Why do hemorrhoids bleed, and what actually stops it?

Taken word for word from the abstract

• n Fifty-two patients were randomized (26 mesoglycan, 26 placebo), and 48 completed the study.
• population enrolled adults with symptomatic grade II to III hemorrhoidal disease
• intervention receive oral mesoglycan or placebo for 40 days
• comparator Participants were randomly assigned (1:1) to receive oral mesoglycan or placebo for 40 days
• primaryOutcome The primary endpoint was the change in the Hemorrhoidal Disease Symptom Score from baseline to day 40.
• result 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)
• result Bleeding improved significantly in the grade III subgroup (P = .03).

Taken word for word from the abstract

• n This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs
• population 82 patients with bleeding-predominant grade III internal HDs
• intervention Cap-assisted endoscopic sclerotherapy (CAES) via a long needle
• intervention single CAES procedure by the injection of liquid polidocanol via a long needle
• comparator This single-arm retrospective observational study
• primaryOutcome 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.
• result The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively.
• result During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79).
• followUp During a follow-up of 24 months

Taken word for word from the abstract

• population A total of 120 patients with Grade III or IV haemorrhoids
• intervention the group of open haemorrhoidectomy with lateral internal sphincterotomy (Group A, n = 60)
• comparator the group of open haemorrhoidectomy alone (Group B, n = 60)
• primaryOutcome Pain and postoperative bleeding were compared during the first 24 h, 48 h, one week and two weeks thereafter.
• result 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.
• n A total of 120 patients with Grade III or IV haemorrhoids were randomly divided into two groups

Taken word for word from the abstract

• n Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups.
• population Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups.
• intervention The experimental group underwent Milligan-Morgan hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy
• comparator the control group underwent Milligan-Morgan hemorrhoidectomy with no additional therapy
• primaryOutcome The primary outcome was the time to return to daily activities.
• result 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)
• limitations Small sample size, nonblinded, single-center design, and short follow-up period.
• followUp improved symptom scores at 1 to 2 months

Taken word for word from the abstract

• population patients who underwent external stripping and internal ligation for circumferential mixed hemorrhoids
• intervention single-agent mirabilite fomentation
• comparator Patients were divided into a mirabilite fomentation group and a control group according to postoperative nursing methods
• primaryOutcome Observational indicators included postoperative bleeding, anal margin edema, sensation of distension, pain (visual analogue scale), urinary retention and time to first urination, wound healing time, overall efficacy, adverse reactions, and patient satisfaction
• result the mirabilite fomentation group had lower bleeding scores on postoperative day 3 and day 7
• result The reduction in edema area and height was more pronounced (both P < .05)
• result The incidence of urinary retention was lower in the mirabilite group (11.1% vs 30.6%, P = .044)
• result Wound healing time was reduced (14.53 ± 2.17 days vs 17.06 ± 2.48 days, P < .001)
• n Propensity score matching was applied to control confounding factors, yielding 72 comparable cases (36 in each group).

Taken word for word from the abstract

• n Among the 202 patients
• population adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment
• intervention conservative treatment, particularly micronized purified flavonoid fraction-based therapy
• comparator At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding.
• primaryOutcome assess the effectiveness of conservative treatment in improving symptoms and quality of life in patients with acute hemorrhoids in Vietnam
• result The mean number of symptoms per patient decreased from 4.6 ± 1.9 at baseline to 1.0 ± 1.5 at week four.
• result At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding.

Taken word for word from the abstract

• n A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included.
• population Patients with grade IV hemorrhoid undergoing LHP plus EH
• intervention LHP plus excisional hemorrhoidectomy (EH)
• comparator LigaSure hemorrhoidectomy
• primaryOutcome The primary outcome was the surgical results and 30-day complications.
• result Patients who underwent LHP plus EH had a lower frequency of urinary retention than those who underwent LigaSure hemorrhoidectomy.
• result Regarding patient-reported outcomes, pain, bleeding, and prolapse improved after postoperative week 6.
• followUp improved after postoperative week 6

Taken word for word from the abstract

• n Among the 307 patients, 162 received mSB and 125 underwent traditional RBL.
• population patients with grade II/III HD who underwent RBL
• intervention modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS)
• comparator traditional RBL
• primaryOutcome The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB)
• result The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05).

