have gained popularity, excisional hemorrhoidectomy remains the most effective treatment for advanced disease. We report a case highlighting the role of pedicle ligation prior to Milligan-Morgan hemorrhoidectomy in improving surgical safety. A 32-year-old man with no significant medical history presented with symptomatic, irreducible grade IV hemorrhoids refractory to conservative treatment. Open excisional hemorrhoidectomy using the Milligan-Morgan technique was performed following the systematic ligation of the hemorrhoidal pedicles. The procedure was completed without intraoperative complications. Postoperative recovery was uneventful, with excellent clinical and functional outcomes. In advanced hemorrhoidal disease, the risk of intraoperative bleeding is increased due to marked vascular congestion and chronic inflammation. Pedicle ligation prior to excision may enhance hemostasis, improve operative field exposure, and reduce perioperative complications. This strategy is particularly relevant in grade IV hemorrhoids, where minimally invasive techniques have shown higher recurrence rates. Pedicle ligation before Milligan-Morgan hemorrhoidectomy is a safe and effective strategy in the management of grade IV hemorrhoids and may improve surgical outcomes in selected patients.", "provenance": [ { "field": "n", "quote": "A 32-year-old man with no significant medical history presented with symptomatic, irreducible grade IV hemorrhoids refractory to conservative treatment." }, { "field": "population", "quote": "A 32-year-old man with no significant medical history presented with symptomatic, irreducible grade IV hemorrhoids refractory to conservative treatment." }, { "field": "intervention", "quote": "Open excisional hemorrhoidectomy using the Milligan-Morgan technique was performed following the systematic ligation of the hemorrhoidal pedicles." }, { "field": "comparator", "quote": "We report a case highlighting the role of pedicle ligation prior to Milligan-Morgan hemorrhoidectomy in improving surgical safety." }, { "field": "primaryOutcome", "quote": "The procedure was completed without intraoperative complications." }, { "field": "result", "quote": "The procedure was completed without intraoperative complications. Postoperative recovery was uneventful, with excellent clinical and functional outcomes." } ] }, { "id": "pmid:41789560", "pmid": "41789560", "doi": "10.1111/codi.70418", "nctId": null, "pmcid": null, "title": "Room for improvement? Evaluating the accuracy of referrals for rectal prolapse to three tertiary care medical centres", "firstAuthor": "Alatout", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "retrospective", "n": 480, "nField": "reported", "population": "patients referred to colorectal surgeons for suspected rectal prolapse", "intervention": "diagnosis of rectal prolapse made by the referring physician", "comparator": "confirmed diagnosis made by the colorectal surgeon at the specialist centre", "primaryOutcome": "accuracy of the rectal prolapse diagnosis", "result": "Over a third of referrals for rectal prolapse were actually a different condition, most often hemorrhoids", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective review of referral accuracy, not a treatment study, so it cannot show whether any treatment works.", "directness": "indirect", "limitations": "Retrospective design; abstract does not describe how the 'correct' diagnosis was confirmed or address treatment outcomes.", "followUp": "", "plainFinding": "Hemorrhoids often misdiagnosed as rectal prolapse", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41789560/", "sourceText": "AIM: Rectal prolapse is a full-thickness intussusception of the rectum beyond the anal canal. It is often mistaken for other anorectal pathologies, leading to inaccurate referrals to colorectal surgeons and inappropriate management. However, the frequency of misdiagnosis is not well characterized. We aimed to assess the diagnostic accuracy of rectal prolapse referrals to three tertiary medical centres. METHODS: This is a retrospective study of patients referred for rectal prolapse to colorectal surgeons at the Mayo Clinic in Rochester, Jacksonville, and Phoenix from 2020 to 2024. The primary outcome is the accuracy of rectal prolapse diagnosis. The secondary outcomes are factors that correlate with diagnostic accuracy. RESULTS: Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients. Among misdiagnosed patients, the correct diagnosis was haemorrhoids (68.0%, n = 134), pelvic floor dysfunction (24.3%, n = 48) and rectocele (18.7%, n = 37). A diagnosis of rectal cancer was found in 3 patients (1.5%). The most common presenting symptoms were protrusion (66.3%, n = 345) and bleeding (33.6%, n = 175). Among the referring physicians, only 50.5% (n = 227) performed an anorectal examination. Overall, there was significant variability in diagnostic accuracy across different specialties, with the highest accuracy from colorectal practices (84.0%) and the lowest from urologists (50.0%). Internal medicine physicians had a lower diagnostic accuracy with anorectal examination than without, though it did not reach statistical significance (44.0% vs. 59.5%, p = 0.2). CONCLUSION: Over one-third of rectal prolapse referrals were incorrectly diagnosed. This study highlights the opportunity for further training of referring providers on anorectal pathologies to improve diagnostic accuracy which could reduce treatment delays and optimize clinical outcomes.", "provenance": [ { "field": "n", "quote": "Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients." }, { "field": "population", "quote": "patients referred for rectal prolapse to colorectal surgeons at the Mayo Clinic in Rochester, Jacksonville, and Phoenix from 2020 to 2024" }, { "field": "intervention", "quote": "The primary outcome is the accuracy of rectal prolapse diagnosis." }, { "field": "comparator", "quote": "Among misdiagnosed patients, the correct diagnosis was haemorrhoids (68.0%, n = 134), pelvic floor dysfunction (24.3%, n = 48) and rectocele (18.7%, n = 37)." }, { "field": "primaryOutcome", "quote": "The primary outcome is the accuracy of rectal prolapse diagnosis." }, { "field": "result", "quote": "Rectal prolapse was inaccurately diagnosed in 38.7% (186/480) of patients." } ] }, { "id": "pmid:41737110", "pmid": "41737110", "doi": "10.7759/cureus.102186", "nctId": null, "pmcid": "PMC12926782", "title": "Comparative Study of Blood Loss and Hemostasis in Doppler-Guided Hemorrhoidal Artery Ligation Versus Open Hemorrhoidectomy", "firstAuthor": "Talib", "multipleAuthors": true, "journal": "Cureus", "year": 2026, "design": "prospective-cohort", "n": 140, "nField": "reported", "population": "adults aged 18 to 65 with moderate to severe hemorrhoids (grade II to IV), some with symptomatic prolapse", "intervention": "Doppler-guided hemorrhoidal artery ligation (DGHAL)", "comparator": "open hemorrhoidectomy", "primaryOutcome": "amount of blood loss during and after surgery", "result": "DGHAL caused less intraoperative bleeding, fewer bleeding complications, and smaller drop in blood counts than open hemorrhoidectomy", "resultDirection": "benefit", "quality": "low", "qualityWhy": "patients were not randomly assigned to treatments, so differences in bleeding could partly reflect why each surgery was chosen, not just the surgery itself.", "directness": "indirect", "limitations": "Non-randomized allocation based on disease severity and patient preference; authors note findings reflect short-term hemostatic advantages rather than overall procedural superiority.", "followUp": "14 days", "plainFinding": "Less bleeding with Doppler-guided surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41737110/", "sourceText": "Background Hemorrhoidal disease is among the most commonly seen anorectal disorders. Surgical treatment is routinely indicated in advanced stages or when conservative measures fail. Although conventional open hemorrhoidectomy remains an effective procedure, it is often accompanied by considerable intraoperative bleeding and postoperative hemorrhagic complications. Doppler-guided hemorrhoidal artery ligation (DGHAL) is a minimally invasive approach that targets the arterial supply of hemorrhoidal tissue and has been proposed to improve hemostatic control. This study aimed to compare intraoperative blood loss and bleeding-related outcomes between DGHAL and open hemorrhoidectomy. Methods This prospective, observational, non-randomized comparative study was conducted from March 2023 to February 2025 at Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. Adults aged 18-65 years with grade II-IV hemorrhoids were enrolled using non-probability consecutive sampling. Grade II cases were included only after documented failure of conservative therapy or rubber band ligation, or in the presence of recurrent bleeding, symptomatic prolapse, or hemorrhoid-related anemia. Patients underwent Doppler-guided hemorrhoidal artery ligation (DGHAL) or open hemorrhoidectomy according to predefined institutional protocols; allocation was non-random and based on disease severity, prolapse extent, bleeding severity, patient preference, and Doppler availability. Intraoperative blood loss was measured using suction volume and sponge weight difference. Additional hemostatic intervention was defined as persistent bleeding lasting >30 seconds or visible arterial spurting requiring sutures or electrocautery. Clinically significant postoperative bleeding was recorded within 24 hours and 14 days. Data were analyzed using SPSS version 26 (IBM Corp., Armonk, New York, USA) with multivariable regression adjustment. Results A total of 140 patients were analyzed, with 70 individuals in each treatment group. Demographic and baseline clinical characteristics were similar between groups. The mean intraoperative blood loss was significantly lower in patients undergoing DGHAL compared with those treated by open hemorrhoidectomy (32.4 ± 14.8 mL vs 68.9 ± 22.6 mL; p < 0.001). Patients in the DGHAL group required fewer supplementary hemostatic interventions and had significantly shorter operative times (p < 0.001). Both early and late postoperative bleeding events occurred less frequently following DGHAL, and the reduction in postoperative hemoglobin levels was also significantly smaller (p < 0.001). Multivariable analysis identified the type of surgical procedure as the most significant independent determinant of blood loss. Conclusion Doppler-guided hemorrhoidal artery ligation was associated with significantly lower intraoperative blood loss and improved short-term hemostatic outcomes compared to open hemorrhoidectomy. These findings support DGHAL as an effective alternative for achieving better perioperative bleeding control; however, they reflect short-term hemostatic advantages rather than overall procedural superiority.", "provenance": [ { "field": "population", "quote": "Adults aged 18-65 years with grade II-IV hemorrhoids were enrolled" }, { "field": "n", "quote": "A total of 140 patients were analyzed, with 70 individuals in each treatment group." }, { "field": "intervention", "quote": "Doppler-guided hemorrhoidal artery ligation (DGHAL)" }, { "field": "comparator", "quote": "open hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "This study aimed to compare intraoperative blood loss and bleeding-related outcomes between DGHAL and open hemorrhoidectomy." }, { "field": "result", "quote": "The mean intraoperative blood loss was significantly lower in patients undergoing DGHAL compared with those treated by open hemorrhoidectomy (32.4 ± 14.8 mL vs 68.9 ± 22.6 mL; p < 0.001)." }, { "field": "followUp", "quote": "Clinically significant postoperative bleeding was recorded within 24 hours and 14 days." } ] }, { "id": "pmid:41676261", "pmid": "41676261", "doi": "10.62347/YPMP9461", "nctId": null, "pmcid": "PMC12886141", "title": "Clinical efficacy and recurrence analysis of endoscopic rubber band ligation combined with external hemorrhoidectomy for mixed hemorrhoids", "firstAuthor": "Feng", "multipleAuthors": true, "journal": "Am J Transl Res", "year": 2026, "design": "retrospective", "n": 330, "nField": "reported", "population": "patients with stage III-IV mixed hemorrhoids (internal and external combined)", "intervention": "endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH)", "primaryOutcome": "1-year recurrence rate and perioperative outcomes/complications", "result": "ERBL+EH had less blood loss, shorter surgery and healing time, less pain, fewer complications, and lower recurrence at 1 year (9.7% vs 31.0%) compared to MMH, though it cost more", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective (not randomized) comparison, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design; not randomized; higher treatment costs in the ERBL+EH group.", "followUp": "1 year", "plainFinding": "Fewer complications, less recurrence than standard surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41676261/", "sourceText": "OBJECTIVE: To evaluate the efficacy and safety of endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH) for mixed hemorrhoids compared with Milligan-Morgan hemorrhoidectomy (MMH), and to identify risk factors for postoperative recurrence. METHODS: A retrospective analysis was conducted on 330 patients with stage III-IV mixed hemorrhoids treated between January 2020 and December 2024. Patients underwent either ERBL+EH (n = 185) or MMH (n = 145). Baseline data, perioperative indicators, complications, treatment costs, and 1-year recurrence were assessed. Follow-up was conducted every 3 months. Group differences were analyzed using χ2 or t-tests, and Cox regression was applied to identify independent risk factors for recurrence. RESULTS: Baseline characteristics were comparable between groups (P > 0.05). ERBL+EH demonstrated significantly better perioperative outcomes, including reduced blood loss, shorter operation and wound healing times, faster pain relief, fewer incisions, and lower postoperative pain scores (all P < 0.05). Complication rates were lower in the ERBL+EH group, particularly anal stenosis, prolapse, incontinence, urinary retention, and incision edema, though postoperative bleeding rates were similar between groups. At 1 year, recurrence was significantly reduced with ERBL+EH (9.7% vs. 31.0%, P < 0.001), with longer time to recurrence (10 vs. 6 months, P = 0.025). Treatment costs were higher in the ERBL+EH group, but length of hospital stay was similar. Clinical efficacy showed a higher rate of marked improvement in the ERBL+EH group (P < 0.001). Multivariate Cox regression identified ERBL+EH as a protective factor against recurrence (HR = 0.218, P = 0.006), while stage IV disease, diabetes, spicy diet, and anal prolapse were independent risk factors. CONCLUSION: ERBL+EH is superior to MMH in perioperative outcomes, complication control, and recurrence reduction, offering a safe and effective treatment for mixed hemorrhoids, albeit at higher cost. Appropriate patient selection and optimized postoperative management may further enhance long-term outcomes.", "provenance": [ { "field": "population", "quote": "330 patients with stage III-IV mixed hemorrhoids" }, { "field": "intervention", "quote": "endoscopic rubber band ligation combined with external hemorrhoidectomy (ERBL+EH)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH)" }, { "field": "primaryOutcome", "quote": "1-year recurrence" }, { "field": "result", "quote": "At 1 year, recurrence was significantly reduced with ERBL+EH (9.7% vs. 31.0%, P < 0.001), with longer time to recurrence (10 vs. 6 months, P = 0.025)." }, { "field": "n", "quote": "A retrospective analysis was conducted on 330 patients" } ] }, { "id": "pmid:41635963", "pmid": "41635963", "doi": "10.1097/SLE.0000000000001421", "nctId": null, "pmcid": null, "title": "Effect of Doppler-guided Hemorrhoidal Artery Ligation Technique and Mucopexy on Posttreatment Symptoms in Hemorrhoidal Disease", "firstAuthor": "Öner", "multipleAuthors": true, "journal": "Surg Laparosc Endosc Percutan Tech", "year": 2026, "design": "retrospective", "n": 94, "nField": "reported", "population": "adults with grade II to IV hemorrhoid disease that didn't improve with medical treatment", "intervention": "Doppler-guided hemorrhoidal artery ligation, with or without mucopexy", "comparator": "none; outcomes compared before and after treatment within the same group", "primaryOutcome": "symptom improvement, hemorrhoid recurrence, and pain scores after surgery", "result": "92.6% had symptoms resolve and recurrence occurred in 9.6% overall, but recurrence was much higher in grade IV disease (31.25%) than grade III (8.16%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective study of one treatment with no comparison group, so it can't show whether another treatment would have done better or worse.", "directness": "indirect", "limitations": "Retrospective design, no control group, and results pooled across hemorrhoid grades II-IV rather than focusing specifically on prolapse.", "followUp": "year 1", "plainFinding": "Good relief, but more failures in severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41635963/", "sourceText": "BACKGROUND: There is currently no universally accepted gold standard for the surgical treatment of hemorrhoidal disease. This study aimed to assess the efficacy and safety of the Doppler-guided hemorrhoidal artery ligation (DG-HAL) technique, with or without concomitant mucopexy, on postoperative clinical outcomes in patients with symptomatic grade II to IV hemorrhoidal disease. PATIENTS AND METHODS: A retrospective analysis was conducted using a prospectively maintained database of patients who underwent DG-HAL ± mucopexy between January 2018 and January 2023 for medically refractory hemorrhoidal disease. Postoperative complications, analgesia type and duration, and time to return to daily activities were recorded. Patients were followed up by a general surgery specialist on postoperative day 1, week 1, month 1, and year 1. Treatment efficacy was evaluated based on changes in symptom severity and hemorrhoid grade across follow-up periods. RESULTS: A total of 94 patients (59 males, 35 females; mean age: 47.8 ± 12.4 y) underwent the procedure. Recurrence occurred in 9 patients (9.6%) during follow-up. Recurrence rates were 8.16% (4/49) in grade III and 31.25% (5/16) in grade IV hemorrhoids. Mean Visual Analogue Scale (VAS) scores for pain were 7.43 (postoperative day 1), 1.72 (week 1), and 0.37 (month 1), demonstrating significant improvement (P < 0.001). No postoperative bleeding, necrosis, or urinary retention was reported. One patient experienced early recurrence on the first postoperative day. Overall symptom resolution was achieved in 92.6% of patients, and 90.4% reported high satisfaction with the treatment. CONCLUSION: DG-HAL with or without mucopexy is a safe and effective minimally invasive surgical option for grade II and III hemorrhoidal disease, with high patient satisfaction, low complication rates, and excellent symptom resolution. However, in patients with grade IV disease, the technique's higher recurrence rate necessitates careful patient selection and individualized surgical planning.", "provenance": [ { "field": "population", "quote": "patients with symptomatic grade II to IV hemorrhoidal disease" }, { "field": "intervention", "quote": "Doppler-guided hemorrhoidal artery ligation (DG-HAL) technique, with or without concomitant mucopexy" }, { "field": "n", "quote": "A total of 94 patients (59 males, 35 females; mean age: 47.8 ± 12.4 y) underwent the procedure." }, { "field": "primaryOutcome", "quote": "Treatment efficacy was evaluated based on changes in symptom severity and hemorrhoid grade across follow-up periods." }, { "field": "result", "quote": "Overall symptom resolution was achieved in 92.6% of patients, and 90.4% reported high satisfaction with the treatment." }, { "field": "result", "quote": "Recurrence rates were 8.16% (4/49) in grade III and 31.25% (5/16) in grade IV hemorrhoids." }, { "field": "comparator", "quote": "A retrospective analysis was conducted using a prospectively maintained database of patients who underwent DG-HAL ± mucopexy between January 2018 and January 2023 for medically refractory hemorrhoidal disease." }, { "field": "followUp", "quote": "Patients were followed up by a general surgery specialist on postoperative day 1, week 1, month 1, and year 1." } ] }, { "id": "pmid:41620904", "pmid": "41620904", "doi": "10.36721/PJPS.2026.39.3.REG.15306.1", "nctId": null, "pmcid": null, "title": "Comparison of Mayinglong musk hemorrhoids ointment and musk hemorrhoids suppository on postoperative pain and healing in mixed hemorrhoids after PPH or RPH", "firstAuthor": "Fan", "multipleAuthors": true, "journal": "Pak J Pharm Sci", "year": 2026, "design": "retrospective", "n": 131, "nField": "reported", "population": "patients with mixed hemorrhoids who had surgery (PPH or RPH)", "intervention": "Mayinglong Musk Hemorrhoids Ointment applied after surgery", "comparator": "Musk Hemorrhoids Suppository applied after surgery", "primaryOutcome": "pain scores and wound healing time/effect after surgery", "result": "Suppository group had lower pain and wound scores, but ointment group had better anal muscle function, less swelling, and faster wound healing time; overall healing effect and complication rates were similar", "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": "indirect", "limitations": "Retrospective design without randomization; compares two post-surgical wound treatments rather than treatment of the prolapse itself", "followUp": "", "plainFinding": "Mixed results, no clear winner", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41620904/", "sourceText": "BACKGROUND: Mixed hemorrhoids are common colorectal diseases; Mayinglong Musk Ointment and Musk Suppositories are used. Their post-PPH/RPH efficacy is unclear. OBJECTIVE: Compare the efficacy of Mayinglong Musk Hemorrhoids Ointment and Suppository in mixed hemorrhoid patients undergoing PPH or RPH. METHODS: A retrospective study enrolled 139 mixed hemorrhoid patients who underwent PPH/RPH at the hospital from Jan to Dec 2024; after exclusions, 131 were analyzed. They were divided into Group A (64 cases, Mayinglong Musk Hemorrhoids Ointment) and Group B (67 cases, Musk Hemorrhoids Suppository). Main outcomes included VAS, wound healing time/effect; secondary outcomes covered anal function indexes (ADP, ARP, HZL, AMSP), WCS score, postoperative complications, anal edema/exudation score and wound granulation morphology score. RESULTS: Compared with Group A, Group B had lower VAS, WCS and wound granulation morphology scores (all P<0.05); Group A showed higher ADP, ARP, AMSP (all P<0.05), lower HZL and anal edema/exudation scores (all P<0.05) and superior wound healing time (P=0.047). No significant differences were found in wound healing effect or postoperative complication rate between the two groups (all P<0.05). CONCLUSION: Both Mayinglong Musk Hemorrhoids Ointment and Musk Hemorrhoids Suppository benefit postoperative recovery with distinct advantages and clinical medication should be tailored to patients' specific postoperative conditions.", "provenance": [ { "field": "n", "quote": "after exclusions, 131 were analyzed" }, { "field": "population", "quote": "139 mixed hemorrhoid patients who underwent PPH/RPH at the hospital from Jan to Dec 2024" }, { "field": "intervention", "quote": "Mayinglong Musk Hemorrhoids Ointment" }, { "field": "comparator", "quote": "Musk Hemorrhoids Suppository" }, { "field": "primaryOutcome", "quote": "Main outcomes included VAS, wound healing time/effect" }, { "field": "result", "quote": "Compared with Group A, Group B had lower VAS, WCS and wound granulation morphology scores (all P<0.05); Group A showed higher ADP, ARP, AMSP (all P<0.05), lower HZL and anal edema/exudation scores (all P<0.05) and superior wound healing time (P=0.047). No significant differences were found in wound healing effect or postoperative complication rate between the two groups" } ] }, { "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 (prolapsed hemorrhoids)", "intervention": "standard hemorrhoid removal surgery plus polidocanol foam injection (sclerotherapy)", "comparator": "standard hemorrhoid removal surgery alone", "primaryOutcome": "time to return to daily activities", "result": "patients who got the added sclerotherapy returned to normal activities about 6 days sooner, with less bleeding and less pain medicine use", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Very small study of only 36 patients, not blinded, done at one hospital, with short follow-up, so results could easily change with more research.", "directness": "direct", "limitations": "Small sample size, nonblinded, single-center design, and short follow-up period.", "followUp": "1 to 2 months", "plainFinding": "Faster recovery, less bleeding with added treatment.", "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)" }, { "field": "n", "quote": "Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled" } ] }, { "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 (prolapsed hemorrhoids)", "intervention": "transanal hemorrhoidal dearterialization (THD)", "comparator": "open excisional hemorrhoidectomy (OEH)", "primaryOutcome": "change in hemorrhoid symptom and quality-of-life scores, and clinical failure rate at 1 year", "result": "THD had a much higher failure and reoperation rate than OEH, but OEH caused more early pain and longer recovery", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but came from a single center, was not blinded, and included only 50 patients", "directness": "direct", "limitations": "single-centre, open-label design with small sample size and three patients lost to follow-up", "followUp": "12 months", "plainFinding": "Surgery works better, but hurts 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": "population", "quote": "patients with grade III haemorrhoids" }, { "field": "n", "quote": "50 patients were randomized (25 OEH patients and 25 THD patients)" }, { "field": "intervention", "quote": "Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence" }, { "field": "comparator", "quote": "Open excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease" }, { "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", "intervention": "stapled hemorrhoidopexy", "comparator": "conventional hemorrhoidectomy", "primaryOutcome": "long-term recurrence, reintervention, anal function and quality of life", "result": "stapled hemorrhoidopexy had higher long-term recurrence, especially prolapse-related, with no difference in reintervention, pain, function or quality of life", "resultDirection": "harm", "quality": "moderate", "qualityWhy": "it pools many randomized trials but trial-sequential analysis shows the evidence is still underpowered and there was some inconsistency between studies.", "directness": "direct", "limitations": "Trial Sequential Analysis showed the accrued information size did not reach the required information size, indicating current evidence remains underpowered; moderate heterogeneity (I2=48%) for overall recurrence.", "followUp": "minimum follow-up of 12 months", "plainFinding": "More recurrence after stapling 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" }, { "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%)" }, { "field": "result", "quote": "No significant differences were found for reintervention, persistent anal pain, functional impairment or QoL." } ] }, { "id": "pmid:41503542", "pmid": "41503542", "doi": "10.1002/hsr2.71577", "nctId": null, "pmcid": "PMC12772977", "title": "Arterial Embolization for the Internal Hemorrhoids Management: A Systematic Review", "firstAuthor": "Golezar", "multipleAuthors": true, "journal": "Health Sci Rep", "year": 2026, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with internal hemorrhoids", "intervention": "arterial embolization of hemorrhoid blood vessels (emborrhoid)", "comparator": "none reported", "primaryOutcome": "effectiveness and complications of embolization treatment", "result": "improved quality of life and reduced bleeding, with some recurrence requiring repeat treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a systematic review of mostly small, non-comparative studies without a control group, so the true benefit is hard to confirm.", "directness": "indirect", "limitations": "No control/comparator group reported; studies included are heterogeneous case series type data; quality assessed only with a reporting checklist, not bias risk tools.", "followUp": "", "plainFinding": "Fewer symptoms, some recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41503542/", "sourceText": "BACKGROUND AND AIMS: Hemorrhoids are common vascular structures that can become symptomatic when prolapsed, representing the most prevalent benign anorectal condition worldwide. Despite affecting up to 11% of the population with symptoms including pain, bleeding, and discomfort, hemorrhoids remain underdiagnosed and often inappropriately managed. This systematic review aimed to evaluate the efficacy, clinical outcomes, and morbidity of endovascular artery embolization in hemorrhoids. METHOD: Up to August 2022, PubMed, Scopus, Web of Science, and Embase were searched comprehensively. All studies had eligible criteria included, except review articles, articles published in a language other than English, and case reports or series of cases. Two independent reviewers performed a literature review and data extraction. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist was used for quality assessment. RESULTS: The systematic review included 15 studies. The patient's age ranged from 40.5 ± 9.51 to 72.2 ± 10.9. Eleven studies mentioned the sample size as gender-specific, with 57.89% (n = 187/323) male patients. The embolic site involved in embolization, according to the frequency, was 424 patients for the superior rectal artery in all studies, and coils and micro coils were utilized as Embolic material in most cases. No major complication or death was noted in 12 studies. The most frequent complications were postoperative pain and tenesmus, bleeding, ulceration and fibrotic scars, and low-grade fever. In 11.79% (n = 27/229) of patients re-embolization and after-treatment surgery were due to surgical failure and symptom recurrence, such as bleeding. CONCLUSION: Rectal artery embolization using microcoils, embolic particles, or a combination is a new method for managing internal hemorrhoids with proper clinical efficacy without significant complications. QoL score has improved after emborrhoid, and most cases had a lower bleeding score.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are common vascular structures that can become symptomatic when prolapsed" }, { "field": "intervention", "quote": "endovascular artery embolization in hemorrhoids" }, { "field": "primaryOutcome", "quote": "evaluate the efficacy, clinical outcomes, and morbidity of endovascular artery embolization in hemorrhoids" }, { "field": "result", "quote": "QoL score has improved after emborrhoid, and most cases had a lower bleeding score." }, { "field": "result", "quote": "In 11.79% (n = 27/229) of patients re-embolization and after-treatment surgery were due to surgical failure and symptom recurrence, such as bleeding." }, { "field": "comparator", "quote": "This systematic review aimed to evaluate the efficacy, clinical outcomes, and morbidity of endovascular artery embolization in hemorrhoids." } ] }, { "id": "pmid:41486911", "pmid": "41486911", "doi": "10.3393/ac.2025.00549.0078", "nctId": null, "pmcid": "PMC12766388", "title": "Cryotherapy reduces pain post-hemorrhoidectomy (CYPHER): a randomized, controlled, superiority trial of intra-anal ice after surgery for grade III hemorrhoids", "firstAuthor": "Seow-En", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2025, "design": "rct", "n": 50, "nField": "reported", "population": "patients with grade III hemorrhoids undergoing hemorrhoidectomy surgery", "intervention": "intra-anal cryotherapy (ice) for 1 minute after surgery", "comparator": "standard postoperative care", "primaryOutcome": "pain at rest on the first day after surgery", "result": "no significant difference in pain at rest on day 1, but less pain after bowel movements and lower pain on day 2", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial, but small with only 50 patients and its main pain measure did not reach significance.", "directness": "direct", "limitations": "small sample size of 25 patients per group; primary outcome did not reach statistical significance", "followUp": "", "plainFinding": "Less pain after bowel movements.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41486911/", "sourceText": "PURPOSE: We aimed to determine whether intra-anal cryotherapy reduces postoperative pain in patients undergoing hemorrhoidectomy. METHODS: This randomized controlled trial was conducted from January 2023 to August 2024. Patients with symptomatic grade III hemorrhoids were randomized 1:1 to receive either 1 minute of intra-anal cryotherapy or standard postoperative care. Because cryotherapy was applied before reversal of general anesthesia, patients were blinded to treatment allocation. The primary outcome was pain at rest on postoperative day (POD) 1. Secondary outcomes included pain after defecation, time to return to work or non-work activities, 30-day complications, and compliance with analgesia. Pain was measured using the visual analog scale. RESULTS: A total of 50 patients were randomized (25 per group). All 50 were included in the analysis. Baseline clinicodemographic characteristics were comparable between groups. The primary outcome, POD 1 pain at rest, did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046). On POD 2, median pain scores at rest and after defecation were both significantly lower in the cryotherapy cohort (at rest: 2.0 vs. 4.0, P=0.043; after defecation: 2.0 vs. 5.0, P=0.001). CONCLUSION: Intra-anal cryotherapy significantly reduces pain after defecation in the early postoperative period following surgery for grade III hemorrhoids. Its therapeutic efficacy, ease of application, and safety support consideration for routine use. Trial registration ClinicalTrials.gov identifier: NCT06005727.", "provenance": [ { "field": "n", "quote": "A total of 50 patients were randomized (25 per group)." }, { "field": "population", "quote": "Patients with symptomatic grade III hemorrhoids" }, { "field": "intervention", "quote": "1 minute of intra-anal cryotherapy" }, { "field": "comparator", "quote": "standard postoperative care" }, { "field": "primaryOutcome", "quote": "The primary outcome was pain at rest on postoperative day (POD) 1." }, { "field": "result", "quote": "did not demonstrate superiority of cryotherapy compared with standard care (median 3.0 vs. 4.0, P=0.062). However, the POD 1 pain score after defecation was significantly lower with cryotherapy than without (3.0 vs. 4.0, P=0.046)." } ] }, { "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 circumferential prolapsed hemorrhoids", "intervention": "TILL (transverse incision with longitudinal ligation) procedure", "comparator": "traditional Milligan-Morgan hemorrhoidectomy", "primaryOutcome": "short-term results including pain, healing time, and anal stenosis risk", "result": "TILL showed less pain, quicker healing, and lower risk of anal stenosis than Milligan-Morgan hemorrhoidectomy", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The study being discussed was retrospective, done at one hospital, with few patients and only short follow-up, so the findings may not generalize.", "directness": "direct", "limitations": "retrospective, single-center design, small sample size, and short follow-up; cannot assess long-term outcomes like recurrence", "followUp": "", "plainFinding": "Less pain, faster healing short-term", "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": "The transverse incision with longitudinal ligation (TILL) procedure is a new method for 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": "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." }, { "field": "primaryOutcome", "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." }, { "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." }, { "field": "limitations", "quote": "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." } ] }, { "id": "pmid:41479928", "pmid": "41479928", "doi": "10.4253/wjge.v17.i12.114581", "nctId": null, "pmcid": "PMC12754250", "title": "Hemorrhoidal elastic band ligation during routine colonoscopy: A comparative study between flexible video endoscopy and rigid proctoscopy", "firstAuthor": "Gomes", "multipleAuthors": true, "journal": "World J Gastrointest Endosc", "year": 2025, "design": "retrospective", "n": 171, "nField": "reported", "population": "patients with anal bleeding and hemorrhoid prolapse referred for colonoscopy", "intervention": "band ligation done during flexible video colonoscopy (EBL)", "comparator": "band ligation done with a rigid proctoscope (RPBL)", "primaryOutcome": "control of bleeding, prolapse recurrence, pain, and satisfaction", "result": "EBL controlled symptoms in more patients after one session, with less prolapse, less bleeding, less pain, and higher satisfaction than RPBL", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study comparing two procedures, not a randomized trial, so other differences between groups could explain the results.", "directness": "direct", "limitations": "Retrospective cohort design; not randomized.", "followUp": "", "plainFinding": "Fewer prolapse recurrences, better symptom control.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41479928/", "sourceText": "BACKGROUND: Among patients referred for colonoscopy to evaluate bowel bleeding, many present with hemorrhoidal disease-associated bleeding and prolapse. AIM: To compare endoscopic band ligation (EBL) with rigid proctoscope band ligation (RPBL) in patients referred for colonoscopy due to internal hemorrhoids. METHODS: This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment. Seventy-five patients underwent EBL, and 96 underwent RPBL. Control of bleeding, prolapse recurrence, pain, tenesmus, overall satisfaction, and cost were analyzed. A log-binomial regression model was used to analyze and compare binary outcomes between the ligation types, which allowed for the direct estimation of relative risks. RESULTS: EBL achieved hemorrhoid symptom control in 92% of patients after a single session, compared with 63.5% for RPBL, which typically required three to four sessions (P < 0.01). Short-term prolapse was significantly lower with EBL (13.3%) than with RPBL (55.2%, P < 0.01), and long-term prolapse recurrence remained lower (8% vs 36.5%, P < 0.01). Short-term bleeding was also reduced with EBL (4% vs 19%, P < 0.01), while long-term bleeding control was comparable between groups (97.3% vs 92.7%). RPBL patients were more likely to report pain (relative risk = 1.29; 95% confidence interval: 1.08-1.54; P < 0.01). Overall satisfaction was markedly higher in the EBL group (86.7% \"very satisfied\") than in the RPBL group (24%, P < 0.01). CONCLUSION: EBL demonstrated superior control of hemorrhoidal symptoms, lower prolapse recurrence, and better short-term bleeding outcomes compared with RPBL. Long-term bleeding control and tenesmus rates were comparable; however, numerical trends favored EBL. Despite a higher per-session cost, the reduced number of sessions made overall expenses similar. EBL appears to be a more effective, efficient, and well-tolerated minimally invasive option for treating symptomatic internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study included 171 patients with previous anal bleeding and hemorrhoidal prolapse complaints who underwent routine colonoscopy who were referred for band ligation treatment." }, { "field": "population", "quote": "patients referred for colonoscopy to evaluate bowel bleeding, many present with hemorrhoidal disease-associated bleeding and prolapse" }, { "field": "intervention", "quote": "endoscopic band ligation (EBL)" }, { "field": "comparator", "quote": "rigid proctoscope band ligation (RPBL)" }, { "field": "primaryOutcome", "quote": "Control of bleeding, prolapse recurrence, pain, tenesmus, overall satisfaction, and cost were analyzed." }, { "field": "result", "quote": "EBL achieved hemorrhoid symptom control in 92% of patients after a single session, compared with 63.5% for RPBL, which typically required three to four sessions (P < 0.01). Short-term prolapse was significantly lower with EBL (13.3%) than with RPBL (55.2%, P < 0.01), and long-term prolapse recurrence remained lower (8% vs 36.5%, P < 0.01)." } ] }, { "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 failed conservative treatment or couldn't have surgery", "intervention": "endoscopic rubber band ligation (ERBL)", "comparator": "endoscopic injection sclerotherapy (EIS)", "primaryOutcome": "effective/cure rate within 3 months after treatment, recurrence, pain, and complications", "result": "both treatments had similar cure rates, but EIS caused less pain and fewer complications, while ERBL showed a trend toward lower recurrence in grade III hemorrhoids", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized study at a single hospital, so differences could be due to other factors despite statistical matching", "directness": "indirect", "limitations": "retrospective design; only one center; higher-grade (III) subgroup recurrence difference lost significance after correction for multiple comparisons", "followUp": "3 months", "plainFinding": "Similar cure rates; EIS less painful, fewer complications.", "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": "population", "quote": "patients with grade I to III internal hemorrhoids who underwent ERBL or EIS" }, { "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" }, { "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": "the EIS group had a lower pain score on the first day after operation" }, { "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)" }, { "field": "n", "quote": "a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group" } ] }, { "id": "pmid:41299195", "pmid": "41299195", "doi": "10.1177/03000605251397889", "nctId": null, "pmcid": "PMC12907802", "title": "The aCute HemORrhoidal disease evALuation International Study (CHORALIS): Subanalysis of the effectiveness of conservative treatment during the acute phase of hemorrhoidal disease in Vietnam", "firstAuthor": "Tin", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2025, "design": "prospective-cohort", "n": 202, "nField": "reported", "population": "adults with acute hemorrhoidal disease (symptoms starting within 48 hours) in Vietnam, most with grade I-II hemorrhoids", "intervention": "conservative treatment, mainly a venoactive drug (micronized purified flavonoid fraction)", "comparator": "no comparison group reported", "primaryOutcome": "improvement in hemorrhoid symptoms and quality of life", "result": "symptoms dropped sharply over four weeks and quality-of-life scores improved significantly, with high patient and doctor satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single-group observational study with no comparison group, so it cannot show whether the improvement was due to the treatment itself.", "directness": "indirect", "limitations": "No control group; most patients had grade I-II (not fully prolapsed) hemorrhoids, with only 12.4% grade III and 5.4% grade IV disease; short follow-up.", "followUp": "four weeks", "plainFinding": "Symptoms and quality of life improved", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41299195/", "sourceText": "BackgroundAlthough hemorrhoidal disease is common worldwide, real-world evidence on the effectiveness of conservative treatments during the acute phase remains limited.ObjectiveWe aimed to assess the effectiveness of conservative treatment in improving symptoms and quality of life in patients with acute hemorrhoids in Vietnam.Patients and methodsThis was a prospective, international, observational, longitudinal study based on a subanalysis of the aCute HemORrhoidal disease evALuation International Study conducted from January 2022 to June 2022 at five major hospitals in Vietnam. The present study included adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment and did not require surgical intervention.ResultsAmong the 202 patients, 53% were male; the mean population age was 40.5 ± 13.7 years, and the mean body mass index was 22.13 ± 2.59 kg/m2. The distribution of hemorrhoid severity was as follows: grade I, 22.3%; grade II, 59.9%; grade III, 12.4%; and grade IV, 5.4%. The mean number of symptoms per patient decreased from 4.6 ± 1.9 at baseline to 1.0 ± 1.5 at week four. At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding. The Hemorrhoid and Fissure Quality of Life significantly decreased across all domains (p < 0.05). Patient and physician satisfaction with conservative treatment was high, at 88.7% and 87.7%, respectively.ConclusionConservative treatment, particularly micronized purified flavonoid fraction-based therapy, improved the clinical symptoms and quality of life in patients with acute hemorrhoids in Vietnam.", "provenance": [ { "field": "n", "quote": "Among the 202 patients, 53% were male" }, { "field": "population", "quote": "adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment and did not require surgical intervention" }, { "field": "intervention", "quote": "Conservative treatment, particularly micronized purified flavonoid fraction-based therapy" }, { "field": "comparator", "quote": "At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding." }, { "field": "primaryOutcome", "quote": "assess the effectiveness of conservative treatment in improving symptoms and quality of life in patients with acute hemorrhoids in Vietnam" }, { "field": "result", "quote": "The mean number of symptoms per patient decreased from 4.6 ± 1.9 at baseline to 1.0 ± 1.5 at week four." }, { "field": "result", "quote": "The Hemorrhoid and Fissure Quality of Life significantly decreased across all domains (p < 0.05)." }, { "field": "result", "quote": "Patient and physician satisfaction with conservative treatment was high, at 88.7% and 87.7%, respectively." } ] }, { "id": "pmid:41285870", "pmid": "41285870", "doi": "10.1038/s41598-025-25263-2", "nctId": null, "pmcid": "PMC12644900", "title": "Short-term and patient-reported outcomes of laser hemorrhoidoplasty plus excisional hemorrhoidectomy for the treatment of grade IV hemorrhoid", "firstAuthor": "Liao", "multipleAuthors": true, "journal": "Sci Rep", "year": 2025, "design": "retrospective", "n": 232, "nField": "reported", "population": "patients with grade IV (prolapsed) hemorrhoids", "intervention": "laser hemorrhoidoplasty plus excisional hemorrhoidectomy", "comparator": "LigaSure hemorrhoidectomy", "primaryOutcome": "surgical results and 30-day complications", "result": "less urinary retention, lower pain scores, and less pain medication needed with laser plus excisional surgery compared to LigaSure surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison using historical controls from different time periods, not a randomized trial, so bias is likely.", "directness": "direct", "limitations": "retrospectively included and historically compared with patients undergoing LigaSure hemorrhoidectomy; Further prospective with large numbers of patients are needed to verify the topic", "followUp": "postoperative week 6", "plainFinding": "Less pain than LigaSure surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41285870/", "sourceText": "Laser hemorrhoidoplasty (LHP) is mainly used for symptomatic grade I-III hemorrhoid. Only a few studies have reported the application of lasers for grade IV hemorrhoids. The study aimed to compare LHP plus excisional hemorrhoidectomy (EH) and LigaSure hemorrhoidectomy in terms of short-term and patient-reported outcomes for the treatment of grade IV hemorrhoids. Patients with grade IV hemorrhoid undergoing LHP plus EH between June 2022 and May 2024 were retrospectively included and historically compared with patients undergoing LigaSure hemorrhoidectomy between January 2019 to May 2022 at a regional hospital. The primary outcome was the surgical results and 30-day complications. The secondary outcome was the postoperative results including pain score by using visual analogue scale (VAS) score and patient-reported outcomes by using the Hemorrhoidal Disease Symptom Score and Short Health ScaleHD. A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included. Patients who underwent LHP plus EH had a lower frequency of urinary retention than those who underwent LigaSure hemorrhoidectomy. LHP plus EH resulted in lower scores for the VAS (maximal) and VAS (mean) on the operation day and postoperative day 1 and required less acetaminophen administration on postoperative day 1. Regarding patient-reported outcomes, pain, bleeding, and prolapse improved after postoperative week 6. LHP plus EH is a safe and feasible alternative method for grade IV hemorrhoids in selected patients with satisfactory short-term postoperative and patient-reported outcomes. Further prospective with large numbers of patients are needed to verify the topic.", "provenance": [ { "field": "population", "quote": "Patients with grade IV hemorrhoid undergoing LHP plus EH" }, { "field": "intervention", "quote": "LHP plus excisional hemorrhoidectomy (EH)" }, { "field": "comparator", "quote": "LigaSure hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The primary outcome was the surgical results and 30-day complications." }, { "field": "result", "quote": "Patients who underwent LHP plus EH had a lower frequency of urinary retention than those who underwent LigaSure hemorrhoidectomy. LHP plus EH resulted in lower scores for the VAS (maximal) and VAS (mean) on the operation day and postoperative day 1 and required less acetaminophen administration on postoperative day 1." }, { "field": "n", "quote": "A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included." } ] }, { "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": "adults with internal hemorrhoids treated with endoscopic sclerotherapy", "intervention": "polidocanol carbon dioxide foam injection", "comparator": "polidocanol air foam injection", "primaryOutcome": "treatment success rate and complications one month after surgery", "result": "similar effectiveness in both 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, so it carries less weight than a controlled trial.", "directness": "indirect", "limitations": "Retrospective design; no randomization; focuses on internal hemorrhoids broadly rather than specifically prolapsed hemorrhoids.", "followUp": "1 month", "plainFinding": "", "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": "patients who received endoscopic polidocanol foam sclerotherapy for internal hemorrhoids" }, { "field": "intervention", "quote": "polidocanol carbon dioxide foam" }, { "field": "comparator", "quote": "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": "Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05)." }, { "field": "result", "quote": "The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05)" } ] }, { "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": "adults with grade I to III internal hemorrhoids treated at one hospital", "intervention": "endoscopic sclerotherapy, rubber band ligation, or combined ligation-sclerotherapy", "comparator": "the three endoscopic treatments compared against each other", "primaryOutcome": "treatment success within 3 months and symptom recurrence after 3 months", "result": "combined therapy had the highest success rate and lowest recurrence rate, especially for more severe grade III hemorrhoids, with similar safety and satisfaction across treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "it is a retrospective, non-randomized comparison from a single hospital, so differences between groups could be due to other factors rather than the treatment itself", "directness": "indirect", "limitations": "retrospective design, unequal and relatively small group sizes (especially only 24 in the combined group), single-center setting", "followUp": "3 months for efficacy; recurrence assessed beyond 3 months", "plainFinding": "Combined treatment worked best, fewer recurrences", "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": "population", "quote": "patients who underwent endoscopic minimally-invasive treatment for internal hemorrhoids at Wuhu First People's Hospital from January 2020 to December 2024" }, { "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": "CT showed the highest efficacy, especially for grade III hemorrhoids (95.0% [19/20])." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "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." } ] }, { "id": "pmid:41180783", "pmid": "41180783", "doi": "10.3748/wjg.v31.i39.110288", "nctId": null, "pmcid": "PMC12576589", "title": "Optimizing circumferential prolapsed hemorrhoid surgery: Transverse incision with longitudinal ligation procedure delivers superior radicality compared to Milligan-Morgan technique", "firstAuthor": "Song", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2025, "design": "retrospective", "n": 180, "nField": "reported", "population": "patients with circumferential prolapsed hemorrhoids requiring surgery", "intervention": "transverse incision with longitudinal ligation procedure (TILL)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH)", "primaryOutcome": "clinical efficacy after wound healing", "result": "TILL showed better overall treatment effects, faster healing, and less pain, edema, and stenosis than MMH", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective comparison, not a randomized trial, so differences between groups could be due to factors other than the surgery itself.", "directness": "direct", "limitations": "Retrospective review; no mention of randomization or blinding.", "followUp": "", "plainFinding": "Faster healing, less pain than standard surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41180783/", "sourceText": "BACKGROUND: Circumferential prolapsed hemorrhoids (CPHs) necessitate surgical intervention. While Milligan-Morgan hemorrhoidectomy (MMH) remains widely used, it compromises functional preservation and associates with significant postoperative pain, edema, and delayed healing in severe CPH cases. To address these limitations, our research team innovatively proposed the transverse incision with longitudinal ligation procedure (TILL). This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function. AIM: To optimize CPH resection and anal function preservation through comparative efficacy-safety evaluation of TILL vs MMH. METHODS: A total of 180 patients were retrospectively reviewed in China. The patients were divided into two groups of 90 based on the surgical methods. The treatment group underwent the TILL procedure, while the control group underwent MMH. The main observation index was the evaluation of clinical efficacy after wound healing. Secondary outcomes included the recurrence rate and wound healing time. Safety measurements were also evaluated. RESULTS: The TILL group showed a significant difference compared to the MMH group (P = 0.022), indicating better overall treatment effects. The time for wound healing in the TILL group was shorter than that in the MMH group (P = 0.001). Compared to those who underwent MMH, those who underwent TILL experienced significantly reduced postoperative pain, with lower average scores for anal edema and anal stenosis (both P < 0.05). CONCLUSION: TILL demonstrates superior efficacy to MMH for advanced CPH, reducing recovery times and postoperative pain, edema, and stenosis while preserving anal function.", "provenance": [ { "field": "n", "quote": "A total of 180 patients were retrospectively reviewed in China." }, { "field": "population", "quote": "Circumferential prolapsed hemorrhoids (CPHs) necessitate surgical intervention." }, { "field": "intervention", "quote": "transverse incision with longitudinal ligation procedure (TILL)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH)" }, { "field": "primaryOutcome", "quote": "The main observation index was the evaluation of clinical efficacy after wound healing." }, { "field": "result", "quote": "The TILL group showed a significant difference compared to the MMH group (P = 0.022), indicating better overall treatment effects." }, { "field": "result", "quote": "The time for wound healing in the TILL group was shorter than that in the MMH group (P = 0.001)." }, { "field": "result", "quote": "Compared to those who underwent MMH, those who underwent TILL experienced significantly reduced postoperative pain, with lower average scores for anal edema and anal stenosis (both P < 0.05)." } ] }, { "id": "pmid:41109750", "pmid": "41109750", "doi": "10.48095/ccrvch2025373", "nctId": null, "pmcid": null, "title": "Emergencies in proctology", "firstAuthor": "Vyčítal", "multipleAuthors": true, "journal": "Rozhl Chir", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with sudden anorectal problems like hemorrhoid crisis, anal fissure, or abscess", "intervention": "diagnosis and treatment of anorectal emergencies including hemorrhoidal crisis", "comparator": "", "primaryOutcome": "", "result": "not specified", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general review describing conditions and management approaches without any study data or outcome results.", "directness": "indirect", "limitations": "The abstract gives no study design details, patient numbers, or outcome data; it is a broad descriptive review of several different anorectal emergencies, not a focused study on prolapsed hemorrhoid treatment.", "followUp": "", "plainFinding": "No treatment outcome reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41109750/", "sourceText": "Acute conditions in proctology refer to anorectal disorders presenting with symptoms such as acute anal pain and bleeding that may require immediate treatment. This pub-lication discusses the diagnosis and management of common anorectal emergencies such as hemorrhoidal crisis, bleeding anorectal varices, anal fissure, anorectal abscess, strangulated rectal prolapse, Fournier gangrene and retained anorectal foreign bodies. Although many acute complications occurring in emergency cases are not life-threat-ening and can be successfully treated in an outpatient setting, accurate diagnosis and proper treatment can prevent serious complications such as sepsis or permanent func-tional impairment. A detailed medical history and careful physical examination, including digital rectal examination and anoscopy, are essential for a correct diagnosis and treatment plan. In some cases, some imaging tests such as computed tomography and ultrasonography are required. When in doubt, treating physicians should not hesitate to consult a specialist for diagnosis, proper treatment and appropriate follow-up, e.g. colorectal surgeon.", "provenance": [ { "field": "population", "quote": "Acute conditions in proctology refer to anorectal disorders presenting with symptoms such as acute anal pain and bleeding that may require immediate treatment." }, { "field": "intervention", "quote": "This pub-lication discusses the diagnosis and management of common anorectal emergencies such as hemorrhoidal crisis, bleeding anorectal varices, anal fissure, anorectal abscess, strangulated rectal prolapse, Fournier gangrene and retained anorectal foreign bodies." }, { "field": "result", "quote": "Although many acute complications occurring in emergency cases are not life-threat-ening and can be successfully treated in an outpatient setting, accurate diagnosis and proper treatment can prevent serious complications such as sepsis or permanent func-tional impairment." } ] }, { "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 grade III prolapsed hemorrhoids", "intervention": "laser hemorrhoidoplasty (LHP)", "comparator": "none (single-arm cohort, before/after comparison over time)", "primaryOutcome": "postoperative pain, proctological symptoms, and complications", "result": "pain peaked at day 7 then resolved by day 14, symptoms improved to zero by day 30, with a 44% cumulative complication rate (mostly mild)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so it cannot show if laser treatment works better than other options.", "directness": "direct", "limitations": "Retrospective design, no control group, data pooled from six different centers which may vary in technique.", "followUp": "1 year", "plainFinding": "Early pain relief, symptoms resolved by one month.", "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": "population", "quote": "100 patients with symptomatic grade III hemorrhoids treated with LHP across six Brazilian centers" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "This multicenter retrospective cohort included 100 patients with symptomatic grade III hemorrhoids treated with LHP" }, { "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%." }, { "field": "n", "quote": "This multicenter retrospective cohort included 100 patients" } ] }, { "id": "pmid:41067778", "pmid": "41067778", "doi": "10.1136/bmjopen-2024-098484", "nctId": null, "pmcid": "PMC12517015", "title": "Liposomal bupivacaine versus ropivacaine perianal infiltration for postoperative analgesia of haemorrhoidectomy: a multicentre, randomised controlled trial", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "BMJ Open", "year": 2025, "design": "rct", "n": 264, "nField": "reported", "population": "Adults having surgery for grade III-IV mixed hemorrhoids", "intervention": "Liposomal bupivacaine injected around the anus after surgery", "comparator": "Ropivacaine injected around the anus after surgery", "primaryOutcome": "Pain scores at rest after hemorrhoid surgery", "result": "Liposomal bupivacaine group had lower pain scores at rest and with movement, and needed rescue painkillers less often, with similar side effects", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a well-designed multicentre randomised trial with a reasonable number of patients, but it studies pain control after surgery rather than how to treat the prolapse itself.", "directness": "indirect", "limitations": "The abstract does not mention blinding of patients or assessors, and it focuses on postoperative analgesia rather than comparing surgical or non-surgical treatments for the prolapse itself.", "followUp": "72 hours", "plainFinding": "Less pain after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41067778/", "sourceText": "OBJECTIVES: To evaluate whether liposomal bupivacaine provides superior postoperative analgesia compared with ropivacaine following haemorrhoidectomy, reduces the need for rescue analgesics in patients with mixed haemorrhoids and maintains a comparable safety profile. DESIGN: Prospective, randomised controlled multicentre trial. SETTING: Three grade 3A general hospitals in Guangxi, China, conducted between September 2023 and July 2024. PARTICIPANTS: Eligible patients were aged 18-75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids). Key exclusion criteria were severe systemic diseases, history of substance abuse or known allergies to local anaesthetics. A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group. INTERVENTIONS: Patients received either ropivacaine (100 mg in 20 mL) or liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were the resting numerical rating scale (NRS) pain scores (0-10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours. The secondary outcomes included the following: (1) exercise NRS pain scores at the same time points; (2) time to first ambulation, ambulation NRS pain scores on postoperative days 1, 2 and 3 and the proportion of patients having ambulation NRS pain scores ≥4; (3) defecation NRS pain scores and the proportion of of patients having score ≥4; (4) the time to the first administration of rescue analgesics and proportion of patients requiring rescue analgesics; (5) proportion of pain-free patients (NRS pain scores ≤1) 0-24, 24-72 and 0-72 hour after surgery; (6) incision assessments on postoperative days 1, 3 and 7 and postoperative adverse events (AEs); and (7) patients' and researchers' satisfaction with pain management. RESULTS: Resting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0-2.0 vs 2.0-4.0 for ropivacaine, p<0.001). Exercise NRS pain scores were also significantly lower in the liposomal bupivacaine group (median, 0-2.0 vs 2.0-5.0, p<0.001). Additionally, median ambulation NRS pain scores were reduced in the liposomal bupivacaine group on postoperative days 1-3 (median, 1.0-2.0 vs 3.0-5.0, p<0.001). By 72 hours after surgery, 78.8% of the patients in the liposomal bupivacaine group had defecated, reporting lower defecation NRS pain scores (median, 3.0 vs 5.0, p<0.001). Fewer patients in this group required rescue analgesics (43.9% vs 83.3%, p<0.001). Incision assessment scores were comparable between groups, with no significant difference in AE rates (3.8% vs 1.5%, p=0.444). CONCLUSIONS: Perianal infiltration of liposomal bupivacaine significantly alleviates postoperative resting and exercise pain in patients undergoing surgery for mixed haemorrhoids, enhances comfort during ambulation and defecation, reduces the need for additional analgesics and demonstrates a safety profile comparable to that of ropivacaine. TRIAL REGISTRATION: chictr.org.cn # ChiCTR2300075276.", "provenance": [ { "field": "n", "quote": "A total of 264 patients (male, n=162; mean age, 43.1±12.2 years) were enrolled and completed the study, with 132 randomised to each group." }, { "field": "population", "quote": "Eligible patients were aged 18-75 years undergoing elective external dissection and internal ligation for mixed haemorrhoids (grade III and IV mixed haemorrhoids)." }, { "field": "intervention", "quote": "liposomal bupivacaine (226 mg in 20 mL) through local infiltration at the end of surgery" }, { "field": "comparator", "quote": "ropivacaine (100 mg in 20 mL)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were the resting numerical rating scale (NRS) pain scores (0-10) at postoperative 1, 5, 7, 9, 11, 24, 36, 48 and 72 hours." }, { "field": "result", "quote": "Resting NRS pain scores were significantly lower in the liposomal bupivacaine group at all time points (median, 0-2.0 vs 2.0-4.0 for ropivacaine, p<0.001)." }, { "field": "result", "quote": "Fewer patients in this group required rescue analgesics (43.9% vs 83.3%, p<0.001)." } ] }, { "id": "pmid:41029419", "pmid": "41029419", "doi": "10.1186/s13741-025-00583-z", "nctId": null, "pmcid": "PMC12486885", "title": "Refining postoperative quality metrics: risk factors for emergency department visits within 3 days after hemorrhoidectomy", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Perioper Med (Lond)", "year": 2025, "design": "retrospective", "n": 662, "nField": "reported", "population": "patients who had surgery (hemorrhoidectomy) for grade III or IV hemorrhoids", "intervention": "conventional hemorrhoidectomy surgery", "comparator": "no separate comparator group; risk factors compared within same surgical cohort", "primaryOutcome": "return to the emergency department within 3 days after discharge", "result": "having thrombosed hemorrhoids or needing 2 or more pain medicines after surgery predicted early ER visits", "resultDirection": "unclear", "quality": "low", "qualityWhy": "single-center retrospective chart review without a comparison treatment group, so it can show risk factors but not prove what treatment works best.", "directness": "indirect", "limitations": "retrospective design, single hospital, only looked at post-surgery ER visits rather than comparing treatments for prolapsed hemorrhoids", "followUp": "3 days", "plainFinding": "Thrombosis, more pain meds raise ER-visit risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41029419/", "sourceText": "BACKGROUND: Very early hospital revisits following hemorrhoidectomy, particularly within 3 days of discharge, may reflect preventable peri-discharge complications more accurately than traditional 30-day readmission rates. However, few studies have systematically examined risk factors associated with this short-term outcome under real-world conditions. METHODS: We conducted a retrospective cohort study of 662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023. The primary outcome was return to the emergency department (ED) within 3 days of discharge. Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression. RESULTS: Of 662 patients, 46 (6.95%) returned to the ED within 3 days. The most common presenting symptom was severe wound pain (78.3%). Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit. Other clinical and laboratory variables were not significantly associated. CONCLUSIONS: This study is among the first to identify specific predictors of ED visits within 3 days after hemorrhoidectomy. The presence of thrombosed hemorrhoids and escalated analgesic use may signal patients at risk for very early unplanned revisits. These findings challenge reliance on 30-day readmission metrics and support 72-h revisit rates as a sensitive quality indicator for discharge appropriateness and perioperative care.", "provenance": [ { "field": "n", "quote": "662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids" }, { "field": "population", "quote": "patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023" }, { "field": "intervention", "quote": "conventional hemorrhoidectomy for grade III or IV hemorrhoids" }, { "field": "comparator", "quote": "Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression." }, { "field": "primaryOutcome", "quote": "The primary outcome was return to the emergency department (ED) within 3 days of discharge." }, { "field": "result", "quote": "Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit." } ] }, { "id": "pmid:41024814", "pmid": "41024814", "doi": "10.4240/wjgs.v17.i9.110034", "nctId": null, "pmcid": "PMC12476758", "title": "Remimazolam reduces State-Trait Anxiety Inventory-State Scale scores in hemorrhoid surgery with spinal-epidural anesthesia: A randomized trial", "firstAuthor": "Hu", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "rct", "n": 60, "nField": "reported", "population": "patients having surgery for prolapsed hemorrhoids (PPH surgery)", "intervention": "remimazolam added to combined spinal-epidural anesthesia", "comparator": "combined spinal-epidural anesthesia alone", "primaryOutcome": "anxiety score (STAI-S), sedation depth, and blood pressure/heart rate", "result": "adding remimazolam lowered anxiety scores, gave deeper sedation, and kept blood pressure more stable at the start of surgery than spinal-epidural anesthesia alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small single-center trial of 60 patients looking at anesthesia-related measures, not at hemorrhoid treatment outcomes themselves", "directness": "indirect", "limitations": "small sample size from a single center; focuses on anesthesia/sedation measures rather than hemorrhoid-specific surgical outcomes", "followUp": "24 hours post-operation", "plainFinding": "Less anxiety with added sedative drug", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41024814/", "sourceText": "BACKGROUND: In the field of anesthesia for procedure for prolapse and hemorrhoids (PPH) surgery, combined spinal-epidural (CSE) anesthesia has been a common approach. However, exploring new combinations to optimize patient outcomes remains crucial. Remimazolam, a short-acting benzodiazepine, shows potential for improving sedation and reducing patient anxiety. The effects of combining remimazolam with CSE anesthesia, compared to traditional CSE anesthesia alone, on patient anxiety, sedation depth, and hemodynamics during PPH surgery have not been fully elucidated. AIM: To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale (STAI-S) scores, sedation, and hemodynamics in PPH surgery. METHODS: This study is a single-center, prospective, randomized controlled trial. Between November 23, 2022, and August 6, 2024, 60 eligible patients were randomly assigned to the CSE anesthesia group or the remimazolam-combined CSE anesthesia group (30 patients each). STAI-S scores, Ramsay sedation scores, and hemodynamic parameters (systolic blood pressure, diastolic blood pressure, heart rate) were measured at multiple time points. Two-way mixed-effects ANOVA and post-hoc analyses were performed. RESULTS: The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room [mean: 28.80 vs 54.03, mean difference (95%CI): 25.23 (21.24-29.23), P < 0.001] and 24 hours post-operation [mean: 45.07 vs 54.53, mean difference (95%CI): 9.47 (6.29-12.64), P < 0.001] than the CSE group. Moreover, the Combined group achieved a deeper sedation level during intraoperative maintenance [median: 5.00 (IQR: 5.00-5.00) vs 2.00 (IQR: 2.00-2.00); median difference (95%CI): 3.00 (3.00-3.00), P < 0.001]. Regarding hemodynamics, a significant inter-group difference in systolic blood pressure was observed at the start of the surgery [mean: 128.8 vs 114.7 for the Combined and CSE groups, mean difference (95%CI): 14.17 (0.77-27.57), adjusted P = 0.033]. CONCLUSION: Remimazolam-combined anesthesia outperformed CSE anesthesia in reducing STAI-S scores, enhancing intraoperative sedation, and stabilizing systolic blood pressure at a critical stage, indicating its superiority in perioperative management.", "provenance": [ { "field": "n", "quote": "60 eligible patients were randomly assigned" }, { "field": "population", "quote": "procedure for prolapse and hemorrhoids (PPH) surgery" }, { "field": "intervention", "quote": "remimazolam-combined CSE anesthesia group" }, { "field": "comparator", "quote": "CSE anesthesia group" }, { "field": "primaryOutcome", "quote": "To compare remimazolam-CSE vs CSE alone on State-Trait Anxiety Inventory-State scale (STAI-S) scores, sedation, and hemodynamics in PPH surgery." }, { "field": "result", "quote": "The Combined group demonstrated significantly lower STAI-S scores before leaving the operating room [mean: 28.80 vs 54.03, mean difference (95%CI): 25.23 (21.24-29.23), P < 0.001] and 24 hours post-operation" }, { "field": "followUp", "quote": "24 hours post-operation" } ] }, { "id": "pmid:41018464", "pmid": "41018464", "doi": "10.7759/cureus.91008", "nctId": null, "pmcid": "PMC12461402", "title": "Evaluating Laser Haemorrhoidoplasty as a Short-Term Approach to Advanced Haemorrhoidal Disease", "firstAuthor": "Tan", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "retrospective", "n": 57, "nField": "reported", "population": "patients with advanced (grade 3 and 4) symptomatic hemorrhoids", "intervention": "laser haemorrhoidoplasty (LHP)", "comparator": "patients' own symptoms before surgery (pre- vs post-treatment)", "primaryOutcome": "severity of pain and frequency of symptoms (bleeding, prolapse, itching, soiling) two months after surgery", "result": "significant improvement in pain, itching, bleeding, soiling, and prolapse symptoms after laser treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study without a control group, so it cannot prove the laser itself caused the improvement.", "directness": "direct", "limitations": "Retrospective design, no comparator group, short follow-up, authors call for larger prospective multicentre studies with long-term outcomes", "followUp": "two months", "plainFinding": "Fewer prolapse and pain symptoms short-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41018464/", "sourceText": "Background Haemorrhoids are a benign anorectal condition that can significantly impact the quality of life of patients. Well-established treatments for advanced haemorrhoidal disease are not without complications. Laser haemorrhoidoplasty (LHP) is a less invasive non-excisional surgical technique that has fewer complications than conventional management. Methodology A retrospective study of all patients who received LHP for symptomatic Grade 3 and Grade 4 haemorrhoids from November 2017 to March 2022 in a district general hospital was conducted to assess short-term functional outcomes. Patients were asked to report the severity of pain on the Visual Analogue Scale and frequency of symptoms based on the Haemorrhoidal Severity Score (HSS developed by Nyström) two months before and after LHP. Participant consent and feedback were obtained either by a written questionnaire or a phone interview. Results A total of 57 patients were interviewed. The most common symptoms were bleeding (n = 54), prolapse needing reduction (n = 45), pain (n = 43), itching and discomfort (n = 28), and soiling (n = 24). There was a significant improvement in the severity of pain (p < 0.0001) postoperatively. Patients reported an improvement of their pre-existing symptoms, including pain (p < 0.00001), itching and discomfort (p = 0.0001), bleeding (p < 0.00001), soiling (p = 0.00007), and prolapse (p < 0.00001) based on HSS. Conclusions Evidence from this study suggests that LHP provides significant short-term improvement in the severity of symptoms for patients with symptomatic third- and fourth-degree haemorrhoids. While the results of this study are encouraging, larger prospective multicentre studies assessing long-term outcomes will be desirable for proper evaluation of LHP with respect to its efficacy and cost-effectiveness.", "provenance": [ { "field": "n", "quote": "A total of 57 patients were interviewed." }, { "field": "population", "quote": "symptomatic Grade 3 and Grade 4 haemorrhoids" }, { "field": "intervention", "quote": "Laser haemorrhoidoplasty (LHP) is a less invasive non-excisional surgical technique" }, { "field": "comparator", "quote": "two months before and after LHP" }, { "field": "primaryOutcome", "quote": "severity of pain on the Visual Analogue Scale and frequency of symptoms based on the Haemorrhoidal Severity Score" }, { "field": "result", "quote": "Patients reported an improvement of their pre-existing symptoms, including pain (p < 0.00001), itching and discomfort (p = 0.0001), bleeding (p < 0.00001), soiling (p = 0.00007), and prolapse (p < 0.00001) based on HSS." } ] }, { "id": "pmid:40995290", "pmid": "40995290", "doi": "10.7759/cureus.90842", "nctId": null, "pmcid": "PMC12454922", "title": "Anorectal Myiasis Caused by Cochliomyia hominivorax in a Septic Tank Worker", "firstAuthor": "Licona", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 55-year-old male septic tank worker with prolapsed hemorrhoids and anorectal maggot infestation complicated by newly diagnosed diabetes", "intervention": "surgical removal of hemorrhoids and larvae plus antibiotics, wound care, glucose control and ivermectin", "comparator": "none - single case treated, no comparison group", "primaryOutcome": "recovery from infestation and hemorrhoid prolapse", "result": "the patient fully recovered after combined surgery and medical treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this treatment works better than others for prolapsed hemorrhoids in general.", "directness": "indirect", "limitations": "single case with an unusual complicating infection, not representative of typical prolapsed hemorrhoid cases", "followUp": "", "plainFinding": "Full recovery after surgery plus antibiotics.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40995290/", "sourceText": "The term \"myiasis\" refers to the parasitic infestation by fly maggots in human tissue. Although cutaneous involvement is well documented, anorectal myiasis is exceedingly rare, particularly when caused by Cochliomyia hominivorax, The New World screwworm fly. We present the case of a 55-year-old male septic tank worker from a rural northern community of Honduras. The patient presented with hyperglycemia, perianal pain, discharge, and prolapsed hemorrhoids. Upon admission, an early evaluation led to a new diagnosis of diabetes type II. We arranged a surgical exploration in the operating theater under general anesthesia. During debridement and exploration, we found numerous larvas invading the anal mucosa and second-/third-degree hemorrhoids. The treatment included submucosal hemorrhoidectomy, larval extraction, systemic antibiotics, outpatient wound care, glycemic control, and a dose of ivermectin, all of which led to a full recovery. This case highlights the diagnostic and therapeutic challenges of myiasis in atypical anatomical sites, impaired wound healing in diabetic patients, and emphasizes occupational risk in low-sanitation environments.", "provenance": [ { "field": "n", "quote": "a 55-year-old male septic tank worker" }, { "field": "population", "quote": "The patient presented with hyperglycemia, perianal pain, discharge, and prolapsed hemorrhoids." }, { "field": "intervention", "quote": "The treatment included submucosal hemorrhoidectomy, larval extraction, systemic antibiotics, outpatient wound care, glycemic control, and a dose of ivermectin, all of which led to a full recovery." }, { "field": "comparator", "quote": "We present the case of a 55-year-old male septic tank worker" }, { "field": "primaryOutcome", "quote": "all of which led to a full recovery" }, { "field": "result", "quote": "all of which led to a full recovery" } ] }, { "id": "pmid:40979427", "pmid": "40979427", "doi": "10.1093/jscr/rjaf650", "nctId": null, "pmcid": "PMC12449783", "title": "High-intensity focused ultrasound rectoanal lifting (HIFU-RAL) for prolapsed hemorrhoids: a case series", "firstAuthor": "Suzuki", "multipleAuthors": false, "journal": "J Surg Case Rep", "year": 2025, "design": "case-series", "n": 10, "nField": "reported", "population": "patients with grade IV prolapsed hemorrhoids", "intervention": "high-intensity focused ultrasound rectoanal lifting (HIFU-RAL)", "comparator": "none", "primaryOutcome": "shrinkage or disappearance of prolapsed hemorrhoid and recurrence of prolapse", "result": "prolapsed lesions shrank or disappeared immediately after treatment, with no prolapse seen for 9 days to 3 months and no adverse events", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a very small, uncontrolled case series with only 10 patients and short follow-up, so it cannot reliably show the treatment works.", "directness": "direct", "limitations": "Small sample size, no comparison group, short follow-up period", "followUp": "9 days to 3 months", "plainFinding": "Prolapse shrank, no complications seen", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40979427/", "sourceText": "Prolapsed hemorrhoids can affect quality of life, owing to associated pain and other symptoms. Although hemorrhoidectomies are curative, postoperative complications such as pain, bleeding, and delayed recovery are unavoidable. Some patients cannot undergo surgery due to comorbidities or social factors. These challenges highlight the need for minimally invasive, immediate treatments. This study explored the effectiveness of high-intensity focused ultrasound rectoanal lifting (HIFU-RAL) in 10 patients with grade IV hemorrhoids. The procedure was completed within 13.5 ± 3.2 min. Immediately afterward, the prolapsed lesions visibly shrank or disappeared. No prolapse was observed between 9 days and 3 months following HIFU-RAL, and no adverse events were reported. Heating induced by HIFU may have triggered contraction of the longitudinal muscles, repositioning the hemorrhoids to their anatomical location and visually reducing the prolapsed lesion. HIFU-RAL is a promising, minimally invasive treatment for prolapsed hemorrhoids that can be performed immediately in a consultation room.", "provenance": [ { "field": "population", "quote": "10 patients with grade IV hemorrhoids" }, { "field": "intervention", "quote": "high-intensity focused ultrasound rectoanal lifting (HIFU-RAL)" }, { "field": "comparator", "quote": "This study explored the effectiveness of high-intensity focused ultrasound rectoanal lifting (HIFU-RAL) in 10 patients with grade IV hemorrhoids." }, { "field": "primaryOutcome", "quote": "Immediately afterward, the prolapsed lesions visibly shrank or disappeared." }, { "field": "result", "quote": "No prolapse was observed between 9 days and 3 months following HIFU-RAL, and no adverse events were reported." }, { "field": "n", "quote": "10 patients with grade IV hemorrhoids" } ] }, { "id": "pmid:40951912", "pmid": "40951912", "doi": "10.5334/aogh.4663", "nctId": null, "pmcid": "PMC12427620", "title": "Assessing Colorectal Care Capacity at an Urban Tertiary Hospital in Ghana", "firstAuthor": "Panzer", "multipleAuthors": true, "journal": "Ann Glob Health", "year": 2025, "design": "retrospective", "n": 2992, "nField": "reported", "population": "patients at a Ghanaian teaching hospital needing colorectal procedures", "intervention": "colorectal surgical care infrastructure and procedures (e.g., hemorrhoidectomy)", "comparator": "", "primaryOutcome": "availability of infrastructure, resources, and case volume for colorectal procedures", "result": "the abstract describes hospital capacity and procedure counts, not treatment outcomes for prolapsed hemorrhoids specifically", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive capacity assessment, not a study comparing treatments or outcomes for prolapsed hemorrhoids.", "directness": "indirect", "limitations": "retrospective, single-center, no outcome or efficacy data reported, does not define or address prolapsed hemorrhoids specifically", "followUp": "", "plainFinding": "Not studied here.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40951912/", "sourceText": "Background: The burden of colorectal diseases continues to rise in Ghana. However, building a surgical workforce to address these diseases has been hampered by the lack of a colorectal specialty training pathway. To address this gap, the first colorectal surgery fellowship in Ghana was established in July 2023. Objective: This study aims to identify strengths and gaps in colorectal care delivery prior to fellowship implementation by assessing relevant infrastructure, resources, and case volume at a Ghanaian teaching hospital. Methods: Data on surgical infrastructure and human resources were collected at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Retrospective, de-identified data were collected on all colorectal procedures performed at KBTH from January 1, 2022, to December 31, 2022. Cases were categorized by common anorectal, abdominal, and endoscopic procedures. Findings: All surgical infrastructure and human resources were always available during the study period, except for immunohistochemistry services. 2,992 colorectal procedures were performed, including 173 anorectal procedures, 167 abdominal procedures, and 2,652 endoscopic procedures. The three most common colorectal surgeries performed were segmental colectomy (n = 76), excisional hemorrhoidectomy (n = 64), and stoma creation/management (n = 52). Some common colorectal services were not provided, including banding of internal hemorrhoids, seton placement for perianal fistulas, rectopexy for rectal prolapse, and pelvic floor evaluations. Conclusions: There is a need for colorectal-specific surgical training and infrastructure in Ghana. KBTH is well-equipped with the resources to support growth of the newly established colorectal surgery fellowship, which will expand colorectal services available for Ghanaians.", "provenance": [ { "field": "population", "quote": "Retrospective, de-identified data were collected on all colorectal procedures performed at KBTH from January 1, 2022, to December 31, 2022." }, { "field": "n", "quote": "2,992 colorectal procedures were performed" }, { "field": "intervention", "quote": "excisional hemorrhoidectomy (n = 64)" }, { "field": "primaryOutcome", "quote": "assessing relevant infrastructure, resources, and case volume at a Ghanaian teaching hospital" }, { "field": "result", "quote": "Some common colorectal services were not provided, including banding of internal hemorrhoids, seton placement for perianal fistulas, rectopexy for rectal prolapse, and pelvic floor evaluations." } ] }, { "id": "pmid:40949368", "pmid": "40949368", "doi": "10.4240/wjgs.v17.i8.107476", "nctId": null, "pmcid": "PMC12427071", "title": "Analysis of recurrence after stapled hemorrhoidopexy in grade IV hemorrhoid disease", "firstAuthor": "Erkek", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "retrospective", "n": 77, "nField": "reported", "population": "patients with grade III or IV hemorrhoids", "intervention": "stapled hemorrhoidopexy (a surgical stapling procedure for hemorrhoids)", "comparator": "grade III hemorrhoids compared with grade IV hemorrhoids after the same procedure", "primaryOutcome": "recurrence of hemorrhoids after surgery", "result": "23.6% of grade IV patients had recurrence versus none of the grade III patients", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a small, retrospective single-center study without a comparison to another treatment, so its findings are not strong evidence.", "directness": "direct", "limitations": "Retrospective design, single center, small sample size, no comparison group receiving a different surgical technique.", "followUp": "", "plainFinding": "High recurrence after stapling in grade IV.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40949368/", "sourceText": "BACKGROUND: Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease, being particularly effective for grade III and IV hemorrhoids. The procedure is associated with better short-term outcomes, including less postoperative pain, shorter operative time, faster return to work, and higher patient satisfaction. However, there is a risk-benefit debate surrounding SH due to significant complications from the procedure, such as anal stenosis, rectovaginal fistula, fecal incontinence, and recurrence. AIM: To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids. METHODS: This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis. Early (less than 7 days after SH) and late (7 or more days after SH) complications were analyzed. Recurrence rates were calculated as well. RESULTS: Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups. Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids. Postoperative bleeding, incomplete defecation, urgent defecation, incontinence, skin tags, and anal fissure were complications reported by both groups. CONCLUSION: Due to the high recurrence rate, SH is not an appropriate treatment option for patients with grade IV hemorrhoids. Open surgery may be a more suitable option for these patients.", "provenance": [ { "field": "n", "quote": "This retrospective, single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis." }, { "field": "population", "quote": "patients with grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "Stapled hemorrhoidopexy (SH) is one of the most commonly used surgical techniques for hemorrhoidal disease" }, { "field": "comparator", "quote": "Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups." }, { "field": "primaryOutcome", "quote": "To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids." }, { "field": "result", "quote": "Recurrence was observed in 4 patients (23.6%) with grade IV hemorrhoids, and no recurrence was noted in patients with grade III hemorrhoids." } ] }, { "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 (HIFU-RAL) and ALTA sclerotherapy", "comparator": "none (no comparison group)", "primaryOutcome": "reduction or resolution of prolapsed lesions and recurrence/adverse events over time", "result": "prolapse was visibly reduced or resolved in all cases immediately, with no recurrences or adverse events during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a tiny uncontrolled case series of only 10 patients with no comparison group, so it cannot reliably show the treatment works better than alternatives", "directness": "direct", "limitations": "small sample size, no control group, case series design", "followUp": "16.0 months", "plainFinding": "Prolapse improved, no recurrence 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": "This case series included 10 symptomatic patients" }, { "field": "primaryOutcome", "quote": "The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time." }, { "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:40824576", "pmid": "40824576", "doi": "10.1001/jama.2025.13083", "nctId": null, "pmcid": null, "title": "Hemorrhoidal Disease: A Review", "firstAuthor": "Ashburn", "multipleAuthors": false, "journal": "JAMA", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease, including prolapsed internal hemorrhoids", "intervention": "range of treatments including fiber/water intake, phlebotonics, rubber band ligation, sclerotherapy, infrared coagulation, and excisional hemorrhoidectomy", "comparator": "different treatments compared to each other and to no treatment/before treatment", "primaryOutcome": "resolution of symptoms such as bleeding, pain, and prolapse", "result": "Dietary changes and phlebotonics help first; rubber band ligation resolves symptoms in most patients with less severe prolapse; surgery has low recurrence for severe or mixed disease but longer recovery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a narrative review summarizing other studies rather than a new controlled trial, so the strength of each claim cannot be verified here.", "directness": "direct", "limitations": "Abstract does not describe how underlying studies were selected or their individual quality; recurrence rates vary widely by treatment.", "followUp": "3 to 6 months", "plainFinding": "Fiber, banding, or surgery relieve prolapse.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40824576/", "sourceText": "IMPORTANCE: Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US. Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse. OBSERVATIONS: Hemorrhoids are classified as internal, external, or mixed (concurrent internal and external hemorrhoidal disease). Internal hemorrhoids originate above the dentate line, the boundary between the upper and lower anal canal, and may cause rectal bleeding, discomfort, and tissue prolapse from the anal canal. Internal hemorrhoid prolapse is classified as grade I (into anal canal), grade II (beyond the anus with spontaneous reduction), grade III (requiring manual reduction), and grade IV (irreducible). External hemorrhoids, arising below the dentate line, cause rectal pain when engorged or thrombosed. Initial treatment of all hemorrhoidal disease involves increasing intake of dietary fiber and water and avoiding straining during defecation. Phlebotonics (eg, flavonoids [thought to improve venous tone]) reduce bleeding, rectal pain, and swelling, although symptom recurrence reaches 80% within 3 to 6 months after treatment cessation. If dietary modification and phlebotonics are ineffective, grade I to grade III internal hemorrhoidal disease can be treated with office-based interventions. Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%. Sclerotherapy, which induces fibrosis with a sclerosant injection, is efficacious in the short term (weeks to months) among 70% to 85% of patients, but long-term remission occurs in only one-third of patients. Infrared coagulation uses heat to coagulate hemorrhoidal tissue, yielding 70% to 80% success in reducing bleeding and prolapse. Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days). External hemorrhoidal disease rarely requires surgery unless acutely thrombosed. Outpatient clot evacuation within 72 hours of onset of a thrombosed external hemorrhoid is associated with decreased pain and reduced risk of repeat thrombosis. Patients presenting more than 72 hours after external hemorrhoid acute thrombosis should receive medical treatment (eg, stool softeners, oral and topical analgesics such as 5% lidocaine). CONCLUSIONS AND RELEVANCE: Hemorrhoidal disease affects 10 million people in the US. First-line treatment is increased fiber intake, avoidance of straining during defecation, and phlebotonics. In-office rubber band ligation for grade I to III internal hemorrhoid disease is first-line procedural treatment for persistent symptoms despite conservative therapies. Excisional hemorrhoidectomy is recommended for grade III to IV prolapse, thrombosis, or mixed hemorrhoidal disease that does not improve with less invasive approaches.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US." }, { "field": "intervention", "quote": "Initial treatment of all hemorrhoidal disease involves increasing intake of dietary fiber and water and avoiding straining during defecation." }, { "field": "intervention", "quote": "Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%." }, { "field": "intervention", "quote": "Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days)." }, { "field": "comparator", "quote": "If dietary modification and phlebotonics are ineffective, grade I to grade III internal hemorrhoidal disease can be treated with office-based interventions." }, { "field": "primaryOutcome", "quote": "Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse." }, { "field": "result", "quote": "Rubber band ligation-placing a band around the base of hemorrhoid tissue during anoscopy to restrict blood flow-resolves symptoms in 89% of patients, but repeated banding is needed in up to 20%." }, { "field": "result", "quote": "Excisional hemorrhoidectomy, for disease unresponsive to office-based therapy or for mixed hemorrhoidal disease, achieves low recurrence (2%-10%), although with longer recovery (9-14 days)." }, { "field": "followUp", "quote": "symptom recurrence reaches 80% within 3 to 6 months after treatment cessation" } ] }, { "id": "pmid:40807017", "pmid": "40807017", "doi": "10.3390/jcm14155397", "nctId": null, "pmcid": "PMC12347116", "title": "Doppler-Guided Haemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR): An Institutional Experience", "firstAuthor": "Gosavi", "multipleAuthors": true, "journal": "J Clin Med", "year": 2025, "design": "retrospective", "n": 128, "nField": "reported", "population": "Adults with Grade II–IV haemorrhoids undergoing elective surgery", "intervention": "Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR)", "comparator": "No comparison group; outcomes stratified by haemorrhoid grade", "primaryOutcome": "Postoperative complications, recurrence, and day-case completion rates", "result": "Day-case completion in 76.6%, recurrence in 17.6%, urinary retention in 3.9%, return to theatre in 0.8%, 30-day readmission in 7.0%; Grade IV disease linked to more recurrence and conversion to excisional surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-institution review without a comparison group, so results may not hold up as strongly as a controlled trial.", "directness": "direct", "limitations": "Retrospective design, single institution, no control group, and the authors say longer-term prospective studies are needed.", "followUp": "", "plainFinding": "Safe, effective for grade II-III hemorrhoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40807017/", "sourceText": "Background: Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR) is a minimally invasive alternative to conventional haemorrhoidectomy. While associated with reduced postoperative pain and quicker recovery, data on its safety, recurrence rates, and applicability across haemorrhoid grades remain limited, particularly in Australian settings. Methods: A retrospective review was conducted on 128 consecutive patients who underwent elective HAL-RAR at a single institution between February 2022 and December 2024. Data on demographics, operative details, postoperative outcomes, and recurrence were collected. Outcomes were stratified by haemorrhoid grade. Multivariate logistic regression was used to identify predictors of recurrence, day-case completion, and conversion to excisional surgery. Results: The median age was 49 years, and 77.3% had Grade II or III haemorrhoids. HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%. Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03-12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03-0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13-46.40). Conclusions: HAL-RAR is a safe, effective, and low-morbidity option for the management of Grade II and III haemorrhoids, suitable for day-case surgery. In selected Grade IV cases, it may offer benefit, although with higher recurrence and conversion risk. Careful patient selection is essential, and longer-term prospective studies are needed to assess durability.", "provenance": [ { "field": "n", "quote": "128 consecutive patients" }, { "field": "population", "quote": "77.3% had Grade II or III haemorrhoids" }, { "field": "intervention", "quote": "Doppler-guided haemorrhoidal artery ligation with rectoanal repair (HAL-RAR)" }, { "field": "comparator", "quote": "Outcomes were stratified by haemorrhoid grade." }, { "field": "primaryOutcome", "quote": "Data on demographics, operative details, postoperative outcomes, and recurrence were collected." }, { "field": "result", "quote": "HAL-RAR was completed as a day case in 76.6% of patients. Postoperative urinary retention occurred in 3.9%, return to theatre in 0.8%, and 30-day readmission in 7.0%. The symptomatic recurrence rate was 17.6%." }, { "field": "result", "quote": "Grade IV haemorrhoids were independently associated with increased recurrence (aOR 3.64, 95% CI 1.03-12.84), reduced likelihood of day-case management (aOR 0.14, 95% CI 0.03-0.93), and higher conversion to excisional haemorrhoidectomy (aOR 7.23, 95% CI 1.13-46.40)." }, { "field": "limitations", "quote": "longer-term prospective studies are needed to assess durability" } ] }, { "id": "pmid:40802349", "pmid": "40802349", "doi": "10.1590/1516-3180.2023.0435.R1.29112024", "nctId": null, "pmcid": "PMC12341433", "title": "A modified stapled hemorrhoidectomy technique to optimize mucosectomy specimen and improve outcomes", "firstAuthor": "Campos", "multipleAuthors": true, "journal": "Sao Paulo Med J", "year": 2025, "design": "case-series", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease undergoing stapled hemorrhoid surgery", "intervention": "a modified stapled hemorrhoidopexy technique using two traction points in the purse-string suture", "comparator": "the classical stapled hemorrhoidopexy technique", "primaryOutcome": "height of the removed mucosal tissue strip and reduction of mucosal prolapse/recurrence", "result": "the abstract describes the technique and reasons it may give a more uniform, taller strip of tissue, but reports no measured patient outcomes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a description of a new surgical technique with no patient outcome data, just a proposed idea still to be tested.", "directness": "direct", "limitations": "no outcome data, no comparison group, and the authors state the hypothesis still needs to be tested in a future randomized study", "followUp": "", "plainFinding": "New surgical technique proposed, untested.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40802349/", "sourceText": "BACKGROUND: Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades. Among the technical options, stapled hemorrhoidopexy is currently considered an optimal alternative because it provides a less painful recovery. However, many reports have associated this technique with higher recurrence rates than excisional techniques. OBJECTIVES: This manuscript presents a technical modification that aims to provide more extensive mucosectomy with mechanical hemorrhoidopexy. DESIGN AND SETTING: The present technical modification was developed and has been recently used in two hospitals in São Paulo (SP), Brazil. METHODS: To achieve this, we placed a circumferential submucosal suture at the 3 o'clock position in the clockwise direction. When the left lateral position (9 o'clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left. Subsequently, the original suture progressed towards the point on the right lateral side, where it was started. RESULTS: Specifically, the modification consists of establishing two traction points from the pursestring suture; thus, the rectal mucosa entering the stapler head will be more uniform, and the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms. CONCLUSIONS: The proposed modification of the original operative technique is simple and aims to improve postoperative results by increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence. In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).", "provenance": [ { "field": "population", "quote": "Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades." }, { "field": "intervention", "quote": "the modification consists of establishing two traction points from the pursestring suture" }, { "field": "comparator", "quote": "a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present)" }, { "field": "primaryOutcome", "quote": "increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence" }, { "field": "result", "quote": "the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms." } ] }, { "id": "pmid:40740911", "pmid": "40740911", "doi": "10.4240/wjgs.v17.i7.107099", "nctId": null, "pmcid": "PMC12305257", "title": "TONEFACT: Can even advanced hemorrhoids be treated without surgery? A paradigm shift in the management of hemorrhoids", "firstAuthor": "Garg", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with advanced or prolapsed hemorrhoids", "intervention": "a non-surgical treatment concept called TONEFACT", "comparator": "surgery for advanced hemorrhoids", "primaryOutcome": "need for surgery and prolapse symptoms", "result": "improved defecation time and reduced prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an opinion piece based mainly on the authors' own experience and observational data, not a controlled trial.", "directness": "indirect", "limitations": "Evidence comes from observational studies and one small non-randomized study, and the authors state it lacks validation from larger randomized controlled trials.", "followUp": "", "plainFinding": "May avoid surgery, unproven.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40740911/", "sourceText": "Hemorrhoids are one of the most common anorectal disorders. Early hemorrhoids are treated conservatively, but advanced hemorrhoids are usually treated with surgery. However, in the last decade, we have worked extensively in the field of conservative management of hemorrhoids. From our experience, we could manage a large proportion of advanced hemorrhoids without surgery by a treatment concept (TONEFACT) with a high satisfaction rate. Evidence for the TONEFACT approach primarily comes from observational studies and a prospective, non-randomized study of 85 patients. This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions. Although promising, these observations lack validation from more extensive randomized controlled trials to draw firm conclusions. In this opinion review, without using much data, we will discuss our viewpoint based on our experience as specified by the journal guidelines.", "provenance": [ { "field": "population", "quote": "advanced hemorrhoids are usually treated with surgery" }, { "field": "intervention", "quote": "a treatment concept (TONEFACT)" }, { "field": "comparator", "quote": "advanced hemorrhoids are usually treated with surgery" }, { "field": "primaryOutcome", "quote": "leading to fewer surgical interventions" }, { "field": "result", "quote": "This has been shown to improve defecation time and reduce prolapse symptoms in early-stage hemorrhoids, leading to fewer surgical interventions." }, { "field": "limitations", "quote": "Although promising, these observations lack validation from more extensive randomized controlled trials to draw firm conclusions." } ] }, { "id": "pmid:40740753", "pmid": "40740753", "doi": "10.23922/jarc.2024-072", "nctId": null, "pmcid": "PMC12307016", "title": "Is Injectable Sclerotherapy with Polidocanol Foam Effective for Treating Hemorrhoids in Patients with Severe Anemia?", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "J Anus Rectum Colon", "year": 2025, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with hemorrhoids and severe anemia", "intervention": "injectable sclerotherapy using Polidocanol foam", "comparator": "none (no comparison group)", "primaryOutcome": "bleeding symptoms and hemorrhoid severity scores (HDSS, SHS)", "result": "bleeding stopped and anemia improved, but two patients had prolapse come back and needed surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It was a retrospective study with no comparison group and the number of patients was not stated, so it can't prove the treatment caused the improvement.", "directness": "indirect", "limitations": "Retrospective design, no control group, number of patients not reported, focus on anemia/bleeding rather than prolapse specifically.", "followUp": "1-year", "plainFinding": "Less bleeding, anemia improved, but some prolapse recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40740753/", "sourceText": "OBJECTIVES: The aim of this study was to evaluate the effectiveness of injectable sclerotherapy using Polidocanol foam in patients with hemorrhoids and severe anemia during a 1-year follow-up period, while utilizing the Hemorrhoidal Disease Severity Score (HDSS) in conjunction with Short Health Scale (SHS) for assessment. METHODS: A retrospective analysis was conducted on patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy using Polidocanol foam between February 2022 and May 2023. RESULTS: The bleeding symptoms in all patients resolved immediately after treatment. Hemoglobin levels increased rapidly within one month after treatment, and statistically significant improvements were observed in HDSS score, and SHS score (P<0.001) during the one-year follow-up. Two patients experienced recurrence of prolapse symptoms during the one-year follow-up period and subsequently underwent hemorrhoidectomy. CONCLUSIONS: The use of Polidocanol foam in injectable sclerotherapy demonstrates highly promising effects in patients suffering from severe anemia caused by hemorrhoids.", "provenance": [ { "field": "population", "quote": "patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy" }, { "field": "intervention", "quote": "injectable sclerotherapy using Polidocanol foam" }, { "field": "comparator", "quote": "A retrospective analysis was conducted on patients with severe anemia and hemorrhoids who underwent injectable sclerotherapy using Polidocanol foam" }, { "field": "primaryOutcome", "quote": "utilizing the Hemorrhoidal Disease Severity Score (HDSS) in conjunction with Short Health Scale (SHS) for assessment" }, { "field": "result", "quote": "The bleeding symptoms in all patients resolved immediately after treatment. Hemoglobin levels increased rapidly within one month after treatment" }, { "field": "result", "quote": "Two patients experienced recurrence of prolapse symptoms during the one-year follow-up period and subsequently underwent hemorrhoidectomy." }, { "field": "followUp", "quote": "during the one-year follow-up" } ] }, { "id": "pmid:40676415", "pmid": "40676415", "doi": "10.1007/s00384-025-04953-3", "nctId": null, "pmcid": "PMC12271287", "title": "Ultrasound-guided pudendal nerve block for postoperative pain management in procedures for prolapse and hemorrhoids: a randomized, double-blinded trial", "firstAuthor": "Pan", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "rct", "n": 71, "nField": "reported", "population": "patients undergoing surgery for prolapse and hemorrhoids", "intervention": "ultrasound-guided pudendal nerve block", "comparator": "local anesthetic infiltration", "primaryOutcome": "postoperative pain scores in the first 48 hours", "result": "pudendal nerve block gave lower pain scores at 6, 12, and 18 hours after surgery, less need for extra pain medicine, and better recovery scores, with no difference in pain at 24 and 48 hours", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized, double-blinded trial but small and only indirectly relevant since it studied pain control after surgery rather than how to treat a prolapsed hemorrhoid itself", "directness": "indirect", "limitations": "small sample size of 71 patients after dropouts; focuses on a surgical pain-control technique rather than hemorrhoid treatment itself", "followUp": "48 h", "plainFinding": "Better pain control after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40676415/", "sourceText": "PURPOSE: The study aimed to evaluate the efficacy of ultrasound-guided pudendal nerve block (PNB) versus local anesthetic infiltration (LAI) in managing the pain. METHODS: This is a prospective, randomized, double-blinded trial, 78 patients undergoing procedure for prolapse and hemorrhoids (PPH) were randomly allocated to receive either ultrasound-guided PNB or LAI. Primary outcomes were postoperative pain scores using the visual analogue scale at multiple time points within the first 48 h. Secondary outcomes included tramadol consumption, incidence of postoperative nausea and vomiting, and quality of recovery-15 (QoR-15) scores. RESULTS: The trial ultimately involved 71 patients. Results showed that the PNB group had significantly lower pain scores at 6, 12, and 18 h postoperatively compared with the LAI group (all P < 0.01), with no significant differences noted at 24 and 48 h. PNB group also had fewer patients requiring supplemental tramadol (5/36) than the LAI group (12/35) (P < 0.05) and experienced a delayed onset of pain (13.83 ± 11.21 h vs. 6.94 ± 2.88 h; P < 0.001). Furthermore, the incidence of anal sphincter spasms was lower in the PNB group (5/36) compared with the LAI group (12/35) (P < 0.04). QoR-15 scores at 24 h postoperatively were significantly higher in the PNB group (119.11 ± 5.87) compared with the LAI group (112.03 ± 7.04) (P < 0.05), indicating a better early recovery experience. Patient satisfaction was higher in the PNB group (28/36 vs. 22/35, P < 0.05). CONCLUSION: Ultrasound-guided PNB was more effective than LAI in pain control and recovery quality. It can be considered an effective method for postoperative pain management in patients undergoing PPH surgery. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ , Registration No. ChiCTR-IPR-15006427) on May 21st, 2015.", "provenance": [ { "field": "n", "quote": "The trial ultimately involved 71 patients." }, { "field": "population", "quote": "78 patients undergoing procedure for prolapse and hemorrhoids (PPH)" }, { "field": "intervention", "quote": "ultrasound-guided PNB" }, { "field": "comparator", "quote": "local anesthetic infiltration (LAI)" }, { "field": "primaryOutcome", "quote": "Primary outcomes were postoperative pain scores using the visual analogue scale at multiple time points within the first 48 h." }, { "field": "result", "quote": "the PNB group had significantly lower pain scores at 6, 12, and 18 h postoperatively compared with the LAI group (all P < 0.01), with no significant differences noted at 24 and 48 h." } ] }, { "id": "pmid:40661710", "pmid": "40661710", "doi": "10.1093/jscr/rjaf501", "nctId": null, "pmcid": "PMC12257625", "title": "Secondary rectal perforation following procedure for prolapsed hemorrhoids: a case report", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a patient who had surgery for prolapsed hemorrhoids", "intervention": "procedure for prolapse and hemorrhoids (PPH) surgery", "comparator": "traditional excisional hemorrhoidectomy (described generally, not directly compared in this case)", "primaryOutcome": "development of rectal perforation after surgery", "result": "patient developed a rectal perforation as a complication after PPH surgery", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, which cannot show how often this happens or compare treatments reliably.", "directness": "direct", "limitations": "Only one patient described; no comparison group; cannot show how common this complication is.", "followUp": "", "plainFinding": "Rare rectal perforation after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40661710/", "sourceText": "The procedure for prolapse and hemorrhoids (PPH) is designed to reposition displaced anal cushions by circumferential resection of the distal rectal mucosa. PPH offers advantages over traditional excisional hemorrhoidectomy, including less postoperative pain and a shorter hospital stay. However, complications such as anastomotic dehiscence and rectal perforation may occur and require prompt management. This case report presents a patient who developed rectal perforation following PPH, aiming to provide valuable insights for clinical practice.", "provenance": [ { "field": "n", "quote": "This case report presents a patient who developed rectal perforation following PPH" }, { "field": "population", "quote": "This case report presents a patient who developed rectal perforation following PPH" }, { "field": "intervention", "quote": "The procedure for prolapse and hemorrhoids (PPH) is designed to reposition displaced anal cushions by circumferential resection of the distal rectal mucosa." }, { "field": "comparator", "quote": "PPH offers advantages over traditional excisional hemorrhoidectomy, including less postoperative pain and a shorter hospital stay." }, { "field": "primaryOutcome", "quote": "complications such as anastomotic dehiscence and rectal perforation may occur and require prompt management" }, { "field": "result", "quote": "This case report presents a patient who developed rectal perforation following PPH" } ] }, { "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 minimally invasive surgery", "comparator": "PPH stapled surgery and EPH (rubber band ligation and dislocation) surgery", "primaryOutcome": "treatment success rate, complications, and anal muscle function", "result": "TST had higher success 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 little detail on blinding, dropout, or statistical testing, limiting confidence.", "directness": "direct", "limitations": "Abstract does not report blinding, loss to follow-up, or statistical significance testing details.", "followUp": "3 months", "plainFinding": "Fewer complications, faster recovery than other surgeries.", "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 pieces per hour the PPH group, and the eastern rubber band ligation and coincident of dislocation for prolapse and hemorrhoid (EPH)group" }, { "field": "primaryOutcome", "quote": "clinical efficacy, postoperative complications, and anal dynamics" }, { "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: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 hemorrhoidal disease, including different stages and anal prolapse", "intervention": "stage-based treatment: conservative care, sclerotherapy, rubber band ligation, surgery (hemorrhoidectomy or minimally invasive techniques)", "comparator": "different treatments compared across disease stages", "primaryOutcome": "symptom control and avoiding recurrence", "result": "treatment choice depends on stage; early stages use conservative/interventional methods, advanced stages need surgery, acute prolapse treated conservatively and topically", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review describing treatment approaches rather than reporting new study results or data.", "directness": "direct", "limitations": "no patient numbers, outcomes data, or comparative results are reported; it is a descriptive overview rather than an original study.", "followUp": "", "plainFinding": "Treat by stage; prolapse managed conservatively.", "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), surgical procedures are effective treatment options for advanced hemorrhoidal disease (stages III and IV)" }, { "field": "comparator", "quote": "\"conventional\" hemorrhoidectomy procedures are increasingly in competition with minimally invasive techniques (e.g. hemorrhoidal artery ligation, laser hemorrhoidoplasty, radiofrequency ablation)" }, { "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": "In cases of acute anal prolapse, a conservative and topical approach is indicated." } ] }, { "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 hemorrhoidal disease of different severity grades (II-IV)", "intervention": "laser hemorrhoidoplasty (LHP)", "comparator": "traditional excisional surgery for hemorrhoids", "primaryOutcome": "efficacy, safety, and long-term outcomes of the laser procedure", "result": "Laser treatment worked well for early-grade hemorrhoids but had higher recurrence and worse long-term results than surgery for advanced (grade IV) cases", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a narrative review without a described systematic search or pooled data, so its conclusions are a summary of existing evidence rather than new rigorous proof.", "directness": "direct", "limitations": "The abstract does not describe how studies were selected or appraised, and calls for standardized protocols and large-scale long-term studies, suggesting current evidence is limited.", "followUp": "", "plainFinding": "Works early, worse for advanced 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": "across different grades of hemorrhoids" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "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": "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." }, { "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: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", "intervention": "endoscopic ligation", "comparator": "cap-assisted endoscopic sclerotherapy (CAES)", "primaryOutcome": "symptom relief (bleeding, prolapse, constipation), complication rate, psychological condition, and anorectal function", "result": "no significant difference overall between the two treatments, but each had specific advantages (ligation better for prolapse/constipation, sclerotherapy better for bleeding and pain)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Very small, non-randomized comparison of only 32 patients with short 3-month follow-up, so findings are not very reliable.", "directness": "direct", "limitations": "Small sample size (14 vs 18 patients), not described as randomized, and only 3 months of follow-up.", "followUp": "3-month follow-up", "plainFinding": "Both treatments worked, no clear winner.", "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": "treatment effect of postoperative bleeding, prolapse, constipation, and complications" }, { "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: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 (hemorrhoids that prolapse)", "intervention": "rubber band ligation", "comparator": "hemorrhoidectomy (surgical removal)", "primaryOutcome": "cost per quality-adjusted life year gained and cost per recurrence avoided over 24 months", "result": "Hemorrhoidectomy gave better quality of life and fewer recurrences than rubber band ligation, but cost more; whether it was worth the extra cost depended on how much society is willing to pay", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It used real randomized trial data but had a small sample size, which limits how confident we can be and may miss rare complications.", "directness": "direct", "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, a less detailed pragmatic approach.", "followUp": "24 months", "plainFinding": "Surgery works better but costs 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": "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)" }, { "field": "comparator", "quote": "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": "n", "quote": "Seventy-nine patients were analyzed (33 for hemorrhoidectomy and 46 for rubber band ligation)." }, { "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": "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)." }, { "field": "limitations", "quote": "The small sample size may limit generalizability and the ability to detect rare but costly complications." } ] }, { "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, mostly grade II and some grade III", "intervention": "polidocanol foam sclerotherapy", "comparator": "rubber band ligation", "primaryOutcome": "success rate and recurrence rate of treatment, based on expert survey and literature review", "result": "experts perceived polidocanol foam as more successful and less likely to recur than rubber band ligation", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "the comparison numbers come from an expert opinion survey and non-controlled studies, not a trial directly comparing the two treatments", "directness": "indirect", "limitations": "abstract does not describe how success/recurrence rates were measured or whether confounders were controlled; findings are based on expert perception and heterogeneous studies", "followUp": "", "plainFinding": "Experts favor foam over 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": "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%)." }, { "field": "n", "quote": "A total of 20 studies met the inclusion criteria." } ] }, { "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": "patients with grade III or IV hemorrhoids or anal fistulas having anal surgery", "intervention": "preoperative enema before surgery", "comparator": "no preoperative enema", "primaryOutcome": "pain scores and painkiller use after surgery, days 0 to 7", "result": "no significant difference overall, but patients having Milligan-Morgan hemorrhoidectomy had less pain with enema on days 2-4", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but done at one hospital with a positive finding only in a smaller subgroup analysis", "directness": "indirect", "limitations": "single center study; positive finding limited to a subgroup (Milligan-Morgan hemorrhoidectomy) rather than the whole study population", "followUp": "postoperative day 0 to day 7", "plainFinding": "Enema before surgery mostly no help.", "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": "versus no preoperative enema (control)" }, { "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": "prospective-cohort", "n": 21, "nField": "reported", "population": "patients with grade III-IV hemorrhoidal disease (prolapsed hemorrhoids)", "intervention": "SHAPE surgery (skin-sparing hemorrhoidectomy combined with suture fixation/mucopexy)", "comparator": "none (before-and-after comparison within same patients)", "primaryOutcome": "change in hemorrhoid symptom severity scores (HDSS and SHS) at 1 month", "result": "Symptom scores dropped sharply after surgery, from a median HDSS of 16 to 0 and SHS from 20 to 4, with short hospital stay and no persistent pain, though some patients had urinary retention or bleeding complications", "resultDirection": "benefit", "quality": "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 well this works compared to other treatments or over time.", "directness": "direct", "limitations": "Very small sample size, no control group, only short-term (1-month) follow-up, and need for long-term data on recurrence.", "followUp": "1-month", "plainFinding": "Fast symptom relief after 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), a novel hybrid technique that integrates the excisional approach of closed hemorrhoidectomy with the tissue-sparing and fixation benefits of suture ligation with mucopexy" }, { "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": "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)." }, { "field": "n", "quote": "21 consecutive patients with grade III-IV HD" } ] }, { "id": "pmid:40385836", "pmid": "40385836", "doi": "10.7759/cureus.82513", "nctId": null, "pmcid": "PMC12085877", "title": "Rectal Diverticulum as a Rare Complication Following the Longo Procedure: A Case Report and Review of Therapeutic Challenges", "firstAuthor": "Niedritis", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "60-year-old woman with grade III hemorrhoids and rectocele", "intervention": "stapled hemorrhoidopexy (Longo procedure)", "comparator": "", "primaryOutcome": "late complication after surgery (rectal diverticulum)", "result": "developed a rare rectal diverticulum at the staple site four years after surgery, which was surgically removed with full recovery", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how often this happens or how treatments generally compare.", "directness": "indirect", "limitations": "Single case report; no comparison group; cannot establish how common this complication is or generalize findings.", "followUp": "four years", "plainFinding": "Rare late complication, successfully surgically corrected.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40385836/", "sourceText": "Iatrogenic rectal diverticulum is an exceptionally rare complication following the Longo procedure (stapled hemorrhoidopexy), with only a handful of cases reported in the literature. This case is noteworthy due to its rarity, the diagnostic challenges it presents, and its therapeutic implications for patients undergoing stapled hemorrhoidopexy. Reporting this case aims to raise awareness among clinicians about this uncommon complication and contribute to the understanding of its clinical management. A 60-year-old woman underwent the Longo procedure in 2021 for symptomatic Grade III hemorrhoidal disease and rectocele. The initial surgery was successful, with no immediate postoperative complications. However, four years later, she presented with rectal discomfort but no other significant symptoms. Diagnostic evaluation, including colonoscopy and rectal ultrasonography, revealed a large diverticulum at the site of the previous stapled anastomosis, at five o'clock position. Surgical intervention was planned, involving resection of the diverticulum and primary repair of the rectal wall. Histopathological examination confirmed the presence of a true diverticulum involving all layers of the rectal wall. The patient recovered well postoperatively, with resolution of symptoms and no further complications at follow-up. This case highlights rectal diverticulum as a rare but significant late complication of the Longo procedure. It underscores the importance of considering this entity in patients with persistent or recurrent symptoms after stapled hemorrhoidopexy. Long-term follow-up and a high index of suspicion are essential for timely diagnosis and management. The case also emphasizes the need for further research to understand the underlying mechanisms, such as altered rectal wall mechanics or stapling-related tissue changes, and to optimize treatment strategies. Clinicians should be aware of this complication to improve patient outcomes and guide informed decision-making in the management of hemorrhoidal disease.", "provenance": [ { "field": "population", "quote": "A 60-year-old woman underwent the Longo procedure in 2021 for symptomatic Grade III hemorrhoidal disease and rectocele." }, { "field": "intervention", "quote": "the Longo procedure (stapled hemorrhoidopexy)" }, { "field": "primaryOutcome", "quote": "Iatrogenic rectal diverticulum is an exceptionally rare complication following the Longo procedure" }, { "field": "result", "quote": "four years later, she presented with rectal discomfort but no other significant symptoms. Diagnostic evaluation, including colonoscopy and rectal ultrasonography, revealed a large diverticulum at the site of the previous stapled anastomosis, at five o'clock position." }, { "field": "result", "quote": "The patient recovered well postoperatively, with resolution of symptoms and no further complications at follow-up." }, { "field": "n", "quote": "A 60-year-old woman underwent the Longo procedure in 2021" } ] }, { "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": "patients with grade III/IV hemorrhoids", "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, higher satisfaction, less pain, fewer complications, faster healing with combined surgery; no difference in hemorrhoid severity score", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study without randomization, so bias and confounding cannot be ruled out.", "directness": "direct", "limitations": "Retrospective design from a single center", "followUp": "12 months", "plainFinding": "Fewer recurrences, less pain, faster healing.", "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": "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." }, { "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": "followUp", "quote": "Follow-up was conducted by telephone or outpatient visit 12 months after surgery." } ] }, { "id": "pmid:40303913", "pmid": "40303913", "doi": "10.1002/hsr2.70724", "nctId": null, "pmcid": "PMC12037693", "title": "The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study", "firstAuthor": "Tavani", "multipleAuthors": true, "journal": "Health Sci Rep", "year": 2025, "design": "case-series", "n": 27, "nField": "reported", "population": "patients who previously had hemorrhoid removal surgery", "intervention": "hemorrhoidectomy (surgical removal of hemorrhoids)", "comparator": "none reported", "primaryOutcome": "patients' reported complications after hemorrhoidectomy", "result": "patients reported physical, psychological, and social complications including pain, bleeding, fear, embarrassment, and social withdrawal", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a small qualitative interview study without a comparison group, so it can only describe patient experiences, not prove cause and effect.", "directness": "indirect", "limitations": "Qualitative design with convenience/purposive sampling of only 27 patients, no control group, and reliance on subjective interview data.", "followUp": "", "plainFinding": "Many physical, emotional, social complications reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40303913/", "sourceText": "BACKGROUND: Hemorrhoidectomy is a common general surgical procedure with numerous and intensive complications. OBJECTIVE: This study sought to investigate the complications of hemorrhoidectomy from the patients' perspective. METHODS: This qualitative study employed a phenomenological approach to explore the experiences of 27 patients with a history of hemorrhoidectomy. Convenience sampling was utilized initially, but purposive sampling was used as the investigation continued. All participants' statements were documented after obtaining informed consent and permission to record their experiences. Interviews were conducted until data saturation was achieved. The interview data was analyzed using content analysis, which involved the systematic extraction, interpretation, and reporting of the concepts and themes in the data. RESULTS: The study identified three main categories of complications: physical, psychological, and social. Additionally, 26 themes and 56 sub-themes were identified and defined under the main categories. Physical complications (PhCs) included nutritional problems, pain, sleep disturbances, physical weakness, bleeding, fecal incontinence, excretion problems, infection, fissures, anal prolapse, urinary retention, and disease recurrence. Psychological complications (PsCs) included fear, aversion, denial, isolation, depression, boredom, embarrassment, feeling defective, and dependency; Social complications (SCs) included secrecy, irritability, social withdrawal, and inability to perform social roles. CONCLUSIONS: In addition to common PhCs such as pain and bleeding, patients with a history of hemorrhoidectomy face numerous PsCs and SCs that need to be communicated to the patient before deciding on this surgery. Furthermore, doctors should also consider special measures to manage these complications properly.", "provenance": [ { "field": "n", "quote": "27 patients with a history of hemorrhoidectomy" }, { "field": "population", "quote": "27 patients with a history of hemorrhoidectomy" }, { "field": "intervention", "quote": "Hemorrhoidectomy is a common general surgical procedure with numerous and intensive complications." }, { "field": "comparator", "quote": "This study sought to investigate the complications of hemorrhoidectomy from the patients' perspective." }, { "field": "primaryOutcome", "quote": "This study sought to investigate the complications of hemorrhoidectomy from the patients' perspective." }, { "field": "result", "quote": "Physical complications (PhCs) included nutritional problems, pain, sleep disturbances, physical weakness, bleeding, fecal incontinence, excretion problems, infection, fissures, anal prolapse, urinary retention, and disease recurrence." } ] }, { "id": "pmid:40303315", "pmid": "40303315", "doi": "10.2147/TCRM.S498067", "nctId": null, "pmcid": "PMC12038854", "title": "Chronic Khat Chewing Induced High-Grade Hemorrhoidal Disease and Post-Operative Bleeding in Yemen", "firstAuthor": "Al-Kubati", "multipleAuthors": false, "journal": "Ther Clin Risk Manag", "year": 2025, "design": "prospective-cohort", "n": 1896, "nField": "reported", "population": "Patients aged 16 to 85 in Yemen with anorectal disease, divided into chronic khat chewers and non-chewers", "intervention": "chronic khat chewing", "comparator": "non-khat chewers", "primaryOutcome": "association between khat chewing and high-grade (including prolapsed, grade IV) hemorrhoidal disease and post-operative bleeding/pain", "result": "khat chewers had far higher rates of severe hemorrhoids needing surgery and more post-operative bleeding than non-chewers", "resultDirection": "harm", "quality": "low", "qualityWhy": "it is an observational cross-sectional study without randomization, so other differences between khat chewers and non-chewers could explain the results.", "directness": "indirect", "limitations": "abstract states future research should focus on establishing causality, identifying confounders, and dose-response relationships, indicating these were not controlled for", "followUp": "three months", "plainFinding": "Khat chewing linked to worse hemorrhoids, more bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40303315/", "sourceText": "BACKGROUND: Khat contains alkaloids, tannins, and flavonoids with physiological and pathological effects. In Yemen, anorectal diseases, including hemorrhoids, are prevalent, and hemorrhoidectomy is frequently performed. PURPOSE: This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain. PATIENTS AND METHODS: This prospective cross-sectional study included 1,896 patients aged 16-85 years, meeting the inclusion criteria were included and followed for three months. PATIENTS WERE DIVIDED INTO TWO GROUPS: Chronic khat chewers (n=1,492) and non-khat chewers (n=404) Data included khat habits, clinical assessments, digital rectal exams, anoproctoscopy, intraoperative findings, and post-operative outcomes. RESULTS: Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease. Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers, where half underwent hemorrhoidopexy. The odds ratio (OR) for hemorrhoids in khat chewers was 27.04. Gender-specific analysis showed a six-fold higher OR for hemorrhoids in khat-chewing females versus non-chewing females. Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05), while no significant differences were observed in females. CONCLUSION: Chronic khat chewing is strongly associated with high-grade hemorrhoidal disease and increased post-operative complications. Mechanisms include chronic constipation, increased anal sphincter tone, and prolonged sitting. These findings highlight the need for public health strategies to reduce khat use and tailored clinical approaches to improve outcomes. Future research should focus on establishing causality, identifying confounders, dose-response relationships, and exploring gender-specific management strategies that target both mechanical and pharmacological factors to optimize surgical care and long-term outcomes.", "provenance": [ { "field": "n", "quote": "This prospective cross-sectional study included 1,896 patients aged 16-85 years" }, { "field": "population", "quote": "Chronic khat chewers (n=1,492) and non-khat chewers (n=404)" }, { "field": "intervention", "quote": "Chronic khat chewing was strongly associated with thrombosed grade IV hemorrhoidal disease." }, { "field": "comparator", "quote": "compared to 25% in non-chewers, where half underwent hemorrhoidopexy" }, { "field": "primaryOutcome", "quote": "This study evaluates the relationship between chronic khat chewing and high-grade hemorrhoidal disease, as well as post-operative complications such as bleeding and pain." }, { "field": "result", "quote": "Among khat chewers, 90% had hemorrhoids, with 75% requiring hemorrhoidectomy or hemorrhoidopexy, compared to 25% in non-chewers" }, { "field": "result", "quote": "Post-operative complications, including bleeding and severe pain, were significantly higher in male khat chewers (p < 0.05)" } ] }, { "id": "pmid:40296923", "pmid": "40296923", "doi": "10.7759/cureus.81394", "nctId": null, "pmcid": "PMC12037196", "title": "Modified Circular Hemorrhoidectomy for Stage IV Hemorrhoids With Terminal Prolapse: A Case Series", "firstAuthor": "Niedritis", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 3, "nField": "reported", "population": "patients with severe stage IV hemorrhoids with terminal prolapse", "intervention": "modified circular hemorrhoidectomy (mucosal bridge preserving surgery)", "comparator": "none", "primaryOutcome": "resolution of symptoms and complications after surgery", "result": "all patients had complete symptom resolution with no recurrence or major complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only three patients were studied with no comparison group, so results could be due to chance.", "directness": "direct", "limitations": "Very small case series of three patients without a control group or long-term data specified.", "followUp": "", "plainFinding": "Surgery resolved prolapsed hemorrhoids completely.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40296923/", "sourceText": "Stage IV hemorrhoids with terminal prolapse present a significant surgical challenge, often requiring innovative approaches to achieve optimal outcomes. This case series highlights the efficacy of modified circular hemorrhoidectomy, a refined technique incorporating mucosal bridge preservation, in three patients with severe circumferential hemorrhoidal disease. The procedure, adapted from the traditional Whitehead hemorrhoidectomy, addresses both internal and external components while minimizing postoperative complications such as anal stenosis and mucosal ectropion. All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up. The modified technique not only demonstrated technical feasibility but also improved functional outcomes and patient satisfaction. This series underscores the potential of modified circular hemorrhoidectomy as a valuable surgical option for stage IV hemorrhoids with terminal prolapse, offering a balance between radical excision and preservation of anatomical integrity. Further studies are warranted to validate these findings and establish their role in modern hemorrhoidal disease management.", "provenance": [ { "field": "n", "quote": "in three patients with severe circumferential hemorrhoidal disease" }, { "field": "population", "quote": "three patients with severe circumferential hemorrhoidal disease" }, { "field": "intervention", "quote": "modified circular hemorrhoidectomy, a refined technique incorporating mucosal bridge preservation" }, { "field": "comparator", "quote": "adapted from the traditional Whitehead hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up." }, { "field": "result", "quote": "All three patients experienced complete resolution of complaints, with no recurrence or major complications during follow-up." } ] }, { "id": "pmid:40291892", "pmid": "40291892", "doi": "10.4240/wjgs.v17.i4.103494", "nctId": null, "pmcid": "PMC12019062", "title": "Single-nucleus RNA sequencing and spatial transcriptomics reveal the mechanism by which Xiaozhiling injection treats internal hemorrhoids", "firstAuthor": "Ke", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "animal", "n": null, "nField": "not-reported", "population": "rats with lab-induced internal hemorrhoids", "intervention": "Xiaozhiling injection (a Chinese medicine treatment)", "comparator": "untreated modeling group (control) rats", "primaryOutcome": "molecular changes in fibroblast genes and fibrosis-related pathways", "result": "the injection activated the Sphk1-S1P pathway and increased collagen production by fibroblasts, suggesting it promotes fibrosis", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small animal study looking only at cell and gene changes, not at whether hemorrhoids actually improved, and it doesn't report how many animals were used.", "directness": "indirect", "limitations": "study is in rats with an induced model, looks only at molecular mechanism, and does not report clinical outcomes like prolapse resolution or complication rates in patients", "followUp": "One week after injection", "plainFinding": "Shows how injection may shrink hemorrhoids", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40291892/", "sourceText": "BACKGROUND: Hemorrhoids, a prevalent chronic condition globally, significantly impact patients' quality of life. While various surgical interventions, such as external stripping and internal ligation, procedure for prolapse and hemorrhoids, and tissue selecting technique, are employed for treatment, they are often associated with postoperative complications, including unsatisfactory defecation, bleeding, and anal stenosis. In contrast, Xiaozhiling injection, a traditional Chinese medicine-based therapy, has emerged as a minimally invasive and effective alternative for internal hemorrhoids. This treatment offers distinct advantages, such as reduced dietary restrictions, broad applicability, and minimal induction of systemic inflammatory responses. Additionally, Xiaozhiling injection effectively eliminates hemorrhoid nuclei, prevents local tissue necrosis, preserves anal cushion integrity, and mitigates postoperative complications, including bleeding and prolapse. Despite its clinical efficacy, the molecular mechanisms underlying its therapeutic effects remain poorly understood, warranting further investigation. AIM: To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids. METHODS: An internal hemorrhoid model was established in rats, and the rats were randomly divided into a modeling group [control group (CK group)] and a treatment group. One week after injection, Stereo-seq and electron microscopy were used to study the changes in gene expression and subcellular structures in fibroblasts. RESULTS: Single-cell sequencing revealed differences in the expression and transcript levels of the genes collagen 3 alpha 1, decorin, and actin alpha 2 in fibroblasts between the CK group and the treatment group. Spatial transcriptome analysis revealed that genes of the sphingosine kinase 1 (Sphk1)/sphingosine-1-phosphate (S1P) pathway spatially overlapped with key genes of the transforming growth factor beta 1 pathway, namely, Sphk1, S1P receptor, and transforming growth factor beta 1, in the treatment group. The proportion of fibroblasts was lower in the treatment group than in the CK group, and Xiaozhiling treatment had a significant effect on the proportion of fibroblasts in hemorrhoidal tissue. Immunohistochemistry revealed a significant increase in the expression of a fibroblast marker. Electron microscopy showed that the endoplasmic reticulum of fibroblasts contained a large amount of glycogen, indicating cell activation. Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site, suggesting that after Xiaozhiling intervention, the Sphk1-S1P pathway could be activated to promote fibrosis. CONCLUSION: Xiaozhiling injection exerts its therapeutic effects on internal hemorrhoids by promoting collagen synthesis and secretion in fibroblasts. After Xiaozhiling intervention, the Sphk1-S1P pathway can be activated to promote fibrosis.", "provenance": [ { "field": "population", "quote": "An internal hemorrhoid model was established in rats" }, { "field": "intervention", "quote": "Xiaozhiling injection" }, { "field": "comparator", "quote": "control group (CK group)" }, { "field": "primaryOutcome", "quote": "To investigate the molecular mechanism underlying the therapeutic effect of Xiaozhiling injection in the treatment of internal hemorrhoids" }, { "field": "result", "quote": "Fibroblast activation and the expression of key genes of the Sphk1-S1P pathway could be observed at the injection site, suggesting that after Xiaozhiling intervention, the Sphk1-S1P pathway could be activated to promote fibrosis" }, { "field": "followUp", "quote": "One week after injection" } ] }, { "id": "pmid:40214502", "pmid": "40214502", "doi": "10.3390/cells14070550", "nctId": null, "pmcid": "PMC11989036", "title": "Utilisation of Deep Neural Networks for Estimation of Cajal Cells in the Anal Canal Wall of Patients with Advanced Haemorrhoidal Disease Treated by LigaSure Surgery", "firstAuthor": "Fišere", "multipleAuthors": true, "journal": "Cells", "year": 2025, "design": "lab", "n": null, "nField": "not-reported", "population": "patients with advanced (grade III and IV) hemorrhoidal disease", "intervention": "LigaSure surgery (haemorrhoidectomy) for hemorrhoids", "comparator": "before versus after surgery (no separate control group)", "primaryOutcome": "pain and bleeding after surgery, and amount of special nerve-like cells (ICCs) in hemorrhoid tissue", "result": "Pain and bleeding were significantly reduced after surgery, and patients with more of these cells were more likely to have bleeding afterward, especially in the most severe disease stage", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, mechanistic lab and imaging study using an AI model on tissue samples, without a comparison treatment group, so it says little about how well the surgery works versus other options.", "directness": "indirect", "limitations": "No total patient number given, no comparator treatment, focus is on cell biology and an AI detection model rather than direct treatment comparison", "followUp": "", "plainFinding": "Surgery reduced pain and bleeding overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40214502/", "sourceText": "Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity in anal canal tissues affected by HD. Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device. A YOLOv11-based machine learning model, trained on 376 immunohistochemical images, automated ICC detection using the CD117 marker, achieving a mean average precision (mAP50) of 92%, with a recall of 86% and precision of 88%. The DNN model accurately identified ICCs in whole-slide images, revealing that one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density. Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery. A significant decrease in bleeding (p < 0.0001) was also noted postoperatively. Notably, patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041), suggesting a potential link between ICC density and HD severity. This AI-driven model, alongside clinical data, may enhance outcome prediction and provide insights into HD pathophysiology.", "provenance": [ { "field": "population", "quote": "one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density" }, { "field": "intervention", "quote": "Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device." }, { "field": "primaryOutcome", "quote": "Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery." }, { "field": "result", "quote": "A significant decrease in bleeding (p < 0.0001) was also noted postoperatively." }, { "field": "result", "quote": "patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041)" }, { "field": "comparator", "quote": "Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery." } ] }, { "id": "pmid:40210842", "pmid": "40210842", "doi": "10.1007/s13304-025-02202-4", "nctId": null, "pmcid": null, "title": "The comparison of doppler-guided haemorrhoidal artery ligation and the tissue selecting technique for patients with grade III/IV haemorrhoids: a retrospective cohort study", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Updates Surg", "year": 2025, "design": "retrospective", "n": 251, "nField": "reported", "population": "patients with grade III or IV hemorrhoids", "intervention": "Doppler-guided hemorrhoid artery ligation (DG-HAL)", "comparator": "tissue-selecting technique (TST)", "primaryOutcome": "post-operative pain, complications, and recurrence of prolapse/bleeding", "result": "DG-HAL caused less pain and fewer complications early on, but had a higher rate of prolapse coming back after 3 years, especially in grade IV cases", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective design without randomization; comparison limited to two surgical techniques only.", "followUp": "3 years", "plainFinding": "Less pain early, more recurrence later", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40210842/", "sourceText": "This study aimed to evaluate the efficacy and the safety of Doppler-guided hemorrhoid artery ligation (DG-HAL) and tissue-selecting technique (TST) in patients with grade III/IV hemorrhoids. We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021. Among them, 119 patients had received TST, and the remaining 132 patients received DG-HAL. We collected and compared clinical characteristics of both groups, including post-operative visual analog scale (VAS) for pain, post-operative bleeding, post-operative defecation, urinary retention, and recurrence rate (prolapse and bleeding). The VAS pain score of the first post-operative defecation and at the post-operative day (POD)1 and 2 for the DG-HAL group was lower than those for the TST group (P = 0.006 and P = 0.029). The incidence of post-operative complications (including bleeding, urinary retention and sensation of rectal tenesmus) in the DG-HAL group was lower than that in the TST group (P = 0.021, P = 0.035 and P = 0.047). At follow-up by telephone or outpatient 3 years after surgery, the recurrence rate (prolapse) was lower in the TST group than in the DG-HAL group (P = 0.013). Subgroup analysis showed a higher prolapse recurrence rate in grade IV patients than grade III patients after DG-HAL (P = 0.013). DG-HAL had fewer complications, lower bleeding rates, and less early post-operative pain but showed a higher recurrence rate than TST at the 3-year follow-up, especially in grade IV patients.", "provenance": [ { "field": "population", "quote": "patients with grade III/IV hemorrhoids" }, { "field": "intervention", "quote": "Doppler-guided hemorrhoid artery ligation (DG-HAL)" }, { "field": "comparator", "quote": "tissue-selecting technique (TST)" }, { "field": "primaryOutcome", "quote": "post-operative visual analog scale (VAS) for pain, post-operative bleeding, post-operative defecation, urinary retention, and recurrence rate (prolapse and bleeding)" }, { "field": "result", "quote": "DG-HAL had fewer complications, lower bleeding rates, and less early post-operative pain but showed a higher recurrence rate than TST at the 3-year follow-up, especially in grade IV patients." }, { "field": "n", "quote": "We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021." } ] }, { "id": "pmid:40192825", "pmid": "40192825", "doi": "10.1007/s10151-025-03137-z", "nctId": null, "pmcid": "PMC11976758", "title": "Botulinum toxin injection for management of post-haemorrhoidectomy pain: an updated systematic review and meta-analysis of randomised clinical trials", "firstAuthor": "Quinn", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2025, "design": "meta-analysis", "n": 340, "nField": "reported", "population": "people who had surgery to remove grade III-IV hemorrhoids", "intervention": "botulinum toxin injection given during hemorrhoid surgery", "comparator": "placebo", "primaryOutcome": "post-operative pain scores", "result": "less pain on days 1, 2 and 4 after surgery, but no difference by day 14", "resultDirection": "mixed", "quality": "low", "qualityWhy": "pooled from only seven small trials totaling 340 patients, so findings are not very precise or robust.", "directness": "direct", "limitations": "Further, more robust randomised controlled trials are needed to strengthen these findings", "followUp": "14 days", "plainFinding": "Less pain short-term, no lasting benefit", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40192825/", "sourceText": "INTRODUCTION: Excisional haemorrhoidectomy remains the gold-standard treatment for grade III-IV haemorrhoids owing to the high success rate. However, post-operative pain management is an ongoing challenge. Botulinum toxin injection is thought to improve pain by targeting the internal anal sphincter spasm which occurs following haemorrhoidectomy. This systematic review and meta-analysis examines the effects of concurrent botulinum toxin injection on post-haemorrhoidectomy pain. METHODS: A search of MEDLINE, EMBASE and Cochrane Databases for randomised controlled trials (RCTs) of botulinum toxin injection compared with placebo for management of post-haemorrhoidectomy pain was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Outcomes assessed included daily post-operative pain scores assessed using an analogue scale (0-10), pain at first defecation, analgesia use, complication rates and time to return to work. RESULTS: A total of seven RCTs assessing 340 patients who underwent an excisional haemorrhoidectomy were included. In total, seven studies (n = 340) found significant reduction in pain post-procedure with botulinum toxin use on day 1 (mean difference, MD -1.53; 95% confidence intervals, CI -2.12, -0.94; p < 0.00001), with similar findings on day 2 and 4 (MD -1.84, 95% CI -3.28, -0.41; p = 0.01 and MD -1.63, 95% CI -2.15, -1.09; p < 0.00001, respectively). However, the analgesic effects were not seen on subsequent analyses up to day 14. Botulinum toxin was seen to be safe, with no significant difference in faecal incontinence (MD 1.05, 95% CI 0.40, 2.75; p = 0.93) or urinary retention (MD 0.37, 95% CI 0.09, 1.53; p = 0.17). CONCLUSIONS: Botulinum toxin use for pain relief post-excisional haemorrhoidectomy is safe and effective in the initial peri-operative period; however, the results were short-lived. Further, more robust randomised controlled trials are needed to strengthen these findings and determine the utility of botulinum toxin in this setting. TRIAL REGISTRATION: PROSPERO Register for Systematic Reviews Registration Number - CRD42024541351 on April 29 2024.", "provenance": [ { "field": "n", "quote": "seven studies (n = 340) found significant reduction in pain" }, { "field": "population", "quote": "340 patients who underwent an excisional haemorrhoidectomy" }, { "field": "intervention", "quote": "Botulinum toxin injection" }, { "field": "comparator", "quote": "compared with placebo" }, { "field": "primaryOutcome", "quote": "daily post-operative pain scores assessed using an analogue scale (0-10)" }, { "field": "result", "quote": "found significant reduction in pain post-procedure with botulinum toxin use on day 1" }, { "field": "result", "quote": "the analgesic effects were not seen on subsequent analyses up to day 14" }, { "field": "limitations", "quote": "Further, more robust randomised controlled trials are needed to strengthen these findings" } ] }, { "id": "pmid:40171091", "pmid": "40171091", "doi": "10.1159/000540702", "nctId": null, "pmcid": "PMC11961092", "title": "Treatment of Hemorrhoidal Disease in Patients with Liver Cirrhosis: A Systematic Review", "firstAuthor": "Ponte", "multipleAuthors": true, "journal": "GE Port J Gastroenterol", "year": 2025, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with liver cirrhosis who also have hemorrhoidal disease", "intervention": "various hemorrhoid treatments (rubber band ligation, injection sclerotherapy, hemorrhoidopexy, emborrhoid technique)", "comparator": "different techniques compared across separate studies, no single head-to-head comparison for most", "primaryOutcome": "symptom improvement, patient satisfaction, prolapse reduction, recurrence, and adverse events", "result": "all treatment methods showed symptom improvement and were considered safe, with varying recurrence and complication rates depending on technique", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it combines only six small studies of mixed, mostly weak designs (just one randomized trial, with cohorts and case series) specifically in cirrhosis patients, so it cannot strongly prove which treatment is best.", "directness": "indirect", "limitations": "small number of studies (six), mostly non-randomized designs, heterogeneous techniques and agents, short follow-up in some studies", "followUp": "3 months", "plainFinding": "Hemorrhoid treatments seemed safe and effective in cirrhosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40171091/", "sourceText": "INTRODUCTION: The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population, varying between 21% and 79%. Managing this clinical condition in these patients is challenging, due to the need to differentiate between bleeding originating from hemorrhoids or anorectal varices, and the unique hemostatic balance of each patient, which can lead to a decompensation of liver function and subsequently increase the anesthetic risk. To date, there are no systematic reviews specifically addressing this topic. METHODS: This was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from three electronic databases. Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated. Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies. RESULTS: Six studies were included - 1 randomized clinical trial (RCT), 2 prospective cohort studies, 1 retrospective cohort study, and 2 case series. The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique. RBL showed great symptomatic improvement and patient satisfaction in 63% and 73% of patients, respectively, and in 90% was associated with one-grade prolapse reduction after only one session. The most frequently reported adverse events included pain (16%) and ulceration/fissure (1-17%). Concerning IS, symptomatic improvement was observed in all patients. Recurrence rates varied with the agent used (EAO: 13% at 12 months; N-butyl-cyanoacrylate: 40% at 12 months; ALTA: 18% at 5 years), and 86.7% of patients exhibited more than one-grade reduction after the initial session. The most frequent adverse event was pain (EAO: 63%; N-butyl-cyanoacrylate: 60%). Stapled hemorrhoidopexy resulted in symptomatic improvement in all patients, although associated with a recurrence rate of 25% within 4 months. With an emborrhoid technique, 80% of the patients showed clinical improvement at a 3-month follow-up, without significant adverse events, at the cost of a 40% recurrence rate. CONCLUSIONS: All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients. This assumption challenges previous concerns regarding significant bleeding after office-based procedures like RBL in this population. Future research should prioritize RCT to thoroughly assess the management of HD in these patients, particularly addressing polidocanol foam sclerotherapy, a minimally invasive technique that has previously been shown to be more effective than RBL in the general population and in patients with bleeding disorders.", "provenance": [ { "field": "population", "quote": "The incidence of hemorrhoidal disease (HD) in cirrhotic patients is similar to that of general population" }, { "field": "intervention", "quote": "The considered techniques encompassed rubber band ligation (RBL), injection sclerotherapy (IS) using 3 agents - aluminum potassium sulfate and tannic acid (ALTA), ethanolamine oleate 5% (EAO), or N-butyl-cyanoacrylate, hemorrhoidopexy, and emborrhoid technique." }, { "field": "comparator", "quote": "Data from each study were initially described individually, followed by a comparative analysis for procedures applied in multiple studies." }, { "field": "primaryOutcome", "quote": "Efficacy (symptomatic improvement, patient satisfaction, quality of life improvement, disease recurrence/need for surgery and/or hemorrhoidal prolapse reduction in anoscopy) and safety (reported adverse events) outcomes were evaluated." }, { "field": "result", "quote": "All the treatment methods assessed in the included studies appear to be effective and safe in cirrhotic patients." }, { "field": "followUp", "quote": "80% of the patients showed clinical improvement at a 3-month follow-up" } ] }, { "id": "pmid:40162427", "pmid": "40162427", "doi": "10.4240/wjgs.v17.i3.103953", "nctId": null, "pmcid": "PMC11948100", "title": "Comparative analysis of Ferguson hemorrhoidectomy combined with doppler-guided hemorrhoidal artery ligation and Ferguson hemorrhoidectomy in hemorrhoidal disease treatment", "firstAuthor": "Eray", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "retrospective", "n": 45, "nField": "reported", "population": "adults with grade III prolapsed hemorrhoids undergoing surgery", "intervention": "Doppler-guided hemorrhoidal artery ligation combined with Ferguson hemorrhoidectomy", "comparator": "Ferguson hemorrhoidectomy alone", "primaryOutcome": "surgical outcomes including bleeding, pain, analgesic use, recovery time, and recurrence", "result": "The combined DG-HAL plus Ferguson group had less intraoperative bleeding and needed fewer days of pain medication, but took longer to return to normal activities and had a higher (though not statistically significant) recurrence rate, while pain scores and complication rates were similar between groups.", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, retrospective comparison of only 45 patients without randomization, limiting confidence in the findings.", "directness": "direct", "limitations": "Retrospective design, small sample size, and some differences (recurrence, complications) did not reach statistical significance.", "followUp": "", "plainFinding": "Less bleeding, slower return to activity.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40162427/", "sourceText": "BACKGROUND: In hemorrhoidal disease, despite the existence of numerous treatment options to alleviate symptoms, surgical intervention continues to be the gold standard. The advantages and disadvantages of many methods have been shown in numerous studies However, only a few studies have compared the effectiveness of combined methods. AIM: To compare the results of a coloproctology clinic that switched to the Doppler-guided hemorrhoidal artery ligation (DG-HAL) + Ferguson hemorrhoidectomy (FH) technique from the FH in the treatment of hemorrhoidal disease. METHODS: In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed. Demographic and clinical data, surgical duration, intraoperative blood loss, hospital stay, postoperative analgesic consumption, pain scores using the Visual Analog Scale (VAS), complications, time to return to normal activities, and the recurrence rate were compared in both groups. RESULTS: The study included 45 patients, with 75.6% (n = 34) male and 24.4% (n = 11) female. The rate of intraoperative blood loss was higher in the FH group (P < 0.05). The VAS scores and postoperative complication rates were similar in both groups. The need for postoperative analgesics was lower in the DG-HAL + FH group (2 vs 4 days, P < 0.05), while the FH group showed a shorter time to return to normal activities (9.5 vs 6.0 days, P = 0.02). The recurrence rate (16.7% vs 0%) and Clavien-Dindo Score-1 complications (20.8% vs 9.5%, P = 0.29) were higher in the DG-HAL + FH group but were insignificant. CONCLUSION: Our study revealed that the addition of the DG-HAL to classical hemorrhoidectomy caused less intraoperative bleeding and a lower postoperative analgesia requirement.", "provenance": [ { "field": "n", "quote": "data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed" }, { "field": "population", "quote": "for grade III hemorrhoidal disease between 2020 and 2022 were analyzed" }, { "field": "intervention", "quote": "In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed." }, { "field": "comparator", "quote": "In this retrospective cohort, data from a total of 45 patients who underwent DG-HAL + FH (n = 24) and FH (n = 21) for grade III hemorrhoidal disease between 2020 and 2022 were analyzed." }, { "field": "primaryOutcome", "quote": "Demographic and clinical data, surgical duration, intraoperative blood loss, hospital stay, postoperative analgesic consumption, pain scores using the Visual Analog Scale (VAS), complications, time to return to normal activities, and the recurrence rate were compared in both groups." }, { "field": "result", "quote": "The need for postoperative analgesics was lower in the DG-HAL + FH group (2 vs 4 days, P < 0.05), while the FH group showed a shorter time to return to normal activities (9.5 vs 6.0 days, P = 0.02). The recurrence rate (16.7% vs 0%) and Clavien-Dindo Score-1 complications (20.8% vs 9.5%, P = 0.29) were higher in the DG-HAL + FH group but were insignificant." } ] }, { "id": "pmid:40125221", "pmid": "40125221", "doi": "10.7759/cureus.79305", "nctId": null, "pmcid": "PMC11927931", "title": "A Comparative Analysis of Gastrointestinal Recovery and Pain Management Outcomes in Stapled Versus Open Hemorrhoidectomy: A Meta-Analysis", "firstAuthor": "Khalid", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "meta-analysis", "n": 292, "nField": "reported", "population": "patients with grade III and IV hemorrhoids", "intervention": "stapled hemorrhoidectomy (surgical stapling device to remove hemorrhoid tissue)", "comparator": "open hemorrhoidectomy (traditional surgical removal)", "primaryOutcome": "gastrointestinal recovery (time to normal diet and bowel movements) and postoperative pain scores", "result": "stapled hemorrhoidectomy had less pain, faster bowel recovery, and shorter hospital stay, but a higher recurrence rate later on", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it pools only seven small studies with 292 patients total, and the included trials varied in design even though risk of bias was mostly rated low.", "directness": "direct", "limitations": "Risk of bias was generally low in most studies, with only a few showing moderate concerns; small number of pooled studies and patients.", "followUp": "12-18 months", "plainFinding": "Less pain but more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40125221/", "sourceText": "Stapled hemorrhoidectomy (SH) and open hemorrhoidectomy (OH) are widely used surgical techniques for managing hemorrhoidal disease. SH is often preferred for its potential benefits, such as reduced postoperative pain and faster recovery, while OH is traditionally employed in advanced or complex cases. However, the comparative impact of these techniques on gastrointestinal function and pain management remains unclear, necessitating further evaluation. This meta-analysis is aimed at comparing the clinical outcomes of SH and OH in patients with grade III and IV hemorrhoids, focusing on operative parameters, postoperative pain, recovery, complications, and recurrence. A systematic search was performed across PubMed, Cochrane CENTRAL, Scopus, ProQuest, and Google Scholar, using relevant keywords and Medical Subject Headings (MeSH) terms. Studies included were randomized controlled trials, cohort studies, and quasi-experimental studies published in English until July 2023, comparing gastrointestinal recovery and pain outcomes between SH and OH. The primary outcomes were gastrointestinal recovery, measured by time to resumption of normal diet and bowel movements, and pain management, assessed by postoperative pain scores. Secondary outcomes included hospital stay, complication rates, and recurrence. Data from eligible studies were pooled, and random-effects models were used to estimate the weighted mean differences and odds ratios (OR) for each outcome. Statistical heterogeneity was assessed using Cochran's Q and I² tests. Seven studies involving 292 patients met the inclusion criteria. SH consistently demonstrated advantages over OH regarding pain management, gastrointestinal recovery, and hospital stay. SH patients reported significantly lower pain scores, reduced analgesic use by 35% on average, and faster recovery, with statistically significant results (p<0.05). SH patients also had a shorter time to the first bowel movement, with a reduced OR (OR=0.60, 95% CI: 0.38-0.98) compared to OH. Regarding complications, SH had lower incontinence rates (OR=0.48, 95% CI: 0.26-0.88), though a higher recurrence rate was noted in the SH group, especially at 12-18 months post-surgery. The risk of bias was generally low in most studies, with only a few showing moderate concerns. SH offers significant short-term benefits over OH, including reduced postoperative pain, faster recovery, and fewer complications. However, the higher recurrence rates in SH suggest that clinicians should carefully consider long-term outcomes when choosing the optimal surgical approach for hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "Seven studies involving 292 patients met the inclusion criteria." }, { "field": "population", "quote": "patients with grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "Stapled hemorrhoidectomy (SH)" }, { "field": "comparator", "quote": "open hemorrhoidectomy (OH)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were gastrointestinal recovery, measured by time to resumption of normal diet and bowel movements, and pain management, assessed by postoperative pain scores." }, { "field": "result", "quote": "SH consistently demonstrated advantages over OH regarding pain management, gastrointestinal recovery, and hospital stay." }, { "field": "result", "quote": "though a higher recurrence rate was noted in the SH group, especially at 12-18 months post-surgery" }, { "field": "followUp", "quote": "especially at 12-18 months post-surgery" }, { "field": "qualityWhy", "quote": "The risk of bias was generally low in most studies, with only a few showing moderate concerns." } ] }, { "id": "pmid:40109828", "pmid": "40109828", "doi": "10.7759/cureus.79154", "nctId": null, "pmcid": "PMC11921753", "title": "Cat Scratch Colon: A Case Report and Review of the Literature", "firstAuthor": "Alsaleh", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "63-year-old woman with alcoholic cirrhosis and chronic kidney disease with rectal bleeding", "intervention": "conservative management of hemorrhoids", "comparator": "referral to colorectal surgeon for other treatment options", "primaryOutcome": "resolution of rectal bleeding", "result": "bleeding initially resolved but patient had intermittent rectal bleeding again, with prolapsed hemorrhoids still seen on repeat colonoscopy 6 months later", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether a treatment generally works.", "directness": "indirect", "limitations": "Single case report; hemorrhoids were an incidental finding alongside another colon condition (cat scratch colon), not the main focus of the study.", "followUp": "6 months later", "plainFinding": "Conservative care didn't stop bleeding returning.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40109828/", "sourceText": "We present a case of a 63-year-old woman with a history of compensated alcoholic cirrhosis and chronic kidney disease (CKD) who presented with a 3-day history of hematochezia. Initial laboratory results showed severe anemia with a hemoglobin level of 4.3 g/dl. She was then prepared for an esophagogastroduodenoscopy (EGD) and colonoscopy (CSP). The EGD showed moderate inflammation in the antrum and duodenal bulb without signs of bleeding. CSP revealed friable mucosa with spontaneous bleeding in the proximal ascending colon and cecum, indicating a cat scratch pattern. Additionally, non-bleeding prolapsed hemorrhoids were identified. The patient reported resolution of bleeding and tolerated diet advancement. We concluded that the bleeding was likely due to hemorrhoids. The patient was educated on conservative management of hemorrhoids and discharged in stable condition. During follow-up, the patient reported intermittent episodes of rectal bleeding. A repeat CSP conducted 6 months later revealed diffuse mild diverticulosis and non-bleeding prolapsed hemorrhoids were also observed. The histopathology of the colonic mucosa was normal. The patient was referred to a colorectal surgeon to discuss other treatment options for her hemorrhoids. We have also reviewed the literature related to this endoscopic finding and explored the similarities and differences in our case compared to those reported in the literature. Based on a comprehensive literature review and our patient's clinical course, we propose recommendations regarding the clinical significance and management strategies of CSC. Larger scale studies are needed to better define the underlying pathophysiology, predisposing factors, clinical implications, and optimal management of CSC.", "provenance": [ { "field": "n", "quote": "a 63-year-old woman" }, { "field": "population", "quote": "a 63-year-old woman with a history of compensated alcoholic cirrhosis and chronic kidney disease (CKD) who presented with a 3-day history of hematochezia" }, { "field": "intervention", "quote": "The patient was educated on conservative management of hemorrhoids and discharged in stable condition." }, { "field": "comparator", "quote": "The patient was referred to a colorectal surgeon to discuss other treatment options for her hemorrhoids." }, { "field": "primaryOutcome", "quote": "The patient reported resolution of bleeding and tolerated diet advancement." }, { "field": "result", "quote": "During follow-up, the patient reported intermittent episodes of rectal bleeding. A repeat CSP conducted 6 months later revealed diffuse mild diverticulosis and non-bleeding prolapsed hemorrhoids were also observed." } ] }, { "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": "people with internal hemorrhoids in the rectum (modeled tissue, not patients)", "intervention": "laser-assisted therapy using a mathematical/numerical heat model", "comparator": "published numerical model used for verification", "primaryOutcome": "temperature changes in the layers of rectal tissue during laser treatment", "result": "the model showed temperature drops at the boundaries between tissue layers, matching previous published models", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a computer simulation of tissue heating, not a study on actual patients, so it can't show whether the treatment helps people.", "directness": "indirect", "limitations": "this is a theoretical/numerical modelling study, not a clinical study on patients with hemorrhoids", "followUp": "", "plainFinding": "Computer model of laser heat effects.", "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": "Internal haemorrhoids are generally not visible from outside due to its growth inside the rectum" }, { "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 (internal and external, often prolapsing)", "intervention": "Ruiyun procedure for hemorrhoids (RPH), a type of hemorrhoid surgery", "comparator": "procedure for prolapse and hemorrhoids (PPH), another type of hemorrhoid surgery", "primaryOutcome": "surgical recovery measures (pain, blood loss, hospital stay, cost) and quality of life after surgery", "result": "RPH had shorter surgery time, less blood loss, less pain, shorter hospital stay, lower cost, and better quality of life at 12 weeks than PPH; no difference in bowel control scores, and readmission rates were not significantly different", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study from a single hospital, so bias and chance effects cannot be ruled out even though patients were matched statistically.", "directness": "direct", "limitations": "Retrospective design, single-center, matched groups rather than randomized, no mention of blinding", "followUp": "12 weeks", "plainFinding": "Faster recovery, less pain, better quality of life", "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" }, { "field": "intervention", "quote": "automatic Ruiyun procedure for hemorrhoids" }, { "field": "comparator", "quote": "procedure for prolapse and hemorrhoids" }, { "field": "primaryOutcome", "quote": "postoperative medical humanistic evaluation, clinical efficacy evaluation, subjective evaluation of patients, the occurrence of complications and the rate of unplanned readmission were compared" }, { "field": "result", "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 (p < 0.001)." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "at the 12th week of follow-up" } ] }, { "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 procedure)", "comparator": "hemorrhoidectomy (surgical removal of hemorrhoids)", "primaryOutcome": "quality of life and recurrence rate at 12 months", "result": "Rubber band ligation was not as good as surgery for quality of life and had a much higher recurrence rate (47.5% vs 6.1%), though it caused less pain and allowed faster return to work", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The trial stopped early due to funding problems, leaving a small sample and limited statistical power.", "directness": "direct", "limitations": "Early termination due to funding constraints resulted in a relatively small sample size and limited statistical power; recruitment was hindered by treatment preferences and the COVID-19 pandemic.", "followUp": "12 months", "plainFinding": "Surgery better long-term, banding faster recovery.", "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": "population", "quote": "Patients (aged 18 years or older) with symptomatic grade III (Goligher) hemorrhoids were included in this study." }, { "field": "intervention", "quote": "rubber band ligation" }, { "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%)" }, { "field": "n", "quote": "Eighty-seven patients were randomly assigned (47 rubber band ligation vs 40 hemorrhoidectomy)." }, { "field": "followUp", "quote": "12-month health-related quality of life" }, { "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." } ] }, { "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 bleeding from hemorrhoids", "intervention": "colonoscopic rubber band ligation", "comparator": "no comparison group", "primaryOutcome": "symptom resolution (bleeding, prolapse, irritation, discharge, pain) and patient satisfaction", "result": "Most symptoms resolved and most patients rated treatment as excellent, but over half had complications afterward", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small single-group study of only 28 patients with no comparison treatment and over half had complications, so it can't show how this compares to other options.", "directness": "indirect", "limitations": "Single-center, single-arm study with only 28 of 108 eligible patients included, short follow-up, and no comparator group.", "followUp": "3 months", "plainFinding": "Band ligation eased bleeding and prolapse 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 for lower Lower gastrointestinal bleeding due to hemorrhoids" }, { "field": "comparator", "quote": "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." }, { "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": "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\"." } ] }, { "id": "pmid:39872768", "pmid": "39872768", "doi": "10.4240/wjgs.v17.i1.99464", "nctId": null, "pmcid": "PMC11757188", "title": "Clinical observation on prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2025, "design": "rct", "n": 100, "nField": "reported", "population": "patients with mixed hemorrhoids", "intervention": "polidocanol foam injection combined with automatic elastic thread ligation (RPH)", "comparator": "procedure for prolapse and hemorrhoids (PPH)", "primaryOutcome": "treatment effectiveness, pain, healing time, quality of life, complications, recurrence", "result": "higher effective rate, faster healing, less pain, better quality of life, fewer complications; no difference in bleeding, anal stenosis, or recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "randomization method (dice rolling) is unreliable and the abstract does not describe blinding or other safeguards against bias.", "directness": "direct", "limitations": "Randomization by dice rolling, single center, no blinding mentioned.", "followUp": "1 year", "plainFinding": "Faster healing, less pain, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39872768/", "sourceText": "BACKGROUND: A total of 100 patients diagnosed with mixed hemorrhoids from October 2022 to September 2023 in our hospital were randomly divided into groups by dice rolling and compared with the efficacy of different treatment options. AIM: To analyze the clinical effect and prognosis of mixed hemorrhoids treated with polidocanol injection combined with automatic elastic thread ligation operation (RPH). METHODS: A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group (n = 50) and the treatment group (n = 50) by rolling the dice. The procedure for prolapse and hemorrhoids (PPH) was adopted in the control group, while polidocanol foam injection + RPH was adopted in the treatment group. The therapeutic effects, operation time, wound healing time, hospital stay, pain situation (24 hours post-operative pain score, first defecation pain score), quality of life (QOL), incidence of complications (post-operative hemorrhage, edema, infection), incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared. RESULTS: Compared with the control group, the total effective rate of treatment group was higher, and the difference was significant (P < 0.05). The operation time/wound healing time/hospital stay in the treatment group were shorter than those in the control group (P < 0.05). The pain scores at 24 hours after operation/first defecation pain score of the treatment group was significantly lower than those in the control group (P < 0.05). After surgery, the QOL scores of the two groups decreased, with the treatment group having higher scores than that of the control group (P < 0.05). Compared with the control group, the incidence of postoperative complications in the treatment group was lower, and the difference was significant (P < 0.05); However, there was no significant difference in the incidence of postoperative bleeding between the two groups (P > 0.05); There was no significant difference in the incidence of anal stenosis 3 months after operation and the recurrence rate 1 year after operation between the two groups (P > 0.05). CONCLUSION: For patients with mixed hemorrhoids, the therapeutic effect achieved by using polidocanol injection combined with RPH was better. The wounds of the patients healed faster, the postoperative pain was milder, QOL improved, and the incidence of complications was lower, and the short-term and long-term prognosis was good.", "provenance": [ { "field": "n", "quote": "A total of 100 patients with mixed hemorrhoids who visited our hospital from October 2022 to September 2023 were selected and randomly divided into the control group (n = 50) and the treatment group (n = 50)" }, { "field": "population", "quote": "patients with mixed hemorrhoids" }, { "field": "intervention", "quote": "polidocanol foam injection + RPH was adopted in the treatment group" }, { "field": "comparator", "quote": "The procedure for prolapse and hemorrhoids (PPH) was adopted in the control group" }, { "field": "primaryOutcome", "quote": "The therapeutic effects, operation time, wound healing time, hospital stay, pain situation (24 hours post-operative pain score, first defecation pain score), quality of life (QOL), incidence of complications (post-operative hemorrhage, edema, infection), incidence of anal stenosis 3 months post-operatively and recurrence rate 1 year post-operatively of the two groups were compared." }, { "field": "result", "quote": "the therapeutic effect achieved by using polidocanol injection combined with RPH was better. The wounds of the patients healed faster, the postoperative pain was milder, QOL improved, and the incidence of complications was lower, and the short-term and long-term prognosis was good." } ] }, { "id": "pmid:39734464", "pmid": "39734464", "doi": "10.4240/wjgs.v16.i12.3899", "nctId": null, "pmcid": "PMC11650247", "title": "Surgical approach for lower postoperative anal stenosis", "firstAuthor": "Ghanem Atalla", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with grade III or IV (advanced) hemorrhoids, including some who had prior hemorrhoid treatments", "intervention": "modified stapled hemorrhoidopexy with staple removal at the 3- and 9-o'clock positions", "comparator": "standard stapled hemorrhoidopexy", "primaryOutcome": "rate of anal narrowing (stenosis) and complications after surgery", "result": "modified technique led to less anal narrowing after surgery compared with the standard technique", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This abstract is a commentary discussing another study that itself had a small sample size, so the evidence is weak and not yet confirmed by larger trials.", "directness": "indirect", "limitations": "The underlying study has a limited sample size, and the commentary notes long-term effects are not yet evaluated.", "followUp": "", "plainFinding": "Less anal narrowing with modified stapling.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39734464/", "sourceText": "After anorectal surgery, hemorrhoids frequently lead to chronic issues, particularly in patients with mixed hemorrhoids. Liu et al investigated the outcomes of staple removal at the 3- and 9-o'clock positions following modified stapled hemorrhoidopexy (SH) in patients with grade III or IV hemorrhoids. This study included patients who underwent standard or modified SH between January 1, 2015, and January 1, 2020. Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications. The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids, resulting in a lower rate of postoperative anal stenosis compared to standard SH. Notably, this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments. While the modified SH demonstrates immediate benefits, further research is necessary to evaluate long-term effects. Despite its advantages, the study's limited sample size restricts the generalizability of the findings, underscoring the need for larger, long-term studies to validate these results. Clinically, the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis, a common concern following typical surgeries. If confirmed by larger trials, this procedure may become the preferred surgical approach for hemorrhoids. In conclusion, the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery, enhancing patient safety and outcomes.", "provenance": [ { "field": "population", "quote": "patients with grade III or IV hemorrhoids" }, { "field": "population", "quote": "this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments" }, { "field": "intervention", "quote": "staple removal at the 3- and 9-o'clock positions following modified stapled hemorrhoidopexy (SH)" }, { "field": "comparator", "quote": "standard or modified SH" }, { "field": "primaryOutcome", "quote": "Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications" }, { "field": "result", "quote": "resulting in a lower rate of postoperative anal stenosis compared to standard SH" }, { "field": "result", "quote": "the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis" } ] }, { "id": "pmid:39578689", "pmid": "39578689", "doi": "10.1002/wjs.12416", "nctId": null, "pmcid": null, "title": "LigaSure versus conventional Milligan MORGAN hemorrhoidectomy in Nigerian patients with symptomatic hemorrhoids", "firstAuthor": "Mustapha", "multipleAuthors": true, "journal": "World J Surg", "year": 2025, "design": "rct", "n": 52, "nField": "reported", "population": "adults with grade III and IV symptomatic hemorrhoids", "intervention": "LigaSure hemorrhoidectomy", "comparator": "conventional Milligan-Morgan hemorrhoidectomy", "primaryOutcome": "blood loss, pain, and duration of surgery", "result": "LigaSure had less blood loss, less pain at 2 weeks, and shorter surgery time than Milligan-Morgan", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial but small, from a single center, with only short-term (3 month) follow-up.", "directness": "direct", "limitations": "Small sample size and short-term follow-up of only 3 months for recurrence.", "followUp": "3 months", "plainFinding": "Faster surgery, less bleeding, less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39578689/", "sourceText": "BACKGROUND: Hemorrhoidectomy is considered as the most effective approach for patients with grade III and grade IV hemorrhoids; the operative procedure may be associated with significant postoperative pain and other complications. Several surgical techniques and devices have been developed to overcome these postoperative problems. OBJECTIVE: To compare perioperative and postoperative outcomes of hemorrhoidectomy performed with the LigaSure and the conventional Milligan-Morgan hemorrhoidectomy among Nigerian patients with symptomatic hemorrhoids. METHODOLOGY: All consenting adult patients who fulfilled the inclusion criteria were randomized to either conventional Milligan-Morgan or LigaSure hemorrhoidectomy. Outcome measures were the duration of the procedure, estimated blood loss, and resolution of symptoms, which were assessed using the Sodergren hemorrhoids severity score (SHSS). Postoperative pain was evaluated using the visual analog scale (VAS), and the short-term recurrence rate was also checked at 3 months. Data were analyzed using the computer software IBM SPSS version 23. RESULTS: Fifty-two patients were randomized equally into the two arms. The median blood loss in the LigaSure group was 10.0 mL, whereas the median blood loss in the Milligan-Morgan group was 26.5 mL, (p = 0.0001). The median postoperative pain at 2 weeks using the VAS was 5.5 in the LigaSure group, and in the Milligan-Morgan group, it was 6.0 (p = 0.002). The mean duration of surgery in the LigaSure group was 18.04 min and 34.19 min in the Milligan-Morgan group (p = 0.0001). CONCLUSION: LigaSure hemorrhoidectomy is faster and associated with less blood loss compared to conventional Milligan-Morgan hemorrhoidectomy.", "provenance": [ { "field": "population", "quote": "patients with grade III and grade IV hemorrhoids" }, { "field": "intervention", "quote": "LigaSure hemorrhoidectomy" }, { "field": "comparator", "quote": "conventional Milligan-Morgan hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "duration of the procedure, estimated blood loss, and resolution of symptoms" }, { "field": "result", "quote": "The median blood loss in the LigaSure group was 10.0 mL, whereas the median blood loss in the Milligan-Morgan group was 26.5 mL, (p = 0.0001)" }, { "field": "result", "quote": "The median postoperative pain at 2 weeks using the VAS was 5.5 in the LigaSure group, and in the Milligan-Morgan group, it was 6.0 (p = 0.002)" }, { "field": "result", "quote": "The mean duration of surgery in the LigaSure group was 18.04 min and 34.19 min in the Milligan-Morgan group (p = 0.0001)" }, { "field": "n", "quote": "Fifty-two patients were randomized equally into the two arms." } ] }, { "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 grades II and III internal hemorrhoids", "intervention": "Endoscopic polidocanol foam sclerobanding (EFSB)", "comparator": "Endoscopic rubber band ligation (ERBL)", "primaryOutcome": "long-term relief from prolapse recurrence and reduced post-procedural pain", "result": "EFSB described as a novel therapy for internal hemorrhoids, with larger confirmatory studies still needed", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a commentary/editorial discussing another study rather than original research, with no new data of its own and small, preliminary basis for conclusions.", "directness": "indirect", "limitations": "The abstract itself says future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.", "followUp": "one-year follow-up", "plainFinding": "New method may help, unconfirmed.", "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" }, { "field": "comparator", "quote": "Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure" }, { "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": "one-year follow-up" } ] }, { "id": "pmid:39525773", "pmid": "39525773", "doi": "10.1097/MS9.0000000000002621", "nctId": null, "pmcid": "PMC11543184", "title": "Outcomes of laser hemorrhoidoplasty for grade II-IV hemorrhoidal disease in Bangladesh", "firstAuthor": "Islam", "multipleAuthors": true, "journal": "Ann Med Surg (Lond)", "year": 2024, "design": "case-series", "n": 86, "nField": "reported", "population": "patients with grade II-IV hemorrhoids", "intervention": "laser hemorrhoidoplasty", "comparator": "none (no comparison group)", "primaryOutcome": "pain, satisfaction, hemorrhoid size reduction, and complications", "result": "all patients had substantial reduction in hemorrhoid size, high satisfaction, and significantly lower pain scores, with a 19.8% complication rate at 6 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a single group of patients followed over a short time with no comparison group, so it can't show whether laser treatment works better than other options.", "directness": "indirect", "limitations": "No control or comparator group; short 6-week follow-up; single-center study in one country.", "followUp": "6th week", "plainFinding": "Smaller hemorrhoids, less pain, high satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39525773/", "sourceText": "BACKGROUND: Laser hemorrhoidoplasty is a minimally invasive procedure to treat hemorrhoids and has shown better outcomes. Less is known about its utility in a lower middle-income country; Bangladesh. METHOD: Between March 2023 and December 2023, 86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty. Follow up was assessed on 1st week, 2nd week, and 6th week including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction, and recurrence. RESULTS: The study included 86 patients, with a higher proportion of male participants (73.3%) and a mean age of 55.43±13.6 years. The majority of subjects (68.60%) had grade 3 hemorrhoids. The average surgery duration was 14.70±4.70 minutes All individuals experienced substantial decreases in the size of their hemorrhoids (100%) and reported high levels of satisfaction after the operation (97.7%). The use of the Wilcoxon signed-rank test demonstrated a statistically significant reduction in both the Visual Analog Scale (VAS) and Patient Global Impression of Improvement (PGI-I) ratings during the three subsequent observation periods (1st week, 2nd week, and 6th week). The 6th week complication rate was 19.8%. Additional mucopexy was performed on all patients with grade IV and three patients with grade III hemorrhoids. CONCLUSION: Laser hemorroidoplasty is a day-care procedure, that is safe and efficacious and can be used in rural area settings with good patient satisfaction. Mucopexy is required in some cases of large hemorrhoidal mass to prevent recurrence.", "provenance": [ { "field": "n", "quote": "86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty" }, { "field": "population", "quote": "86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty" }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty is a minimally invasive procedure to treat hemorrhoids" }, { "field": "comparator", "quote": "86 patients with grade II-IV hemorrhoids underwent laser hemorroidoplasty" }, { "field": "primaryOutcome", "quote": "Follow up was assessed on 1st week, 2nd week, and 6th week including pain, satisfaction, symptom improvement, incapacity for work, complications, reduction, and recurrence." }, { "field": "result", "quote": "All individuals experienced substantial decreases in the size of their hemorrhoids (100%) and reported high levels of satisfaction after the operation (97.7%)." }, { "field": "result", "quote": "The 6th week complication rate was 19.8%." } ] }, { "id": "pmid:39473713", "pmid": "39473713", "doi": "10.23922/jarc.2024-034", "nctId": null, "pmcid": "PMC11513414", "title": "Efficacy and Safety of a New Technique Combining Injection Sclerotherapy and External Hemorrhoidectomy for Prolapsed Hemorrhoids: A Single-center Observational Study", "firstAuthor": "Abe", "multipleAuthors": true, "journal": "J Anus Rectum Colon", "year": 2024, "design": "retrospective", "n": 3403, "nField": "reported", "population": "patients with grade II-IV mixed internal and external hemorrhoids (prolapsed hemorrhoids)", "intervention": "external hemorrhoidectomy combined with ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy, called EA", "comparator": "conventional hemorrhoidectomy (referenced for comparison, not a concurrent study arm)", "primaryOutcome": "postoperative complications and recurrence/reoperation rates", "result": "3.5% had complications, 4.0% needed reoperation for recurrence, and 5- and 10-year recurrence-free rates were 92.5% and 67.2%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center retrospective study without a true comparison group, so it can't firmly prove it's better than standard surgery.", "directness": "direct", "limitations": "No concurrent control group; single-center design; retrospective observational study.", "followUp": "26.4 months", "plainFinding": "Fewer complications, good long-term results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39473713/", "sourceText": "OBJECTIVES: To date, there have been no reports on the long-term effects of a method that combines external hemorrhoidectomy with aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy. This study aimed to investigate the efficacy and safety of external hemorrhoidectomy combined with ALTA sclerotherapy (EA) in reducing postoperative complications associated with conventional hemorrhoidectomy. METHODS: EA was performed under sacral epidural anesthesia, and ALTA sclerotherapy was applied to the remaining internal hemorrhoids after resection of the external hemorrhoids. Mixed internal and external hemorrhoids were treated with EA, whereas internal hemorrhoids without external hemorrhoids were treated with ALTA sclerotherapy. The three EA patterns were defined as EA1, EA2, and EA3, depending on the number of EAs performed. RESULTS: This study included 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids. EA1 was the most common, with 1,789 (52.6%) cases, followed by EA2 (36.2%) and EA3 (11.2%). Postoperative complications occurred in 120 (3.5%) patients and increased with the number of EAs, with fever and bleeding being common in the early postoperative period, and perianal abscess and/or fistula being common after 1 month. The mean postoperative follow-up period was 26.4 months, and 136 (4.0%) patients underwent reoperation for recurrent internal or mixed hemorrhoids. The reoperation rate for EA1 was significantly higher than that for EA2 and EA3. The 5- and 10-year cumulative recurrence-free rates were 92.5% and 67.2%, respectively. CONCLUSIONS: EA is as curative as conventional hemorrhoidectomy and reduces postoperative complications. Therefore, EA is the preferred procedure for patients with mixed hemorrhoids.", "provenance": [ { "field": "n", "quote": "This study included 3,403 patients who underwent EA for grade II-IV mixed hemorrhoids." }, { "field": "population", "quote": "3,403 patients who underwent EA for grade II-IV mixed hemorrhoids" }, { "field": "intervention", "quote": "external hemorrhoidectomy combined with ALTA sclerotherapy (EA)" }, { "field": "comparator", "quote": "EA is as curative as conventional hemorrhoidectomy and reduces postoperative complications." }, { "field": "primaryOutcome", "quote": "Postoperative complications occurred in 120 (3.5%) patients and increased with the number of EAs" }, { "field": "result", "quote": "The 5- and 10-year cumulative recurrence-free rates were 92.5% and 67.2%, respectively." }, { "field": "followUp", "quote": "The mean postoperative follow-up period was 26.4 months" } ] }, { "id": "pmid:39399139", "pmid": "39399139", "doi": "10.1055/s-0043-1777663", "nctId": null, "pmcid": "PMC11466518", "title": "Management of Acute Hemorrhoidal Crisis: Evaluation, Treatment, and Special Considerations", "firstAuthor": "Khan", "multipleAuthors": true, "journal": "Clin Colon Rectal Surg", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with acute hemorrhoid flare-ups involving severe bleeding, prolapse, or thrombosis", "intervention": "range of treatments from symptom-control measures to surgical removal of hemorrhoids", "comparator": "", "primaryOutcome": "best approach to evaluating and treating acute hemorrhoidal crisis", "result": "", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review describing general management approaches rather than presenting new study data or comparative results.", "directness": "direct", "limitations": "The abstract does not describe study methods, data sources, or specific limitations.", "followUp": "", "plainFinding": "Reviews treatment options, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39399139/", "sourceText": "Hemorrhoidal disease is one of most common pathologies seen by colorectal and general surgeons. Although hemorrhoids themselves are a normal anatomic occurrence, development of symptomatic disease, usually due to bleeding, prolapse, or thrombosis, can cause significant patient distress. Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis. Management of this pathology varies from nonoperative intervention for symptom control to definitive incisional or excisional hemorrhoidectomy. Here we will explore the approach to evaluating and treating acute hemorrhoidal crises.", "provenance": [ { "field": "population", "quote": "Acute presentation related to significant thrombosis or bleeding is referred to as acute hemorrhoidal crisis." }, { "field": "intervention", "quote": "Management of this pathology varies from nonoperative intervention for symptom control to definitive incisional or excisional hemorrhoidectomy." }, { "field": "primaryOutcome", "quote": "Here we will explore the approach to evaluating and treating acute hemorrhoidal crises." } ] }, { "id": "pmid:39351563", "pmid": "39351563", "doi": "10.4240/wjgs.v16.i9.2787", "nctId": null, "pmcid": "PMC11438809", "title": "Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2024, "design": "retrospective", "n": 500, "nField": "reported", "population": "adults with grade III or IV prolapsed internal hemorrhoids (mixed hemorrhoids) undergoing surgery", "intervention": "modified stapled hemorrhoidopexy (removing staples at 3- and 9-o'clock positions)", "comparator": "standard stapled hemorrhoidopexy", "primaryOutcome": "rate of anal narrowing (stenosis) after surgery", "result": "Fewer patients in the modified surgery group developed anal narrowing afterward compared to standard surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study comparing two surgical groups without randomization, so other differences between groups could explain the results.", "directness": "direct", "limitations": "Retrospective, single-center, observational design; groups differed in prior surgical history (54% vs 40.3% had prior hemorrhoid surgery).", "followUp": "", "plainFinding": "Fewer anal narrowing complications after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39351563/", "sourceText": "BACKGROUND: Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH. AIM: To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids. METHODS: This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. RESULTS: Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH. CONCLUSION: The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.", "provenance": [ { "field": "population", "quote": "Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included." }, { "field": "intervention", "quote": "staple removal at the 3- and 9-o'clock positions during modified SH" }, { "field": "comparator", "quote": "standard or modified SH" }, { "field": "primaryOutcome", "quote": "To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids." }, { "field": "result", "quote": "The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis." }, { "field": "n", "quote": "We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH." } ] }, { "id": "pmid:41341550", "pmid": "41341550", "doi": "10.52787/agl.v54i3.429", "nctId": null, "pmcid": "PMC12310256", "title": "[Anal Pathology in General Practice: A Syndromic Approach to Diagnosis]", "firstAuthor": "Moreira", "multipleAuthors": false, "journal": "Acta Gastroenterol Latinoam", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people seen in general practice with anal symptoms", "intervention": "", "comparator": "", "primaryOutcome": "not reported", "result": "The review describes diagnosis and management approaches but does not report a specific treatment result or outcome measure", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing diagnostic approaches, not a study testing a treatment, so it provides no evidence of effect.", "directness": "indirect", "limitations": "No study design, no patient outcomes, no data on treatment effectiveness are reported; it is a general guide covering many anal conditions, not focused specifically on prolapsed hemorrhoids.", "followUp": "", "plainFinding": "General guide, no treatment results given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41341550/", "sourceText": "Anal pathologies represent a common reason for consultation in general and specialized medical practice, often misinterpreted by patients as hemorrhoids. This review article focuses on providing a guide for the initial diagnosis and management of major anal pathologies, aiming to assist general practitioners and gastroenterologists in their daily practice. The differential diagnoses of the most prevalent syndromes, including anal tumor syndrome, prolapse syndrome, and painful syndrome are explored. The importance of a detailed anamnesis and a directed physical examination is emphasized. The article also describes in detail the clinical characteristics and management of conditions such as skin tags, condylomas, hemorrhoids, and anal abscesses. Therapeutic options are briefly discussed. This review provides practical tools to improve diagnostic accuracy and treatment effectiveness.", "provenance": [ { "field": "population", "quote": "Anal pathologies represent a common reason for consultation in general and specialized medical practice" }, { "field": "result", "quote": "Therapeutic options are briefly discussed." }, { "field": "primaryOutcome", "quote": "This review provides practical tools to improve diagnostic accuracy and treatment effectiveness." } ] }, { "id": "pmid:39228195", "pmid": "39228195", "doi": "10.3393/ac.2023.00871.0124", "nctId": null, "pmcid": "PMC11375232", "title": "The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease", "firstAuthor": "Brillantino", "multipleAuthors": true, "journal": "Ann Coloproctol", "year": 2024, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease (prolapse grades 1 to 4)", "intervention": "various treatments: outpatient procedures, laser, sclerotherapy, artery ligation, stapled hemorrhoidopexy, hemorrhoidectomy", "comparator": "different treatment options compared across prolapse grades", "primaryOutcome": "best treatment choice by hemorrhoid prolapse grade", "result": "Different procedures recommended depending on severity: outpatient laser or sclerotherapy for grade 1; nonexcisional procedures as first-line for grade 2; stapled hemorrhoidopexy or hemorrhoidectomy for grades 3 and 4, with stapled hemorrhoidopexy as gold standard for grade 3", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an expert consensus guideline based on panel discussion and literature review, not new trial data, so it reflects opinion more than direct evidence.", "directness": "direct", "limitations": "Based on expert consensus (Delphi method) rather than original trial results; no patient numbers or outcome data given.", "followUp": "", "plainFinding": "Treatment choice depends on prolapse grade", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39228195/", "sourceText": "The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.", "provenance": [ { "field": "population", "quote": "the diagnosis and management of hemorrhoidal disease" }, { "field": "intervention", "quote": "outpatient procedures including hemorrhoidal laser procedure and sclerotherapy" }, { "field": "comparator", "quote": "nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy" }, { "field": "primaryOutcome", "quote": "to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option" }, { "field": "result", "quote": "In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options." }, { "field": "result", "quote": "stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse" } ] }, { "id": "pmid:39183158", "pmid": "39183158", "doi": "10.3760/cma.j.cn112138-20231123-00337", "nctId": null, "pmcid": null, "title": "[Clinical analysis of percutaneous superselective superior rectal artery embolization for grades Ⅱ-Ⅲ internal hemorrhoids]", "firstAuthor": "Zhou", "multipleAuthors": true, "journal": "Zhonghua Nei Ke Za Zhi", "year": 2024, "design": "retrospective", "n": 22, "nField": "reported", "population": "patients with grade II-III internal hemorrhoids", "intervention": "superselective superior rectal artery embolization (a minimally invasive procedure blocking blood flow to hemorrhoid vessels)", "comparator": "before-and-after comparison within same patients (no control group)", "primaryOutcome": "bleeding score, quality of life score, and prolapse score", "result": "bleeding, quality of life, and prolapse scores all significantly improved after treatment compared to before", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small study of 22 patients with no comparison group, just measuring change before and after treatment.", "directness": "direct", "limitations": "Retrospective analysis, small sample size, no control group for comparison", "followUp": "12 months", "plainFinding": "Improved bleeding and prolapse scores.