Taken word for word from the abstract

• population Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population.
• intervention Topical formulations containing fluocinolone acetonide (FLA) and ketocaine hydrochloride (KH) combine anti-inflammatory and anesthetic effects, providing rapid and sustained relief from pain, itching, and inflammation.
• primaryOutcome providing rapid and sustained relief from pain, itching, and inflammation
• result Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD.
• result The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events.

Taken word for word from the abstract

• n This case series included 10 symptomatic patients, consisting of 5 men and 5 women.
• population Clinical examination identified 8 cases of prolapsed hemorrhoids (Goligher grade III-IV) and 2 cases of rectal mucosal prolapse.
• intervention 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
• primaryOutcome The combined efficacy of HIFU-RAL and ALTA sclerotherapy was evaluated over time.
• result In all cases, the prolapsed lesions were visibly reduced or resolved immediately after the procedure.
• followUp median: 16.0 months; interquartile range: 10.5-25.8 months

Taken word for word from the abstract

• population grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable
• intervention Superior rectal artery embolization ("Emborrhoid") offers a catheter-based alternative
• comparator Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis.
• primaryOutcome Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence.
• result Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief.
• result Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted.
• n Twenty-two studies encompassing 810 procedures qualified.

Taken word for word from the abstract

• n A total of 1147 patients underwent the procedure
• population patients with internal hemorrhoids treated with endoscopic sclerotherapy
• intervention endoscopic sclerotherapy
• comparator The recurrence rate, recurrence time, and related factors for different hemorrhoid grades were analyzed.
• primaryOutcome assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates
• result The overall effective rate was 92.85% (1065/1147).
• followUp follow-up periods ranging from 3 to 49 months (mean: 25.61 ± 13.23 months)

Taken word for word from the abstract

• n our first 15 treated patients
• population 20% of our patients were in stage 2 and 80% were in stage 3 of the disease before the intervention. 80% of our patients had pain, 80% had bleeding
• intervention superselective embolization of the superior mesenteric artery branches with hairy coils under local anesthesia from a femoral puncture
• comparator The analysis of our clinical study was performed based on a prospective clinical design
• primaryOutcome The average value on the basis of the hemorrhoidal bleeding scale during early control was 0.23 and the average value was 0.23 during the 12-week control
• result Out of 15 patients, 14 became completely asymptomatic and complaint-free, and 1 patient’s hemorrhoidal bleeding scale value decreased from 6 to 3 during the follow-up
• followUp during the 12-week control

Taken word for word from the abstract

• n 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy
• population 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy
• intervention laser hemorrhoidoplasty
• comparator conventional surgical hemorrhoidectomy
• primaryOutcome Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding.
• result bleeding outcomes were more favorable in the laser group, with 100% experiencing minor bleeding compared to the conventional group, which showed a higher incidence of both minor and moderate bleeding.

Taken word for word from the abstract

• n A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD
• population 21 consecutive patients with grade III-IV HD who underwent SHAPE
• intervention 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
• comparator A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD who underwent SHAPE on 3 hemorrhoidal columns
• primaryOutcome 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
• result 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)
• followUp At 1-month follow-up

Taken word for word from the abstract

• population 30 patients both sexes (15 males and 15 females), recruited from the Second Opinion Medical Consulting Network for a spontaneous anecdotical post marketing evaluation of grade 1,2,3 haemorrhoids (n=23), anal fistulas (n=2) and fissures (n=5)
• intervention 5% lidocaine ointment (Octosedan Laboratori Baldacci S.p.A., Italy) for two months
• comparator Of the 19 patients previously treated with flavonoids or heparinoid therapy with unsatisfactory results, 9 (30%) participants found benefit from the new treatment.
• primaryOutcome the primary endpoints of the investigation were tolerability and effectiveness to relieve pain, itching, soiling and discomfort at rest or during and after stool emission
• result 28/30 treated patients had significantly symptom impro-vement (p<0.0001)
• n 30 patients both sexes (15 males and 15 females)

Taken word for word from the abstract

• n The total sample size analyzed was 220 patients
• population Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids
• intervention Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms
• intervention the medication was administered for at least 36 days
• comparator compared to baseline
• primaryOutcome resolution of complaints and stabilization of all key clinical parameters
• result early resolution and reduction of complaints such as pain, discomfort, itching, and blood streaks during defecation were observed by the control visit after seven days of therapy, compared to baseline.
• result In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period.
• result after 30 days, not only was there consistent resolution of complaints in the majority of patients, but there was also a significant improvement in quality of life (SF-36)

Taken word for word from the abstract

• n We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
• population Lower gastrointestinal bleeding due to hemorrhoids
• intervention Colonoscopic Rubber band ligation
• comparator 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.
• primaryOutcome Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively.
• result Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively.

Taken word for word from the abstract

• n 18 patients (11 males, 7 females)
• population rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated
• intervention coil embolization of the superior rectal artery
• comparator The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month
• primaryOutcome rectal bleeding grading was assessed using the Paris bleeding severity score
• result The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month.

Taken word for word from the abstract

• n Fifty-two patients were randomized equally into the two arms.
• population patients with grade III and grade IV hemorrhoids
• intervention LigaSure hemorrhoidectomy
• comparator conventional Milligan-Morgan hemorrhoidectomy
• primaryOutcome the duration of the procedure, estimated blood loss, and resolution of symptoms
• result 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).

Taken word for word from the abstract

• population Wistar rats by inducing hemorrhoids development with the application of croton oil preparation (COP) in the recto-anal area
• intervention AG, which was administered orally at the doses of 20, 60 and 200 mg/kg/day and JG, which was topically applied (100 mg/animal/day)
• comparator Prednisolone was employed as the standard drug and was administered orally at the dose of 1 mg/kg/day
• primaryOutcome Gross pathological observation demonstrated remarkable decrease in croton oil-induced swelling, hemorrhage and formation of pseudomembrane
• result AG and JG were able to attenuate the croton oil-induced macro and microscopic anomalies.

Taken word for word from the abstract

• population Patients with stage III and IV hemorrhoids aged over 18 years who patients who underwent hemorrhoidectomy were included.
• intervention Patients in the main group were recommended to use a purified micronized flavonoid fraction
• comparator In the control group (70 patients), the use of this group of drugs was not expected.
• primaryOutcome Patients independently assessed the intensity of symptoms - pain, tenesmus, itching and bleeding.
• result After 7, 21, 40 and 60 days, a statistically significant lower severity of pain, bleeding and tenesmus was revealed among patients in the main group compared to the control group.
• n 135 patients were randomized.

Taken word for word from the abstract

• n 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization
• population 22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization
• intervention percutaneous superselective superior rectal artery embolization in the treatment of grades Ⅱ-Ⅲ internal hemorrhoids
• comparator The clinical scores before and after treatment were compared by the nonparametric rank sum test
• primaryOutcome French bleeding score,quality of life score,prolapse score
• result Compared with those prior to operation, the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05).

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• n Of 3592 participants, 3505 were analyzed
• population adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification)
• intervention particularly micronized purified flavonoid fraction (MPFF; 73.7%)
• comparator and diosmin (14.6%)
• primaryOutcome improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL
• result MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001)
• followUp The 4-week observational prospective CHORALIS study

Taken word for word from the abstract

• population patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy
• intervention laser hemorrhoidoplasty with feeding vessel suture ligation
• comparator Milligan-Morgan hemorrhoidectomy
• primaryOutcome postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications
• result the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences
• result the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences
• n The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy.

Taken word for word from the abstract

• n Total 64 adult patients with mean age 38.6 years
• population Total 64 adult patients with mean age 38.6 years and male female ratio 1.7:1 were included in this study
• intervention evaluate the outcome of conventional surgeries
• comparator This descriptive, prospective, observational study was performed from diagnosis of haemorrhoidal disease to surgical intervention
• primaryOutcome Clinico-pathological data and outcome in the form of complications and recurrence within follow-up period was studied
• result Complication less recovery was seen in 56(87.5%) cases, where delayed wound healing and pain was reported in 2(3.6%) patient each, followed by 1(1.6%) each reported urinary retention, anal sepsis, primary bleeding and reactionary bleeding