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39183158/", "sourceText": "Objective: To investigate the safety and efficacy of percutaneous superselective superior rectal artery embolization in the treatment of grades Ⅱ-Ⅲ internal hemorrhoids. Methods: The clinical data of 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization in the Department of Interventional and Minimally Invasive Tumor Therapy of the Second Hospital of Shandong University from September 2019 to February 2022 were retrospectively analyzed. According to the blood supply artery of hemorrhoids, superselective embolization was performed with embolization materials. The surgical efficacy,postoperative complications,and 12-month follow-up results were analyzed. The clinical score data (French bleeding score,quality of life score,prolapse score) were expressed using the median (Q1, Q3). The clinical scores before and after treatment were compared by the nonparametric rank sum test (Wilcoxon test),and the Z-value was calculated. P-values <0.05 indicate statistically significant differences. Results: The operation was successful in all 22 patients (technical success rate: 100%). The main postoperative side effects and complications included tenesmus (81.8%,18/22),anal bulge (68.2%,15/22),and mild pain in the anus (22.7%,5/22). The above reactions were improved 3-5 days after operation; three patients had congestion and dull pain at the puncture site,which improved spontaneously without treatment. The patients were followed up for 12 months. Compared with those prior to operation, the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05). Conclusion: Superselective superior rectal artery embolization is a relatively safe and low-risk treatment for grades Ⅱ-Ⅲ internal hemorrhoids. It is an option for the treatment of internal hemorrhoids,particularly hemorrhagic internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "22 patients with grades Ⅱ-Ⅲ internal hemorrhoids" }, { "field": "population", "quote": "grades Ⅱ-Ⅲ internal hemorrhoids" }, { "field": "intervention", "quote": "percutaneous superselective superior rectal artery embolization" }, { "field": "comparator", "quote": "The clinical scores before and after treatment were compared" }, { "field": "primaryOutcome", "quote": "French bleeding score,quality of life score,prolapse score" }, { "field": "result", "quote": "the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05)" }, { "field": "followUp", "quote": "followed up for 12 months" } ] }, { "id": "pmid:39144877", "pmid": "39144877", "doi": "10.7759/cureus.64570", "nctId": null, "pmcid": "PMC11323718", "title": "A Hospital-Based Longitudinal Study of Rubber Band Ligation and Sclerotherapy Treatment for Internal Hemorrhoids From South India", "firstAuthor": "J", "multipleAuthors": true, "journal": "Cureus", "year": 2024, "design": "prospective-cohort", "n": 200, "nField": "reported", "population": "patients with grade one and two internal hemorrhoids at a tertiary care hospital in Madurai, India", "intervention": "rubber band ligation", "comparator": "sclerotherapy", "primaryOutcome": "postoperative pain, complications, and treatment outcome", "result": "sclerotherapy had less pain, fewer complications, and better treatment response than rubber band ligation", "resultDirection": "harm", "quality": "low", "qualityWhy": "this was a non-randomized observational comparison, so differences between groups could be due to factors other than the treatment itself", "directness": "indirect", "limitations": "not randomized; abstract does not describe blinding or how patients were assigned to groups", "followUp": "nine weeks", "plainFinding": "Sclerotherapy had fewer complications than banding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39144877/", "sourceText": "Background Hemorrhoids are an extremely common surgical condition affecting millions of individuals worldwide. Treatment options for hemorrhoids vary depending on the severity of symptoms and the type of hemorrhoids. The common non-surgical procedures for grade one and two hemorrhoids include rubber band ligation and sclerotherapy. The present study aims to compare the efficiency of rubber band ligation and sclerotherapy for the treatment of symptomatic grade one and two internal hemorrhoids in a tertiary care hospital. Methodology We conducted a one-year longitudinal survey among 200 patients with internal hemorrhoids in a tertiary care center in Madurai. We gathered data on demographic profiles, symptoms, postoperative complications, intraoperative pain, and treatment outcomes. Data analysis was done using the Pearson chi-square test to assess the difference between rubber band ligation and sclerotherapy treatment groups. A p-value <0.05 was considered statistically significant. Results A total of 200 patients were studied, of whom 100 belonged to the rubber band ligation treatment group and 100 belonged to the sclerotherapy treatment group. The preoperative symptoms were similarly distributed between both treatment groups. Intraoperative and immediate postoperative pain was higher in the rubber band ligation group than in the sclerotherapy group. Post-procedure complications were more commonly seen in the rubber band ligation group than in the sclerotherapy group at various weeks of the procedures. Conclusions Postoperative complications such as bleeding, prolapse, and infection/discharge were significantly different between the two treatment groups. The treatment outcome was significantly different between the two treatment groups after three, six, and nine weeks postoperatively. Overall, the sclerotherapy group was associated with fewer postoperative complications, more excellent patient response, and a more complete response to treatment than the rubber band ligation group.", "provenance": [ { "field": "n", "quote": "We conducted a one-year longitudinal survey among 200 patients with internal hemorrhoids in a tertiary care center in Madurai." }, { "field": "population", "quote": "symptomatic grade one and two internal hemorrhoids in a tertiary care hospital" }, { "field": "intervention", "quote": "rubber band ligation" }, { "field": "comparator", "quote": "sclerotherapy" }, { "field": "primaryOutcome", "quote": "Intraoperative and immediate postoperative pain was higher in the rubber band ligation group than in the sclerotherapy group." }, { "field": "result", "quote": "Overall, the sclerotherapy group was associated with fewer postoperative complications, more excellent patient response, and a more complete response to treatment than the rubber band ligation group." }, { "field": "followUp", "quote": "after three, six, and nine weeks postoperatively" } ] }, { "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 sclerobanding (combined foam sclerotherapy and rubber band ligation)", "comparator": "endoscopic rubber band ligation alone", "primaryOutcome": "hemorrhoid symptom severity, prolapse recurrence, and post-procedure pain", "result": "lower symptom scores, less prolapse recurrence, and less pain with combined foam sclerobanding vs banding alone", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "randomized, multicenter study with reasonable follow-up, but moderate size and no blinding mentioned.", "directness": "direct", "limitations": "no mention of blinding; only internal hemorrhoid grades II-III studied", "followUp": "12 months", "plainFinding": "Less pain and recurrence with combo treatment", "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": "population", "quote": "A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals" }, { "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": "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." }, { "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": "n", "quote": "A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals" } ] }, { "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)", "comparator": "conventional excisional hemorrhoidectomy (CEH)", "primaryOutcome": "hemorrhoid recurrence after surgery", "result": "THD had higher recurrence than CEH, but patients recovered faster after THD", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools six randomized trials but recurrence finding is based on relatively few patients and a wide confidence interval.", "directness": "indirect", "limitations": "Only 6 RCTs with 465 patients total; subgroup analysis showed similar results but overall evidence base is limited.", "followUp": "", "plainFinding": "More recurrence but faster recovery with THD.", "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": "intervention", "quote": "Transanal Haemorrhoidal Dearterialization" }, { "field": "comparator", "quote": "Conventional Excisional Haemorrhoidectomy" }, { "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)." }, { "field": "population", "quote": "Haemorrhoids" } ] }, { "id": "pmid:39070221", "pmid": "39070221", "doi": "10.2147/IJGM.S470580", "nctId": null, "pmcid": "PMC11277963", "title": "Demography of Haemorrhoids in Jamhuriat Hospital, Kabul", "firstAuthor": "Bek", "multipleAuthors": true, "journal": "Int J Gen Med", "year": 2024, "design": "retrospective", "n": 252, "nField": "reported", "population": "patients diagnosed with hemorrhoids at a hospital in Kabul, Afghanistan", "intervention": "none - descriptive study of patient records, though surgery was noted as common treatment", "comparator": "", "primaryOutcome": "demographic characteristics and frequency of hemorrhoids, including symptoms and treatment type used", "result": "most patients were male, low income, aged 30-40; common symptoms were bleeding, prolapse, and pain; surgery was used for over half of patients with third- or fourth-degree hemorrhoids", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective, single-hospital record review describing patient characteristics, not a comparison of treatments, so it cannot show whether any treatment works.", "directness": "indirect", "limitations": "retrospective design, single center, no comparison between treatments, no outcomes after treatment reported", "followUp": "", "plainFinding": "Describes who gets hemorrhoids, not treatment results.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39070221/", "sourceText": "BACKGROUND: Hemorrhoids, common benign anorectal conditions, are associated with various factors, such as low fiber intake, constipation, and pregnancy. Treatment typically involves procedures such as banding and surgery. OBJECTIVE: This retrospective investigation aimed to assess the frequency and demography of hemorrhoids in Kabul, Afghanistan. MATERIALS AND METHODS: This study was conducted at Jamhuriat Hospital in Kabul, Afghanistan. Two hundred and fifty-two patients who were diagnosed with hemorrhoids were included. All pertinent demographic data were collected from the medical records and analyzed using IBM SPSS Statistics 25. RESULTS: Males composed 83.7% of the patients, and 32.9% were aged 30-40 years. A lower socioeconomic status was common (61.1%). Bleeding, prolapse, and pain were frequent symptoms. Surgical management was common for third- and fourth-degree hemorrhoids (51.6%). CONCLUSION: This study found a high prevalence of hemorrhoids among males (83.7%) and low-income individuals (61.1%), highlighting the need for further research into risk factors for delayed presentation.", "provenance": [ { "field": "n", "quote": "Two hundred and fifty-two patients who were diagnosed with hemorrhoids were included." }, { "field": "population", "quote": "patients who were diagnosed with hemorrhoids" }, { "field": "intervention", "quote": "Surgical management was common for third- and fourth-degree hemorrhoids (51.6%)." }, { "field": "primaryOutcome", "quote": "This retrospective investigation aimed to assess the frequency and demography of hemorrhoids in Kabul, Afghanistan." }, { "field": "result", "quote": "Males composed 83.7% of the patients, and 32.9% were aged 30-40 years. A lower socioeconomic status was common (61.1%). Bleeding, prolapse, and pain were frequent symptoms. Surgical management was common for third- and fourth-degree hemorrhoids (51.6%)." } ] }, { "id": "pmid:39009485", "pmid": "39009485", "doi": "10.1016/j.asjsur.2024.06.006", "nctId": null, "pmcid": null, "title": "Stapled hemorrhoidopexy for hemorrhoids: A overview of systematic reviews and meta-analysis", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2024, "design": "systematic-review", "n": 23, "nField": "reported", "population": "people with hemorrhoids undergoing surgery", "intervention": "stapled hemorrhoidopexy", "comparator": "other hemorrhoid surgery methods (pooled from meta-analyses)", "primaryOutcome": "postoperative pain, complications and recurrence", "result": "Stapled hemorrhoidopexy reduced postoperative pain but increased bleeding and prolapse recurrence", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is an overview of mostly low and critically low quality reviews, so its conclusions are not very reliable", "directness": "direct", "limitations": "Most of the included meta-analyses and reviews were rated low or critically low quality, and the overview authors say caution should be exercised interpreting findings", "followUp": "", "plainFinding": "Less pain, but more bleeding, recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39009485/", "sourceText": "Stapled hemorrhoidopexy has been used for years to treat hemorrhoids. Despite numerous systematic reviews and meta-analyses on the topic, inconsistent conclusions have left people uncertain about its effectiveness and raised doubts about the quality of these reviews.In order to provide reliable evidence for clinical practice, it is crucial to conduct an overview to assess the quality of MAs/SRs regarding the efficacy and complications of SH.A comprehensive search was performed across seven databases to identify MAs/SRs on the efficacy and complications of SH from inception to October 2023. The selected MAs/SRs were then assessed using three well-established tools: AMSTAR-2, PRISMA 2020and GRADE. These assessments provide a robust evaluation of the quality and reliability of the included MAs/SRs.We removed overlapping randomized controlled trials (RCTs) and conducted a new meta-analysis of the outcomes. The overview included 23 meta-analyses.In AMSTAR-2, three reviews were deemed moderate quality, nine reviews were classified as low quality, and eleven reviews were evaluated as critically low quality.In PRISMA 2020,certain deficiencies were exhibited, such as abstracts (0/23:0 %),final retrieval date (0/23:0 %), sensitivity analysis (6/23:26.09 %),publication bias assessment (11/23:47.83 %), the quality of evidence (2/23:8.70 %) and so on.In GRADE,twenty-six items were rated as moderate quality (27.96 %),forty-one items were rated as low quality (44.09 %) and twenty-six items were rated as critically low quality (27.96 %).SH has been found to be an effective intervention for reducing postoperative pain, shortening procedure time, and promoting wound healing. The re-analysis indicated that SH can reduce postoperative pain in hemorrhoid patients (odds ratio = 0.28, 95 % confidence interval [0.15,0.55], p = 0.0002; I2 = 74 %, p < 0.00001). But SH is associated with a higher risk of postoperative bleeding and recurrence of prolapse.Given that the reviews included in this overview were rated as low quality, caution should be exercised when interpreting the findings.", "provenance": [ { "field": "n", "quote": "The overview included 23 meta-analyses." }, { "field": "result", "quote": "SH can reduce postoperative pain in hemorrhoid patients (odds ratio = 0.28, 95 % confidence interval [0.15,0.55], p = 0.0002; I2 = 74 %, p < 0.00001). But SH is associated with a higher risk of postoperative bleeding and recurrence of prolapse." }, { "field": "primaryOutcome", "quote": "SH has been found to be an effective intervention for reducing postoperative pain, shortening procedure time, and promoting wound healing." }, { "field": "intervention", "quote": "Stapled hemorrhoidopexy has been used for years to treat hemorrhoids." }, { "field": "comparator", "quote": "We removed overlapping randomized controlled trials (RCTs) and conducted a new meta-analysis of the outcomes." }, { "field": "population", "quote": "to identify MAs/SRs on the efficacy and complications of SH" }, { "field": "limitations", "quote": "Given that the reviews included in this overview were rated as low quality, caution should be exercised when interpreting the findings." } ] }, { "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 to shrink hemorrhoids (1470 nm diode laser ablation)", "comparator": "none (single group, before-after outcomes)", "primaryOutcome": "symptom relief, hemorrhoid size reduction, complications, and recurrence", "result": "symptoms and hemorrhoid size improved with low recurrence and high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, so results could be due to other factors over time.", "directness": "direct", "limitations": "Retrospective design with no control group for comparison.", "followUp": "up to five years", "plainFinding": "Fewer symptoms, low recurrence with laser.", "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 at three different medical centers in 2017-2022." }, { "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 overall satisfaction rate was 95% with symptomatic relief." }, { "field": "result", "quote": "the long-term recurrence rate was 5% over up to five years of follow-up" } ] }, { "id": "pmid:38868538", "pmid": "38868538", "doi": "10.1002/hsr2.2192", "nctId": null, "pmcid": "PMC11168280", "title": "Myrrh sitz bath for wound healing after hemorrhoidectomy: A retrospective study of adverse effects and treatment outcomes", "firstAuthor": "Al Amri", "multipleAuthors": false, "journal": "Health Sci Rep", "year": 2024, "design": "retrospective", "n": 67, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids", "intervention": "myrrh sitz bath used as self-treatment for wound care after hemorrhoid surgery", "comparator": "standard wound care after hemorrhoid surgery", "primaryOutcome": "wound healing grade and complication rate", "result": "more high-grade wound healing but also more complications with myrrh compared to standard care", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this was a small retrospective study where patients chose their own treatment, the myrrh group was older and sicker, and it looked at wound care after surgery rather than treatment of a prolapsed hemorrhoid itself.", "directness": "indirect", "limitations": "retrospective design, self-medication without medical advice, small myrrh group (15 patients), myrrh group was significantly older with more comorbidities, higher complication rate in myrrh group", "followUp": "", "plainFinding": "Better healing but more complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38868538/", "sourceText": "BACKGROUND AND AIM: Hemorrhoids affect 75% of people worldwide. surgical hemorrhoidectomy remains the definitive intervention for severe cases. Postoperative wound care is critical, and alternative treatments, like Myrrh, are of growing interest due to their potential wound-healing properties. This study aimed to compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy. METHODS: A retrospective cohort study was carried out using medical records from Abha Private Hospital for the period of January-December 2022. The data of patients who underwent hemorrhoidectomy were collected and categorized based on postoperative wound care into two groups: Group A for Myrrh-based wound care as a self-medication and Group B for standard wound care. RESULTS: The study included 67 patients who underwent hemorrhoidectomy. Out of these patients, 52 had standard wound care, while 15 used Myrrh-based wound care as self-treatment without medical advice. The Myrrh group patients were significantly older with more comorbidities. The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001). These results indicate that despite the good healing capacity of Myrrh, cautious usage must be considered. CONCLUSION: Myrrh sitz baths appear more effective than standard wound care in enhancing healing after hemorrhoidectomy. However, increased complications suggest the necessity for comprehensive evaluation and research on its safety profile. These findings can guide future research and clinical practices related to postoperative wound care.", "provenance": [ { "field": "n", "quote": "The study included 67 patients who underwent hemorrhoidectomy." }, { "field": "population", "quote": "patients who underwent hemorrhoidectomy" }, { "field": "intervention", "quote": "Group A for Myrrh-based wound care as a self-medication" }, { "field": "comparator", "quote": "Group B for standard wound care" }, { "field": "primaryOutcome", "quote": "to compare the safety, efficacy, and treatment outcomes of Myrrh sitz baths with standard clinical care in promoting wound healing after hemorrhoidectomy" }, { "field": "result", "quote": "The Myrrh group had significant Grade III wound healing outcomes 9/15 (60%) compared to the standard care group 2/52 (3.8%) (p < 0.001). However, despite the better healing outcomes, the Myrrh group had a significantly higher complication rate 7/15(46.7%) than the standard care group 1/52 (1.9%) (p < 0.001)." } ] }, { "id": "pmid:38864797", "pmid": "38864797", "doi": "10.1016/j.jopan.2024.02.006", "nctId": null, "pmcid": null, "title": "Effect of Pressure and Nonpressure Dressings on Postoperative Complications in Patients With Mixed Hemorrhoids: A Single-blind Controlled Study", "firstAuthor": "Xue", "multipleAuthors": true, "journal": "J Perianesth Nurs", "year": 2024, "design": "rct", "n": 186, "nField": "reported", "population": "patients with grade II to III mixed hemorrhoids undergoing hemorrhoidectomy surgery", "intervention": "nonpressure wound dressing after hemorrhoid surgery", "comparator": "pressure wound dressing after hemorrhoid surgery", "primaryOutcome": "postoperative complications such as urinary retention, skin injury, and pain", "result": "nonpressure dressings led to less urinary retention, less skin injury, less pain and anal distension, but no difference in edema, hospital stay or cost", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but only single-blind and focused on a narrow aftercare detail rather than the surgery or hemorrhoid treatment itself", "directness": "indirect", "limitations": "single-blind design, limited to postoperative dressing type rather than the underlying hemorrhoid treatment", "followUp": "", "plainFinding": "Less pain and retention with nonpressure dressing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38864797/", "sourceText": "PURPOSE: To compare the clinical effects of nonpressure and pressure dressings on the postoperative complications of modified Milligan-Morgan hemorrhoidectomy. DESIGN: Randomized controlled trial. METHODS: A total of 186 patients with grade II to III mixed hemorrhoids who had been excluded from cardiovascular and cerebrovascular diseases and anorectal surgery were included and randomly assigned to the nonpressure dressings group and the pressure dressings group by random number table. The incidence of acute urinary retention and medical adhesive-related skin injury, pain, hemostatic effect, anal distension, anal edema, use of analgesics, length of hospital stay, and hospitalization costs were compared between the two groups. The Consolidated Standards of Reporting Trials checklist for randomized controlled trials was used in this study. FINDINGS: The incidence of acute urinary retention in both men and women was significantly lower in the nonpressure dressing group (relative risk [RR] = 0.20, 95% confidence interval [CI] [0.13, 0.37], P = .002); (RR = 0.47, 95% CI [0.22, 0.76], P = .015). The postoperative pain at 6 hours/18 hours/25 hours was significantly lower in the nonpressure dressing group (P < .001, P = .004 < 0.05, P = .009). The anal distension at 6 hours and the number of patients who used analgesics were significantly lower in the nonpressure dressing group (P < .001). The incidence of medical adhesive-related skin injuries was significantly lower in the nonpressure dressing group (RR = 0.061, 95% CI [0.020, 0.189], P < .001). No primary bleeding was observed in both groups. However, there were no significant differences between both groups in terms of anal edema scores, length of stay, or hospitalization expenses. No adverse events were reported in either group during the study period. CONCLUSIONS: Nonpressure dressings can effectively reduce the incidence of acute urinary retention and medical adhesion-related skin injury after surgery for grade III to IV mixed hemorrhoids. They can also safely relieve pain and distension.", "provenance": [ { "field": "n", "quote": "A total of 186 patients with grade II to III mixed hemorrhoids" }, { "field": "population", "quote": "patients with grade II to III mixed hemorrhoids who had been excluded from cardiovascular and cerebrovascular diseases and anorectal surgery" }, { "field": "intervention", "quote": "nonpressure dressings group" }, { "field": "comparator", "quote": "pressure dressings group" }, { "field": "primaryOutcome", "quote": "The incidence of acute urinary retention and medical adhesive-related skin injury, pain, hemostatic effect, anal distension, anal edema, use of analgesics, length of hospital stay, and hospitalization costs were compared between the two groups." }, { "field": "result", "quote": "The incidence of acute urinary retention in both men and women was significantly lower in the nonpressure dressing group" }, { "field": "result", "quote": "there were no significant differences between both groups in terms of anal edema scores, length of stay, or hospitalization expenses" } ] }, { "id": "pmid:38821379", "pmid": "38821379", "doi": "10.1016/j.redare.2024.05.005", "nctId": null, "pmcid": null, "title": "Protocol of a clinical trial on the effectiveness of pudendal nerve block with and without neurostimulation in reducing posthemorroidectomy pain", "firstAuthor": "Soto Sánchez", "multipleAuthors": true, "journal": "Rev Esp Anestesiol Reanim (Engl Ed)", "year": 2024, "design": "registered-trial-no-results", "n": null, "nField": "not-reported", "population": "adults with hemorrhoids needing surgery", "intervention": "pudendal nerve block guided by neurostimulation", "comparator": "pudendal nerve block guided by anatomical landmarks", "primaryOutcome": "pain level 24 hours after hemorrhoid surgery", "result": "not yet available, this is a trial protocol", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is only a study protocol with no results reported yet", "directness": "indirect", "limitations": "single-center study; results not yet available so effectiveness cannot be judged", "followUp": "24 h", "plainFinding": "No results yet, trial planned.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38821379/", "sourceText": "INTRODUCTION: Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation. METHODS: The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected. RESULTS: Not avaliable until the end of the study. CONCLUSIONS: The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.", "provenance": [ { "field": "population", "quote": "Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included." }, { "field": "intervention", "quote": "pudendal nerve block guided by anatomical references and guided by neurostimulation" }, { "field": "comparator", "quote": "pudendal nerve block guided by anatomical references and guided by neurostimulation" }, { "field": "primaryOutcome", "quote": "to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation" }, { "field": "result", "quote": "RESULTS: Not avaliable until the end of the study." } ] }, { "id": "pmid:38750150", "pmid": "38750150", "doi": "10.1007/s00384-024-04642-7", "nctId": null, "pmcid": "PMC11096207", "title": "Effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for hemorrhoidal symptoms: a prospective, observational study", "firstAuthor": "Marik", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 60, "nField": "reported", "population": "adults with mild-to-moderate symptomatic non-bleeding hemorrhoids", "intervention": "sucralfate rectal ointment or suppositories", "comparator": "no comparison group (before-and-after treatment only)", "primaryOutcome": "patient-reported hemorrhoid symptom severity score", "result": "symptom severity score significantly improved after treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, uncontrolled, observational study without a placebo or comparison group, so improvement cannot be clearly attributed to the treatment.", "directness": "indirect", "limitations": "No control group, open-label design, authors state larger controlled trials are needed to confirm results.", "followUp": "", "plainFinding": "Fewer hemorrhoid symptoms overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38750150/", "sourceText": "BACKGROUND AND AIMS: A high number of topical products are available for the treatment of hemorrhoidal symptoms. Sucralfate-based topical products constitute a new treatment alternative that act as a mechanical barrier to facilitate healing. The aim of this prospective, observational study was to determine patient- and physician-assessed effectiveness and tolerability of rectal ointment and suppositories containing sucralfate for the treatment of hemorrhoidal symptoms in routine clinical practice. METHODS: Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled. Patients were administered treatment twice per day for at least 1 week until symptom resolution and/or for a maximum of 4 weeks. The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14). Physician-assessed effectiveness (9 symptoms, 0 to 5 Likert scale), hemorrhoid grade, and patient satisfaction were also determined. RESULTS: Five investigators enrolled 60 patients; mean age was 48.4 ± 16.6 years and 72.4% were female. Pain or pressure sensitivity was reported as the most severe symptom by patients, and pressure sensitivity, discharge, soiling, and prolapse by physicians. Mean patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001). Investigator-assessed mean baseline symptom score was 18.1 ± 3.9 and improved by -7.1 ± 4.5, -6.9 ± 5.4, and -7.3 ± 3.5, respectively (p < 0.0001). Investigator-assessed symptoms of pressure sensitivity, swelling, and discharge were improved to the greatest extent. Hemorrhoid grade was improved in 38% of patients at the end of treatment. Compliance with treatment was 97.4% and patient satisfaction with application and onset of action was high (81.3% and 76.2%, respectively). Both the ointment and suppository were well tolerated. CONCLUSIONS: The effectiveness of topical ointment or suppository containing sucralfate on patient- and investigator-assessed hemorrhoidal symptoms in real-life clinical practice was demonstrated. Patient satisfaction was high and treatments were well tolerated. Larger controlled trials are warranted to confirm the results.", "provenance": [ { "field": "population", "quote": "Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled." }, { "field": "intervention", "quote": "rectal ointment and suppositories containing sucralfate" }, { "field": "comparator", "quote": "prospective, observational study" }, { "field": "primaryOutcome", "quote": "The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14)." }, { "field": "result", "quote": "Mean patient-assessed mSSS at baseline was 6.6 ± 1.9 and was significantly improved overall and in the ointment and suppository groups individually by -4.6 ± 2.0, -4.4 ± 1.8, and -4.8 ± 2.2, respectively (p < 0.0001)." }, { "field": "n", "quote": "Five investigators enrolled 60 patients" } ] }, { "id": "pmid:38733497", "pmid": "38733497", "doi": "10.1186/s42155-024-00458-2", "nctId": null, "pmcid": "PMC11088570", "title": "Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials", "firstAuthor": "Morsi", "multipleAuthors": true, "journal": "CVIR Endovasc", "year": 2024, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with symptomatic internal hemorrhoids (bleeding or discomfort), excluding those with rectal prolapse", "intervention": "rectal artery embolization (RAE)", "comparator": "no single comparator; review compared design elements across 15 studies of RAE", "primaryOutcome": "common design and data elements (patient selection, technique, outcomes) used in RAE studies", "result": "studies varied widely in criteria and outcomes; technical success ranged 72-100% and most reported no major complications, but rectal prolapse was an exclusion criterion, not a target condition", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a qualitative review of very different small studies (cohorts, one RCT, case series) with inconsistent methods, so it cannot show whether the treatment works.", "directness": "indirect", "limitations": "Great heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe; qualitative only, no pooled statistics.", "followUp": "1 to 18 months", "plainFinding": "Studied bleeding hemorrhoids, not prolapse.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38733497/", "sourceText": "BACKGROUND: Internal hemorrhoids (IH) is a common medical condition that can result in morbidity secondary to bleeding and discomfort. Treatment for IH has traditionally consisted of dietary and conservative medical management, focal treatments including banding and sclerotherapy or hemorrhoidectomy. Recently, rectal artery embolization (RAE) has been studied as a potential treatment for bleeding predominant IH. We performed a common design and data element analysis of studies that report on RAE. MATERIALS AND METHODS: We conducted a qualitative systematic literature review for rectal artery embolization (RAE) for symptomatic hemorrhoidal disease. The screening process involved five online databases (PubMed, Embase, Google Scholar, DOAJ, and Scopus). Additionally, ClinicalTrials.gov was examined for active, unpublished completed studies. The initial search yielded 2000 studies, with 15 studies meeting the inclusion criteria after screening and assessment. The included studies comprised one RCT, one case series, one pilot study and 12 cohort studies. RESULTS: The population analysis revealed a male predominance across all studies, with varying cohort sizes. The baseline Goligher hemorrhoid grade was utilized in 80% of studies. The majority (73.3%) employed a transfemoral approach, and coils were the primary embolic material in 60% of studies, 26.6% were combination of coils and particles, and 6.6% were particles only. Patient selection criteria highlighted RAE's applicability for high surgical risk patients and those with anemia, chronic hematochezia, or treatment-refractory cases. Exclusion criteria emphasized factors such as previous surgeries, colorectal cancer, rectal prolapse, acute hemorrhoidal complications, and contrast allergy. Study designs varied, with cohort studies being the most common (12/15; 80%). Procedural details included the use of metallic coils and detachable micro-coils, with a high technical success rate reported in most studies ranging from 72 to 100%. The follow-up ranged from 1 to 18 months. The majority of studies reported no major immediate or post-procedural complications. CONCLUSION: While all studies focused on RAE as a treatment for IH, there was a great degree of heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe. Future literature should attempt to standardize these design elements to help facilitate secondary analyses and increase understanding of RAE as a treatment option.", "provenance": [ { "field": "n", "quote": "The initial search yielded 2000 studies, with 15 studies meeting the inclusion criteria after screening and assessment." }, { "field": "population", "quote": "Internal hemorrhoids (IH) is a common medical condition that can result in morbidity secondary to bleeding and discomfort." }, { "field": "population", "quote": "Exclusion criteria emphasized factors such as previous surgeries, colorectal cancer, rectal prolapse, acute hemorrhoidal complications, and contrast allergy." }, { "field": "intervention", "quote": "rectal artery embolization (RAE) for symptomatic hemorrhoidal disease" }, { "field": "comparator", "quote": "The included studies comprised one RCT, one case series, one pilot study and 12 cohort studies." }, { "field": "primaryOutcome", "quote": "We performed a common design and data element analysis of studies that report on RAE." }, { "field": "result", "quote": "Procedural details included the use of metallic coils and detachable micro-coils, with a high technical success rate reported in most studies ranging from 72 to 100%." }, { "field": "result", "quote": "The majority of studies reported no major immediate or post-procedural complications." }, { "field": "limitations", "quote": "there was a great degree of heterogeneity among included studies, particularly regarding inclusion criteria, exclusion criteria, outcomes measures and timeframe" }, { "field": "followUp", "quote": "The follow-up ranged from 1 to 18 months." } ] }, { "id": "pmid:38681103", "pmid": "38681103", "doi": "10.11604/pamj.2024.47.66.36210", "nctId": null, "pmcid": "PMC11055179", "title": "Anal disorders in pregnant and postpartum women: epidemiological, diagnostic and therapeutic aspects in 10 maternities of Bamako in Mali", "firstAuthor": "Togo", "multipleAuthors": true, "journal": "Pan Afr Med J", "year": 2024, "design": "prospective-cohort", "n": 1422, "nField": "reported", "population": "pregnant women in Bamako, Mali followed from first trimester through 6 weeks postpartum", "intervention": "general treatment for anal pathologies (hygiene/diet counseling, laxatives, topical treatments, analgesics, perineal rehabilitation)", "comparator": "no comparator group; descriptive treatment approach only", "primaryOutcome": "rate and risk factors of anal pathologies including hemorrhoidal disease (external hemorrhoids with thrombosis or prolapse, and internal hemorrhoids)", "result": "13% of pregnant women had hemorrhoidal disease, with risk factors including age ≥30, chronic constipation, newborn weight >3500 g, and prolonged fetal expulsion time; treatment described but not tested for efficacy", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a descriptive study of disease frequency and risk factors, not a trial testing whether a treatment works, so it can't show if the treatment actually helps.", "directness": "indirect", "limitations": "The abstract does not evaluate treatment outcomes or compare treatments, only describes general management alongside risk factor identification; no control group for treatment comparison.", "followUp": "6 weeks after delivery", "plainFinding": "Hemorrhoids common in pregnancy; treatment not tested for success.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38681103/", "sourceText": "Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1st, 2019, to May 31st, 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications.", "provenance": [ { "field": "n", "quote": "we followed up 1,422 pregnant women" }, { "field": "population", "quote": "pregnant women admitted to the hospitals and who were followed up through the postpartum" }, { "field": "intervention", "quote": "The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation." }, { "field": "comparator", "quote": "We carried out a prospective, multi-centric, and analytical study" }, { "field": "primaryOutcome", "quote": "Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids." }, { "field": "result", "quote": "we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192)" }, { "field": "result", "quote": "Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000" } ] }, { "id": "pmid:38642473", "pmid": "38642473", "doi": "10.1016/j.ijnurstu.2024.104765", "nctId": null, "pmcid": null, "title": "Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial", "firstAuthor": "Liao", "multipleAuthors": true, "journal": "Int J Nurs Stud", "year": 2024, "design": "rct", "n": 64, "nField": "reported", "population": "adults with grade III or IV prolapsed hemorrhoids having hemorrhoid removal surgery", "intervention": "warm water sitz bath started 6 hours after hemorrhoidectomy", "comparator": "warm water sitz bath started on day 1 after hemorrhoidectomy as usual", "primaryOutcome": "urinary retention and wound pain after hemorrhoidectomy", "result": "no difference in urinary retention between groups, but the early sitz bath group had significantly lower pain scores", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, single-center, and only looked at post-surgery care, not the hemorrhoid treatment itself.", "directness": "indirect", "limitations": "small sample of 64 patients from a single surgical ward, conducted over one year", "followUp": "", "plainFinding": "Less pain, no less urinary retention.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38642473/", "sourceText": "BACKGROUND: Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE: To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN: This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S): This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS: A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS: There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS: Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION: ClinicalTrials.gov ID: NCT04535765.", "provenance": [ { "field": "population", "quote": "Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled." }, { "field": "n", "quote": "A total of 64 participants (32 each in the experimental and control groups) were enrolled." }, { "field": "intervention", "quote": "The experimental group started warm-water sitz bath 6 h after the surgery" }, { "field": "comparator", "quote": "the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual" }, { "field": "primaryOutcome", "quote": "To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain." }, { "field": "result", "quote": "There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18)." } ] }, { "id": "pmid:38601399", "pmid": "38601399", "doi": "10.7759/cureus.55929", "nctId": null, "pmcid": "PMC11004848", "title": "Manual Reduction of Strangulated Internal Hemorrhoids Using Sugar: A Case Report", "firstAuthor": "Fujimoto", "multipleAuthors": false, "journal": "Cureus", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "51-year-old woman with long-standing prolapsed internal hemorrhoids that became strangulated and hard to push back in", "intervention": "applying sugar directly to the swollen hemorrhoids to shrink them before manual reduction", "comparator": "standard manual reduction with lidocaine jelly and hydrocortisone ointment alone", "primaryOutcome": "whether the prolapsed hemorrhoid could be manually pushed back in and pain relieved", "result": "after sugar was applied the swelling went down enough that manual reduction became possible and pain improved, avoiding emergency surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether sugar reliably works better than usual care.", "directness": "direct", "limitations": "only one patient was reported, with no comparison group, so results may not generalize.", "followUp": "two weeks", "plainFinding": "Sugar helped shrink and reduce prolapse.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38601399/", "sourceText": "Emergency hemorrhoidectomy for strangulated internal hemorrhoids should be avoided when possible. Manual reductions can relieve pain and prevent the need for emergency surgery. Herein, we present a 51-year-old female patient. Over the preceding 20 years, she experienced prolapsed internal hemorrhoids every time she defecated and had been performing manual reductions herself. Due to significant pain and difficulty during the manual reduction of the hemorrhoids, she was transported to the emergency room. Anal inspection revealed prolapsed internal hemorrhoids and partial congestion. After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult. Based on previous reports of using sugar to reduce stomal prolapse, we applied sugar directly to the hemorrhoids. Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible. After one day of hospitalization for bed rest, the patient was discharged once it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved. Two weeks later, a grade III internal hemorrhoid was observed, which had markedly reduced in size compared with the time of admission. Using sugar to reduce strangulated internal hemorrhoids manually can be useful due to its simplicity, minimal invasiveness, and cost-effectiveness.", "provenance": [ { "field": "population", "quote": "a 51-year-old female patient" }, { "field": "population", "quote": "she experienced prolapsed internal hemorrhoids every time she defecated" }, { "field": "intervention", "quote": "we applied sugar directly to the hemorrhoids" }, { "field": "comparator", "quote": "After 10 minutes of applying Lidocaine Hydrochloride Jelly 2% and Escherichia coli culture suspension/hydrocortisone ointment, the manual reduction was still difficult." }, { "field": "primaryOutcome", "quote": "manual reduction was still difficult" }, { "field": "result", "quote": "Ten minutes later, the number of prolapsed hemorrhoids decreased, and manual reduction was possible." }, { "field": "result", "quote": "it was confirmed that there was no prolapse of the internal hemorrhoids and that her pain had improved" }, { "field": "n", "quote": "we present a 51-year-old female patient" }, { "field": "followUp", "quote": "Two weeks later, a grade III internal hemorrhoid was observed" } ] }, { "id": "pmid:38596109", "pmid": "38596109", "doi": "10.1016/j.heliyon.2024.e28465", "nctId": null, "pmcid": "PMC11002042", "title": "Modified whitehead hemorrhoidectomy versus partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids: A retrospective analysis", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Heliyon", "year": 2024, "design": "retrospective", "n": 366, "nField": "reported", "population": "patients with grade IV (fourth-degree) circular mixed hemorrhoids", "intervention": "modified Whitehead hemorrhoidectomy surgery", "comparator": "partial hemorrhoidectomy surgery", "primaryOutcome": "surgical complications, residual hemorrhoids, and hemorrhoid recurrence", "result": "No residual hemorrhoids or recurrence after modified Whitehead surgery, versus residues in 58 and recurrence in 19 patients after partial hemorrhoidectomy; rates of bleeding, pain, infection, incontinence, and urinary retention were similar between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison without statistical testing of key outcomes like recurrence, so it cannot reliably prove one surgery is better.", "directness": "direct", "limitations": "Retrospective design, no randomization, and the abstract itself calls for prospective randomized trials to confirm results", "followUp": "", "plainFinding": "Fewer recurrences, similar complication rates overall.