Taken word for word from the abstract

• n The control group (Group I) of 29 patients receiving standard local treatment plus placebo and the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product.
• population Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study.
• intervention the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product
• comparator The control group (Group I) of 29 patients receiving standard local treatment plus placebo
• primaryOutcome To assess the effect of a multi-ingredient myophlebotropic dietary supplement used as an adjunct on the rate and effectiveness of symptom relief in patients with stage II and III hemorrhoidal disease.
• result The treatment did not affect the rate of spontaneous bleeding, which was low at the beginning of the study, but significantly reduced the rate of bleeding during defecation.
• result After 30 days of observation, it was found that the improvement in the severity of hemorrhoidal disease symptoms was significantly higher in the group using the tested preparation.
• followUp after 30 days of therapy

Taken word for word from the abstract

• population following excisional haemorrhoidectomy
• intervention the potential of flavonoids in alleviating the postoperative symptom burden following excisional haemorrhoidectomy
• comparator in favour of the flavonoid groups
• primaryOutcome The primary outcome investigated was post-operative pain.
• result statistically significant decreases in post-operative pain in favour of the flavonoid groups (Standardized Mean Difference -0.66 [95% confidence intervals (CI) -0.82, -0.52]; P < 0.00001), and bleeding (Odds Ratio 0.13 [95% CI 0.09, 0.19]; P < 0.00001)
• n Ten articles with 775 patients were included.

Taken word for word from the abstract

• n Five investigators enrolled 60 patients
• population Adult patients with diagnosed, mild-to-moderate, symptomatic non-bleeding hemorrhoids treated with rectal ointment or suppositories containing sucralfate were enrolled.
• intervention Patients were administered treatment twice per day for at least 1 week until symptom resolution and/or for a maximum of 4 weeks.
• comparator The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14).
• primaryOutcome The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14).
• result 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).

Taken word for word from the abstract

• n including 472 patients
• population Bleeding, prolapse and pain were the main reasons for consultation.
• intervention Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%).
• comparator improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003)
• primaryOutcome the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively)
• result improvement was more marked in the surgery group with a better rate of "very good satisfaction" (73% vs. 54%, P=0.003)

Taken word for word from the abstract

• n a total of 18 patients with IV-degree HD, aged between 18 and 75 years
• population 18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification
• intervention combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles
• comparator from 16 preoperatively (T0) to 2 at 3-month follow-up (T3)
• primaryOutcome The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms
• result A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months.
• result Neither post-operative bleeding nor any type of complications occurred.

Taken word for word from the abstract

• population In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding.
• intervention oral mesoglycan reduced the severity of CVD signs and symptoms
• comparator adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone
• primaryOutcome mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding
• result In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding.

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• n A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified.
• population Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism
• intervention Injection sclerotherapy (IST) has been proposed as a treatment option for these patients.
• primaryOutcome The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months.
• result Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions.

Taken word for word from the abstract

• n 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.
• population 115 patients with grade III/IV hemorrhoids
• intervention MMH + ND-HAL
• comparator received MMH
• primaryOutcome 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
• result 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).
• followUp At follow-up by telephone or outpatient 12 months after surgery

Taken word for word from the abstract

• population 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 higher cure rate (6 months: 74.51% vs. 64.71%, P = 0.044)
• result 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.
• n A total of 306 patients were finally included for analysis.
• followUp 12 months: 0.65% vs. 5.88%, P = 0.010

Taken word for word from the abstract

• n Eighty patients (62.5% males) with a mean age of 48 ± 9 years were recruited prospectively.
• population 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.
• intervention In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred.
• comparator VAS and QL improved 4 points and 1.5 respectively after embolization.
• primaryOutcome Fifty-five (68.7%) participants had the absence of rectal bleeding after 12 months of embolization.
• result 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.

Taken word for word from the abstract

• n A total of 100 patients were finally included.
• population patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment
• intervention rubber band ligation (RBL)
• comparator This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included
• primaryOutcome Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale)
• result a significant reduction was found in the HDSS and SHS scores (p < 0.001)
• result The overall success rate of banding was 89%.