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38596109/", "sourceText": "BACKGROUND: Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of this procedure for grade IV circular hemorrhoid patients. METHODS: Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed. Clinical data were extracted from the database at our institution, and long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication. RESULTS: A total of 205 patients were included in this study. The mean operative time was 59.2 ± 13.8 min. The average hospital stay was 4.6 ± 1.0 days. For postoperative complications, 66 (32.2%) patients had urinary retention, 10 (4.9%) patients had a sense of incomplete rectal emptying, 5 (2.4%) patients had anal incontinence, and 6 (2.9%) patients had wound infection. For long-term postoperative complications, 3 (1.5%) patients experienced mild to moderate anal stricture, 2 (1%) patients experienced mucosal ectropion, they all had smooth recoveries, and none of them needed secondary surgery. None of these patients had a hemorrhoid recurrence. A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included. There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence. After modified Whitehead hemorrhoidectomy, 3 patients developed anal stenosis, and 2 had mucosal ectropion. Four patients developed anal stricture after partial hemorrhoidectomy, and none had mucosal ectropion. They all had smooth recoveries, and none of them needed a secondary surgery. For the mean duration of surgery, postoperative bleeding, postoperative pain, wound infection, sense of incomplete rectal emptying, anal incontinence, and urinary retention, no statistically significant differences were found between the two groups. CONCLUSIONS: Compared with partial hemorrhoidectomy, modified whitehead hemorrhoidectomy is an effective and safe surgical procedure and does not significantly increase the risk of anal stenosis and mucosal ectropion for grade IV circular hemorrhoid patients. Prospective randomized controlled trials are needed to verify our results.", "provenance": [ { "field": "population", "quote": "Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed." }, { "field": "intervention", "quote": "modified Whitehead hemorrhoidectomy" }, { "field": "comparator", "quote": "partial hemorrhoidectomy" }, { "field": "n", "quote": "A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included." }, { "field": "result", "quote": "There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence." }, { "field": "result", "quote": "no statistically significant differences were found between the two groups" }, { "field": "primaryOutcome", "quote": "long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication" }, { "field": "limitations", "quote": "Prospective randomized controlled trials are needed to verify our results." } ] }, { "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 seeking consultation", "intervention": "surgical treatment for hemorrhoids", "comparator": "medical or instrumental (non-surgical) treatment", "primaryOutcome": "bleeding and prolapse scores, patient satisfaction after treatment", "result": "Surgery led to greater improvement in bleeding and prolapse scores and higher satisfaction (73% vs 54%) than non-surgical treatment, though only 17% of patients needed surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-center observational study without randomization, so differences between treatment groups could be due to disease severity rather than treatment itself.", "directness": "direct", "limitations": "Single-center, non-randomized, patients not randomly assigned to treatment groups which may bias comparisons.", "followUp": "", "plainFinding": "Surgery gave better relief and satisfaction.", "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": "Bleeding, prolapse and pain were the main reasons for consultation." }, { "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": "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)." } ] }, { "id": "pmid:38577073", "pmid": "38577073", "doi": "10.4240/wjgs.v16.i3.731", "nctId": null, "pmcid": "PMC10989325", "title": "Analysis of factors impacting postoperative pain and quality of life in patients with mixed hemorrhoids: A retrospective study", "firstAuthor": "Sun", "multipleAuthors": true, "journal": "World J Gastrointest Surg", "year": 2024, "design": "retrospective", "n": 164, "nField": "reported", "population": "patients with mixed hemorrhoids (grade III or IV) who had surgery", "intervention": "Milligan-Morgan hemorrhoidectomy surgery", "comparator": "no separate comparison group; pain and quality of life compared across different days after the same surgery", "primaryOutcome": "pain scores and quality-of-life scores after surgery", "result": "Pain steadily decreased after surgery and was gone in all patients by 28 days; quality-of-life scores were significantly higher at 28 days than at 14 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one surgery type with no comparison treatment, so it can't show whether another approach would do better or worse.", "directness": "indirect", "limitations": "Retrospective design, no control/comparator group, and the abstract focuses on 'mixed hemorrhoids' grade III/IV rather than a precisely defined 'prolapsed hemorrhoid'.", "followUp": "28 d", "plainFinding": "Pain faded, quality of life improved after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38577073/", "sourceText": "BACKGROUND: Hemorrhoids are among the most common and frequently encountered chronic anorectal diseases in anorectal surgery. They are venous clusters formed by congestion, expansion, and flexion of the venous plexus in the lower part of the rectum. Mixed hemorrhoids bleed easily and recurrently, and this can result in severe anemia. Hence, they may have a negative effect on the health of the patient and surgical treatment is required. Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids. However, most patients experience different degrees of postoperative pain that may cause anxiety. AIM: To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery. METHODS: The clinical data of patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy were collected retrospectively. The basic characteristics of the enrolled patients with mixed hemorrhoids were recorded, and based on the Goligher clinical grading system, the hemorrhoids were classified as grades III or IV. The endpoint of this study was the disappearance of pain in all patients. Quantitative data were presented as mean ± SD, such as age, pain score, and QoL score. Student's t-test was used to compare the groups. RESULTS: A total of 164 patients were enrolled. The distribution of the visual analog scale pain scores of all patients at 3, 7, 14 and 28 d after surgery showed that post-surgery pain was significantly reduced with the passage of time. Fourteen days after the operation, the pain had completely disappeared in some patients. Twenty-eight days after the surgery, none of the patients experienced any pain. Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery, we observed that the quality-of-life scores of the patients post-surgery had significantly improved. There were six items that were compared at 14- and 28-d post-surgery. The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57). The mean health condition score 28 d after surgery (4.80 ± 0.41) was also higher than that at 14 d post-surgery (4.01 ± 0.62). The mean physical health score 28 d after surgery (32.10 ± 2.96) was significantly higher than that at 14 d post-surgery (23.41 ± 2.85). The mean psychological health score 28 d after surgery (27.22 ± 1.62) was significantly higher than that at 14 d post-surgery (21.37 ± 1.70). The mean social relations score 28 d after surgery (12.21 ± 1.59) was significantly higher than that at 14 d post-surgery (6.32 ± 1.66). The mean surrounding environment score 28 d after surgery (37.13 ± 2.88) was significantly higher than that at 14 d post-surgery (28.42 ± 2.86). The differences in quality-of-life scores at day 14 and day 28 post-surgery were observed to be statistically significant (P < 0.001). CONCLUSION: Milligan-Morgan hemorrhoidectomy can significantly improve the postoperative QoL of patients. Age, sex, and the number of surgical resections were important factors influencing Milligan-Morgan hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "A total of 164 patients were enrolled." }, { "field": "population", "quote": "patients with mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "Milligan-Morgan hemorrhoidectomy has been widely used since 1937 for the treatment of grade III and IV hemorrhoids." }, { "field": "comparator", "quote": "Comparing the World Health Organization Quality of Life - BREF self-reporting questionnaire scores of patients between 14 and 28 d after surgery" }, { "field": "primaryOutcome", "quote": "To assess the factors influencing pain scores and quality of life (QoL) in patients with mixed hemorrhoids post-surgery." }, { "field": "result", "quote": "Twenty-eight days after the surgery, none of the patients experienced any pain." }, { "field": "result", "quote": "The mean QoL score 28 d after surgery (4.79 ± 0.46) was higher than that at 14 d post-surgery (3.79 ± 0.57)." } ] }, { "id": "pmid:38542515", "pmid": "38542515", "doi": "10.3390/ijms25063543", "nctId": null, "pmcid": "PMC10971013", "title": "Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model", "firstAuthor": "Wen", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2024, "design": "retrospective", "n": null, "nField": "not-reported", "population": "people with high-grade hemorrhoids who had surgery", "intervention": "stapled procedure for prolapse and hemorrhoids (PPH)", "comparator": "traditional hemorrhoidectomy surgery", "primaryOutcome": "postoperative pain and anal stenosis (narrowing) complications", "result": "PPH reduced pain after surgery but caused anal stenosis more often than traditional surgery; rat studies showed more scarring and inflammation with PPH-like tension", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a small retrospective review combined with animal experiments, with no patient numbers given, so it cannot reliably show how well PPH works in people.", "directness": "indirect", "limitations": "abstract does not report number of patients, is retrospective, and relies partly on a rat model rather than human outcomes", "followUp": "", "plainFinding": "Less pain but more stenosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38542515/", "sourceText": "High-grade hemorrhoids are usually recommended to receive operational treatments. However, these traditional surgeries are associated with severe postoperative pain. A procedure for prolapse and hemorrhoids (PPH), a circular staple device, has been developed to improve short-term outcomes, including reducing the severity of postoperative pain. PPH, compared to conventional surgery, has been associated with the incidence of anatomical anal stenosis. The causes of stenosis after PPH are not yet clear. We first analyzed the complications of our patients with PPH, and then developed a rat model to verify the tension force of PPH using Hematoxylin-eosin, Masson's trichrome, immunohistochemistry, and immunofluorescence staining. Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy. We simulated the status of PPH and developed a rat model to verify PPH's tension force, including the scarring area and the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors. The tension wound histological data showed more extensive granulation tissue and inflammatory cell infiltration and a thicker epidermis than the control group on day 12 post-operation and tension treatment. In addition to IL-1β and IL-10 cytokines on day 3 and IL-1β, IL-6, and IL-10 cytokines on day 12 post-operation in the tension group, two angiogenic factors, CD31 and VEGF-A, were found to have a more significant expression on day 7 post-operation in the tension group. The mean scar area was larger and the distribution of fibrotic proteins (collagen 1, α-SMA, CTGF, and MMP2) in the tension group was significantly broader than in the control on day 12 post-operation and tension treatment. Based on the findings of our animal model, the development of a lesser tensile force for PPH to decrease the deposition of proinflammatory factors, angiogenic factors, and fibrotic factors is urgently required.", "provenance": [ { "field": "population", "quote": "High-grade hemorrhoids are usually recommended to receive operational treatments." }, { "field": "intervention", "quote": "A procedure for prolapse and hemorrhoids (PPH), a circular staple device, has been developed to improve short-term outcomes" }, { "field": "comparator", "quote": "PPH, compared to conventional surgery, has been associated with the incidence of anatomical anal stenosis." }, { "field": "primaryOutcome", "quote": "Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy." }, { "field": "result", "quote": "Our clinical data showed that PPH significantly improved postoperative pain, but that it resulted in higher incidences of complications, including anal stenosis, than hemorrhoidectomy." } ] }, { "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", "intervention": "ALTA (aluminum potassium sulfate and tannic acid) sclerotherapy injection", "comparator": "none (pooled single-arm outcomes across studies)", "primaryOutcome": "recurrence of hemorrhoids and complications after treatment", "result": "About 10% of patients had recurrence and about 5% had complications after ALTA sclerotherapy, with no significant link between recurrence and hemorrhoid grade", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It pooled data from different studies without a comparison group, so it cannot show how ALTA compares to other treatments.", "directness": "indirect", "limitations": "No control group; abstract calls for long-term follow-up and high-quality randomized trials to clarify ALTA's place in treatment", "followUp": "", "plainFinding": "Moderate recurrence, low complication rate.", "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" }, { "field": "population", "quote": "patients with hemorrhoidal disease" }, { "field": "intervention", "quote": "Aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy" }, { "field": "primaryOutcome", "quote": "Primary endpoints included overall recurrence and type of recurrence" }, { "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." }, { "field": "comparator", "quote": "Twelve studies with 4249 patients met all the inclusion criteria and were eventually included." } ] }, { "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 grade II or III internal hemorrhoids", "intervention": "hemorrhoidectomy (surgical removal), compared with in-office procedures or medical management", "comparator": "different age groups (18-30, 31-50, 51-75) and hemorrhoid grade (II vs III)", "primaryOutcome": "which treatment patients chose first and how long until hemorrhoidectomy, based on age and hemorrhoid grade", "result": "younger patients and those with grade III hemorrhoids were more likely to choose surgery first, but time from diagnosis to surgery did not differ by age or grade", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective study looking only at what treatment people chose, not whether treatments worked, and the authors note personal biases could affect the 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": "Younger patients chose surgery more often.", "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": "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)." }, { "field": "primaryOutcome", "quote": "determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention" }, { "field": "result", "quote": "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%)." }, { "field": "result", "quote": "no significant differences in the length of time to hemorrhoidectomy were noted on the basis of hemorrhoid grade or age" } ] }, { "id": "pmid:38380823", "pmid": "38380823", "doi": "10.1097/DCR.0000000000003211", "nctId": null, "pmcid": null, "title": "Efficacy of Micronized Purified Flavonoid Fraction in the Posthemorrhoidectomy Period Trial: Open-Label Randomized Controlled Trial", "firstAuthor": "Medkova", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "rct", "n": 50, "nField": "reported", "population": "patients who had surgery to remove grade III-IV hemorrhoids", "intervention": "micronized purified flavonoid fraction added to standard post-surgery care", "comparator": "standard post-surgery care alone", "primaryOutcome": "thrombosis or swelling of tissue bridges after surgery, and pain scores", "result": "lower rate of thrombosis/swelling and better patient-rated treatment effect with flavonoid fraction, but no difference in pain scores", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small, single-center study where both patients and doctors knew who got which treatment, which can bias results.", "directness": "indirect", "limitations": "Single-center, open-label design (not blinded)", "followUp": "60 days", "plainFinding": "Fewer complications, but no less pain", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38380823/", "sourceText": "BACKGROUND: Frequent early postoperative complications of hemorrhoidectomy are thrombosis and edema of mucocutaneous \"bridges.\" OBJECTIVE: This study aimed to investigate the efficacy of micronized purified flavonoid fraction in preventing complications after elective hemorrhoidectomy. DESIGN: Prospective unicentral open-label randomized controlled trial. SETTINGS: 2021-2022 at the Clinic of Colorectal and Minimally Invasive Surgery at Sechenov University (Moscow, Russia). PATIENTS: Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids. INTERVENTIONS: After hemorrhoidectomy, patients were randomly assigned either to standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group, or to standard treatment with micronized purified flavonoid fraction, referred to as the study group, and followed up for 60 days. MAIN OUTCOME MEASURES: Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale оn postoperative days 1-7, 14, 21, and 30; quality of life and patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30; and perianal skin tags оn postoperative day 60. RESULTS: The data from 50 patients were analyzed (25 in each group). The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14. Patients in the study group had significantly lower rates of perianal skin tags. LIMITATIONS: Unicenter open-label design. CONCLUSIONS: Micronized purified flavonoid fraction in the posthemorrhoidectomy period is an effective adjunct to standard treatment that helps reduce the rate of thrombosis and edema of mucocutaneous bridges, improves patient-assessed treatment effect, and prevents postoperative perianal skin tags formation. Micronized purified flavonoid fraction in the posthemorrhoidectomy period is not associated with additional pain relief in comparison with nonmicronized purified flavonoid fraction standard treatment. See Video Abstract . EFICACIA DE LA FRACCIN DE FLAVONOIDES PURIFICADA MICRONIZADA EN EL PERODO POSTERIOR A LA HEMORROIDECTOMA ENSAYO MOST ENSAYO CONTROLADO, ALEATORIZADO, ABIERTO: ANTECEDENTES:Una complicación postoperatoria temprana frecuente de la hemorroidectomía es la trombosis y el edema de los \"puentes\" mucocutáneos.OBJETIVO:Investigamos la eficacia de la fracción de flavonoides purificada micronizada en la prevención de complicaciones después de una hemorroidectomía electiva.DISEÑO:Ensayo controlado aleatorio, prospectivo, unicentral, abierto.AJUSTES:2021-2022 Clínica de Cirugía Colorrectal y Mínimamente Invasiva Universidad Sechenov (Moscú, Rusia).PACIENTES:Pacientes después de hemorroidectomía, que se realizó para hemorroides de grado III-IV.INTERVENCIONES:Después de la hemorroidectomía, los pacientes fueron asignados aleatoriamente al tratamiento estándar (antiinflamatorios no esteroides perorales y anestésicos locales, esteroides tópicos, psyllium, baños de asiento tibios, gel de nifedipina) - grupo de control, o al tratamiento estándar con flavonoide purificado micronizado. fracción (grupo de estudio) y seguido durante 60 días.RESULTADOS DE MEDIDAS PRINCIPALES:Trombosis o edema de puentes mucocutáneos e intensidad del dolor en una escala analógica visual entre el 1.º, 7.º, 14.º, 21.º y 30.º día postoperatorio; calidad de vida y efecto del tratamiento evaluado por el paciente el día 1, 3, 7, 21 y 30 del postoperatorio; Marcas cutáneas perianales en el día 60 del postoperatorio.RESULTADOS:Se analizaron los datos de 50 pacientes (25 en cada grupo). La escala analógica visual no demostró diferencias entre grupos en cada punto de seguimiento. En comparación con el grupo de control, los pacientes en el grupo de estudio tuvieron un efecto del tratamiento evaluado por el paciente significativamente mayor en los días 1, 3, 7, 21 y 30 después de la operación, una tasa significativamente menor de trombosis o edema de los puentes mucocutáneos en los días 1, 7 y 14.. Los pacientes del grupo de estudio tuvieron tasas significativamente más bajas de marcas en la piel perianal.LIMITACIONES:Diseño Unicenter de etiqueta abierta.CONCLUSIONES:La fracción de flavonoides purificada micronizada en el período posterior a la hemorroidectomía es un complemento eficaz del tratamiento estándar que ayuda a reducir la tasa de trombosis y edema de los puentes mucocutáneos, mejora el efecto del tratamiento evaluado por el paciente y previene la formación de marcas cutáneas perianales posoperatorias. La fracción de flavonoides purificados micronizados en el período posterior a la hemorroidectomía no se asocia con un alivio adicional del dolor en comparación con el tratamiento estándar con la fracción de flavonoides purificados no micronizados. (Traducción-Yesenia Rojas-Khalil ).", "provenance": [ { "field": "n", "quote": "The data from 50 patients were analyzed (25 in each group)." }, { "field": "population", "quote": "Patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids." }, { "field": "intervention", "quote": "standard treatment with micronized purified flavonoid fraction" }, { "field": "comparator", "quote": "standard treatment (peroral nonsteroid anti-inflammatory drugs and local anesthetics, topical steroids, psyllium, warm sitz baths, and nifedipine gel), referred to as the control group" }, { "field": "primaryOutcome", "quote": "Thrombosis or edema of mucocutaneous bridges and pain intensity on a visual analog scale" }, { "field": "result", "quote": "The visual analog scale demonstrated no differences between groups in each follow-up point. Compared to the control group, the patients in the study group had a significantly higher patient-assessed treatment effect оn postoperative days 1, 3, 7, 21, and 30 and a significantly lower rate of thrombosis or edema of mucocutaneous bridges оn postoperative days 1-7 and 14." }, { "field": "limitations", "quote": "Unicenter open-label design." }, { "field": "followUp", "quote": "followed up for 60 days" } ] }, { "id": "pmid:38380816", "pmid": "38380816", "doi": "10.1097/DCR.0000000000003273", "nctId": null, "pmcid": null, "title": "Randomized Controlled Trial to Compare Stapled Hemorrhoidopexy Plus Ligation Anopexy With Stapled Hemorrhoidopexy for Managing Grade III and IV Hemorrhoidal Disease", "firstAuthor": "Elshazly", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2024, "design": "rct", "n": 124, "nField": "reported", "population": "patients with grade III and IV prolapsed hemorrhoids", "intervention": "stapled hemorrhoidopexy plus ligation anopexy", "comparator": "stapled hemorrhoidopexy alone", "primaryOutcome": "recurrence of hemorrhoids and patient satisfaction after at least 2 years", "result": "fewer patients had recurrent prolapse and better long-term satisfaction with the added ligation procedure, while short-term outcomes were similar between groups", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "randomized trial but from a single center with no mention of blinding of outcome assessors beyond initial allocation, limiting confidence.", "directness": "direct", "limitations": "It was a single-center experience, so longer follow-up was needed.", "followUp": "36 months (interval, 24-47)", "plainFinding": "Fewer recurrences, better satisfaction long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38380816/", "sourceText": "BACKGROUND: Despite the benefits of the stapled hemorrhoidopexy in the short term, management of prolapsing hemorrhoids, the long-term results are still insufficient regarding recurrent prolapse and patient satisfaction. The current study investigates the addition of ligation anopexy to stapled hemorrhoidopexy. OBJECTIVE: Valuation of adding ligation anopexy to stapled hemorrhoidopexy in improving short-term and long-term results in the treatment of grade III and IV hemorrhoids. DATA SOURCES: Between January 2018 and January 2020, we recruited 124 patients with grade III and IV hemorrhoids at Alexandria Main University Hospital. STUDY SELECTION: Randomized controlled trial. INTERVENTIONS: One hundred twenty-four patients were blindly randomly assigned to 2 equal groups: stapled hemorrhoidopexy (group I) and stapled hemorrhoidopexy plus ligation anopexy (group II). MAIN OUTCOME MEASURES: Recurrence of hemorrhoids and patient satisfaction after a follow-up period of at least 2 years. RESULTS: The average operating time was noticeably less in the stapled hemorrhoidopexy group. Postoperative pain, analgesia requirement, hemorrhoid symptoms score, return to work, complications rate, and quality of life 1 month after surgery were similar between groups. Following a mean follow-up of 36 months (interval, 24-47), in group I, 10 patients (16%) reported recurrent external swelling and/or prolapse compared to 3 patients (5%) in group II ( p = 0.0368). Five patients in group I required redo surgery, whereas no patients required redo surgery in group II. Long-term patient satisfaction was significantly better in group II. LIMITATIONS: It was a single-center experience, so longer follow-up was needed. CONCLUSIONS: Stapled hemorrhoidopexy and stapled hemorrhoidopexy plus ligation anopexy were similar in short-term results with regard to complications rate, hemorrhoids symptoms score, return to work, and quality of life. Long-term results were significantly better with regard to recurrence of external swelling and/or prolapse and patient satisfaction after stapled hemorrhoidopexy plus ligation anopexy. See Video Abstract . TRIAL REGISTRATION NUMBER: Pan African Clinical Trials Registry identifier PACTR20180100293130. ECA PARA COMPARAR LA HEMORROIDOPEXIA CON GRAPAS MS ANOPEXIA POR LIGADURA CON LA HEMORROIDOPEXIA CON GRAPAS PARA EL TRATAMIENTO DE LA ENFERMEDAD HEMORROIDAL DE GRADO III Y IV: ANTECEDENTES:A pesar de los beneficios de la hemorroidopexia con grapas a corto plazo, el manejo de las hemorroides prolapsadas, los resultados a largo plazo aún son insuficientes en cuanto al prolapso recurrente y la satisfacción del paciente, por lo que en nuestro estudio actual agregamos anopexia por ligadura a la hemorroidopexia con grapas.OBJETIVO:Valoración de añadir anopexia por ligadura a la hemorroidopexia con grapas para mejorar los resultados a corto y largo plazo en el tratamiento de las hemorroides grado III-IV.FUENTES DE DATOS:Entre enero de 2018 y enero de 2020 reclutamos a 124 pacientes con hemorroides de grado III-IV en el hospital universitario principal de Alexandria.SELECCIÓN DEL ESTUDIO:Ensayo controlado aleatorio PACTR201801002931307.INTERVENCIÓN(S):124 pacientes fueron asignados al azar de forma ciega a dos grupos iguales, hemorroidopexia con grapas (grupo I) y hemorroidopexia con grapas más anopexia por ligadura (grupo II).PRINCIPALES MEDIDAS DE RESULTADO:Recurrencia de hemorroides y satisfacción del paciente después de un período de seguimiento de al menos dos años.RESULTADOS:El tiempo operatorio promedio fue notablemente menor en el grupo de hemorroidopexia con grapas. Mientras tanto, el dolor posoperatorio, la necesidad de analgesia, la puntuación de los síntomas de hemorroides, el regreso al trabajo, la tasa de complicaciones y la calidad de vida un mes después de la cirugía fueron similares. Después de un seguimiento medio de 36 meses (intervalo: 24-47), el Grupo I, 10 pacientes (16%) se quejaron de inflamación externa recurrente y/o prolapso en comparación con 3 pacientes (5%) en el Grupo II ( p = 0,0368) que requiere rehacer la cirugía. No fue necesaria una nueva cirugía en el grupo II; además, la satisfacción del paciente a largo plazo fue significativamente mejor en el grupo II.LIMITACIONES:Se necesita un seguimiento más prolongado y experiencia en un solo centro.CONCLUSIONES:La hemorroidopexia con grapas comparada con la hemorroidopexia con grapas más anopexia por ligadura fue similar en resultados a corto plazo en cuanto a tasa de complicaciones, puntuación de síntomas de hemorroides, regreso al trabajo y calidad de vida. Los resultados a largo plazo fueron significativamente mejores en cuanto a la recurrencia de la inflamación externa y/o el prolapso y la satisfacción del paciente después de la hemorroidopexia con grapas más anopexia por ligadura. (Traducción-Dr. Mauricio Santamaria ).", "provenance": [ { "field": "population", "quote": "patients with grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "stapled hemorrhoidopexy plus ligation anopexy (group II)" }, { "field": "comparator", "quote": "stapled hemorrhoidopexy (group I)" }, { "field": "primaryOutcome", "quote": "Recurrence of hemorrhoids and patient satisfaction after a follow-up period of at least 2 years." }, { "field": "result", "quote": "in group I, 10 patients (16%) reported recurrent external swelling and/or prolapse compared to 3 patients (5%) in group II ( p = 0.0368)" }, { "field": "n", "quote": "One hundred twenty-four patients were blindly randomly assigned to 2 equal groups" }, { "field": "followUp", "quote": "Following a mean follow-up of 36 months (interval, 24-47)" } ] }, { "id": "pmid:38357940", "pmid": "38357940", "doi": "10.14309/ctg.0000000000000687", "nctId": null, "pmcid": "PMC11124638", "title": "Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States", "firstAuthor": "Lembo", "multipleAuthors": true, "journal": "Clin Transl Gastroenterol", "year": 2024, "design": "retrospective", "n": 690, "nField": "reported", "population": "adults with chronic idiopathic constipation", "intervention": "prucalopride treatment", "comparator": "same patients' symptoms before treatment vs after treatment", "primaryOutcome": "constipation-related symptoms and complications, including hemorrhoids and rectal bleeding", "result": "hemorrhoids and rectal bleeding were less common after starting prucalopride, along with several other constipation symptoms and complications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective claims-data study with no comparison group, just before-and-after comparisons in the same patients, so other changes over time could explain the improvement.", "directness": "indirect", "limitations": "Retrospective cohort design using insurance claims data; no untreated control group; relies on diagnosis codes rather than direct clinical assessment.", "followUp": "6 months", "plainFinding": "Fewer hemorrhoid complications after constipation treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38357940/", "sourceText": "INTRODUCTION: This real-world US-based claims study compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC). METHODS: This observational, retrospective cohort analysis used the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental Database (January 2015-June 2020). Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code during the baseline or study period were included. The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding) were examined. Constipation-related symptoms and complications were identified using ICD-10-CM , ICD-10 - Procedure Coding System , or Current Procedural Terminology codes. Data were stratified by age (overall, 18-64 years, and ≥65 years). RESULTS: This study included 690 patients: The mean (SD) patient age was 48.0 (14.7) years, and 87.5% were women. The proportions of patients overall with constipation-related symptoms decreased 6 months after prucalopride initiation (abdominal pain [50.4% vs 33.3%, P < 0.001]; abdominal distension [gaseous] [23.9% vs 13.3%, P < 0.001]; and nausea [22.6% vs 17.7%, P < 0.01]; no improvements observed for incomplete defecation). Similarly, the proportions of patients overall with constipation-related complications decreased 6 months after prucalopride initiation (intestinal obstruction [4.9% vs 2.0%, P < 0.001]; hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]). DISCUSSION: This study suggests that prucalopride may be associated with improved constipation-related symptoms and complications 6 months after treatment initiation.", "provenance": [ { "field": "n", "quote": "This study included 690 patients" }, { "field": "population", "quote": "adults with chronic idiopathic constipation (CIC)" }, { "field": "intervention", "quote": "prucalopride initiation" }, { "field": "comparator", "quote": "6 months before and after prucalopride initiation" }, { "field": "primaryOutcome", "quote": "constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding)" }, { "field": "result", "quote": "hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]" }, { "field": "followUp", "quote": "6 months after prucalopride initiation" } ] }, { "id": "pmid:38301138", "pmid": "38301138", "doi": "10.1089/jicm.2023.0228", "nctId": null, "pmcid": null, "title": "Efficacy of Individualized Homeopathic Medicines in the Treatment of Hemorrhoids: Double-Blind, Randomized, Placebo-Controlled Trial", "firstAuthor": "Koley", "multipleAuthors": true, "journal": "J Integr Complement Med", "year": 2024, "design": "rct", "n": 140, "nField": "reported", "population": "adults aged 18 to 65 with hemorrhoids grades I to III for at least 3 months", "intervention": "individualized homeopathic medicines plus standard supportive care", "comparator": "placebo pills plus standard supportive care", "primaryOutcome": "anorectal symptom severity and quality-of-life questionnaire score", "result": "homeopathy group had significantly better symptom and quality-of-life scores than placebo", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single small trial of an implausible treatment with short follow-up and the authors themselves say it needs larger confirmatory trials.", "directness": "indirect", "limitations": "Single-center trial, short 3-month follow-up, included only grades I-III (not prolapsed grade IV), and authors say findings need confirmation by phase 3 trials.", "followUp": "3 months", "plainFinding": "Better symptom relief than placebo", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38301138/", "sourceText": "Objectives: To investigate the efficacy and safety of individualized homeopathic medicines (IHMs) in treating hemorrhoids compared with placebo. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The trial was conducted at the surgery outpatient department of the State National Homoeopathic Medical College and Hospital, Lucknow, Uttar Pradesh, India. Subjects: Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months. Excluded were the patients with grade IV hemorrhoids, anal fissure, and fistula, hypertrophic anal papillae, inflammatory bowel disease, coagulation disorders, rectal malignancies, obstructed portal circulation, patients requiring immediate surgical intervention, and vulnerable samples. Interventions: Patients were randomized to Group 1 (n = 70; IHMs plus concomitant care; verum) and Group 2 (n = 70; placebos plus concomitant care; control). Outcome measures: Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire, and secondary-the EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire and EQ visual analogue scale (VAS); all of them were measured at baseline, and every month, up to 3 months. Results: Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed. The level of significance was set at p < 0.05 two tailed. Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos. Sulfur was the most frequently prescribed medicine. No harm or serious adverse events were reported from either of the groups. Conclusions: IHMs demonstrated superior results over placebo in the short-term treatment of hemorrhoids of grades I-III. The findings are promising, but need to be substantiated by further phase 3 trials. Clinical Trial Registration Number: CTRI/2020/03/024342.", "provenance": [ { "field": "population", "quote": "Patients were 140 women and men, aged between 18 and 65 years, with a diagnosis of primary hemorrhoids grades I-III for at least 3 months." }, { "field": "intervention", "quote": "Group 1 (n = 70; IHMs plus concomitant care; verum)" }, { "field": "comparator", "quote": "Group 2 (n = 70; placebos plus concomitant care; control)" }, { "field": "primaryOutcome", "quote": "Primary-the anorectal symptom severity and quality-of-life (ARSSQoL) questionnaire" }, { "field": "result", "quote": "Statistically significant between-group differences were elicited in the ARSSQoL total (Mann-Whitney U [MWU]: 1227.0, p < 0.001) and EQ-5D-5L VAS (MWU: 1228.0, p = 0.001) favoring homeopathy against placebos." }, { "field": "n", "quote": "Out of the 140 randomized patients, 122 were protocol compliant. Intention-to-treat sample (n = 140) was analyzed." } ] }, { "id": "pmid:38283447", "pmid": "38283447", "doi": "10.7759/cureus.51195", "nctId": null, "pmcid": "PMC10818029", "title": "Horseshoe Abscess as a Rare Complication After Transanal Hemorrhoid Dearterialization With Mucopexy: A Case Report", "firstAuthor": "Nakao", "multipleAuthors": true, "journal": "Cureus", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "72-year-old man with rectal prolapse and internal hemorrhoids", "intervention": "Transanal hemorrhoidal dearterialization (THD) surgery to cut off blood supply to hemorrhoids", "comparator": "None", "primaryOutcome": "Development of complications after surgery", "result": "Patient developed a rare horseshoe-shaped abscess around the anus after surgery, requiring drainage and antibiotics, then recovered well", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common this problem is or whether the surgery works overall.", "directness": "direct", "limitations": "Single case, exact cause of the complication unclear, no established incidence or risk factors", "followUp": "", "plainFinding": "Rare abscess complication after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38283447/", "sourceText": "Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus. Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain, allowing for same-day surgery discharge. Horseshoe abscess is a rare but known complication of anorectal surgery, characterized by an abscess that extends around the anal canal, often involving the ischiorectal fossa and adjacent structures. Although horseshoe abscesses have been reported after various anorectal surgeries, including hemorrhoidectomy, their occurrence following THD has not been well-documented in the literature. A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids and presented to the hospital on postoperative day 6 with severe rectal pain. A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening. A rectal examination under anesthesia confirmed the presence of purulent drainage from the anus, and surgical drainage of the abscess was performed. The patient received antibiotics and analgesics and experienced a favorable recovery. The exact pathophysiology of a horseshoe abscess following THD remains unclear, and the incidence and risk factors associated with this complication are not well-established. Moreover, there has yet to be a consensus on the optimal management of horseshoe abscesses after THD, whether through surgical or medical approaches. This case emphasizes the importance of considering horseshoe abscess as a potential complication of THD and highlights the need for further research to understand better its incidence, risk factors, and optimal management strategies.", "provenance": [ { "field": "population", "quote": "A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids" }, { "field": "intervention", "quote": "Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus." }, { "field": "comparator", "quote": "Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain" }, { "field": "primaryOutcome", "quote": "presented to the hospital on postoperative day 6 with severe rectal pain" }, { "field": "result", "quote": "A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening." }, { "field": "result", "quote": "The patient received antibiotics and analgesics and experienced a favorable recovery." }, { "field": "n", "quote": "A 72-year-old male underwent THD" } ] }, { "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 IV prolapsed hemorrhoids (piles)", "intervention": "stapled hemorrhoidopexy (SH)", "comparator": "harmonic scalpel hemorrhoidectomy (HSH)", "primaryOutcome": "procedure time, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year", "result": "Stapled hemorrhoidopexy was faster and caused less pain early on, but harmonic scalpel surgery had less bleeding, fewer recurrences at 1 year, and higher patient satisfaction after 2 weeks", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a single-center, single-blind randomized trial with only 70 patients and one year of follow-up, so the findings may not generalize widely.", "directness": "direct", "limitations": "Single-center, single-blind design with relatively small sample size and only 1 year of follow-up.", "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": "50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles" }, { "field": "intervention", "quote": "Group I underwent SH" }, { "field": "comparator", "quote": "group II underwent HSH" }, { "field": "primaryOutcome", "quote": "regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year" }, { "field": "result", "quote": "The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction." }, { "field": "result", "quote": "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)." }, { "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": "The patients were divided into two groups of 35 patients each." } ] }, { "id": "pmid:38115561", "pmid": "38115561", "doi": "10.1111/ans.18823", "nctId": null, "pmcid": null, "title": "Transanal open haemorrhoidopexy: a well-tolerated, minimally invasive surgical method for haemorrhoids grade II to IV", "firstAuthor": "Ihle", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2024, "design": "retrospective", "n": 135, "nField": "reported", "population": "adults with prolapsed hemorrhoids (grade II to IV)", "intervention": "transanal open haemorrhoidopexy surgery", "comparator": "no control group; retrospective study without comparison", "primaryOutcome": "rate of hemorrhoid recurrence one year after surgery", "result": "15% of patients had recurrent prolapsing hemorrhoids at one year, and 17% needed a repeat operation; most had pain for up to two weeks and no serious complications occurred", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a small, single-center retrospective study with no comparison group and only 65% of patients responding to follow-up, so it can't reliably show whether the surgery works better than alternatives.", "directness": "direct", "limitations": "No control group; only 65% of the original 135 patients consented to participate in the outcome survey; retrospective chart review for early complications.", "followUp": "1 year", "plainFinding": "Low recurrence, brief postoperative pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38115561/", "sourceText": "BACKGROUND: To determine 1-year postoperative recurrence rates, postoperative pain and complication rates of transanal open haemorrhoidopexy applied also in grade IV haemorrhoids. METHODS: Single-centre retrospective observational study without control group. The primary outcome was recurrence rate after 1 year postoperatively. Secondary outcomes were length of postoperative pain, use of opiates and postoperative complications. The recurrence rate was assessed with the Sodergren haemorrhoid symptom severity score questionnaire. For information on the early postoperative period, a retrospective chart review based on the routine 3-month clinical follow-up was done. RESULTS: 135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy. 88 patients (65%) consented to participate in the study when approached later via mail. 23% of patients had haemorrhoids Goligher grade IV. 15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse. The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively. 21% of patients reported no postoperative pain, 54% described pain for a duration of up to 1 week and 22% for up to 2 weeks. Two patients reported a longer duration of pain of 3 and 4 weeks, respectively. No complications grade Clavien-Dindo III or higher were detected. CONCLUSION: The results of our study indicate that transanal open haemorrhoidopexy has a recurrence rate comparable to traditional haemorrhoidectomy including grade IV haemorrhoids and is associated with less pain and tissue damage. A randomized controlled trial may provide further support for the routine application of this method, but may pose challenges.", "provenance": [ { "field": "population", "quote": "135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy" }, { "field": "intervention", "quote": "transanal open haemorrhoidopexy" }, { "field": "comparator", "quote": "Single-centre retrospective observational study without control group" }, { "field": "primaryOutcome", "quote": "The primary outcome was recurrence rate after 1 year postoperatively" }, { "field": "result", "quote": "The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively" }, { "field": "result", "quote": "15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse" }, { "field": "n", "quote": "135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy" } ] }, { "id": "pmid:38110284", "pmid": "38110284", "doi": "10.3760/cma.j.cn441530-20231012-00129", "nctId": null, "pmcid": null, "title": "[The occurrence, precaution and treatment strategies of postoperative fecal incontinence in rectal and anal diseases]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhonghua Wei Chang Wai Ke Za Zhi", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients undergoing surgery for hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas", "intervention": "various prevention and treatment strategies for postoperative fecal incontinence (e.g. biofeedback, pelvic floor exercises, nerve stimulation, surgery)", "comparator": "", "primaryOutcome": "occurrence and management of postoperative fecal incontinence", "result": "article summarizes literature on causes and strategies to prevent/treat fecal incontinence after anorectal surgery, without quantitative findings", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative literature summary with no original data, controls, or outcome measurements, so it cannot show whether any treatment works.", "directness": "indirect", "limitations": "No original study data, no defined population of prolapsed hemorrhoid patients, and no measured outcomes—purely a literature-based discussion.", "followUp": "", "plainFinding": "Review on preventing bowel control problems after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38110284/", "sourceText": "In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI). Surgeons need to conduct preoperative assessments based on the patient's individual condition to select an appropriate surgical plan, aiming to minimize the incidence of postoperative FI and improve the patient's postoperative quality of life as much as possible while effectively treating the disease. Additionally, the proficiency of the surgeon's skills, appropriate preoperative dietary adjustments for the patient, regular bowel habits, and exercises targeting the pelvic floor muscles all contribute to reducing the incidence of postoperative FI in patients. For patients who have already developed FI after surgery, on the basis of suitable diet, regular bowel habits, and medication, clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions. This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI. It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field.", "provenance": [ { "field": "population", "quote": "In the surgical treatment of hemorrhoids, rectal prolapse, rectal cancer, anal fissures, or anal fistulas, inadvertent damage to the nerves or muscles responsible for bowel control may potentially lead to varying degrees of fecal incontinence (FI)." }, { "field": "intervention", "quote": "clinical practitioners can adopt such methods as biofeedback, pelvic floor muscle exercise, sacral nerve stimulation, percutaneous tibial nerve stimulation, acupuncture, injectable bulking agents, anal or vaginal inserts, transanal irrigation, surgical interventions, psychological support, etc., to individualized treatment for patients' conditions." }, { "field": "primaryOutcome", "quote": "It elaborates on strategies for the prevention and treatment of postoperative FI, aiming to serve as a reference for peers in the field." }, { "field": "result", "quote": "This article, combining the literature, summarizes the current status of common diseases that may lead to postoperative FI." } ] }, { "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": "people with hemorrhoids, usually aged 25-65", "intervention": "injection therapy for hemorrhoids", "comparator": "other hemorrhoid treatments (conservative, ligation, surgery)", "primaryOutcome": "effectiveness and safety of injection treatment", "result": "expert consensus document giving recommendations on drug types and methods for injection treatment, not a study of outcomes", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an expert consensus statement summarizing recommendations, not a study measuring treatment outcomes in patients.", "directness": "indirect", "limitations": "No original patient data, outcomes, or comparative results are reported; it is a consensus guideline based on review of existing evidence.", "followUp": "", "plainFinding": "Expert guideline on injection treatment, no outcome data.", "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" }, { "field": "comparator", "quote": "The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures." }, { "field": "primaryOutcome", "quote": "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:38104065", "pmid": "38104065", "doi": "10.1186/s12876-023-03062-1", "nctId": null, "pmcid": "PMC10725019", "title": "The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study", "firstAuthor": "He", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2023, "design": "retrospective", "n": 222, "nField": "reported", "population": "adults with grade IV hemorrhoids", "intervention": "C-shaped partial stapled hemorrhoidopexy (C-PSH)", "comparator": "circular stapled hemorrhoidopexy (CSH)", "primaryOutcome": "five-year recurrence rate of hemorrhoids", "result": "Recurrence rates were similar between groups, but C-PSH had less pain, less fecal urgency, and fewer major complications", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences could be due to patient selection rather than the surgery itself.", "directness": "direct", "limitations": "Retrospective design with propensity score matching, not randomized", "followUp": "five-year", "plainFinding": "Less pain, similar recurrence rate", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38104065/", "sourceText": "OBJECTIVES: The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). METHODS: Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications. RESULTS: The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence. CONCLUSIONS: The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.", "provenance": [ { "field": "population", "quote": "patients with grade IV hemorrhoids" }, { "field": "n", "quote": "After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed." }, { "field": "intervention", "quote": "accessible C-shaped partial stapled hemorrhoidopexy (C-PSH)" }, { "field": "comparator", "quote": "circular stapled hemorrhoidopexy (CSH)" }, { "field": "primaryOutcome", "quote": "The primary outcome was the five-year recurrence rate of hemorrhoids." }, { "field": "result", "quote": "fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05)." } ] }, { "id": "pmid:38026482", "pmid": "38026482", "doi": "10.3389/fsurg.2023.1290706", "nctId": null, "pmcid": "PMC10657801", "title": "Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study", "firstAuthor": "Pata", "multipleAuthors": true, "journal": "Front Surg", "year": 2023, "design": "case-series", "n": 51, "nField": "reported", "population": "adults with grade II or III hemorrhoids not responding to conservative treatment, who were also on blood-thinning or antiplatelet medication", "intervention": "sclerobanding (combined rubber band ligation with polidocanol foam sclerotherapy), done without stopping blood thinners", "comparator": "none - all patients received the same procedure, compared to their own outcomes over time", "primaryOutcome": "safety, complications, hospital readmission, death, and need for repeat treatment", "result": "no serious complications; 13.7% had mild issues like pain or clot in a hemorrhoid, all resolved with simple treatment; 4% needed another procedure for bleeding; no deaths", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small pilot study with no comparison group, so it shows the treatment seems safe but can't prove it works better than other options", "directness": "indirect", "limitations": "small pilot study, no control group, authors say larger multicentre studies and controlled trials are needed to confirm results", "followUp": "23 months", "plainFinding": "Safe, low-risk treatment in high-risk patients", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38026482/", "sourceText": "INTRODUCTION: Around 20% of population in western countries is under anticoagulant treatment. However, there is paucity of evidence about the treatment of HD in patients under anticoagulant/antiplatelet therapy, although both suspension and continuation in the perioperative period may increase the risk of severe complications. The aim of this pilot study was to confirm the feasibility and safety of sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy), an office-based procedure, for the treatment of second-and third-degree HD in patients under anticoagulant/antiplatelet therapy without suspension. MATERIALS AND METHODS: Patients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled between November 2019 and October 2021. Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated. RESULTS: Fifty-one patients were recruited, 23 female (45.1%) and 28 male (54.9%), with an average age of 65 years ± 11.4 SD (range 42-90). Twenty-seven patients (52.9%) had II-degree haemorrhoidal disease, and 24 (47.1%) had grade III-degree. The most frequently taken medications were dual antiplatelet therapy (51%) and new oral anticoagulants (NOACs) (21.6%). The mean follow-up was 23 months. No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported. Postoperative complications were not statistically significantly associated with the number of nodules treated (1, 2, or 3), the disease grade (2nd vs. 3rd) or the specific anticoagulant/antiplatelet regimen. During follow-up, 2 patients (4%) required a new procedure for recurrent bleeding: one an infrared photocoagulation as outpatient, and another a haemorrhoidectomy after 3 months. No cases of intraoperative or postoperative mortality occurred. CONCLUSIONS: Sclerobanding is a safe and effective technique in treating intermediate-grade haemorrhoidal disease in patients at high risk on anticoagulant/antiplatelet therapy. Sclerobanding is repeatable, usually does not require anaesthesia, and is cost-effective. Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results.", "provenance": [ { "field": "n", "quote": "Fifty-one patients were recruited" }, { "field": "population", "quote": "Patients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled" }, { "field": "intervention", "quote": "sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy)" }, { "field": "intervention", "quote": "without suspension" }, { "field": "comparator", "quote": "Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated." }, { "field": "primaryOutcome", "quote": "Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated." }, { "field": "result", "quote": "No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported." }, { "field": "result", "quote": "2 patients (4%) required a new procedure for recurrent bleeding" }, { "field": "result", "quote": "No cases of intraoperative or postoperative mortality occurred." }, { "field": "followUp", "quote": "The mean follow-up was 23 months." }, { "field": "limitations", "quote": "Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results." } ] }, { "id": "pmid:38013354", "pmid": "38013354", "doi": "10.1097/MD.0000000000036189", "nctId": null, "pmcid": "PMC10681574", "title": "Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids", "firstAuthor": "He", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2023, "design": "retrospective", "n": null, "nField": "not-reported", "population": "adults aged 18-65 with grade III or IV (severe) hemorrhoids", "intervention": "combined Doppler-guided hemorrhoidal artery ligation plus procedure for prolapse and hemorrhoids (PPH)", "comparator": "standard PPH alone", "primaryOutcome": "treatment success rate, pain scores, wound healing, complications", "result": "combined treatment healed faster, had less pain, higher success rate, and fewer complications than PPH alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective study comparing two surgery groups without randomization, so other differences between patients could explain the results.", "directness": "direct", "limitations": "retrospective design; abstract states long-term efficacy requires further observation", "followUp": "", "plainFinding": "Faster healing, less pain, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38013354/", "sourceText": "Hemorrhoids are a prevalent anorectal condition that affects a wide range of adult populations. The severity of this condition was graded using a validated hemorrhoidal grading system, specifically focusing on grade III and IV cases. This retrospective study aimed to compare the clinical efficacy of a standard Procedure for Prolapse and Hemorrhoids (PPH) with a combined Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL) and a PPH approach in patients with severe hemorrhoids. Conducted from May 2021 to January 2023, the study included patients aged 18-65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids. Patients with a history of anorectal surgery and significant comorbidities were excluded. The control group underwent standard PPH, whereas the observation group received DG-HAL followed by PPH. Clinical outcomes were measured using variables such as the operative duration, intraoperative blood loss, postoperative wound healing time, and length of hospital stay. Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain. The complication rates were also assessed. baseline characteristics were homogeneous between the 2 groups. The observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025). The VAS pain scores were also significantly lower in the observation group (P = .002). A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05). The combined DG-HAL and PPH surgical approach exhibited superior clinical efficacy in treating severe hemorrhoids. This technique offers high effectiveness, reduced postoperative VAS pain scores, and lower complication rates. The long-term efficacy requires further observation.", "provenance": [ { "field": "population", "quote": "patients aged 18-65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids" }, { "field": "intervention", "quote": "the observation group received DG-HAL followed by PPH" }, { "field": "comparator", "quote": "The control group underwent standard PPH" }, { "field": "primaryOutcome", "quote": "Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain." }, { "field": "result", "quote": "The observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025)." }, { "field": "result", "quote": "A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05)." } ] }, { "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 and IV prolapsed hemorrhoids undergoing surgery", "intervention": "Doppler-guided hemorrhoidal artery ligation with rectoanal repair", "comparator": "none - single group study", "primaryOutcome": "number and clock-position locations of artery ligatures needed to stop the Doppler signal", "result": "on average 7 ligatures and 3 mucopexies were needed per patient, with artery locations varying between patients and more needed on the right side of the rectum", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single-group case series with no comparison group and it reports anatomical findings rather than symptom outcomes, so it cannot show whether the treatment actually works.", "directness": "indirect", "limitations": "no control group, no reported symptom or recurrence outcomes, and no randomization or blinding", "followUp": "", "plainFinding": "Artery locations vary; Doppler guidance needed.", "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": "population", "quote": "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)." }, { "field": "n", "quote": "In total, 146 patients were included: 111 (76%) men, and 35 (24%) women." } ] }, { "id": "pmid:37927595", "pmid": "37927595", "doi": "10.3389/fphar.2023.1270339", "nctId": null, "pmcid": "PMC10620711", "title": "Traditional Chinese Medicine in the treatment of hemorrhoids-a review of preparations used and their mechanism of action", "firstAuthor": "Zhou", "multipleAuthors": true, "journal": "Front Pharmacol", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "Traditional Chinese Medicine treatments", "comparator": "no specific comparator, review of mechanisms and surgery mentioned generally", "primaryOutcome": "symptom relief and mechanism of action in treating hemorrhoids", "result": "not a trial result; review discusses mechanisms by which TCM may relieve symptoms", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing proposed mechanisms, not a controlled study testing treatment effectiveness.", "directness": "indirect", "limitations": "No original data, no controlled comparisons, no quantified outcomes; abstract itself notes few summary literature exist on mechanisms.", "followUp": "", "plainFinding": "Reviews TCM mechanisms, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37927595/", "sourceText": "Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain, severely affecting the quality of life. Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively. Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients, reducing pain, and improving the quality of life. However, there are few summary literature about the mechanism of TCM in the prevention and treatment of hemorrhoids. Based on the etiology of hemorrhoids in both traditional Chinese and Western medicine, this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids, hoping to provide a basis for the better application of TCM in clinical and experimental research.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain, severely affecting the quality of life." }, { "field": "intervention", "quote": "Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients, reducing pain, and improving the quality of life." }, { "field": "comparator", "quote": "Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively." }, { "field": "primaryOutcome", "quote": "this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids" }, { "field": "result", "quote": "hoping to provide a basis for the better application of TCM in clinical and experimental research" } ] }, { "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 prolapsed hemorrhoids", "intervention": "ALTA sclerotherapy combined with rectal mucopexy (AM surgery)", "comparator": "none - no comparison group, single-arm study", "primaryOutcome": "long-term success rate of the procedure, pain, complications, and satisfaction", "result": "Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, with low pain scores, few complications, and high patient satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-institution study with no comparison group, so it can't show whether the treatment is better than other options.", "directness": "direct", "limitations": "Retrospective design from a single institution with no control group for comparison.", "followUp": "five years", "plainFinding": "High success, low pain, few complications.", "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 of prospectively collected data from a single institution." }, { "field": "intervention", "quote": "ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse." }, { "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." } ] }, { "id": "pmid:37838461", "pmid": "37838461", "doi": "10.1016/j.suc.2023.05.014", "nctId": null, "pmcid": null, "title": "Anorectal Emergencies", "firstAuthor": "Drezdzon", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with anorectal emergencies", "intervention": "not reported", "comparator": "", "primaryOutcome": "", "result": "The abstract describes the article as a review of diagnosis and management approaches but does not report specific treatment outcomes or results", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing general topics without presenting original data, comparisons, or outcome results.", "directness": "indirect", "limitations": "No specific data, methods, outcomes, or results are reported; this is a general overview article covering multiple conditions, not a focused study on prolapsed hemorrhoids.", "followUp": "", "plainFinding": "General review, no specific findings reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37838461/", "sourceText": "Anorectal emergencies are rare presentations of common anorectal disorders, and surgeons are often called on to assist in their diagnosis and management. Although most patients presenting with anorectal emergencies can be managed nonoperatively or with a bedside procedure, surgeons must also be able to identify surgical anorectal emergencies, such as gangrenous rectal prolapse. This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess and unique situations including rectal foreign body and anorectal sexually transmitted infections.", "provenance": [ { "field": "population", "quote": "Anorectal emergencies are rare presentations of common anorectal disorders" }, { "field": "intervention", "quote": "workup, diagnosis, and management of common anorectal emergencies including thrombosed hemorrhoids, incarcerated hemorrhoids, anal fissure, anorectal abscess, rectal prolapse, and pilonidal abscess" }, { "field": "result", "quote": "This article provides a review of pertinent anatomy; examination techniques; and workup, diagnosis, and management of common anorectal emergencies" } ] }, { "id": "pmid:37692631", "pmid": "37692631", "doi": "10.7759/cureus.43119", "nctId": null, "pmcid": "PMC10483433", "title": "Laser Hemorrhoidoplasty Versus Ligasure Hemorrhoidectomy: A Comparative Analysis", "firstAuthor": "Durgun", "multipleAuthors": true, "journal": "Cureus", "year": 2023, "design": "retrospective", "n": 100, "nField": "reported", "population": "patients with grade III hemorrhoids (a type of prolapsed hemorrhoid)", "intervention": "laser hemorrhoidoplasty (LHP)", "comparator": "LigaSure hemorrhoidectomy (LigH)", "primaryOutcome": "pain scores, recovery time, and recurrence after surgery", "result": "LHP had less pain and faster return to activity but higher recurrence than LigH", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective (non-randomized) study comparing two surgery types, so differences could be due to patient selection rather than the treatments themselves.", "directness": "direct", "limitations": "Retrospective analysis of patient records rather than a randomized trial.", "followUp": "", "plainFinding": "Less pain, but more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37692631/", "sourceText": "Background and objective Minimally invasive techniques in the surgical treatment of hemorrhoids have been gaining in popularity. Laser hemorrhoidoplasty (LHP) and LigaSure™ (LigH; Medtronic, Dublin, Ireland) hemorrhoidectomy methods are the most recent innovative methods that are increasingly used. In this study, we aimed to compare the effectiveness of these two innovative techniques. Methods The data of patients who underwent LHP or LigH for grade III hemorrhoidal disease at our clinic between January 2022 and June 2023 were retrospectively analyzed. Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded. Results A total of 100 patients were included in the study. Of these, 48 patients had LHP surgery and 52 had LigH surgery. The demographic characteristics of both groups were similar. The mean operation time was statistically significantly shorter in the LHP group (p<0.001). The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001). The median time to return to daily activity was 2.3 (range: one to three) days in the LHP group and 4.6 (range: 3-11) days in the LigH group (p<0.001). Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001). Conclusion Based on our findings, LHP is an effective procedure for the surgical treatment of hemorrhoidal disease as it is associated with less morbidity, less pain, early return to work, and acceptable recurrence rates.", "provenance": [ { "field": "population", "quote": "patients who underwent LHP or LigH for grade III hemorrhoidal disease" }, { "field": "n", "quote": "A total of 100 patients were included in the study." }, { "field": "intervention", "quote": "Laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "LigaSure™ (LigH; Medtronic, Dublin, Ireland) hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Postoperative pain levels, time to return to work or daily activities, complication rates, and recurrence rates of the treated patients were recorded." }, { "field": "result", "quote": "The visual analog scale (VAS) scores on postoperative days one and seven were lower in favor of the LHP (2.4 ± 0.7 and 1.2 ± 0.9 vs. 6.2 ± 1.5 and 3.8 ± 1.3, respectively; p< 0.001)." }, { "field": "result", "quote": "Recurrence was observed in 11 (22%) patients in the LHP group and in three (6%) patients in the LigH group (p<0.001)." } ] }, { "id": "pmid:37653473", "pmid": "37653473", "doi": "10.1186/s12876-023-02933-x", "nctId": null, "pmcid": "PMC10469794", "title": "Milligan-Morgan hemorrhoidectomy combined with non-doppler hemorrhoidal artery ligation for the treatment of grade III/IV hemorrhoids: a single centre retrospective study", "firstAuthor": "Long", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2023, "design": "retrospective", "n": 115, "nField": "reported", "population": "adults with grade III/IV (prolapsed) hemorrhoids", "intervention": "surgery combining Milligan-Morgan hemorrhoidectomy with non-Doppler hemorrhoidal artery ligation", "comparator": "Milligan-Morgan hemorrhoidectomy alone", "primaryOutcome": "pain, bleeding, swelling, urinary retention, recurrence, and patient satisfaction after surgery", "result": "the combined surgery caused less pain, less bleeding, less swelling, less urinary retention, lower recurrence, and higher satisfaction than hemorrhoidectomy alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized comparison from one hospital, so other factors besides the surgery could explain the differences", "directness": "direct", "limitations": "retrospective design, single centre, not randomized", "followUp": "12 months", "plainFinding": "Less pain, fewer complications, less recurrence", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37653473/", "sourceText": "BACKGROUND: Milligan-Morgan hemorrhoidectomy (MMH) is the most widely used surgical procedure because of its precise curative effect, but it has the disadvantages such as obvious postoperative pain and bleeding. To retrospectively evaluate the efficacy and safety of MMH combined with non-Doppler hemorrhoidal artery ligation (MMH + ND-HAL) for the treatment of grade III/IV hemorrhoids. METHODS: We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids, 53 patients had received MMH + ND-HAL, and the remaining 62 patients received MMH. We collected and compared demographic and clinical characteristics of both groups, including intraoperative blood loss, postoperative visual analog scale (VAS) for pain, analgesic consumption, postoperative bleeding, perianal incision edema, urinary retention, anal stenosis, anal incontinence incidence, recurrence rate (prolapse or bleeding), and patient satisfaction. RESULTS: The VAS pain score of the first postoperative defecation and at the postoperative 12 h, 1 day, 2 days, 3 days, and 7 days, as well as the total analgesic consumption within 7 days, for the MMH + ND-HAL group were lower than those for the MMH group (P < 0.05). The intraoperative blood loss, the incidence of postoperative bleeding, perianal incision edema, and urinary retention in the MMH + ND-HAL group was lower than that in the MMH group (P < 0.05). No anal stenosis or anal incontinence occurred in either group. At follow-up by telephone or outpatient 12 months after surgery, the recurrence rate (prolapse or bleeding) was lower in the MMH + ND-HAL group than in the MMH group (P < 0.05), and satisfaction was higher in the MMH + ND-HAL group than in the MMH group (P < 0.05). CONCLUSIONS: MMH + ND-HAL was a satisfactory surgical modality for treating III/IV hemorrhoids.", "provenance": [ { "field": "n", "quote": "We conducted a retrospective analysis of 115 patients with grade III/IV hemorrhoids, 53 patients had received MMH + ND-HAL, and the remaining 62 patients received MMH." }, { "field": "population", "quote": "115 patients with grade III/IV hemorrhoids" }, { "field": "intervention", "quote": "MMH + ND-HAL" }, { "field": "comparator", "quote": "the remaining 62 patients received MMH" }, { "field": "primaryOutcome", "quote": "postoperative visual analog scale (VAS) for pain, analgesic consumption, postoperative bleeding, perianal incision edema, urinary retention, anal stenosis, anal incontinence incidence, recurrence rate (prolapse or bleeding), and patient satisfaction" }, { "field": "result", "quote": "the recurrence rate (prolapse or bleeding) was lower in the MMH + ND-HAL group than in the MMH group (P < 0.05), and satisfaction was higher in the MMH + ND-HAL group than in the MMH group (P < 0.05)" }, { "field": "followUp", "quote": "At follow-up by telephone or outpatient 12 months after surgery" } ] }, { "id": "pmid:37634164", "pmid": "37634164", "doi": "10.1007/s10151-023-02855-6", "nctId": null, "pmcid": null, "title": "Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: a network meta-analysis", "firstAuthor": "Yuan", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "meta-analysis", "n": 3573, "nField": "reported", "population": "adults with hemorrhoids undergoing surgery", "intervention": "different surgical procedures for hemorrhoids (e.g. Ligasure, Milligan-Morgan, Ferguson, Harmonic scalpel, PPH, TST, STARR)", "comparator": "the other surgical procedures compared with each other", "primaryOutcome": "operating time, blood loss, hospital stay, time to first bowel movement, recurrence, anal narrowing, and pain after surgery", "result": "Different procedures were best for different outcomes: Ligasure had shortest operating time and least blood loss, TST had quickest return of bowel function, STARR had lowest recurrence, PPH had least anal narrowing, and Ferguson had least pain after 24 hours, while other procedures performed worse on these same measures", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools many randomized trials using network meta-analysis, which is a strong method, but comparing many different surgeries indirectly across trials makes the individual comparisons less certain.", "directness": "indirect", "limitations": "The abstract does not specify how many of the hemorrhoid patients had prolapse, so findings may not apply specifically to prolapsed hemorrhoids; indirect network comparisons carry more uncertainty than direct head-to-head trials.", "followUp": "", "plainFinding": "Different surgeries best for different outcomes", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37634164/", "sourceText": "PURPOSE: This study used a network meta-analysis to evaluate the efficacy and safety of different surgical approaches in patients with hemorrhoids. METHODS: PubMed, Embase, Web of science, and Cochrane Library were searched for randomized controlled trials on patients with hemorrhoids treated by different surgical procedures. The search was conducted until January 15, 2023. Two investigators independently screened the resulting literature, extracted information, evaluated the risk of bias of the included studies, and performed a network meta-analysis. RESULT: A total of 23 randomized controlled studies were included and involved 3573 patients and 10 interventions, namely L (Ligasure), M-M (Milligan-Morgan), F (Ferguson), H (Harmonic), OH (open Harmonic), CH (closed Harmonic), PPH (procedure for prolapse and hemorrhoids), TST (tissue selecting technique), T-S (TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection). Network meta-analysis results showed that L has the shortest mean operating time and STARR has the longest mean operating time, F and H have the longest length of hospitalization and T-S has the shortest length of hospitalization, PPH has the most intraoperative blood loss and L has the least intraoperative blood loss, TST has the shortest time to first defecation and M-M has the longest time to first defecation, STARR had the least recurrence and PPH had the most recurrence, PPH had the least anal stenosis and L had the most anal stenosis, and F had the least postoperative pain after 24 h and PPH had the most postoperative pain after 24 h. CONCLUSION: Current evidence suggests that L is best at reducing mean operative time and intraoperative bleeding, T-S is best at reducing mean length of stay, TST has the shortest time to first defecation, STARR is best at reducing recurrence rates, PPH is best at reducing postoperative anal stricture, and F is best at reducing postoperative pain after 24 h.", "provenance": [ { "field": "population", "quote": "patients with hemorrhoids treated by different surgical procedures" }, { "field": "n", "quote": "involved 3573 patients and 10 interventions" }, { "field": "intervention", "quote": "L (Ligasure), M-M (Milligan-Morgan), F (Ferguson), H (Harmonic), OH (open Harmonic), CH (closed Harmonic), PPH (procedure for prolapse and hemorrhoids), TST (tissue selecting technique), T-S (TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection)" }, { "field": "comparator", "quote": "different surgical approaches in patients with hemorrhoids" }, { "field": "primaryOutcome", "quote": "L has the shortest mean operating time and STARR has the longest mean operating time, F and H have the longest length of hospitalization and T-S has the shortest length of hospitalization, PPH has the most intraoperative blood loss and L has the least intraoperative blood loss, TST has the shortest time to first defecation and M-M has the longest time to first defecation, STARR had the least recurrence and PPH had the most recurrence, PPH had the least anal stenosis and L had the most anal stenosis, and F had the least postoperative pain after 24 h and PPH had the most postoperative pain after 24 h" }, { "field": "result", "quote": "L is best at reducing mean operative time and intraoperative bleeding, T-S is best at reducing mean length of stay, TST has the shortest time to first defecation, STARR is best at reducing recurrence rates, PPH is best at reducing postoperative anal stricture, and F is best at reducing postoperative pain after 24 h" } ] }, { "id": "pmid:37620667", "pmid": "37620667", "doi": "10.1007/s00423-023-03081-2", "nctId": null, "pmcid": null, "title": "The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2023, "design": "rct", "n": 306, "nField": "reported", "population": "patients with circumferential mixed hemorrhoids", "intervention": "modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation (M-TST-CACP)", "comparator": "procedure for prolapse and hemorrhoids (PPH)", "primaryOutcome": "cure rate, recurrence, anal incontinence, and anal stenosis", "result": "M-TST-CACP had higher cure rate, lower recurrence, lower incontinence scores, and lower anal stenosis rates than PPH", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but it was conducted at a single center and only the statistical analyst was blinded.", "directness": "direct", "limitations": "single-center, statistical analyst-blinded only (not patients or surgeons)", "followUp": "12 months", "plainFinding": "Better cure, less recurrence than PPH", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37620667/", "sourceText": "PURPOSE: This study aimed to explore the efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation (M-TST-CACP) in the treatment of circumferential mixed hemorrhoids. METHODS: This was a single-center, statistical analyst-blinded, randomized controlled trial (RCT). A total of 306 patients were finally included for analysis. The efficiency (efficacy, recurrence, anal smoothness, quality of life, and wound healing time) and safety (anal incontinence, pain level, anal stenosis, urinary retention, perianal edema, and postoperative bleeding) were evaluated. The statistical difference in continuous data between M-TST-CACP group and procedure for prolapse and hemorrhoids (PPH) group was compared using t-test or Mann-Whitney U test. The statistical difference in counting data between the two groups were compared using Pearson χ2 test. Difference within each group in different time points was evaluated using repeated-measures analysis of variance. RESULTS: M-TST-CACP group showed a higher cure rate (6 months: 74.51% vs. 64.71%, P = 0.044), lower recurrence (6 months: 0% vs. 4.58%, P = 0.015; 12 months: 0.65% vs. 5.88%, P = 0.010), lower anal incontinence score (1 month: 1.29 ± 1.17 vs. 1.93 ± 1.33; 3 months: 1.07 ± 0.87 vs. 1.59 ± 1.01; 6 months: 0.58 ± 0.61 vs. 1.00 ± 0.90; all P < 0.001), and lower rate of anal stenosis (1 month: 0% vs. 7.84%; 3 months: 0% vs. 9.80%; both P < 0.001) than the PPH group. CONCLUSIONS: M-TST-CACP had better efficiency and safety than the PPH, which could be a reasonable adoption for the surgeons to treat circumferential mixed hemorrhoids.", "provenance": [ { "field": "n", "quote": "A total of 306 patients were finally included for analysis." }, { "field": "population", "quote": "circumferential mixed hemorrhoids" }, { "field": "intervention", "quote": "modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation (M-TST-CACP)" }, { "field": "comparator", "quote": "procedure for prolapse and hemorrhoids (PPH)" }, { "field": "primaryOutcome", "quote": "The efficiency (efficacy, recurrence, anal smoothness, quality of life, and wound healing time) and safety (anal incontinence, pain level, anal stenosis, urinary retention, perianal edema, and postoperative bleeding) were evaluated." }, { "field": "result", "quote": "M-TST-CACP group showed a higher cure rate (6 months: 74.51% vs. 64.71%, P = 0.044), lower recurrence (6 months: 0% vs. 4.58%, P = 0.015; 12 months: 0.65% vs. 5.88%, P = 0.010), lower anal incontinence score (1 month: 1.29 ± 1.17 vs. 1.93 ± 1.33; 3 months: 1.07 ± 0.87 vs. 1.59 ± 1.01; 6 months: 0.58 ± 0.61 vs. 1.00 ± 0.90; all P < 0.001), and lower rate of anal stenosis (1 month: 0% vs. 7.84%; 3 months: 0% vs. 9.80%; both P < 0.001) than the PPH group." } ] }, { "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": "patients with grade III prolapsed hemorrhoids (Goligher grade III)", "intervention": "hemorrhoidal artery ligation with mucopexy (dearterialization)", "comparator": "excisional hemorrhoidectomy (surgical removal)", "primaryOutcome": "symptoms, postoperative complications, and recurrence at 24 months", "result": "Artery ligation had fewer complications but significantly more recurrences than excisional hemorrhoidectomy at 24 months", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, multicenter study relying on self-reported data from different centers, which limits confidence in the comparison.", "directness": "direct", "limitations": "The retrospective design and the self-reported nature of data from different centers.", "followUp": "24-month", "plainFinding": "Fewer complications, but more recurrence.", "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": "n", "quote": "Data from 1681 patients were analyzed." }, { "field": "population", "quote": "Clinical data from patients with Goligher's grade III hemorrhoidal disease" }, { "field": "intervention", "quote": "hemorrhoidal artery ligation" }, { "field": "comparator", "quote": "excisional hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "to 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": "At the 24-month follow-up assessment, recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; p = 0.001)." }, { "field": "followUp", "quote": "24-month follow-up period" } ] }, { "id": "pmid:37601476", "pmid": "37601476", "doi": "10.1097/AS9.0000000000000296", "nctId": null, "pmcid": "PMC10431348", "title": "Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study", "firstAuthor": "Bonomo", "multipleAuthors": true, "journal": "Ann Surg Open", "year": 2023, "design": "retrospective", "n": 122, "nField": "reported", "population": "patients with grade II-III prolapsed hemorrhoids", "intervention": "Doppler-guided hemorrhoidal artery ligation (DG-HAL)", "comparator": "hemorrhoidal artery ligation without Doppler guidance (HAL)", "primaryOutcome": "recurrence of hemorrhoids and patient satisfaction", "result": "no significant difference in recurrence rate between DG-HAL and HAL, but DG-HAL took longer to perform", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized single-center comparison, so differences between groups could be due to other factors, not just the treatment.", "directness": "direct", "limitations": "Retrospective design, single center, not randomized, unequal group sizes.", "followUp": "46 months (6-86)", "plainFinding": "Doppler guidance gave no extra benefit.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37601476/", "sourceText": "BACKGROUND: Hemorrhoidal artery ligation (HAL) may reduce postoperative pain and complications and shorten patients' recovery when compared to standard hemorrhoidectomy. It is unclear if the Doppler guide (DG) is useful in reducing recurrence risk. OBJECTIVE: To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade. METHODS: Between January 1, 2014 and January 31, 2021, 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy. Mucopexy was routinely performed. After discharge, patients were subjected to 1-week, 1-, 3-, 6-, and 12-month clinical assessment. Thereafter, they were interviewed by telephone annually. RESULTS: Seventy-six (62.3%) DG-HAL and 46 (37.7%) HAL procedures were performed. Median surgical time was 30 (15-45) minutes for DG-HAL versus 25 (15-40) minutes for HAL (P = 0.005). No intraoperative complications occurred. Postoperative bleeding needing surgery occurred in 2 (1.6%) patients in the DG-HAL group. During a median follow-up of 46 months (6-86), we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574). No cases of incontinence or anal stenosis occurred. No significant difference was observed between the two groups in terms of patients' satisfaction. At multivariate analysis, age ≥ 65 years resulted a protective factor for recurrence (odds ratio 0.31; 95% confidence interval 0.09-0.98; P = 0.047). CONCLUSIONS: In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.", "provenance": [ { "field": "population", "quote": "122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy." }, { "field": "intervention", "quote": "To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade." }, { "field": "comparator", "quote": "To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade." }, { "field": "n", "quote": "122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy." }, { "field": "primaryOutcome", "quote": "To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade." }, { "field": "result", "quote": "we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574)" }, { "field": "result", "quote": "In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group." }, { "field": "followUp", "quote": "During a median follow-up of 46 months (6-86)" } ] }, { "id": "pmid:37568521", "pmid": "37568521", "doi": "10.3390/jcm12155119", "nctId": null, "pmcid": "PMC10420034", "title": "Evaluation of Clinical Manifestations of Hemorrhoidal Disease, Carried Out Surgeries and Prolapsed Anorectal Tissues: Associations with ABO Blood Groups of Patients", "firstAuthor": "Fišere", "multipleAuthors": true, "journal": "J Clin Med", "year": 2023, "design": "case-series", "n": null, "nField": "not-reported", "population": "adults with hemorrhoidal disease, mostly grade III and IV, undergoing surgery", "intervention": "surgical treatment of hemorrhoids (mostly the Longo technique)", "comparator": "blood type O patients versus patients with other ABO blood types", "primaryOutcome": "associations between ABO blood group and hemorrhoid symptoms, surgery type, and tissue changes", "result": "blood type O patients had more surgeries performed below the dentate line and different patterns of tissue damage, and males had more vascular rupture than females", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small, non-randomized observational study without a clear control group or reported number of patients, so it cannot show whether any treatment works.", "directness": "indirect", "limitations": "No exact sample size given, no comparison of treatment outcomes, and authors say future studies should include earlier-grade patients for a fuller picture.", "followUp": "", "plainFinding": "Blood type linked to tissue changes, not treatment efficacy", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37568521/", "sourceText": "Hemorrhoidal disease (HD) is a chronic multifactorial disease. Increased abdominal pressure, along with hyperperfusion, neovascularization, overexpression of inflammatory mediators, and dysbiosis, contributes to the development of HD. The deterioration of the anchoring connective tissue with reduced collagen content and altered collagen ratios, dilatation of blood vessels and thrombosis, muscle injury, and inflammation gradually lead to clinically manifesting prolapse and bleeding from hemorrhoids. The associations of the ABO blood types with a disease have been investigated for the upper gastrointestinal tract only. This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups. Clinical and various morphological methods, combined with extensive bioinformatics, were used. The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids. There were significantly more complaints reported by HD females compared to males (p = 0.0094). The Longo technique appeared mostly used, and there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%). HD males were found to present with significantly more often inflamed rectal mucosa (p < 0.05). Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types. HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165). Furthermore, 0 blood type HD males were significantly more often affected by a disease manifested with tissue hemorrhage compared to the 0 blood type HD females (p = 0.0081). Collectively, the local status of chronically injured anorectal tissue should be considered when applying surgical techniques. Future studies could include patients with HD grades I and II to gain a comprehensive understanding of the disease progression, allowing for a comparison of tissue changes at different disease stages.", "provenance": [ { "field": "population", "quote": "The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids." }, { "field": "intervention", "quote": "The Longo technique appeared mostly used" }, { "field": "comparator", "quote": "there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%)" }, { "field": "primaryOutcome", "quote": "This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients' ABO blood groups." }, { "field": "result", "quote": "Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types." }, { "field": "result", "quote": "HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165)." }, { "field": "n", "quote": "a moderately-sized cohort of equally represented males and females" } ] }, { "id": "pmid:37525828", "pmid": "37525828", "doi": "10.2147/RMHP.S407021", "nctId": null, "pmcid": "PMC10387252", "title": "Prevention and Treatment of Anastomotic Strictures After Procedure for Prolapse and Hemorrhoids", "firstAuthor": "Wei", "multipleAuthors": true, "journal": "Risk Manag Healthc Policy", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with severe prolapsed hemorrhoids or rectal mucosal prolapse", "intervention": "stapled surgery to remove and reposition prolapsed hemorrhoid tissue (PPH)", "comparator": "", "primaryOutcome": "narrowing of the surgical join (anastomotic stricture/stenosis) after PPH surgery", "result": "Review describes causes, surgical warnings, and treatments for anastomotic stenosis, a common complication of PPH surgery, without reporting quantitative outcome data", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review summarizing clinical experience and prior literature rather than new controlled data, so it cannot show whether the treatment works.", "directness": "direct", "limitations": "Abstract does not report study design details, sample size, or outcome data; it is a review based on 'experience of clinical applications' rather than a systematic analysis.", "followUp": "", "plainFinding": "Describes surgery complication, not effectiveness.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37525828/", "sourceText": "Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy, is a common method of treating hemorrhoids due to its low risk of complications and minimal postoperative pain. Several complications have appeared alongside the rise of treated cases, however, and this has led to a progressive slowing of the clinical use of PPH in recent years. Anastomotic stenosis is one of the most common complications of PPH, but the greater amount of tissue removed and the speed with which it can heal make it the best choice for patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse. Therefore, academics continue to comprehensively study PPH to take advantage of annular resection and reduce complications. In this paper, we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications.", "provenance": [ { "field": "population", "quote": "patients with severe prolapsed annular hemorrhoids or rectal mucosal prolapse" }, { "field": "intervention", "quote": "Procedure for Prolapse and Hemorrhoids (PPH), also known as circular stapled hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Anastomotic stenosis is one of the most common complications of PPH" }, { "field": "result", "quote": "we analyzed the causes, intraoperative warnings, and postoperative therapy of anastomotic stenosis induced by PPH, with an eye toward scientific application in the anorectal field, based on the experience of clinical applications" } ] }, { "id": "pmid:37458757", "pmid": "37458757", "doi": "10.1007/s00330-023-09923-3", "nctId": null, "pmcid": null, "title": "Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry", "firstAuthor": "De Gregorio", "multipleAuthors": true, "journal": "Eur Radiol", "year": 2023, "design": "registry", "n": 80, "nField": "reported", "population": "adults with bleeding hemorrhoids graded mild to moderate (Goligher grade I-III)", "intervention": "catheter-directed hemorrhoidal embolization using microcoils (with microspheres if bleeding recurred)", "comparator": "no comparison group; outcomes measured before and after treatment in the same patients", "primaryOutcome": "whether rectal bleeding stopped at 12 months", "result": "68.7% of patients had no rectal bleeding after 12 months, while 31.3% had bleeding come back, and no major complications were seen", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm registry with no comparison group, so improvement could be due to other factors rather than the procedure itself.", "directness": "indirect", "limitations": "No control group for comparison; some patients needed a second embolization or surgery; only minor complications were tracked in detail.", "followUp": "12 months", "plainFinding": "Less bleeding after embolization treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37458757/", "sourceText": "OBJECTIVES: To evaluate the safety and efficacy of catheter-directed hemorrhoidal embolization (CDHE) by microcoil embolization for rectal bleeding due to hemorrhoids classified as Goligher grade I-III. METHODS: Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively. All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study. In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred. Follow-up evaluation (1, 3, 6, and 12 months) included clinical examination and anoscopy. A questionnaire was conducted to determine improvement regarding bleeding, quality of life before, and the degree of patient satisfaction of each participant. RESULTS: Technical success was achieved in 100% of the cases. Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding. Seventeen (21.3%) patients underwent a second embolization, and four patients (5%) were treated with open hemorrhoidectomy. No major complications were observed. Sixteen participants had minor complications. Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey. Likewise, the degree of satisfaction in the telephone survey at 12 months revealed a high degree of patient satisfaction (8.3±1.1). CONCLUSIONS: The present study demonstrates that CDHE is a feasible, well-tolerated, ambulatory, anal sphincter-sparing procedure for the treatment of internal hemorrhoids. CLINICAL RELEVANCE STATEMENT: CDHE is a simple procedure, well tolerated and accepted by patients, that preserves the anal sphincter and presents few complications when metal devices or microspheres are used as embolic agents. KEY POINTS: • The technical success rate of CDHE, defined as the closure of all the SRA in their distal segment, was achieved 100% of all patients. However, a second embolization treatment was required since 21.25% of the patients experienced rectal bleeding. • Overall, CDHE's safety profile is acceptable. After the procedure and 1 year of follow-up, no significant complications were observed. • Encouraging clinical outcomes have demonstrated CDHE in individuals with hemorrhoids and mild prolapse Goligher grades I-III with persistent rectal bleeding.", "provenance": [ { "field": "n", "quote": "Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively." }, { "field": "population", "quote": "All patients had symptomatic bleeding hemorrhoids. All patients were classified according to Goligher classification: grade I (13.7%), grade II (71.1%), grade III (15%), and no grade IV were recruited in this study." }, { "field": "intervention", "quote": "microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred" }, { "field": "primaryOutcome", "quote": "Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization." }, { "field": "result", "quote": "Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization. VAS and QL improved 4 points and 1.5 respectively after embolization. A total of 25/80 (31.3%) had a recurrence in rectal bleeding." }, { "field": "comparator", "quote": "Subjective post-treatment symptom and QL surveys showed significant differences from the baseline survey." } ] }, { "id": "pmid:37451888", "pmid": "37451888", "doi": "10.1016/j.asjsur.2023.06.069", "nctId": null, "pmcid": null, "title": "Role of antibiotics in Milligan-Morgan hemorrhoidectomy for Grade III to IV Hemorrhoids: A randomized clinical trial", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2024, "design": "rct", "n": 150, "nField": "reported", "population": "patients with grade III to IV prolapsed hemorrhoids undergoing surgery", "intervention": "IV antibiotics given before or before and after hemorrhoid surgery", "comparator": "no antibiotics given around hemorrhoid surgery", "primaryOutcome": "pain scores, healing complications, and infection markers after surgery", "result": "no meaningful difference in pain, complications, or infection markers between antibiotic and no-antibiotic groups", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but relatively small and compared antibiotic use rather than hemorrhoid treatment itself.", "directness": "indirect", "limitations": "study focuses on antibiotic prophylaxis for surgery, not on comparing treatment methods for prolapsed hemorrhoids themselves", "followUp": "1 year", "plainFinding": "Antibiotics didn't improve surgery recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37451888/", "sourceText": "PURPOSE: This study was mainly to compare the safety and long-term clinical efficacy of using intravenous antibiotics in Milligan Morgan hemorrhoidectomy for Grade III to IV Prolapsing Hemorrhoids. METHODS: This was a parallel group, 3-arm, randomized clinical trial to evaluate the efficacy of intravenous prophylactic antibiotics. A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids from January 2020 to August 2022 were enrolled. Patients were randomly assigned to three groups using a computer-generated table. Group A did not receive any prophylactic antibiotic, group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation. RESULTS: There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery (p> 0.05). Compared with VAS values on the 1st day postoperatively, these values got decreased on the 3rd day and 7th day after surgery (p< 0.05). In addition, there was no significant difference among the first defecation time, wound edema, bleeding, urinary retention after surgery (p> 0.05). There was no significant difference in the outcome comparison between all 3 groups' basal and the 3rd day postoperatively no matter in WBC, NUET% or CRP (p> 0.05). However, compared with basal, the WBC, NUET%,CRP(p< 0.05) of group A and group B on the 3rd day postoperatively got rised, the rate of recurrence of hemorrhoids follow-up for 1 year was 1.4%. CONCLUSIONS: Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy.", "provenance": [ { "field": "n", "quote": "A total of 150 consecutive patients undergoing Milligan Morgan hemorrhoidectomy (MMH) in a tertiary hospital for grade III/IV hemorrhoids" }, { "field": "population", "quote": "Grade III to IV Prolapsing Hemorrhoids" }, { "field": "intervention", "quote": "group B received 2 g I/V Cefoxitin Sodium before the induction of anesthesia, and group C received 2 g I/V Cefoxitin Sodium before the induction of anesthesia and 6 h after operation" }, { "field": "comparator", "quote": "Group A did not receive any prophylactic antibiotic" }, { "field": "primaryOutcome", "quote": "There was no significant difference in measured VAS values on the 1st day,3rd day and 7th day after surgery" }, { "field": "result", "quote": "Our results suggest that there is no efficacy on intravenous prophylactic antibiotics in Milligan Morgan hemorrhoidectomy." } ] }, { "id": "pmid:37390253", "pmid": "37390253", "doi": "10.1097/MD.0000000000034062", "nctId": null, "pmcid": "PMC10313252", "title": "Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2023, "design": "retrospective", "n": 415, "nField": "reported", "population": "Patients who had stapler surgery (PPH) for hemorrhoids between 2014 and 2017", "intervention": "Building a prediction model using patient factors (like BMI, anal pressure, hemorrhoid grade) to forecast recurrence after PPH surgery", "comparator": "No treatment comparator; patients were split into a training group and a validation group to test the model", "primaryOutcome": "Risk of hemorrhoids coming back after PPH surgery", "result": "The model predicted recurrence with moderate-to-good accuracy (AUC 0.813 in training, 0.679 in validation; AUC 0.839 and 0.746 for 5-year recurrence)", "resultDirection": "unclear", "quality": "low", "qualityWhy": "It's a retrospective single-center study building a prediction tool, not testing a treatment, and its accuracy dropped notably when checked in a separate group of patients.", "directness": "indirect", "limitations": "Retrospective data collection from a single hospital, and the model performed worse in the validation group than the training group", "followUp": "", "plainFinding": "Predicts recurrence risk after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37390253/", "sourceText": "This study aimed to establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids. The clinical data of patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017 were collected retrospectively and followed up regularly after the operation. Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125). Logistic regression method was used to select meaningful predictors. The prediction model was constructed with nomographs, and the model was evaluated with correction curve, receiver operating characteristic curve and C index. The decision analysis curve was used to determine the clinical utility of the nomogram. Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram. The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate. The C index (0.737) and clinical decision curve showed that the model had high clinical practical value. The prediction model of hemorrhoid recurrence risk after hemorrhoidectomy based on multiple clinical indicators can be used for individualized prediction of hemorrhoid recurrence in patients after hemorrhoidectomy, and early intervention measures can be given to individuals with a high recurrence risk to reduce the risk of recurrence.", "provenance": [ { "field": "n", "quote": "Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125)." }, { "field": "population", "quote": "patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017" }, { "field": "intervention", "quote": "Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram." }, { "field": "comparator", "quote": "which were divided into training group (n = 290) and verification group (n = 125)" }, { "field": "primaryOutcome", "quote": "establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids" }, { "field": "result", "quote": "The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate." } ] }, { "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": "adults with prolapsed internal hemorrhoids involving at least 3 columns", "intervention": "transanal hemorrhoidal dearterialization (THD) with mucopexy", "comparator": "Ferguson hemorrhoidectomy", "primaryOutcome": "rate of hemorrhoids coming back (recurrence)", "result": "recurrence rates were similar between the two procedures, but THD caused less pain and higher early satisfaction", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it's a fairly large multicenter study with long follow-up, but surgeons chose which operation to perform rather than patients being randomly assigned, so the groups may not be fully comparable.", "directness": "direct", "limitations": "not randomized — each surgeon performed only the operation they were most experienced in, which could bias results", "followUp": "Median follow-up was 3.1 (1.0-5.5) years", "plainFinding": "Less pain, similar recurrence rates.", "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)" }, { "field": "followUp", "quote": "Median follow-up was 3.1 (1.0-5.5) years." } ] }, { "id": "pmid:37257493", "pmid": "37257493", "doi": "10.1177/00031348231180925", "nctId": null, "pmcid": null, "title": "Prevention of Rectal Stenosis After Procedure for Prolapse and Hemorrhoids by Anastomotic Thread-Drawing and Anal Enlargement", "firstAuthor": "Wei", "multipleAuthors": true, "journal": "Am Surg", "year": 2023, "design": "rct", "n": 400, "nField": "reported", "population": "adults with severe mixed hemorrhoids needing surgery", "intervention": "thread-drawing during surgery plus anal enlargement after PPH (procedure for prolapse and hemorrhoids)", "comparator": "PPH alone, or PPH with only thread-drawing, or PPH with only anal enlargement", "primaryOutcome": "rate of rectal narrowing (stenosis) after surgery", "result": "no rectal stenosis in the group getting both thread-drawing and anal enlargement, versus 11%, 7%, and 14% stenosis in the other three groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was randomized but the abstract gives no detail on randomization method, blinding, or how patients were allocated, and it appears to be a single-center trial.", "directness": "direct", "limitations": "no information given on randomization process, blinding, or loss to follow-up", "followUp": "1-3 years", "plainFinding": "Fewer anal strictures after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37257493/", "sourceText": "PURPOSE: to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. METHODS: A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years. RESULTS: The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C. CONCLUSION: Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.", "provenance": [ { "field": "population", "quote": "400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022" }, { "field": "intervention", "quote": "Thread-drawing during operation and anal enlargement after PPH" }, { "field": "comparator", "quote": "Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone" }, { "field": "primaryOutcome", "quote": "to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH)" }, { "field": "result", "quote": "There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C." }, { "field": "n", "quote": "A total of 400 patients with severe mixed hemorrhoids" }, { "field": "followUp", "quote": "followed up for 1-3 years" } ] }, { "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": "endoscopic rubber band ligation of hemorrhoids alone", "comparator": "combined ligation of hemorrhoids and nearby normal tissue", "primaryOutcome": "overall treatment success rate (complete or partial symptom resolution)", "result": "no significant difference in success rate between the two methods, but the combined method caused more pain afterward", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, open-label (not blinded), and some patients were lost to follow-up.", "directness": "indirect", "limitations": "open-label design, moderate sample size, and some patients did not complete the 12-month follow-up", "followUp": "12 months", "plainFinding": "Similar relief, more pain with combined method", "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": "population", "quote": "Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned" }, { "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": "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": "followUp", "quote": "Patients were followed up at 3, 6, and 12 months" } ] }, { "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": "people with hemorrhoids", "intervention": "rubber band ligation", "comparator": "coagulation treatment", "primaryOutcome": "treatment success, prolapse recurrence, bleeding, pain, and urine retention after treatment", "result": "no difference in efficacy, prolapse, or recurrence, but rubber band ligation caused more pain and less bleeding than coagulation", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Only nine trials of moderate quality were pooled, so the comparison carries limited certainty.", "directness": "direct", "limitations": "All trials were of moderate methodological quality.", "followUp": "", "plainFinding": "Similar success, but more pain with banding.", "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": "randomised clinical trials that 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 after treatment" }, { "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 hemorrhoid disease", "intervention": "various treatments and new drug molecules for hemorrhoids", "comparator": "", "primaryOutcome": "safety and effectiveness of hemorrhoid treatments", "result": "review summarizes developments but does not report a specific outcome result", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general narrative review without original data, trial numbers, or outcome statistics.", "directness": "indirect", "limitations": "No original study data, no patient numbers, no specific results reported; broad literature summary only.", "followUp": "", "plainFinding": "No specific findings 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 that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue." }, { "field": "intervention", "quote": "To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids." }, { "field": "primaryOutcome", "quote": "To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids." }, { "field": "result", "quote": "This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past." } ] }, { "id": "pmid:37077863", "pmid": "37077863", "doi": "10.3389/fsurg.2023.1132277", "nctId": null, "pmcid": "PMC10106721", "title": "Analgesic effect of subcutaneous injection of different concentrations of methylene blue after hemorrhoidectomy: A retrospective study", "firstAuthor": "Long", "multipleAuthors": true, "journal": "Front Surg", "year": 2023, "design": "retrospective", "n": 180, "nField": "reported", "population": "patients with grade III or IV hemorrhoids having hemorrhoid removal surgery", "intervention": "injection of methylene blue (0.1% or 0.2%) under the skin after hemorrhoid surgery", "comparator": "no methylene blue injection after hemorrhoid surgery", "primaryOutcome": "pain scores and amount of pain medicine needed over 14 days after surgery", "result": "both methylene blue concentrations reduced pain and pain medicine use compared with no injection, with no difference between the two concentrations, but the higher concentration caused more temporary incontinence symptoms at one month", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective study with patients sorted into non-randomized groups, which makes it easier for other differences to explain the results.", "directness": "indirect", "limitations": "retrospective design, not randomized, groups assigned by surgeon choice rather than random allocation", "followUp": "14 days for pain, 1 and 3 months for incontinence scores", "plainFinding": "Less pain, but higher dose less safe", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37077863/", "sourceText": "OBJECTIVE: Subcutaneous injection of methylene blue around the anus may help reduce postoperative pain. However, the concentration of methylene blue is still controversial. Therefore, Our study aims to investigate the efficacy and safety of different methylene blue injected concentrations subcutaneously in pain treatment after hemorrhoidectomy. METHODS: A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed. All patients underwent hemorrhoidectomy under spinal anesthesia and were divided into three groups. Group A received subcutaneous injection of 0.1% methylene blue after hemorrhoidectomy, group B received subcutaneous injection of 0.2% methylene blue, and Group C did not received subcutaneous injection of methylene blue. The primary outcome measures were the visual analog scale (VAS) pain score on postoperative days 1, 2, 3, 7, 14, and total analgesic consumption within 14 days. Secondary outcomes were complications after hemorrhoidectomy, including acute urinary retention, secondary bleeding, perianal incision edema, and perianal skin infection, and the Wexner scores used to assess the level of anal incontinence at one and three months after surgery. RESULTS: There was no significant difference among three groups in sex, age, course of the disease, hemorrhoid grade and the number of incisions, and there was no significant difference in the volume of methylene blue injected between group A and group B. The VAS pain score and total analgesics consumption within 14 days in group A and group B were significantly lower than those in group C, but the differences between group A and group B were not statistically significant. The Wexner scores of group B were significantly higher than those of group A and group C one month after the operation, but the differences between group A and group C were not statistically significant. In addition, the Wexner score among three groups decreased to zero at three months after operation. There was no significant difference in the incidence of other complications among three groups. CONCLUSION: The perianal injection of 0.1% methylene blue and 0.2% methylene blue have a similar analgesic effect in pain treatment after hemorrhoidectomy, but 0.1% methylene blue has higher safety.", "provenance": [ { "field": "population", "quote": "A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed." }, { "field": "intervention", "quote": "Group A received subcutaneous injection of 0.1% methylene blue after hemorrhoidectomy, group B received subcutaneous injection of 0.2% methylene blue" }, { "field": "comparator", "quote": "Group C did not received subcutaneous injection of methylene blue." }, { "field": "primaryOutcome", "quote": "The primary outcome measures were the visual analog scale (VAS) pain score on postoperative days 1, 2, 3, 7, 14, and total analgesic consumption within 14 days." }, { "field": "result", "quote": "The VAS pain score and total analgesics consumption within 14 days in group A and group B were significantly lower than those in group C, but the differences between group A and group B were not statistically significant." }, { "field": "result", "quote": "The Wexner scores of group B were significantly higher than those of group A and group C one month after the operation" }, { "field": "n", "quote": "A total of 180 consecutive patients with grade III or IV hemorrhoids from March 2020 to December 2021 were reviewed." } ] }, { "id": "pmid:37077600", "pmid": "37077600", "doi": "10.7759/cureus.36304", "nctId": null, "pmcid": "PMC10108892", "title": "A Prospective Study Comparing Stapler and Open Surgical Technique of Hemorrhoidectomy", "firstAuthor": "Kumar", "multipleAuthors": true, "journal": "Cureus", "year": 2023, "design": "prospective-cohort", "n": 60, "nField": "reported", "population": "patients with grade III and IV hemorrhoids", "intervention": "stapled hemorrhoidectomy surgery", "comparator": "open hemorrhoidectomy surgery", "primaryOutcome": "postoperative pain, operating time, hospital stay, complications, and recurrence", "result": "stapler hemorrhoidectomy had shorter operating time and hospital stay, less postoperative pain, and no recurrence at three months compared to open hemorrhoidectomy which had 10% recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small non-randomized prospective study of only 60 patients from a single center, so the results may not be reliable for all patients.", "directness": "direct", "limitations": "Not described as randomized; small sample size of 60 patients from a single institution.", "followUp": "three months", "plainFinding": "Stapler surgery: less pain, faster recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37077600/", "sourceText": "Introduction Hemorrhoids are basically anal cushions which turn out to be pathological giving rise to bleeding, pain and protrusion outside the anal canal. The chief complaint of patients with hemorrhoids is bleeding from the rectum which is usually painless and associated with episodes of defecation. The study was done to assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence between the stapler and open hemorrhoidectomy for grade III and IV hemorrhoids. Material and methods The present prospective study was conducted among 60 patients in the General Surgery department at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar over the duration of two years presenting with grade III and IV degree hemorrhoids. Thirty patients each were divided into open hemorrhoidectomy and stapled hemorrhoidectomy groups. The study evaluated variables like operative time, stay at the hospital and postoperative complications and compared them between the two techniques. Follow-up of patients was done at regular intervals. Evaluation of postoperative pain was done using visual analogue scale (VAS) with ranges from 0 to 10. We evaluated the data using the chi-square test with a p-value <0.05 as significant. Results Of 60 patients, 47 (78.3%) were males and 13 (21.7%) were females with a male: female ratio being 3.6:1. The operating time and hospital stay were much less in the stapler hemorrhoidectomy group as compared to the open procedure group. Also, postoperative pain (visual analogue scale) was less in the stapler hemorrhoidectomy group with 36.7% of patients presenting with pain at one week, 23.3% at one month and 3.3% at three months in the open hemorrhoidectomy group whereas 13.3% presenting as pain in one week, 10% presenting at one month and none presenting at three months in the stapler hemorrhoidectomy group. There was recurrence seen in 10% of cases at three months in the open hemorrhoidectomy group as compared to the stapler hemorrhoidectomy group where no recurrence was found at three months follow-up. Conclusion Hemorrhoid offers a variety of surgical modalities of treatment. We have come to the conclusion that stapled hemorrhoidectomy has less complications and good patient compliance. It can be an effective option in the treatment of third and fourth-grade hemorrhoids. With proper training and expertise, stapler hemorrhoidectomy is a better and reliable technique for hemorrhoid surgery.", "provenance": [ { "field": "population", "quote": "The present prospective study was conducted among 60 patients in the General Surgery department at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar over the duration of two years presenting with grade III and IV degree hemorrhoids." }, { "field": "intervention", "quote": "stapled hemorrhoidectomy" }, { "field": "comparator", "quote": "open hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The study was done to assess postoperative pain, time duration of the procedure, complications in the postoperative period, return to normal work, and recurrence between the stapler and open hemorrhoidectomy for grade III and IV hemorrhoids." }, { "field": "result", "quote": "The operating time and hospital stay were much less in the stapler hemorrhoidectomy group as compared to the open procedure group." }, { "field": "result", "quote": "There was recurrence seen in 10% of cases at three months in the open hemorrhoidectomy group as compared to the stapler hemorrhoidectomy group where no recurrence was found at three months follow-up." }, { "field": "n", "quote": "The present prospective study was conducted among 60 patients" } ] }, { "id": "pmid:37074488", "pmid": "37074488", "doi": "10.1007/s00384-023-04403-y", "nctId": null, "pmcid": "PMC10115677", "title": "Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial", "firstAuthor": "Shen", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2023, "design": "rct", "n": 124, "nField": "reported", "population": "patients with mixed hemorrhoids having PPH surgery (stapled hemorrhoidopexy)", "intervention": "electroacupuncture at the Baliao point added to PPH surgery", "comparator": "PPH surgery alone", "primaryOutcome": "pain and anal swelling after surgery", "result": "lower pain and swelling scores, fewer painkillers needed, and less urinary retention with electroacupuncture", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but only looks at short-term pain-related outcomes after one surgical technique, with no mention of blinding.", "directness": "indirect", "limitations": "abstract does not mention blinding, and outcomes are limited to short-term pain, swelling, and urinary symptoms rather than hemorrhoid cure or recurrence", "followUp": "72 h", "plainFinding": "Less post-surgery pain with acupuncture.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37074488/", "sourceText": "PURPOSE: The purpose of this study was to explore the effect of electroacupuncture (EA) at Baliao point on short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH) in patients with mixed hemorrhoids. METHODS: A total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57), with patients in the control group receiving only PPH surgery and patients in the EA group receiving PPH surgery and EA at Baliao point. RESULTS: The visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group. The anal distension scores at 8, 48, and 72 h after operation were also significantly lower than those of control group. The number of postoperative analgesic drug administration per patient was also significantly lower in the EA group. The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery. CONCLUSION: EA treatment at the Baliao point can alleviate short-term anal pain and anal swelling after the procedure for prolapse and hemorrhoids, reduce the incidence of urinary retention, and decrease the use of postoperative analgesic drugs. TRIAL REGISTRATION: This study was approved and registered by the Chinese Clinical Trial Center, Registration number: ChiCTR2100043519, Registration time: February 21, 2021 ( https://www.chictr.org.cn/ ).", "provenance": [ { "field": "population", "quote": "patients with mixed hemorrhoids" }, { "field": "intervention", "quote": "patients in the EA group receiving PPH surgery and EA at Baliao point" }, { "field": "comparator", "quote": "patients in the control group receiving only PPH surgery" }, { "field": "primaryOutcome", "quote": "short-term complications, such as anal pain and swelling, after procedure for prolapse and hemorrhoids (PPH)" }, { "field": "result", "quote": "The visual analogue scale (VAS) scores of EA group at 8, 24, 48, and 72 h after operation were significantly lower than those of control group." }, { "field": "result", "quote": "The incidence of urinary retention and tenesmus in EA group was significantly lower than that in control group within the first day after surgery." }, { "field": "n", "quote": "A total of 124 eligible patients undergoing PPH surgery were included in this study and randomly divided into a control group (n = 67) and an EA group (n = 57)" }, { "field": "followUp", "quote": "at 8, 24, 48, and 72 h after operation" } ] }, { "id": "pmid:37064065", "pmid": "37064065", "doi": "10.1093/jscr/rjad177", "nctId": null, "pmcid": "PMC10097556", "title": "Extensive subcutaneous emphysema and intra-abdominal sepsis following haemorrhoid operation: a rare complication of a novel procedure", "firstAuthor": "Turco", "multipleAuthors": true, "journal": "J Surg Case Rep", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "71-year-old woman with grade III/IV haemorrhoids", "intervention": "Doppler-guided haemorrhoid artery ligation and recto anal repair (HAL-RAR) surgery", "comparator": "", "primaryOutcome": "", "result": "developed rectal perforation, severe infection and sepsis requiring emergency surgery and colostomy", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "single patient case report, so it cannot show how often this happens or how the treatment generally performs", "directness": "direct", "limitations": "only one patient described, no comparison group, cannot estimate how common this complication is", "followUp": "", "plainFinding": "Serious bowel injury after this procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37064065/", "sourceText": "Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III and IV haemorrhoids. A 71-year-old female presented with sepsis, abdominal distension and extensive subcutaneous emphysema and was found to have intra- and extraperitoneal rectal perforation requiring repair, laparoscopy and sigmoid colostomy. Suture ligation of the haemorrhoidal artery can inadvertently be above the peritoneal reflection and result in full thickness rectal perforation secondary to ischaemic necrosis. Previous vaginal prolapse mesh repair should be considered as a relative contraindication to HAL-RAR as it can significantly distort the anatomy.", "provenance": [ { "field": "population", "quote": "A 71-year-old female presented with sepsis, abdominal distension and extensive subcutaneous emphysema" }, { "field": "intervention", "quote": "Doppler-guided haemorrhoidal artery ligation and recto anal repair (HAL-RAR) procedure is a relatively new, minimally invasive procedure for the treatment of Grades III and IV haemorrhoids." }, { "field": "result", "quote": "found to have intra- and extraperitoneal rectal perforation requiring repair, laparoscopy and sigmoid colostomy" }, { "field": "n", "quote": "A 71-year-old female presented with sepsis" } ] }, { "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": "prospective-cohort", "n": 120, "nField": "reported", "population": "patients with internal hemorrhoids (grades I-III)", "intervention": "endoscopic rubber band ligation with multiple bands per session", "comparator": "fewer bands vs more bands, and grade II vs grade III hemorrhoids", "primaryOutcome": "no hemorrhoid symptoms 6 weeks after treatment", "result": "78.8% had no symptoms at 6 weeks; grade II did better than grade III (87.8% vs 69.2%); recurrence was lower with more bands for grade III hemorrhoids", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was not a randomized trial, so differences between band numbers or grades could be due to other factors, not just the treatment itself.", "directness": "direct", "limitations": "No control group or randomization described; recurrence varied by severity grade and band number without controlling for other factors.", "followUp": "14.3 ± 7.9 (1.3-30.9) months", "plainFinding": "More bands helped shrink worse hemorrhoids.", "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": "Patients with IH were treated with ERBL." }, { "field": "intervention", "quote": "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)." }, { "field": "comparator", "quote": "grade II hemorrhoids required significantly fewer bands than grade III hemorrhoids (3.45 ± 0.85 vs 4.35 ± 1.06, P = 0.000)" }, { "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": "result", "quote": "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%)." }, { "field": "followUp", "quote": "The median follow-up time was 14.3 ± 7.9 (1.3-30.9) months." } ] }, { "id": "pmid:37056735", "pmid": "37056735", "doi": "10.3389/fmed.2023.1156328", "nctId": null, "pmcid": "PMC10086184", "title": "Multiple thread ligations versus stapled hemorrhoidopexy on operative outcomes of grade III hemorrhoids: A retrospective cohort study", "firstAuthor": "Zhou", "multipleAuthors": true, "journal": "Front Med (Lausanne)", "year": 2023, "design": "retrospective", "n": 230, "nField": "reported", "population": "patients with grade III hemorrhoids (prolapsed hemorrhoids)", "intervention": "multiple thread ligations (MTL) surgery", "comparator": "stapled hemorrhoidopexy (SH) surgery", "primaryOutcome": "prolapse coming back within 6 months", "result": "similar recurrence rates between the two surgeries, but MTL was faster and had less bleeding risk", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized comparison of two surgeries, so differences could be due to other factors rather than the treatment itself.", "directness": "direct", "limitations": "retrospective cohort design with propensity score matching rather than randomization; only univariate analysis used for the bleeding difference", "followUp": "6 months", "plainFinding": "Similar recurrence; faster surgery, less bleeding with MTL.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37056735/", "sourceText": "OBJECT: Controversy remains regarding the safety and efficacy of hemorrhoid ligation and stapled hemorrhoidopexy (SH) in the treatment of hemorrhoids. The study was to explore the operative outcomes of patients underwent multiple thread ligations (MTL) with SH for the management of grade III hemorrhoids. METHODS: This cohort study included patients who underwent MTL (MTL group, 128 cases) or SH (SH group, 141 cases) for grade III hemorrhoids between June 2019 and May 2021. A total of 115 patients in MTL group and 115 patients in SH group were finally included by propensity score matching with a ratio of 1:1. The primary outcome was the recurrence of prolapse within 6 months. Secondary outcomes were operative time, post-operative pain scores, hospital stay, the incidence of complications, Wexner incontinence score, and quality of life of patients with constipation at 6 months post procedure. RESULTS: Multiple thread ligations and SH resulted in comparable recurrence within 6 months of follow-up, with five and seven cases of recurrence, respectively, (P = 0.352). The two groups had comparable outcomes in terms of post-operative pain, hospital stay, Wexner incontinence scores, and constipation-related quality of life (all P > 0.05). The median operative time was 16 min (15-18 min) in the MTL group versus 25 min (16-33 min) in the SH group (P < 0.01). Univariate analysis showed that the MTL technique had a lower risk of postoperative bleeding than that with the SH technique (P < 0.05). CONCLUSION: The study indicated that the MTL technique might achieve comparable operative outcomes compared with the SH technique for the management of grade III hemorrhoids, nevertheless, MTL seemed to be associated with less risk of surgical bleeding than SH.", "provenance": [ { "field": "n", "quote": "A total of 115 patients in MTL group and 115 patients in SH group were finally included by propensity score matching with a ratio of 1:1." }, { "field": "population", "quote": "grade III hemorrhoids" }, { "field": "intervention", "quote": "multiple thread ligations (MTL)" }, { "field": "comparator", "quote": "stapled hemorrhoidopexy (SH)" }, { "field": "primaryOutcome", "quote": "The primary outcome was the recurrence of prolapse within 6 months." }, { "field": "result", "quote": "Multiple thread ligations and SH resulted in comparable recurrence within 6 months of follow-up, with five and seven cases of recurrence, respectively, (P = 0.352)." }, { "field": "result", "quote": "Univariate analysis showed that the MTL technique had a lower risk of postoperative bleeding than that with the SH technique (P < 0.05)." }, { "field": "followUp", "quote": "recurrence of prolapse within 6 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 hemorrhoid disease", "intervention": "Laser hemorrhoidoplasty (LHP) using a 1470-nm diode laser", "comparator": "Conventional Milligan-Morgan excisional hemorrhoidectomy (MM)", "primaryOutcome": "Postoperative pain, wound care, and recurrence of hemorrhoid symptoms", "result": "LHP caused less pain and easier wound care but had a higher rate of symptom recurrence (21.6% vs 8.1%) compared to MM", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, which makes it easier for bias to affect the results.", "directness": "direct", "limitations": "Retrospective design without randomization; authors call for larger comparative studies", "followUp": "25 ± 8 months", "plainFinding": "Less pain, but higher 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": "population", "quote": "grade III symptomatic HD patients" }, { "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": "n", "quote": "93 patients received conventional Milligan Morgan as control group and 81 patients received laser hemorrhoidoplasty treatment" }, { "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": "case-series", "n": 129, "nField": "reported", "population": "adults with grade II-III hemorrhoids (prolapsing and bleeding types)", "intervention": "radiofrequency ablation (Rafaelo device) of hemorrhoids", "comparator": "none; outcomes compared to patients' own baseline before treatment", "primaryOutcome": "quality-of-life score specific to hemorrhoid disease (HEMO-FISS-QoL) at 3 months", "result": "quality-of-life score dropped sharply and symptoms such as bleeding and prolapse were much less common at 3 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison group, so it can't rule out that patients would have improved anyway.", "directness": "indirect", "limitations": "No control group; some patients needed repeat surgery or had complications; follow-up for symptom comparisons mainly limited to 3 months despite 1-year study aim.", "followUp": "1 year's follow-up", "plainFinding": "Less prolapse, bleeding, 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": "comparator", "quote": "Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months." }, { "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": "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" }, { "field": "n", "quote": "A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres." }, { "field": "followUp", "quote": "with 1 year's follow-up" } ] }, { "id": "pmid:36899291", "pmid": "36899291", "doi": "10.1007/s13304-023-01490-y", "nctId": null, "pmcid": "PMC10042767", "title": "Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment", "firstAuthor": "Mascagni", "multipleAuthors": true, "journal": "Updates Surg", "year": 2023, "design": "case-series", "n": 14, "nField": "reported", "population": "patients who developed perirectal hematoma after stapled surgery for hemorrhoidal prolapse or obstructed defecation", "intervention": "conservative treatment (antibiotics, monitoring) or angiographic embolization for the hematoma", "comparator": "no comparator; described treatment algorithm for different severity hematomas", "primaryOutcome": "whether the hematoma resolved without needing major abdominal surgery", "result": "most hematomas resolved with conservative care and self-drainage; the few progressive ones were treated with embolization, and no patient needed major surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, retrospective case series of a rare complication, not a controlled comparison of treatments for prolapse itself.", "directness": "indirect", "limitations": "retrospective design, very small number of cases (14 out of 3058), no control group, and it studies a surgical complication rather than hemorrhoid prolapse treatment directly.", "followUp": "", "plainFinding": "Complication usually resolved without major surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36899291/", "sourceText": "Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs. A retrospective analysis of a prospective database of three high-volume proctology units was performed between 2008 and 2018, and all PH cases were analyzed. In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse. Among these, 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring); most of them were resolved with spontaneous drainage. Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization. This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications.", "provenance": [ { "field": "n", "quote": "3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse" }, { "field": "n", "quote": "14 (0.46%) large PH cases were reported" }, { "field": "population", "quote": "Perirectal hematoma (PH) is one of the most feared complications of stapling procedures" }, { "field": "intervention", "quote": "12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring)" }, { "field": "intervention", "quote": "Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization" }, { "field": "comparator", "quote": "The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs" }, { "field": "primaryOutcome", "quote": "This approach helped ensure that no patients with PH were referred for major abdominal surgery" }, { "field": "result", "quote": "Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications." } ] }, { "id": "pmid:36881287", "pmid": "36881287", "doi": "10.1007/s13304-023-01480-0", "nctId": null, "pmcid": null, "title": "Laser hemorrhoidoplasty for II-IV grade hemorrhoids: should we treat them the same?", "firstAuthor": "Ram", "multipleAuthors": true, "journal": "Updates Surg", "year": 2023, "design": "retrospective", "n": 162, "nField": "reported", "population": "patients with grade II to IV hemorrhoids", "intervention": "laser hemorrhoidoplasty surgery", "comparator": "comparison between hemorrhoid grades (II, III, IV) rather than a separate control treatment", "primaryOutcome": "symptom relief and post-operative complications after surgery", "result": "most patients had symptom relief, but grade IV hemorrhoids had much higher rates of bleeding, readmission, and reoperation", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective analysis without a comparison group receiving different treatment, so it cannot prove the surgery caused the outcomes.", "directness": "direct", "limitations": "Retrospective analysis of a prospective database; no control group treated with another method.", "followUp": "", "plainFinding": "Effective but riskier for grade IV.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36881287/", "sourceText": "Laser Hemorrhoidoplasty (LHP) is a novel therapeutic option for hemorrhoids. In this study, we aimed to evaluate the post-operative outcomes of patients undergoing LHP surgery based on hemorrhoid grade. A retrospective analysis of a prospective database of all patients who underwent LHP surgery between September 2018 and October 2021 was performed. Patients' demographics, clinical perioperative data, and post-operative outcomes were recorded and analyzed. One hundred and sixty two patients that underwent laser hemorrhoidoplasty (LHP) were included. Median operative time was 18 min (range 8-38). Median total energy applied was 850 Joule (450-1242). Complete remission of symptoms following surgery was reported by 134 patients (82.7%), while 21 patients (13%) reported partial symptomatic relief. Nineteen patients (11.7%) presented with post-operative complications, and 11 patients (6.75%) were re-admitted following surgery. Post-operative complication rate was significantly higher in patients with grade 4 hemorrhoids compared to grades 3 or 2, due to a higher rate of post-operative bleeding (31.6% vs. 6.5% and 6.7%, respectively; p = 0.004). Furthermore, post-operative readmission rate (26.3% vs. 5.4% and 6.2%; p = 0.01) and reoperation rate were also significantly higher in grade IV hemorrhoids (21.1% vs. 2.2% and 0%; p = 0.001). Multivariate analysis found that grade IV hemorrhoids had a significantly higher risk for post-operative bleeding (OR 6.98, 95% CI 1.68-28.7; p = 0.006), 30-day readmission (OR 5.82, 95% CI 1.27-25.1; p = 0.018), and hemorrhoids recurrence (OR 11.4, 95% CI 1.18-116; p = 0.028). LHP is an effective treatment for hemorrhoids grades II-IV, but carries significant risk for bleeding and re-intervention in patients with grade IV hemorrhoids.", "provenance": [ { "field": "n", "quote": "One hundred and sixty two patients that underwent laser hemorrhoidoplasty (LHP) were included." }, { "field": "population", "quote": "patients undergoing LHP surgery based on hemorrhoid grade" }, { "field": "intervention", "quote": "Laser Hemorrhoidoplasty (LHP) is a novel therapeutic option for hemorrhoids." }, { "field": "comparator", "quote": "Post-operative complication rate was significantly higher in patients with grade 4 hemorrhoids compared to grades 3 or 2" }, { "field": "primaryOutcome", "quote": "Complete remission of symptoms following surgery was reported by 134 patients (82.7%), while 21 patients (13%) reported partial symptomatic relief." }, { "field": "result", "quote": "LHP is an effective treatment for hemorrhoids grades II-IV, but carries significant risk for bleeding and re-intervention in patients with grade IV hemorrhoids." } ] }, { "id": "pmid:36829253", "pmid": "36829253", "doi": "10.1186/s13063-023-07175-6", "nctId": null, "pmcid": "PMC9951398", "title": "Modified ultrasound scalpel haemorrhoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial", "firstAuthor": "Yu", "multipleAuthors": true, "journal": "Trials", "year": 2023, "design": "registered-trial-no-results", "n": 78, "nField": "reported", "population": "adults with mixed hemorrhoids requiring surgery", "intervention": "modified ultrasonic scalpel hemorrhoidectomy", "comparator": "Milligan-Morgan (conventional) hemorrhoidectomy", "primaryOutcome": "healing time, return to normal activity, complications, anal function, quality of life, and patient satisfaction", "result": "Study protocol only; no outcome results reported yet", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a trial protocol describing planned methods, so no outcome data are yet available to judge effectiveness.", "directness": "indirect", "limitations": "Only patients will be blinded (not researchers), and the planned sample size is small.", "followUp": "6 months", "plainFinding": "No results yet reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36829253/", "sourceText": "BACKGROUND: Haemorrhoids are common and frequently occurring diseases in the clinical setting, and severe haemorrhoids require surgical treatment. There are various surgical methods to treat haemorrhoids, but each has advantages and disadvantages. In recent years, ultrasonic scalpels have been used in haemorrhoid surgery and have achieved good results. Ultrasonic scalpel haemorrhoidectomy is safer and more effective in the surgical treatment of grade III and IV haemorrhoids, with less intraoperative bleeding, less postoperative pain, and fewer complications than diathermic therapy, electrosurgical haemorrhoidectomy, PROXIMATE® PPH haemorrhoidal circular stapler haemorrhoidopexy (PPH), and traditional haemorrhoidectomy. In previous reports, the majority of ultrasonic scalpel haemorrhoidectomies were performed as open procedures, with only the body of the haemorrhoid removed with the ultrasonic scalpel and the wound left open for drainage and natural healing. However, we performed a preliminary experiment with 12 patients who underwent open ultrasonic scalpel haemorrhoidectomy in the early stage. The results showed that 8 patients had different degrees of postoperative bleeding, and 4 of them required a second haemostatic surgery under anaesthesia. Therefore, we modified the open ultrasonic scalpel haemorrhoidectomy procedure by removing the mucosa of the internal haemorrhoid and closing the base of the incision with figure-eight penetrating sutures and designed this study protocol to evaluate its clinical efficacy and safety. METHODS: A randomised single-blind parallel-controlled trial is proposed for this project, and patients who meet the inclusion criteria will be divided into a test group and a control group, with 39 patients in each group. The experimental group will be treated with modified ultrasonic scalpel haemorrhoidectomy, and the control group will be treated with the Milligan-Morgan operation. The effectiveness of modified ultrasonic scalpel haemorrhoidectomy for haemorrhoids will be objectively evaluated, including the incision healing time and the time for patients to return to normal activities, postoperative complications, evaluations of anal function 3 months and 6 months after surgery, an evaluation of quality of life 6 months after surgery, and an evaluation of the patient satisfaction rate 6 months after surgery. The safety assessment will consider all adverse and serious adverse events associated with the study treatment. DISCUSSION: The study was approved by the ethics committee. The first patient was registered on July 1 2021. The purpose of this trial will be to evaluate the clinical efficacy and safety of the modified ultrasonic scalpel haemorrhoidectomy procedure for the treatment of mixed haemorrhoids and to provide an evidence base for the clinical promotion and application of the procedure. A limitation of this study is that only the patients will be single-blinded because the researchers and the patients cannot be blinded at the same time, which may produce certain bias in the results. In addition, the sample size of this study will be small, and the test results will only represent the findings from this clinical trial. In later stages, the sample size needs to be further expanded to improve the level of evidence. Despite its limitations, we hope the present study will help provide a more optimised surgical approach in the selection of haemorrhoid surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry (Registration ID: ChiCTR2100047229). Registered on June 11, 2021.", "provenance": [ { "field": "n", "quote": "with 39 patients in each group" }, { "field": "population", "quote": "treatment of mixed haemorrhoids" }, { "field": "intervention", "quote": "The experimental group will be treated with modified ultrasonic scalpel haemorrhoidectomy" }, { "field": "comparator", "quote": "the control group will be treated with the Milligan-Morgan operation" }, { "field": "primaryOutcome", "quote": "including the incision healing time and the time for patients to return to normal activities, postoperative complications, evaluations of anal function 3 months and 6 months after surgery, an evaluation of quality of life 6 months after surgery, and an evaluation of the patient satisfaction rate 6 months after surgery" }, { "field": "result", "quote": "The purpose of this trial will be to evaluate the clinical efficacy and safety of the modified ultrasonic scalpel haemorrhoidectomy procedure" }, { "field": "followUp", "quote": "an evaluation of quality of life 6 months after surgery" } ] }, { "id": "pmid:36819323", "pmid": "36819323", "doi": "10.7759/cureus.33873", "nctId": null, "pmcid": "PMC9933788", "title": "The Effect of High Altitude on Short-Term Outcomes of Post-hemorrhoidectomy", "firstAuthor": "Al-Sawat", "multipleAuthors": true, "journal": "Cureus", "year": 2023, "design": "retrospective", "n": 135, "nField": "reported", "population": "patients who had hemorrhoid removal surgery in Saudi Arabia, living at either high or low altitude", "intervention": "living in a high-altitude region (Taif) after hemorrhoidectomy", "comparator": "living in a sea-level/low-altitude region (Jeddah) after hemorrhoidectomy", "primaryOutcome": "recovery time, pain, and complications after hemorrhoid surgery", "result": "low-altitude patients returned to normal activity sooner and had less pain on day 7, while high-altitude patients had more urinary retention", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective study comparing locations, not treatments, so it cannot directly show how to treat a prolapsed hemorrhoid.", "directness": "indirect", "limitations": "retrospective design using patient files, comparing geographic regions rather than treatment methods", "followUp": "Day 7", "plainFinding": "Altitude affected recovery, not treatment choice.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36819323/", "sourceText": "Background Hemorrhoids are caused by the distal displacement of the hemorrhoidal cushions and venous distention. Hemorrhoidal illness is still a prevalent issue. Hemorrhoidal symptoms affect 5% of the general population and 50% of people over the age of 50. Surgical therapy ensures satisfactory results that are much better than those obtained with conservative treatments, particularly for grade III and IV hemorrhoids. Objectives This study aims to compare postoperative complications of hemorrhoidectomy among patients who live in a high-altitude region (Taif) and a sea-level (low-altitude level) region (Jeddah). Methods This retrospective study was conducted among patients who underwent hemorrhoidectomy between January 2019 and January 2022 in Taif and Jeddah, Saudi Arabia. Simple random sampling was used to select the study population, and data were collected from patient files. Data analysis was conducted using IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, NY). Results A total of 135 patients were included in this study. Most of our patients were males (73.3%). Patients from Jeddah represented more than half of the study population, and 45.2% were from Taif. The majority of low-altitude area patients require less than a week to return to normal activities (54.1%), whereas the majority of high-altitude area patients (59%) require more than a week (P = 0.047). 94.1% of participants felt pain on Day 1, and 54.1% had pain on Day 7. According to our findings, approximately one-fourth of patients (25.2%) developed recurrent hemorrhoids, and 27.4% experienced recurrent hemorrhoid symptoms. When we compared low-altitude regions and high-altitude regions in postoperative complications of hemorrhoidectomy, we found that urinary retention was most common in the high-altitude regions (37.7%). Conclusion Our results found that urinary retention was the most common complication in the high-altitude region. Early return to regular activity with less postoperative pain on Day 7 was a significant finding among low-altitude area patients.", "provenance": [ { "field": "n", "quote": "A total of 135 patients were included in this study." }, { "field": "population", "quote": "This retrospective study was conducted among patients who underwent hemorrhoidectomy between January 2019 and January 2022 in Taif and Jeddah, Saudi Arabia." }, { "field": "intervention", "quote": "high-altitude region (Taif)" }, { "field": "comparator", "quote": "sea-level (low-altitude level) region (Jeddah)" }, { "field": "primaryOutcome", "quote": "This study aims to compare postoperative complications of hemorrhoidectomy among patients who live in a high-altitude region (Taif) and a sea-level (low-altitude level) region (Jeddah)." }, { "field": "result", "quote": "The majority of low-altitude area patients require less than a week to return to normal activities (54.1%), whereas the majority of high-altitude area patients (59%) require more than a week (P = 0.047)." }, { "field": "result", "quote": "we found that urinary retention was most common in the high-altitude regions (37.7%)." } ] } ], "faqs": [ { "q": "What is a prolapsed hemorrhoid?", "a": "It's an internal hemorrhoid — a cushion of blood vessels inside the anal canal — that has slipped down and bulges out through the anus. Doctors grade it by how it behaves: grade III needs to be pushed back in by hand, and grade IV stays out all the time and can't be pushed back in." }, { "q": "How do you get rid of prolapsed hemorrhoids?", "a": "Studied options include rubber band ligation, injection treatments, laser or radiofrequency procedures, stapled hemorrhoidopexy, and excisional hemorrhoidectomy (surgical removal). In the trials reviewed here, excisional surgery gave the lowest chance of the prolapse returning, while banding and newer minimally invasive techniques caused less pain but recurred more often." }, { "q": "Prolapsed hemorrhoids vs external hemorrhoids — what's the difference?", "a": "A prolapsed hemorrhoid starts inside the anal canal and pushes out through the anus; an external hemorrhoid forms under the skin right at the anal opening and doesn't come from inside. The studies summarized here focus on internal hemorrhoids that have prolapsed (grade III-IV), not on external hemorrhoids alone." }, { "q": "Should I avoid stapled hemorrhoid surgery (stapled hemorrhoidopexy)?", "a": "Not necessarily, but go in informed: a large pooled analysis of randomized trials found stapled hemorrhoidopexy comes back more often long-term than standard excisional surgery, and rare serious complications have been reported. Ask your surgeon how recurrence and complication rates compare for the specific technique they're offering you." }, { "q": "Can I push a prolapsed hemorrhoid back in myself?", "a": "A single case report describes a prolapsed hemorrhoid being pushed back manually, but this isn't a studied, reliable treatment for grade III-IV disease and doesn't prevent it from prolapsing again. See a doctor for an evaluation rather than relying on manual reduction alone." }, { "q": "Since stapled surgery can raise the risk of prolapse coming back, what should I do instead?", "a": "A large analysis of 17 trials (2,072 patients) found that stapled hemorrhoidopexy had a higher rate of long-term recurrence than conventional excisional hemorrhoidectomy, especially prolapse coming back again, with no difference in reoperation, pain, or quality of life between the two. If avoiding recurrence is your priority, conventional excisional hemorrhoidectomy is the better-supported surgical option for grade III-IV prolapse — talk with your surgeon about this trade-off against stapled surgery's usually easier recovery." } ], "searchedAs": [ "what is a prolapsed hemorrhoid", "how to get rid of prolapsed hemorrhoids", "prolapsed hemorrhoids vs external hemorrhoids" ], "patientTakeaway": "A prolapsed hemorrhoid is internal tissue that has pushed out through the anus, and at grade III-IV it usually needs more than creams to resolve. Across these studies, standard surgical removal keeps the prolapse from coming back better than stapling or banding, though it hurts more and takes longer to heal; stapling and banding mean less pain but a higher chance it returns. Talk to a colorectal specialist about which trade-off — lower recurrence versus easier recovery — matters more to you.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Hemorrhoids\"[Mesh] OR hemorrhoid*[tiab] OR haemorrhoid*[tiab]) AND (prolaps*[tiab] OR \"Rectal Prolapse\"[Mesh] OR \"grade III\"[tiab] OR \"grade IV\"[tiab]) AND (treatment[tiab] OR therapy[tiab] OR management[tiab] OR \"Hemorrhoidectomy\"[Mesh] OR hemorrhoidectomy[tiab] OR ligation[tiab] OR \"rubber band\"[tiab] OR stapled[tiab] OR reduction[tiab])" }, "pubmedQueryTranslation": "(\"Hemorrhoids\"[MeSH Terms] OR \"hemorrhoid*\"[Title/Abstract] OR \"haemorrhoid*\"[Title/Abstract]) AND (\"prolaps*\"[Title/Abstract] OR \"Rectal Prolapse\"[MeSH Terms] OR \"grade III\"[Title/Abstract] OR \"grade IV\"[Title/Abstract]) AND (\"treatment\"[Title/Abstract] OR \"therapy\"[Title/Abstract] OR \"management\"[Title/Abstract] OR \"Hemorrhoidectomy\"[MeSH Terms] OR \"Hemorrhoidectomy\"[Title/Abstract] OR \"ligation\"[Title/Abstract] OR \"rubber band\"[Title/Abstract] OR \"stapled\"[Title/Abstract] OR \"reduction\"[Title/Abstract])", "searchedOn": "2026-10-13", "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. 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