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• population outpatients with grade II-III haemorrhoids
• intervention RFA (Rafaelo©)
• n A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres.
• primaryOutcome Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery.
• result Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months.
• result the rate of patients reporting bleeding (21% vs. 84%, p < 0.001)

Taken word for word from the abstract

• n Retrospective analysis of 134 patients
• population symptomatic refractory internal hemorrhoids
• intervention Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils.
• comparator Standard-of-care evaluations were performed at baseline and the 1 month follow-up
• primaryOutcome hemorrhoid-related pain (HRP) (0-10), hemorrhoid symptoms score (HSS) (5-20), quality of life (QoL) (0-4), French bleeding score (FBS) (0-9), and HG (0-4)
• result There were significant improvements in all mean outcomes at 1 month: HSS (11-7.8; P < .01), HRP (4.1-1.3; P < .01), QoL (2.2-0.8; P < .01), FBS (4.4-2.2; P < .01), and HG (2.3-1.2; P < .05).

Taken word for word from the abstract

• n A total of 183 patients with II-degree HD
• population aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment
• intervention underwent sclerotherapy with 3% polidocanol foam
• comparator This was an open label, single-arm, phase 2b trial
• primaryOutcome Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score.
• result The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow-up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125).

Taken word for word from the abstract

• population Chronic hemorrhoidal disease is a common anorectal condition that leads to hemorrhoidal hyperplasia
• intervention Embolization of the rectal arteries (ie, emborrhoid) has recently emerged as an effective treatment option
• comparator The most standard treatment involves dietary and hygiene measures, use of phlebotonic drugs, and nonsurgical treatment such as infrared photocoagulation or elastic band ligation.
• primaryOutcome Studies have shown improvement in symptoms and high technical success rates after treatment.
• result Studies have shown improvement in symptoms and high technical success rates after treatment.

Taken word for word from the abstract

• n A total of 22 RCTs, including 2,335 participants were included in the analysis.
• population treating postoperative hemorrhoid complications
• intervention Micronized purified flavonoid fractions (MPFF) have been shown to improve hemorrhoid symptoms.
• primaryOutcome MPFF improved the clinical efficacy of post-hemorrhoidectomy and reduced the bleeding rate, pain score, and edema score
• result MPFF improved the clinical efficacy of post-hemorrhoidectomy and reduced the bleeding rate, pain score, and edema score, although no substantial effect on adverse reactions was reported.
• limitations due to the small sample size, the standardized treatment regimen of MPFF could not be obtained; therefore, further research is warranted.

Taken word for word from the abstract

• n A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL.
• population consecutive patients with grade II or III internal hemorrhoids treated with RBL
• intervention modified RBL
• comparator conventional RBL
• primaryOutcome Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed.
• result Five cases of postoperative DB have been observed in the conventional RBL group, compared to none in the modified ones, with a significant difference (P < 0.05).
• result 8 cases in the modified RBL group experienced a recurrence rate of 5.4%, whereas 17 patients in the conventional RBL group experienced a recurrence rate of 13.6%. The difference was statistically significant (P < 0.05).

Taken word for word from the abstract

• n Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24).
• population patients with HD grades II and III
• intervention Polidocanol foam sclerotherapy (SP)
• comparator doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR)
• primaryOutcome Therapeutic success (Sodergren's and bleeding scores) was the primary outcome.
• result Complete success was higher in the SP group (91.7% vs. 68.2%, p=0.045) and SP patients had less complications (25% vs. 68.2%, p=0.003).
• followUp Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session.

Taken word for word from the abstract

• n Thirteen eligible studies were identified including 381 patients.
• population Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life.
• intervention Rectal artery embolisation (RAE) is a recently described technique for the management of HD
• primaryOutcome Primary outcomes were: French bleeding score (FBS), Visual analogue scale (VAS) for pain, general quality of life (QoL) score, and the Goligher prolapse score (GPS).
• result Rectal artery embolisation was associated with improvements in the FBS (mean difference [MD] 2.66; 95% confidence interval [CI] 2.10-3.23), VAS (MD 1.92; 95% CI 1.58-2.27) and QoL (MD 1.41; 95% CI 1.20-3.80), although the grade of internal haemerrhoids increased with uncertain clinical significance (MD 0.30; 95% CI 0.23-0.36).
• result Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%).

Taken word for word from the abstract

• n There were 183 patients
• population patients with 2nd-degree haemorrhoids
• intervention The aim of the present study was to evaluate the efficacy and safety of 3% polidocanol foam for treating 2nd-degree haemorrhoids.
• comparator A multicentre, open-label, single-arm, phase 2 trial
• primaryOutcome The primary outcome was to establish the success rate after one sclerotherapy session in terms of complete resolution of bleeding episodes one week after the injection.
• result Complete resolution of bleeding was reached in 125/183 patients (68.3%) at 1 week and the recurrence rate was 12% (15/125).
• result The overall 1-year success rate was 95.6% (175/183).

Taken word for word from the abstract

• population patients with contraindications for open surgery
• intervention embolization of the hemorrhoidal arteries
• comparator Treatment options range from dietary measures to open surgery.
• primaryOutcome allows efficient symptom control even in patients with contraindications for open surgery
• result The treatment of bleeding hemorrhoids seems to be particularly effective.
• result Embolization of hemorrhoidal arteries is a safe treatment

Taken word for word from the abstract

• population this formulation reduces the migration of mesenchymal (fibroblasts) and immune (RAW 264.7) cells
• population treated human hemorrhoid and fistula tissues as compared to untreated ones
• intervention polyherbal formulation Anoac‑H
• comparator treated human hemorrhoid and fistula tissues as compared to untreated ones
• primaryOutcome Anoac‑H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages
• result inflammation, as well as the expression of RANTES and VEGF, were significantly reduced in treated human hemorrhoid and fistula tissues as compared to untreated ones, confirming the in vitro results

Taken word for word from the abstract

• n The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies.
• population The age of the patients varies between 18 and 74 years old.
• intervention We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure).
• comparator HeLP laser treatment was significantly superior to surgical treatment
• primaryOutcome postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001)
• result LHP laser treatment was significantly superior to surgical treatment in terms of operative duration (p < 0.00001), intraoperative bleeding (p < 0.00001), postoperative pain at H12 and H24 (p < 0.00001 and p = 0.0003), and postoperative bleeding rate (p < 0.001).

Taken word for word from the abstract

• n 43 patients (24 men and 19 women; mean age, 52 years [18-77 years])
• population symptomatic Grades 2 and 3 hemorrhoidal disease
• intervention superior rectal artery embolization
• comparator Clinical success was assessed at 7 days, 1 month, and 6 months of follow-up by updating the clinical scores.
• primaryOutcome anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life
• result The reduction in the French bleeding score (global and single entity) in Grade 3 prolapse was statistically significant (P = .001). Improvement in the quality of life was significant in both groups (P < .05).

Taken word for word from the abstract

• n Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each
• population patients undergoing excisional hemorrhoidectomy
• intervention receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period
• comparator double-placebo (G1)
• primaryOutcome Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated
• result Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks
• result There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001)

Taken word for word from the abstract

• n Twenty consecutive patients with grade II and III hemorrhoids
• population Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach
• intervention selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance
• comparator METHODS: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence.
• primaryOutcome evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding
• result Control of prolapse and bleeding was achieved in all patients (n=20).
• followUp After a mean follow-up of 13 months no recurrences were diagnosed.

Taken word for word from the abstract

• n Fourteen studies (n = 362) were identified.
• population patients with grades I-III hemorrhoids and chronic bleeding
• intervention catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding
• comparator when the coils-only group was compared with the coils and particles group
• primaryOutcome A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004).
• result the average rebleeding rate was 21.5% (n = 111; SD, 18.2; range, 0%-44%) versus 10.05% (N = 108; SD, 4.8; range, 5%-15.7%), respectively (P < .0001)
• result The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5).
• limitations The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure
• followUp The mean maximum follow-up duration was 12.1 months

Taken word for word from the abstract

• n A total of 105 patients (60 men, 45 women) underwent HAL-RAR.
• population patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease
• intervention hemorrhoidal artery ligation with rectoanal repair (HAL-RAR)
• comparator Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR
• primaryOutcome Demographics, degree of disease, hospital stay, postoperative pain, complications, and recurrence were recorded.
• result At 12 months, 92.4% of patients experienced complete resolution of symptoms, 2 patients intermittent bleeding, and 2 recurrence.
• limitations Long-term follow-up is lacking and would better establish the results of this technique.

Taken word for word from the abstract

• population Hemorrhoidal disease (HD) is common in adults.
• population In patients undergoing surgery, postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia.
• intervention Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used
• comparator postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia.
• primaryOutcome In acute HD, MPFF can reduce HD symptoms such as bleeding, pain, anal discomfort, anal discharge and pruritus.
• result MPFF reduces the duration of hospital stay following surgery, facilitating a return to normal activity and improving quality of life.
• result MPFF may also prevent HD recurrence.

Taken word for word from the abstract

• n We enrolled 433 patients (277 SLAP1 and 156 SLAP2).
• population Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP
• intervention sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse
• comparator The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery.
• primaryOutcome Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis.
• result Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients.
• result An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2.

Taken word for word from the abstract

• n The study population comprised 126 patients
• population Patients with mixed hemorrhoids (grade III or IV)
• intervention a large C suture during PPH
• comparator this retrospective study
• primaryOutcome The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed.
• result None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding.

Taken word for word from the abstract

• n The data of 35 patients with symptomatic second- and third-degree hemorrhoids
• population 35 patients with symptomatic second- and third-degree hemorrhoids
• intervention stapled hemorrhoidopexy using a PPH03 stapler
• result A single patient needed reoperation for a staple line bleeding, two patients had a thrombosis of internal hemorrhoids and in one patient a small prolapse was diagnosed at 3 months follow-up
• result Global satisfaction rate was 94%.
• followUp Patients were followed-up for 6 (1-9) years.

Taken word for word from the abstract

• n A total of 35 patients were enrolled.
• population Patients over the age of 18 years with chronic, symptomatic grade I and II internal hemorrhoids who failed 2 weeks of conservative therapy
• intervention Hemorrhoid energy therapy was administered in clinic, and 2 postprocedure visits were completed.
• comparator The limitations include lack of comparative groups, single-center design, and small cohort of patients.
• primaryOutcome The primary end point was to evaluate the effect of hemorrhoid energy therapy on hemorrhoid symptoms and its safety.
• result After the procedure, patient hemorrhoid symptom scores decreased from mean 5.5 to 1.4.
• followUp decreased to <1.0 after 14 days

Taken word for word from the abstract

• n We decided to treated 10 urgent cases
• population III- and IV-degree hemorrhoids
• intervention 3% polidocanol foam
• comparator "bridge treatment"
• primaryOutcome resolution of bleeding and pruritus
• result all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1)

Taken word for word from the abstract

• n Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial
• population Primary endpoint was resolution of symptoms
• intervention Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy
• comparator Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up
• primaryOutcome Primary endpoint was resolution of symptoms
• result Analysis of 276 patients who completed the 2-year follow-up showed an overall resolution of symptoms in 89.9% (248/276) of patients. Statistically significant improvement of quality of life, pain reduction, bleeding and frequency of acute symptoms were reported.

Taken word for word from the abstract

• population patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019
• intervention radiofrequency thermocoagulation of hemorrhoids
• n Seventy-four patients, with a mean age of 53 years, underwent operation during the study period
• primaryOutcome the anatomical and functional result was satisfactory in more than 93% of patients
• result At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients.
• result Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery
• comparator Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated.

Taken word for word from the abstract

• n 39 patients (26 males, mean age 51 [22-77]) were interviewed after an RFT intervention
• population 42 outpatients were operated for internal haemorrhoids using RFT
• intervention Radiofrequency thermocoagulation (RFT)
• comparator Assessment was performed prior to the intervention and during follow-up
• primaryOutcome bleeding, improvement, and satisfaction using a verbal analogical scale
• result bleeding drastically decreased from 7/10 to 1/10 (p < 0.0001) and entirely stopped in 62% of patients
• followUp After a mean follow-up of 15 months

Taken word for word from the abstract

• n A total of 75 patients were included in the study
• population patients with symptomatic grades 2 or 3 HD
• intervention the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating
• comparator We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL.
• primaryOutcome We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL.
• result At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65).
• result ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity.