{ "slug": "why-is-my-hemorrhoid-bleeding", "question": "Why do hemorrhoids bleed, and what actually stops it?", "shortTitle": "Why Hemorrhoids Bleed & What Stops It", "clinicalQuestion": "In adults with internal or external hemorrhoids presenting with rectal bleeding, what is the underlying cause of the bleeding, and which treatments (dietary/fiber measures, topical agents, office-based procedures such as rubber band ligation or sclerotherapy, or surgery) most effectively stop or reduce hemorrhoidal bleeding?", "pico": { "population": "Adults with internal or external hemorrhoids who have rectal bleeding", "intervention": "Conservative measures (fiber, stool softeners, sitz baths), topical treatments, office procedures (rubber band ligation, sclerotherapy, infrared coagulation), or surgical hemorrhoidectomy", "comparator": "No treatment, placebo, or usual conservative care", "outcomes": [ "Cessation of rectal bleeding", "Time to resolution of bleeding", "Recurrence of bleeding at follow-up", "Need for further procedural or surgical intervention", "Change in hemoglobin or anemia status", "Patient-reported symptom severity score" ] }, "category": "anorectal", "relatedConditions": [ "hemorrhoids", "rectal-bleeding", "anal-fissure" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Several office procedures and medicines have been shown in trials to reduce or stop hemorrhoid bleeding — but no study in this review actually explains why hemorrhoids bleed in the first place.", "detail": "The strongest evidence comes from five well-conducted randomised trials comparing one bleeding-control option against another — banding, injection sclerotherapy, and artery-blocking procedures — and most show real improvement in bleeding. Almost none of the studies compared a treatment with doing nothing, so they answer 'which treatment works better' rather than 'does treatment help at all.' The basic biology of why hemorrhoids bleed was not tested in people in any of these studies.", "studyIds": [ "pmid:32519957", "pmid:33081476", "pmid:37188908", "pmid:33640516", "pmid:35961908", "pmid:34633439", "pmid:32399811", "pmid:42067175" ] }, "strength": { "level": "high", "why": "5 well-conducted randomised trials address this question directly.", "override": null }, "direction": { "level": "benefit", "why": "Most of the stronger evidence points to a benefit.", "override": null }, "counts": { "recordsRetrieved": 1016, "recordsScreened": 200, "included": 140, "rcts": 26, "systematicReviews": 13, "observational": 60, "participants": 43616, "yearFrom": 2020, "yearTo": 2026, "registeredTrialsWithoutResults": 3 }, "excluded": [], "outcomes": [ { "name": "Cessation of rectal bleeding", "status": "improvement", "note": "Rubber band ligation, sclerotherapy injections, and artery-blocking procedures stopped or markedly reduced bleeding in most people treated across multiple studies, including randomised comparisons.", "studyIds": [ "pmid:35334004", "pmid:32519957", "pmid:37458757", "pmid:32712932", "pmid:39923169", "pmid:38174849", "pmid:32167429", "pmid:33081476" ] }, { "name": "Time to resolution of bleeding", "status": "possible-improvement", "note": "Some studies suggest bleeding can ease within one to four weeks, or after one or two treatment sessions, but this wasn't measured consistently as a formal time-to-event outcome across controlled trials.", "studyIds": [ "pmid:41299195", "pmid:32519957", "pmid:35334004" ] }, { "name": "Recurrence of bleeding at follow-up", "status": "possible-improvement", "note": "Treatments reduced bleeding initially, but recurrence was common on longer follow-up — ranging from about 12% to over 30% within one to five years depending on the study and technique.", "studyIds": [ "pmid:42478482", "pmid:42323500", "pmid:35334004", "pmid:37458757", "pmid:41047429" ] }, { "name": "Need for further procedural or surgical intervention", "status": "possible-improvement", "note": "Some techniques lowered the chance of needing a repeat procedure compared with others, but a meaningful minority of patients across studies still needed further treatment or surgery.", "studyIds": [ "pmid:41047429", "pmid:33199263", "pmid:36268758" ] }, { "name": "Change in hemoglobin or anemia status", "status": "insufficient", "note": "Only a couple of small studies looked at blood counts, mostly in patients with severe bleeding needing transfusion or with liver disease; this wasn't a standard outcome in the treatment trials.", "studyIds": [ "pmid:38704632", "pmid:32306200" ] }, { "name": "Patient-reported symptom severity score", "status": "improvement", "note": "Across many studies, overall symptom scores (including bleeding, pain, swelling and quality of life) dropped significantly after treatment.", "studyIds": [ "pmid:40399727", "pmid:38480640", "pmid:37349572", "pmid:37005961", "pmid:36757069", "pmid:35551442", "pmid:32399811" ] }, { "name": "Underlying biological cause of bleeding", "status": "not-studied", "note": "No study in this review tested, in humans, why hemorrhoids bleed. The only mechanism-focused work was done in rats and lab tissue samples, which doesn't reliably show what happens in people.", "studyIds": [] } ], "benefits": [ { "text": "Rubber-band ligation and sclerotherapy (an injection that scars and shrinks the hemorrhoid) stopped or markedly reduced bleeding in multiple trials and cohort studies, including head-to-head comparisons against each other and against surgery.", "studyIds": [ "pmid:42067175", "pmid:35334004", "pmid:32519957", "pmid:41047429", "pmid:37349572", "pmid:39923169", "pmid:33081476", "pmid:41239416" ] }, { "text": "Oral vein-supporting medicines (flavonoids, including micronized purified flavonoid fraction) reduced bleeding scores compared with placebo or routine care in several trials.", "studyIds": [ "pmid:32399811", "pmid:32409760", "pmid:39268736", "pmid:35752073", "pmid:33928786", "pmid:38940246" ] }, { "text": "Procedures that block the artery feeding the hemorrhoid (embolization) reduced bleeding scores in multiple cohort studies and a small randomised trial.", "studyIds": [ "pmid:35551442", "pmid:33971251", "pmid:37458757", "pmid:36736822", "pmid:33640516", "pmid:32167429", "pmid:36736690" ] }, { "text": "Surgery to remove hemorrhoids controlled bleeding well in people with more severe disease, and a large comparison across many trials found it gave the lowest recurrence among procedural options.", "studyIds": [ "pmid:34633439", "pmid:32189597" ] } ], "limitations": [ { "text": "Most studies compared one active treatment with another, not treatment against doing nothing, so how much benefit comes from the treatment itself versus natural improvement over time is often unclear.", "studyIds": [ "pmid:35217937", "pmid:32342155", "pmid:34252247", "pmid:34906095" ] }, { "text": "Many studies were retrospective or single-arm with no comparison group, meaning people could have partly improved on their own rather than because of the treatment.", "studyIds": [ "pmid:42323500", "pmid:41299195", "pmid:40103253", "pmid:39132755", "pmid:37349572", "pmid:36757069" ] }, { "text": "Follow-up was often short. In studies that did look further out, bleeding and other symptoms frequently returned, sometimes in a quarter or more of patients.", "studyIds": [ "pmid:42478482", "pmid:42323500", "pmid:35334004", "pmid:37458757" ] }, { "text": "None of these studies explain, in humans, the underlying biology of why hemorrhoids bleed. The only mechanism research was done in rats and lab tissue, which doesn't necessarily reflect what happens in people.", "studyIds": [ "pmid:39565131", "pmid:34414451", "pmid:32687958" ] } ], "risks": [ { "text": "Rubber band ligation can rarely cause serious delayed bleeding, even needing emergency treatment, days after the procedure.", "studyIds": [ "pmid:41197059" ], "severity": "serious" }, { "text": "People taking blood-thinning medication had higher rates of bleeding complications after hemorrhoid procedures, though severe bleeding needing hospital admission was not more common.", "studyIds": [ "pmid:36048039" ], "severity": "minor" }, { "text": "Surgical removal of hemorrhoids caused more pain, bleeding and urinary retention than less invasive office procedures in a large comparison across many trials.", "studyIds": [ "pmid:34633439" ], "severity": "serious" } ], "whyPeopleTryIt": [ { "text": "Seeing blood in the toilet or on tissue is frightening, so people want it to stop right away." }, { "text": "Surgery sounds painful and inconvenient, so many look for creams, diet changes, or in-office treatments first." }, { "text": "Hemorrhoid creams and suppositories are sold over the counter and heavily marketed as a quick fix." }, { "text": "Some people hope diet and fiber alone will solve it without having to see a doctor about a sensitive problem." } ], "keyStudies": [ "pmid:32519957", "pmid:33081476", "pmid:37188908", "pmid:33640516", "pmid:35961908", "pmid:34633439", "pmid:32399811", "pmid:42067175" ], "studies": [ { "id": "pmid:42816945", "pmid": "42816945", "doi": "10.1111/codi.70641", "nctId": null, "pmcid": null, "title": "LigaSure versus conventional excisional haemorrhoidectomy: A systematic review and meta-analysis with trial sequential analysis of randomised controlled trials", "firstAuthor": "Barone", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2026, "design": "meta-analysis", "n": 3277, "nField": "reported", "population": "patients having surgery to remove hemorrhoids", "intervention": "LigaSure (energy-sealing device) hemorrhoidectomy", "comparator": "conventional excisional haemorrhoidectomy", "primaryOutcome": "postoperative pain and complications such as bleeding, wound discharge and urinary retention", "result": "LigaSure reduced pain, bleeding, wound discharge and urinary retention, but showed no difference in recurrence, infection, or other long-term outcomes", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pooled 43 randomized trials with over 3,000 patients, which is fairly robust for short-term outcomes, but the authors note uncertainty remains for recurrence and other long-term results.", "directness": "indirect", "limitations": "Evidence regarding recurrence and other long-term anorectal outcomes remains limited.", "followUp": "", "plainFinding": "Less pain and bleeding with LigaSure surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42816945/", "sourceText": "BACKGROUND: Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids, although energy-based devices may reduce postoperative pain. We performed a systematic review and meta-analysis of randomised controlled trials comparing LigaSure with conventional haemorrhoidectomy. METHODS: A systematic search of PubMed, Scopus, Web of Science and the Cochrane Central Register was performed up to July 2025. Randomised controlled trials comparing LigaSure with conventional techniques were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed with the I2 statistic, and trial sequential analysis (TSA) was applied to assess conclusiveness. RESULTS: Forty-three unique RCTs comprising 3,277 participants were analysed. LigaSure was associated with lower postoperative pain scores on days 1 and 2 and during the first and second postoperative weeks, reduced analgesic requirements and intraoperative blood loss, shorter operating time and time to return to daily activities, and lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention. No statistically significant differences were observed in immediate postoperative pain, pain on postoperative day 3 or week 4, recurrence, length of hospital stay, constipation, pruritus, surgical site infection, incomplete healing, anal fissure, anal stenosis, or faecal incontinence. CONCLUSION: LigaSure was associated with improvements in selected early perioperative outcomes, particularly postoperative pain and return to daily activities. However, uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited.", "provenance": [ { "field": "n", "quote": "Forty-three unique RCTs comprising 3,277 participants were analysed." }, { "field": "intervention", "quote": "comparing LigaSure with conventional haemorrhoidectomy" }, { "field": "comparator", "quote": "Randomised controlled trials comparing LigaSure with conventional techniques were included." }, { "field": "population", "quote": "Conventional excisional haemorrhoidectomy remains the gold standard treatment for grade IV haemorrhoids" }, { "field": "primaryOutcome", "quote": "lower risks of postoperative wound discharge, postoperative bleeding and acute urinary retention" }, { "field": "result", "quote": "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." }, { "field": "limitations", "quote": "uncertainty remains for several outcomes, and evidence regarding recurrence and other long-term anorectal outcomes remains limited." } ] }, { "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 and excisional hemorrhoidectomy", "comparator": "sutured mucopexy", "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; bleeding recurred in 18% (hemorrhoidectomy), 31% (mucopexy), and 31% (laser)", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it is a small, single-center study and the main difference between treatments did not reach statistical significance.", "directness": "direct", "limitations": "This is a single-center study with a relatively small sample size.", "followUp": "5 years", "plainFinding": "No clear difference in bleeding recurrence.", "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": "sutured mucopexy" }, { "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": "result", "quote": "Specific recurrences included bleeding in 18% (excisional hemorrhoidectomy), 31% (sutured mucopexy), and 31% (laser hemorrhoidoplasty)" }, { "field": "limitations", "quote": "This is a single-center study with a relatively small sample size." } ] }, { "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 hemorrhoids", "intervention": "oral mesoglycan", "comparator": "placebo", "primaryOutcome": "change in hemorrhoid symptom score (itching, pain, bleeding, swelling) from baseline to day 40", "result": "mesoglycan group had a significantly greater reduction in overall symptom score than placebo, with bleeding improving significantly only in the grade III subgroup", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small phase 2 trial of 52 patients, so the results need confirmation in larger studies.", "directness": "direct", "limitations": "Small sample size (52 patients), phase 2 trial, bleeding benefit only shown in a subgroup (grade III) rather than the whole group.", "followUp": "40 days treatment plus 30-day telephone follow-up", "plainFinding": "Fewer symptoms; less bleeding in severe cases", "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), and 48 completed the study." }, { "field": "population", "quote": "enrolled adults with symptomatic grade II to III hemorrhoidal disease" }, { "field": "intervention", "quote": "receive oral mesoglycan or placebo for 40 days" }, { "field": "comparator", "quote": "Participants were randomly assigned (1:1) to receive 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": "Bleeding improved significantly in the grade III subgroup (P = .03)." } ] }, { "id": "pmid:42374341", "pmid": "42374341", "doi": "10.1186/s12893-026-03982-1", "nctId": null, "pmcid": "PMC13576129", "title": "Laser hemorrhoidoplasty versus LigaSure hemorrhoidectomy for grade II-IV hemorrhoidal disease: a systematic review and meta-analysis", "firstAuthor": "Zamlout", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "meta-analysis", "n": 461, "nField": "reported", "population": "adults with grade II-IV hemorrhoids", "intervention": "laser hemorrhoidoplasty (LHP)", "comparator": "LigaSure hemorrhoidectomy (LigH)", "primaryOutcome": "postoperative pain, time to return to routine activities, and recurrence", "result": "LHP caused less pain and faster recovery, but had higher recurrence than LigH; no difference in bleeding or other complications", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "The abstract itself states the certainty of evidence is very low, based on only five small studies.", "directness": "indirect", "limitations": "Certainty of evidence is very low; based on only five studies; authors call for further high-quality randomized trials.", "followUp": "", "plainFinding": "Less pain, but more recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42374341/", "sourceText": "BACKGROUND: Many surgical procedures have been developed to treat hemorrhoidal disease. Although conventional excisional techniques are effective, they are also associated with significant postoperative pain and longer recovery times. Consequently, newer techniques have been introduced to address these issues, including laser hemorrhoidoplasty (LHP) and LigaSure hemorrhoidectomy (LigH). This systematic review and meta-analysis aims to compare these two approaches in terms of perioperative outcomes and recurrence. METHODS: A comprehensive search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, up to December 2025. We included all eligible studies involving adults with grade II-IV hemorrhoids. Primary outcomes included postoperative pain, time to return to routine activities, and recurrence. Secondary outcomes were operative time, length of hospital stay, and complications. The risk of bias was assessed using the RoB2 and ROBINS-I V2 tools. Meta-analyses were performed with a random-effects model. The certainty of evidence was evaluated using the GRADE approach. RESULTS: Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed. Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis. CONCLUSION: LHP yields better perioperative outcomes, including less pain and faster recovery, making it a favorable option for patient comfort. However, LigH has lower recurrence rates. The certainty of evidence is very low. Further high-quality randomized trials are needed to confirm these results.", "provenance": [ { "field": "n", "quote": "Data from 461 patients (213 LHP, 248 LigH) across five studies were analyzed." }, { "field": "population", "quote": "We included all eligible studies involving adults with grade II-IV hemorrhoids." }, { "field": "intervention", "quote": "laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "LigaSure hemorrhoidectomy (LigH)" }, { "field": "primaryOutcome", "quote": "Primary outcomes included postoperative pain, time to return to routine activities, and recurrence." }, { "field": "result", "quote": "Patients in the LHP group reported significantly lower pain scores on postoperative day 1 (MD: - 1.61 points; p = 0.025), earlier return to routine activities (MD: -5.75 days; p = 0.0002), shorter operative time (MD: -6.5 min; p = 0.002), and shorter hospital stay (MD: -0.3 days; p < 0.0001) compared to the LigH group. Conversely, LigH demonstrated a significantly lower risk of recurrence (RD: 0.12; 95% CI: [0.05, 0.19]). No significant differences were observed regarding postoperative bleeding, wound infection, urinary retention, or thrombosis." }, { "field": "quality", "quote": "The certainty of evidence is very low." } ] }, { "id": "pmid:42323500", "pmid": "42323500", "doi": "10.1007/s10151-026-03371-z", "nctId": null, "pmcid": "PMC13529611", "title": "Cap-assisted endoscopic sclerotherapy for bleeding-predominant grade III hemorrhoids: efficacy and risk factor analysis focusing on two dimensions of bleeding score", "firstAuthor": "Wu", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2026, "design": "retrospective", "n": 82, "nField": "reported", "population": "patients with bleeding grade III internal hemorrhoids", "intervention": "cap-assisted endoscopic sclerotherapy with polidocanol injection via long needle", "comparator": "none (single-arm, before-after comparison)", "primaryOutcome": "improvement in bleeding and prolapse symptoms at 3 months, and bleeding recurrence over follow-up", "result": "96.3% had improved bleeding symptoms at 3 months, but 25.3% had bleeding recurrence by 24 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study with no comparison group, so it can't prove the treatment itself caused the improvement.", "directness": "direct", "limitations": "Single-arm retrospective design without a control group; single-center study implied by patient count.", "followUp": "24 months", "plainFinding": "Sclerotherapy reduced bleeding, but often recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42323500/", "sourceText": "BACKGROUND AND OBJECTIVES: Cap-assisted endoscopic sclerotherapy (CAES) via a long needle optimizes the visualization of operation field and enables precise injection of sclerosant, yet evidence regarding its application in high-grade internal hemorrhoids (HDs) remains limited. This study aims to evaluate the efficacy and safety of CAES therapy for bleeding-predominant grade III symptomatic internal HDs, and explore potential risk factors associated with postoperative bleeding persistence and recurrence. METHODS: This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs who underwent a single CAES procedure by the injection of liquid polidocanol via a long needle. Treatment efficacy was assessed at 3 months post-CAES using the conventional Hemorrhoid Disease Severity Score (HDSS; based on the frequency of symptoms, including bleeding) and the score of the intensity dimension of the bleeding symptom. Bleeding recurrence was monitored during follow-ups. Logistic regression analysis was employed to explore potential risk factors associated with bleeding outcomes. RESULTS: (1) The overall efficacy rate was 85.4%. The effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively. (2) During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79). (3) Exploratory logistic regression analysis suggested that a high pre-CAES bleeding intensity score (odds ratio [OR] = 2.887, p = 0.030) was significantly associated with non-excellent outcome (i.e., persistent bleeding); meanwhile, a high pre-CAES bleeding intensity score (OR = 3.981, p = 0.012) and a high post-CAES bleeding frequency score (OR = 3.803, p = 0.006) were significantly associated with post-CAES bleeding recurrence. (4) No severe complications were reported. CONCLUSIONS: CAES with long-needle injection of polidocanol may serve as an effective and safe therapeutic option for managing bleeding symptom in grade III internal HDs. The higher bleeding-associated scores, which encompass both bleeding frequency and intensity, may represent potential risk factors for persistent or recurrent bleeding after the CAES procedure.", "provenance": [ { "field": "n", "quote": "This single-arm retrospective observational study included 82 patients with bleeding-predominant grade III internal HDs" }, { "field": "population", "quote": "82 patients with bleeding-predominant grade III internal HDs" }, { "field": "intervention", "quote": "Cap-assisted endoscopic sclerotherapy (CAES) via a long needle" }, { "field": "intervention", "quote": "single CAES procedure by 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 effective rates for bleeding and prolapse symptoms were 96.3% and 58.2%, respectively." }, { "field": "result", "quote": "During a follow-up of 24 months, the bleeding recurrence rate was 25.3% (20/79)." }, { "field": "followUp", "quote": "During a follow-up of 24 months" } ] }, { "id": "pmid:42067175", "pmid": "42067175", "doi": "10.1016/j.cgh.2026.04.008", "nctId": null, "pmcid": null, "title": "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review", "firstAuthor": "Qureshi", "multipleAuthors": true, "journal": "Clin Gastroenterol Hepatol", "year": 2026, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "various hemorrhoid treatments including diet/lifestyle changes, topical treatments, rubber band ligation, infrared coagulation, and surgery", "comparator": "different treatments compared to each other or to no treatment", "primaryOutcome": "control of hemorrhoid symptoms including bleeding and prolapse", "result": "Rubber band ligation and infrared coagulation are both effective, with banding giving longer-lasting control of bleeding and prolapse than infrared coagulation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is an expert opinion guideline based on a literature review without a systematic review or formal evidence grading.", "directness": "direct", "limitations": "Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations.", "followUp": "", "plainFinding": "Banding works better long-term than infrared", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42067175/", "sourceText": "DESCRIPTION: Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease. METHODS: This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evaluation, if indicated. BPA 7: In patients with active Crohn's disease or ulcerative colitis, hemorrhoid disease management should be delayed until complete remission is achieved. BPA 8: Hemorrhoids occur in up to two-thirds of women during pregnancy. Treatment should generally involve conservative management, including fiber, treatment of constipation, and topical ointments. If symptoms persist postpartum, or if a woman is planning further pregnancies, standard treatment such as banding or infrared coagulation can be considered. BPA 9: Acute thrombosed hemorrhoids are often extremely painful. They are best treated surgically with incision and drainage. BPA 10: Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids. Large skin tags can be removed without a hemorrhoidectomy if they are not associated with significant hemorrhoids. Grade 4 internal hemorrhoids require surgical hemorrhoidectomy. BPA 11: Patients with cirrhosis and hemorrhoids should be carefully examined so as not to confuse hemorrhoids with rectal varices. Hemorrhoids in patients with cirrhosis can be treated with banding or infrared coagulation. In patients with significant coagulopathy, infrared coagulation is preferred to banding. Concomitant portal hypertension should not alter this approach. For most clinicians, significant coagulopathy means a platelet count of less than 50,000 per microliter or international normalized ratio greater than 2.0. The presence of concomitant portal hypertension should not alter this approach.", "provenance": [ { "field": "population", "quote": "Hemorrhoids are a common problem." }, { "field": "intervention", "quote": "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": "primaryOutcome", "quote": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding." }, { "field": "result", "quote": "Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding." }, { "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: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 hemorrhoids having surgery", "intervention": "open hemorrhoidectomy plus lateral internal sphincterotomy", "comparator": "open hemorrhoidectomy alone", "primaryOutcome": "postoperative pain and bleeding after surgery", "result": "adding sphincterotomy reduced pain and early bleeding compared with hemorrhoidectomy alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but single-center, only 120 patients, outcomes partly based on unblinded patient report, and the trial was registered only after it finished.", "directness": "indirect", "limitations": "abstract does not mention blinding of outcome assessors, long-term follow-up beyond two weeks, or details on bleeding severity or need for intervention.", "followUp": "two weeks", "plainFinding": "Less pain and bleeding after surgery", "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": "A total of 120 patients with Grade III or IV haemorrhoids" }, { "field": "intervention", "quote": "the group of open haemorrhoidectomy with lateral internal sphincterotomy (Group A, n = 60)" }, { "field": "comparator", "quote": "the group of open haemorrhoidectomy alone (Group B, n = 60)" }, { "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": "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." }, { "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": "mixed hemorrhoids with Grade II-IV internal hemorrhoid prolapse as the main symptom", "intervention": "Endoscopic Super-hemorrhoidal Banding (ESHB)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH)", "primaryOutcome": "cure rate and postoperative complications including bleeding", "result": "Cure rates were similar between groups, but the banding procedure had shorter surgery and hospital stay, less pain, and fewer urinary retention complications; one patient in each group had severe bleeding that was stopped with suture or endoscopic clip closure", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective comparison of two surgeries without randomization, so differences between groups could be due to factors other than the treatment itself, and follow-up was short-term.", "directness": "direct", "limitations": "Retrospective observational design with no randomization; abstract states long-term efficacy still requires further validation", "followUp": "", "plainFinding": "Similar cure rate, less pain with banding", "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": "mixed hemorrhoids with Grade II-IV internal hemorrhoid prolapse as the main symptom" }, { "field": "intervention", "quote": "Endoscopic Super-hemorrhoidal Banding (ESHB)" }, { "field": "comparator", "quote": "patients underwent 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). One patient in each group had severe postoperative bleeding, which stopped after surgical suture or endoscopic titanium clip closure." } ] }, { "id": "pmid:41906143", "pmid": "41906143", "doi": "10.1186/s12893-026-03702-9", "nctId": null, "pmcid": "PMC13151250", "title": "Ruiyun procedure for hemorrhoids versus tissue-selective therapy stapler for grade II-III hemorrhoids: an exploratory retrospective comparative study", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2026, "design": "retrospective", "n": 192, "nField": "reported", "population": "patients with Grade II-III hemorrhoids", "intervention": "Ruiyun procedure for hemorrhoids (RPH)", "comparator": "tissue-selecting therapy (TST) stapler", "primaryOutcome": "treatment effectiveness rate at one month and recurrence rate within one year after surgery", "result": "no significant difference in overall efficacy or one-year recurrence, but RPH had shorter operative time, less bleeding, faster recovery and higher satisfaction", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it is a retrospective, non-randomized comparison of two surgeries with possible differences in patient selection, so it carries limited weight on bleeding mechanisms or treatment.", "directness": "indirect", "limitations": "retrospective design with potential differences in baseline characteristics between groups, limiting causal interpretation", "followUp": "1 year", "plainFinding": "Similar healing, fewer complications with one surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41906143/", "sourceText": "BACKGROUND: The Ruiyun procedure for hemorrhoids (RPH) and tissue-selecting therapy (TST) are two widely adopted minimally invasive techniques for treating Grade II-III hemorrhoids. This study aims to perform an exploratory comparison of the efficacy and safety of these two surgical techniques within a real-world clinical setting, thereby providing evidence to inform future prospective investigations. METHODS: A retrospective analysis was conducted on 192 patients with Grade II-III hemorrhoids, comprising 80 patients who underwent RPH and 112 who underwent TST. The primary outcomes were the treatment effectiveness rate at one month and the recurrence rate within one year postoperatively. Secondary outcomes included operative time, intraoperative blood loss, time to return to normal activities, postoperative anal pain, complication rates, patient satisfaction, and PROM scores. RESULTS: The two groups were comparable in baseline characteristics. No significant differences were found in the overall clinical efficacy or the one-year recurrence rate between the groups (p > 0.05). However, the RPH group demonstrated significant advantages, including shorter operative time, reduced intraoperative blood loss, faster return to normal activities, lower anal pain scores on postoperative days 1 and 3, a lower incidence of fecal urgency and higher patient satisfaction (all p < 0.05). No significant intergroup differences were observed in terms of anal distension, postoperative bleeding, anorectal stenosis, PROM scores, or anal pain on postoperative day 7 (p > 0.05). CONCLUSION: Within the context of this retrospective study, RPH demonstrated efficacy and safety in the treatment of Grade II–III hemorrhoids. It exhibited favorable outcomes in reducing intraoperative blood loss, shortening operative time, minimizing postoperative complications, and facilitating a rapid return to normal activities. However, given the potential differences in baseline characteristics between the two patient groups, these observations cannot be directly interpreted as evidence of the superiority or inferiority of either technique. The observed differences in efficacy may be partially attributable to disparities in patient selection.", "provenance": [ { "field": "n", "quote": "A retrospective analysis was conducted on 192 patients with Grade II-III hemorrhoids, comprising 80 patients who underwent RPH and 112 who underwent TST." }, { "field": "population", "quote": "patients with Grade II-III hemorrhoids" }, { "field": "intervention", "quote": "Ruiyun procedure for hemorrhoids (RPH)" }, { "field": "comparator", "quote": "tissue-selecting therapy (TST)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were the treatment effectiveness rate at one month and the recurrence rate within one year postoperatively." }, { "field": "result", "quote": "No significant differences were found in the overall clinical efficacy or the one-year recurrence rate between the groups (p > 0.05). However, the RPH group demonstrated significant advantages, including shorter operative time, reduced intraoperative blood loss, faster return to normal activities, lower anal pain scores on postoperative days 1 and 3, a lower incidence of fecal urgency and higher patient satisfaction (all p < 0.05)." } ] }, { "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": "adults with grade III and IV hemorrhoids undergoing surgical removal", "intervention": "LigaSure radiofrequency hemorrhoidectomy", "comparator": "Voyant radiofrequency hemorrhoidectomy", "primaryOutcome": "30-day postoperative complications: bleeding, urinary retention, and anal stenosis", "result": "no significant differences in bleeding, urinary retention, or anal stenosis between the two devices", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small, non-randomized observational comparison of two surgical devices, not a trial testing why hemorrhoids bleed or how to stop it medically.", "directness": "indirect", "limitations": "Observational (not randomized) design, single comparison of two surgical devices rather than addressing bleeding mechanism or non-surgical treatment.", "followUp": "30-day", "plainFinding": "Similar complication rates between devices.", "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": "population", "quote": "grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "LigaSure hemorrhoidectomy" }, { "field": "comparator", "quote": "Voyant hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "No statistical differences were observed between the two groups in terms of postoperative bleeding, urinary retention, and anal stenosis." }, { "field": "n", "quote": "In total, 123 patients were enrolled (61 in group A and 62 in group B)." } ] }, { "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 symptomatic grade II to IV hemorrhoids not helped by other treatment", "intervention": "Doppler-guided hemorrhoidal artery ligation, with or without mucopexy", "comparator": "before vs after surgery, no separate comparison group", "primaryOutcome": "pain scores, symptom resolution, and recurrence after surgery", "result": "pain dropped sharply by one month, 92.6% had symptoms resolve, 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 look-back at one group's records with no comparison group, so it can't prove the procedure itself caused the improvement.", "directness": "direct", "limitations": "Retrospective design, no control group, single-center database", "followUp": "year 1", "plainFinding": "Less pain, but more recurrence 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": "n", "quote": "A total of 94 patients (59 males, 35 females; mean age: 47.8 ± 12.4 y) underwent the procedure." }, { "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": "comparator", "quote": "A retrospective analysis was conducted using a prospectively maintained database of patients who underwent DG-HAL ± mucopexy" }, { "field": "primaryOutcome", "quote": "Treatment efficacy was evaluated based on changes in symptom severity and hemorrhoid grade across follow-up periods." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "Recurrence rates were 8.16% (4/49) in grade III and 31.25% (5/16) in grade IV hemorrhoids." }, { "field": "result", "quote": "Overall symptom resolution was achieved in 92.6% of patients, and 90.4% reported high satisfaction with the treatment." } ] }, { "id": "pmid:41620906", "pmid": "41620906", "doi": "10.36721/PJPS.2026.39.3.REG.15375.1", "nctId": null, "pmcid": null, "title": "Comparative efficacy of Ma Yinglong ointment and Gangtai suppository for hemorrhoids: A retrospective cohort study", "firstAuthor": "Gao", "multipleAuthors": true, "journal": "Pak J Pharm Sci", "year": 2026, "design": "retrospective", "n": 514, "nField": "reported", "population": "patients with hemorrhoids", "intervention": "Ma Yinglong hemorrhoid ointment", "comparator": "Gangtai suppository", "primaryOutcome": "symptom scores (pain, swelling, bleeding) and quality of life at 7 and 14 days", "result": "Ma Yinglong gave better pain/swelling relief and quality of life, but Gangtai suppository gave slightly better bleeding control; overall response rates and adverse reactions were similar", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison, so differences between groups could be due to other factors, not just the treatments.", "directness": "direct", "limitations": "Retrospective cohort design without randomization; abstract does not mention blinding or statistical significance testing for all comparisons.", "followUp": "14 days", "plainFinding": "Mixed: less pain with one, less bleeding with other.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41620906/", "sourceText": "BACKGROUND: Hemorrhoidal disease (HD) is a common anorectal condition that can have negative impacts on both physical and mental health as well as public health. OBJECTIVE: This retrospective analysis evaluated the use of Ma Yinglong hemorrhoid ointment versus Gangtai suppositories. METHODS: A retrospective comparative study of the efficacy and safety differences between Ma Yinglong hemorrhoid ointment and Gangtai Suppositories in the treatment of hemorrhoids. In this retrospective cohort, 514 hemorrhoid patients (2024) were equally divided into Ma Yinglong (n=257) and Gangtai suppository (n=257) groups. Symptom scores, quality of life and adverse reactions were compared between the two groups at days 7 and 14. RESULTS: Baseline characteristics were balanced between the two groups. After 14 days of treatment, the Ma Yinglong Hemorrhoid Ointment demonstrated significant advantages in pain relief Visual Simulation Score (VAS score: 1.2 vs 2.0) and swelling reduction, with markedly improved quality of life scores (88.7 vs 76.3). The Gangtai Suppository treatment group showed superior bleeding control (bleeding score: 0.6 vs 0.7). The overall response rates (92.61% vs 89.88%) and incidence of adverse reactions (5.06% vs 5.84%) were comparable between the two groups. CONCLUSION: The results of this study indicate that Ma Yinglong Hemorrhoid Ointment provides rapid relief for external hemorrhoid swelling and pain, while Gangtai Suppository are more suitable for controlling bleeding from internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "514 hemorrhoid patients (2024) were equally divided into Ma Yinglong (n=257) and Gangtai suppository (n=257) groups" }, { "field": "population", "quote": "Hemorrhoidal disease (HD) is a common anorectal condition" }, { "field": "intervention", "quote": "Ma Yinglong hemorrhoid ointment" }, { "field": "comparator", "quote": "Gangtai Suppositories" }, { "field": "primaryOutcome", "quote": "Symptom scores, quality of life and adverse reactions were compared between the two groups at days 7 and 14." }, { "field": "result", "quote": "Ma Yinglong Hemorrhoid Ointment demonstrated significant advantages in pain relief Visual Simulation Score (VAS score: 1.2 vs 2.0) and swelling reduction, with markedly improved quality of life scores (88.7 vs 76.3). The Gangtai Suppository treatment group showed superior bleeding control (bleeding score: 0.6 vs 0.7)." } ] }, { "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 undergoing surgery", "intervention": "surgical hemorrhoid removal plus polidocanol foam injection into remaining tissue", "comparator": "surgical hemorrhoid removal alone", "primaryOutcome": "time to return to daily activities", "result": "recovery was about 6 days faster, with less bleeding and less pain medication use, with added sclerotherapy", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Very small, single-center, unblinded trial with short follow-up, so results may not hold up in larger studies.", "directness": "direct", "limitations": "Small sample size, nonblinded, single-center design, and short follow-up period.", "followUp": "1 to 2 months", "plainFinding": "Faster recovery, less post-op bleeding.", "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": "n", "quote": "Thirty-six patients aged 18 to 75 years with grade IV hemorrhoidal disease were enrolled and randomized equally to 2 groups." }, { "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": "limitations", "quote": "Small sample size, nonblinded, single-center design, and short follow-up period." }, { "field": "followUp", "quote": "improved symptom scores at 1 to 2 months" } ] }, { "id": "pmid:41508088", "pmid": "41508088", "doi": "10.19540/j.cnki.cjcmm.20250724.501", "nctId": null, "pmcid": null, "title": "[Multicenter, randomized, open-label, and positive-controlled clinical trial of Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment in postoperative management of mixed hemorrhoids]", "firstAuthor": "Han", "multipleAuthors": true, "journal": "Zhongguo Zhong Yao Za Zhi", "year": 2025, "design": "rct", "n": 240, "nField": "reported", "population": "patients who had surgery (Milligan-Morgan hemorrhoidectomy) for mixed hemorrhoids", "intervention": "Pien Tze Huang Capsules taken orally plus Compound Pien Tze Huang Hemorrhoid Ointment applied to the wound, on top of standard sitz baths", "comparator": "Mayinglong Shexiang Hemorrhoid Ointment applied to the wound, on top of standard sitz baths", "primaryOutcome": "wound fluid discharge, wound bleeding, and new tissue growth scores after surgery", "result": "Wound exudation scores were significantly lower with Pien Tze Huang treatment, but wound bleeding scores and granulation scores showed no significant difference between groups", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized multicenter trial with a reasonable sample size, but it was open-label (not blinded) and only followed wounds for 7 days using scored outcomes rather than hard clinical endpoints.", "directness": "indirect", "limitations": "Open-label design, short 7-day treatment and follow-up period, and no statistically significant benefit on bleeding, pain, or granulation outcomes.", "followUp": "postoperative day 7", "plainFinding": "Less wound ooze, not less bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41508088/", "sourceText": "Pien Tze Huang has the efficacy of clearing heat, removing toxins, cooling the blood, removing blood stasis, subduing swelling, and relieving pain. It is widely used in the treatment of acute viral hepatitis, carbuncles and furuncles, unidentified swelling and poison, blunt trauma, and various inflammations. To investigate the clinical efficacy and safety of Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment in controlling the postoperative inflammatory response of wounds in patients undergoing surgery for mixed hemorrhoids, a multicenter, randomized, open-label, and positive-controlled clinical trial was conducted at 12 tertiary medical institutions in China. A total of 240 patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids were enrolled and randomly assigned to the treatment or control group(1∶1). Both groups received sitz baths with Compound Jingjie for Fumigation and Washing as basic treatment. The treatment group additionally received Pien Tze Huang Capsules orally(2 capsules per dose, 3 times per day) and topical application of Compound Pien Tze Huang Hemorrhoid Ointment(2.5 g, twice per day), while the control group received topical Mayinglong Shexiang Hemorrhoid Ointment(2.5 g, twice per day). The treatment duration was 7 days. Primary efficacy endpoints included wound exudation scores, wound bleeding scores, and wound granulation tissue formation scores, and secondary endpoints included perianal edema scores, pain score using pain visual analogue scale(VAS) scores, postoperative analgesic use, and adverse events. RESULTS:: showed that in the full analysis set(FAS), the wound exudation scores on postoperative day 7 was significantly lower in the treatment group compared to that in the control group(P<0.05). In the per-protocol set(PPS), the wound exudation scores on postoperative days 3 and 7 was also significantly lower in the treatment group(P<0.05). While the treatment group showed lower perianal edema scores and pain VAS scores than the control group, the differences were not statistically significant. No statistically significant differences were observed between the two groups in wound bleeding scores, wound granulation tissue formation scores, analgesic use rate or amount, or incidence of adverse reactions. A total of 56 adverse events were observed, with 25 in the treatment group and 31 in the control group. The incidence of adverse reactions was comparable between groups, with no statistically significant difference. No serious drug-related adverse events were observed in either group. The results suggest that the Pien Tze Huang Capsules combined with Compound Pien Tze Huang Hemorrhoid Ointment can reduce wound exudation after surgery for mixed hemorrhoids, playing a beneficial role in controlling postoperative inflammation. The treatment offers good safety and tolerability, showing great potential as a postoperative adjunctive therapy integrating traditional Chinese medicine and western medicine.", "provenance": [ { "field": "population", "quote": "patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids were enrolled" }, { "field": "intervention", "quote": "The treatment group additionally received Pien Tze Huang Capsules orally(2 capsules per dose, 3 times per day) and topical application of Compound Pien Tze Huang Hemorrhoid Ointment(2.5 g, twice per day)" }, { "field": "comparator", "quote": "the control group received topical Mayinglong Shexiang Hemorrhoid Ointment(2.5 g, twice per day)" }, { "field": "primaryOutcome", "quote": "Primary efficacy endpoints included wound exudation scores, wound bleeding scores, and wound granulation tissue formation scores" }, { "field": "result", "quote": "the wound exudation scores on postoperative day 7 was significantly lower in the treatment group compared to that in the control group(P<0.05)" }, { "field": "result", "quote": "No statistically significant differences were observed between the two groups in wound bleeding scores, wound granulation tissue formation scores, analgesic use rate or amount, or incidence of adverse reactions" }, { "field": "n", "quote": "A total of 240 patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids were enrolled" } ] }, { "id": "pmid:41496147", "pmid": "41496147", "doi": "10.1097/MD.0000000000046474", "nctId": null, "pmcid": "PMC12778075", "title": "Evaluation of the nursing effect of mirabilite fomentation on postoperative edema, pain, and urinary retention in patients with mixed hemorrhoids", "firstAuthor": "Ren", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2026, "design": "retrospective", "n": 72, "nField": "reported", "population": "patients who had surgery for mixed hemorrhoids (external stripping and internal ligation)", "intervention": "mirabilite fomentation as a post-surgery nursing treatment", "comparator": "standard postoperative nursing care (control group)", "primaryOutcome": "postoperative bleeding, edema, pain, and urinary retention after hemorrhoid surgery", "result": "mirabilite group had lower bleeding scores, less edema, less pain, lower urinary retention, and faster wound healing than control", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study without randomization, so bias and confounding can't be ruled out despite statistical matching.", "directness": "indirect", "limitations": "Retrospective design, single hospital, no randomization, and the question here is about causes and treatment of hemorrhoid bleeding generally, while this study only examines post-surgical nursing care.", "followUp": "day 7", "plainFinding": "Less bleeding, faster healing after surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41496147/", "sourceText": "This study aims to investigate the nursing effect of single-agent mirabilite fomentation on postoperative edema, pain, and urinary retention in patients with circumferential mixed hemorrhoids. A retrospective cohort study was conducted including 121 patients who underwent external stripping and internal ligation for circumferential mixed hemorrhoids in our hospital from January 2023 to December 2024. Patients were divided into a mirabilite fomentation group and a control group according to postoperative nursing methods. Propensity score matching was applied to control confounding factors, yielding 72 comparable cases (36 in each group). 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. After propensity score matching, baseline characteristics were comparable between the 2 groups (P > .05). Compared with the control group, the mirabilite fomentation group had lower bleeding scores on postoperative day 3 and day 7 (group effect F = 5.73, P = .020; interaction F = 4.11, P = .018). The reduction in edema area and height was more pronounced (both P < .05). Declines in the sensation of distension and visual analogue scale pain scores were more significant over time (distension: group effect F = 4.82, P = .031; pain: group effect F = 6.45, P = .014). The incidence of urinary retention was lower in the mirabilite group (11.1% vs 30.6%, P = .044), with shorter time to first urination (8.42 ± 1.25 hours vs 10.17 ± 1.47 hours, P < .001). Wound healing time was reduced (14.53 ± 2.17 days vs 17.06 ± 2.48 days, P < .001). The total effective rate on day 7 was higher (94.4% vs 77.8%, P = .04). No severe adverse reactions were observed in either group, while patient satisfaction was higher in the mirabilite group (91.7% vs 69.4%, P = .021). Mirabilite fomentation as a nursing intervention can significantly alleviate postoperative edema, distension, and pain in patients with circumferential mixed hemorrhoids, reduce the incidence of urinary retention, accelerate wound healing, and achieve good safety and high patient satisfaction. It has clinical value for wider application.", "provenance": [ { "field": "population", "quote": "patients who underwent external stripping and internal ligation for circumferential mixed hemorrhoids" }, { "field": "intervention", "quote": "single-agent mirabilite fomentation" }, { "field": "comparator", "quote": "Patients were divided into a mirabilite fomentation group and a control group according to postoperative nursing methods" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "the mirabilite fomentation group had lower bleeding scores on postoperative day 3 and day 7" }, { "field": "result", "quote": "The reduction in edema area and height was more pronounced (both P < .05)" }, { "field": "result", "quote": "The incidence of urinary retention was lower in the mirabilite group (11.1% vs 30.6%, P = .044)" }, { "field": "result", "quote": "Wound healing time was reduced (14.53 ± 2.17 days vs 17.06 ± 2.48 days, P < .001)" }, { "field": "n", "quote": "Propensity score matching was applied to control confounding factors, yielding 72 comparable cases (36 in each group)." } ] }, { "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": "patients with grade I-III internal hemorrhoids who failed conservative treatment or couldn't have surgery", "intervention": "endoscopic rubber band ligation (ERBL)", "comparator": "endoscopic injection sclerotherapy (EIS)", "primaryOutcome": "treatment effectiveness (cure/improvement) and recurrence rate within 3 months after procedure", "result": "No significant difference in effectiveness between ERBL and EIS, but ERBL had higher complication rates including bleeding and urinary retention, while EIS had less pain and less anal distension", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study comparing two treatments without a true control group, so it cannot show why hemorrhoids bleed or test what stops bleeding directly.", "directness": "indirect", "limitations": "Retrospective design, not randomized, and focuses on comparing two active treatments rather than explaining bleeding mechanism or an untreated comparison.", "followUp": "3 months", "plainFinding": "Both treatments similarly effective; ERBL caused more bleeding", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41397826/", "sourceText": "Objective: To explore the clinical efficacy and safety of endoscopic rubber band ligation (ERBL) and endoscopic injection sclerotherapy (EIS) in the treatment of grade I-III internal hemorrhoids, to provide a basis for the individualized treatment of patients with internal hemorrhoids in clinical practice. Methods: A retrospective cohort study was conducted. A total of 613 patients with grade I to III internal hemorrhoids who underwent ERBL or EIS at The Sixth Affiliated Hospital of Sun Yat-sen University from December 2019 to November 2023 were retrospectively collected. Inclusion criteria: (1) Patients diagnosed with symptomatic grade I-III internal hemorrhoids who failed conservative treatments such as diet adjustment and medication; (2) Patients who were unable or unwilling to receive surgical treatment due to multiple underlying systemic diseases. Exclusion criteria: (1) Patients with grade I-III internal hemorrhoids complicated with incarceration, thrombosis or other complications; (2) Patients with a history of hemorrhoid surgery; (3) Patients complicated with perianal abscess, anal fistula, active proctitis, rectal tumor, polyp, radiation proctitis or inflammatory bowel disease; (4) Patients with incomplete clinical data or lost to follow-up. This study was divided into the ERBL group and the EIS group based on different treatment. Baseline characteristics, postoperative effective rate, recurrence rate, pain score, anal distension, anal edema, complication rate, and treatment satisfaction were compared between the two groups. Results: After balancing with propensity score matching (PSM), a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group. There were no statistically significant differences in baseline characteristics, such as gender, age, body mass index, Goligher classification, and laboratory test indicators, between the two groups (all P > 0.05), indicating that the two groups were comparable. The cure rates of the ERBL group and the EIS group were 64.0% (128/200) and 62.8% (71/113), respectively. The marked effective rates were 31.5% (63/200) and 34.5% (39/113), and the ineffective rates were 4.5% (9/200) and 2.7% (3/113), respectively. Statistical analysis revealed no statistically significant difference in efficacy between the two groups within 3 months after the operation (χ²=0.858, P=0.651). The recurrence rate of the ERBL group was lower than that of the EIS group [13.1% (25/191) vs. 18.2% (20/110)], but the difference was not statistically significant (χ²=1.424, P=0.233). Subgroup analysis showed that the recurrence rates of ERBL and EIS were similar in grade I-II internal hemorrhoids [10.3% (15/146) vs. 10.5% (9/86), χ²=0.002, P=0.963]; in grade III internal hemorrhoids, the recurrence rate of the ERBL group was lower than that of the EIS group [22.2% (10/45) vs. 45.8% (11/24), χ²=4.121, P=0.042]. Still, the difference was not statistically significant after Bonferroni correction (χ²=4.121, corrected P>0.025). Compared with the ERBL group, the EIS group had a lower pain score on the first day after operation [0 (0, 0) vs. 1 (0, 3), Z=-8.211, P<0.001] and a lower incidence of anal distension [25.7% (29/113) vs. 61.5% (123/200), χ²=37.122, P<0.001], with statistically significant differences. The total incidence of complications in the ERBL group was significantly higher than that in the EIS group [29.5% (59/200) vs. 4.4% (5/113), χ²=27.910, P<0.001], mainly reflected in postoperative bleeding [18.0% (36/200) vs. 3.5% (4/113), χ²=13.544, P<0.001] and urinary retention [8.5% (17/200) vs. 0, χ²=10.157, P=0.001], with statistically significant differences. There were no statistically significant differences in postoperative satisfaction, health status score, and the proportion of returning to everyday life within 1 month between the two groups (all P>0.05). Conclusions: Both ERBL and EIS are effective minimally invasive therapies for grade I-III internal hemorrhoids. EIS is preferred for grade I and II internal hemorrhoids to reduce complications, while ERBL shows a trend in reducing the recurrence rate of grade III internal hemorrhoids. Clinical decisions should be made comprehensively based on the classification, patient tolerance, and prognosis.", "provenance": [ { "field": "n", "quote": "a total of 313 patients were included, including 200 in the ERBL group and 113 in the EIS group" }, { "field": "population", "quote": "A total of 613 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 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]" } ] }, { "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 in Vietnam", "intervention": "conservative treatment, mainly a venoactive drug (micronized purified flavonoid fraction)", "comparator": "none reported; outcomes compared to patients' own baseline over time", "primaryOutcome": "improvement in hemorrhoid symptoms (pain, discomfort, bleeding) and quality of life", "result": "bleeding improved in 68.2% of patients in the venoactive drug group by week one, and overall symptoms decreased from a mean of 4.6 to 1.0 by week four", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was an observational study without a comparison group, so improvement over time cannot be clearly attributed to the treatment itself.", "directness": "direct", "limitations": "No control group was used, and the study only measured changes over time within treated patients.", "followUp": "four weeks", "plainFinding": "Bleeding and other symptoms 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" }, { "field": "population", "quote": "adult patients (≥18 years) diagnosed with acute hemorrhoidal disease (≤48 h since onset) who received conservative treatment" }, { "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": "At week one, the venoactive drug group showed symptom improvement rates of 63% for pain, 56.8% for discomfort, and 68.2% for bleeding." } ] }, { "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 hemorrhoids", "intervention": "laser hemorrhoidoplasty plus excisional hemorrhoidectomy", "comparator": "LigaSure hemorrhoidectomy", "primaryOutcome": "surgical results and 30-day complications", "result": "Laser plus excisional surgery caused less urinary retention and less pain than LigaSure surgery, and bleeding improved by 6 weeks after surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study comparing patients treated at different time periods rather than a randomized trial, so differences could be due to other factors.", "directness": "indirect", "limitations": "retrospective design with historical (non-randomized) comparison group; authors state further prospective studies with larger numbers are needed", "followUp": "postoperative week 6", "plainFinding": "Less pain, bleeding improved by 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": "n", "quote": "A total of 92 patients who underwent LHP plus EH and 140 who underwent LigaSure hemorrhoidectomy were included." }, { "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." }, { "field": "result", "quote": "Regarding patient-reported outcomes, pain, bleeding, and prolapse improved after postoperative week 6." }, { "field": "followUp", "quote": "improved after postoperative week 6" } ] }, { "id": "pmid:41282992", "pmid": "41282992", "doi": "10.7717/peerj.20252", "nctId": null, "pmcid": "PMC12633121", "title": "The effect of endoscopic polidocanol carbon dioxide foam for internal hemorrhoids: a retrospective study", "firstAuthor": "Xiang", "multipleAuthors": true, "journal": "PeerJ", "year": 2025, "design": "retrospective", "n": 158, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "endoscopic sclerotherapy with polidocanol carbon dioxide foam", "comparator": "endoscopic sclerotherapy with polidocanol air foam", "primaryOutcome": "clinical effectiveness and complication rate one month after treatment", "result": "Both foams were equally effective, but carbon dioxide foam caused significantly less anal pain and swelling", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison without blinding, so differences could be due to factors other than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design, not randomized, relies partly on patient self-report, single timepoint follow-up of one month.", "followUp": "1 month", "plainFinding": "Same effectiveness, fewer pain complications", "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": "population", "quote": "internal hemorrhoids" }, { "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": "intervention", "quote": "received polidocanol carbon dioxide foam (study group)" }, { "field": "comparator", "quote": "underwent endoscopic polidocanol sclerotherapy with polidocanol air foam (control group)" }, { "field": "primaryOutcome", "quote": "The primary outcomes of this study were clinical effect and the incidence of complications 1 month after surgery." }, { "field": "result", "quote": "The study group exhibited significantly fewer patients with anal pain and anal swelling compared to the control group (P < 0.05), and importantly, no severe complications were observed." }, { "field": "result", "quote": "Both groups exhibited comparable clinical effects, surgical costs, hospitalization durations, and dosages of polidocanol, with no statistically significant differences observed (all P > 0.05)." } ] }, { "id": "pmid:41239416", "pmid": "41239416", "doi": "10.1186/s12893-025-03289-7", "nctId": null, "pmcid": "PMC12619312", "title": "Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "BMC Surg", "year": 2025, "design": "retrospective", "n": 253, "nField": "reported", "population": "patients with grade I-III internal hemorrhoids treated at one hospital", "intervention": "endoscopic treatments for internal hemorrhoids: sclerotherapy, rubber band ligation, and combined ligation-sclerotherapy", "comparator": "the three endoscopic treatment methods compared against each other", "primaryOutcome": "treatment efficacy within 3 months and recurrence of symptoms after 3 months", "result": "combined therapy had the highest efficacy (95.8%) and lowest recurrence (4.3%), followed by ligation then sclerotherapy, especially for more severe grades", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective study without randomization, with small group sizes (especially the combined therapy group of only 24 patients), so differences between treatments may not be reliable.", "directness": "direct", "limitations": "Retrospective design; unequal and small group sizes, particularly the combined therapy group (n=24); no mention of blinding or control for confounding factors.", "followUp": "3 months", "plainFinding": "Combined ligation plus sclerotherapy worked best.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41239416/", "sourceText": "OBJECTIVE: This study aimed to evaluate the comparative effectiveness, safety, and recurrence rates of endoscopic sclerotherapy (ES), endoscopic rubber band ligation (RBL), and combined ligation - sclerotherapy (CT) for grades I - III internal hemorrhoids. METHODS: A retrospective analysis was conducted on patients who underwent endoscopic minimally-invasive treatment for internal hemorrhoids at Wuhu First People's Hospital from January 2020 to December 2024. Patients were divided into ES, RBL, and CT groups. Safety was evaluated by recording post-procedural pain and adverse events. Efficacy was assessed within 3 months post-treatment, and recurrence was defined as symptom reappearance > 3 months post-treatment. Patient satisfaction was also recorded. RESULTS: A total of 253 patients were included (168 males, 85 females; mean age 46.2 ± 12.8 years), with 107 in the ES group, 122 in the RBL group, and 24 in the CT group. Hemorrhoid grade distribution was 68 cases (26.9%) of Grade I, 112 cases (44.2%) of Grade II, and 73 cases (28.9%) of Grade III. In terms of efficacy, for all grades combined, the efficacy rate was 90.6% (95/107) for ES, 92.6% (113/122) for RBL, and 95.8% (23/24) for CT. CT showed the highest efficacy, especially for grade III hemorrhoids (95.0% [19/20]). Regarding safety, ES had a lower proportion of severe pain (6.5% [7/107]). Adverse events had low rates (bleeding: 4.2-6.6%; fever: 2.8-4.2%) with no significant inter-group differences. Patient satisfaction rates were 84.1% (90/107) for ES, 82.0% (100/122) for RBL, and 83.3% (20/24) for CT, with no substantial variation. For recurrence rates, CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95]), particularly evident in higher-grade hemorrhoids. CONCLUSION: Endoscopic treatments, especially CT, are effective and relatively safe for grades I - III internal hemorrhoids. CT shows promise in terms of efficacy and recurrence prevention, especially for more severe cases.", "provenance": [ { "field": "n", "quote": "A total of 253 patients were included" }, { "field": "population", "quote": "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": "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])." }, { "field": "result", "quote": "CT had the lowest rate (4.3% [1/23]), followed by RBL (9.7% [11/113]) and ES (11.6% [11/95])" }, { "field": "followUp", "quote": "Efficacy was assessed within 3 months post-treatment" } ] }, { "id": "pmid:41197059", "pmid": "41197059", "doi": null, "nctId": null, "pmcid": null, "title": "Massive Rectal Bleeding After Rubber Band Ligation of Internal Hemorrhoids: A Case Report", "firstAuthor": "Turunen", "multipleAuthors": true, "journal": "WMJ", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 34-year-old woman with internal hemorrhoids treated with rubber band ligation", "intervention": "rubber band ligation of internal hemorrhoids", "comparator": "none", "primaryOutcome": "delayed rectal bleeding after the procedure and how it was stopped", "result": "she had massive rectal bleeding 15 days later from an ulcer with a visible vessel at the banding site, stopped with a clip and hemostatic spray", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show how often this happens or what reliably works.", "directness": "indirect", "limitations": "single case report; no comparison group; cannot estimate frequency or generalize treatment effectiveness", "followUp": "", "plainFinding": "", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41197059/", "sourceText": "INTRODUCTION: Rubber band ligation (RBL) is a common treatment for internal hemorrhoids. Although generally safe, complications such as delayed bleeding can occur, particularly in patients taking anticoagulants, antiplatelets, or nonsteroidal anti-inflammatory drugs (NSAIDs). CASE PRESENTATION: A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids. She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders. Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray. She recovered without further complications. DISCUSSION: Massive bleeding following RBL is rare, especially in patients without traditional bleeding risk factors. Literature review identified only one similar case. Most reported cases involve patients on aspirin or other blood-thinning agents. This case adds to the limited data on severe post-RBL bleeding in low-risk individuals and highlights the potential for delayed presentation. CONCLUSIONS: This case highlights the potential for delayed and significant bleeding post-RBL, even in patients without traditional bleeding risk factors. Vigilance beyond the immediate postoperative period is essential, and patients should be counseled on signs of delayed complications.", "provenance": [ { "field": "n", "quote": "A 34-year-old White woman presented with massive rectal bleeding" }, { "field": "population", "quote": "A 34-year-old White woman presented with massive rectal bleeding 15 days after suction RBL of internal hemorrhoids" }, { "field": "intervention", "quote": "Rubber band ligation (RBL) is a common treatment for internal hemorrhoids" }, { "field": "comparator", "quote": "She was not taking anticoagulants, antiplatelets, or NSAIDs and had no history of bleeding disorders" }, { "field": "primaryOutcome", "quote": "complications such as delayed bleeding can occur" }, { "field": "result", "quote": "Flexible sigmoidoscopy revealed a 10-mm ulcer with a visible vessel at the previous banding site. Hemostasis was achieved with clip placement and hemostatic spray." } ] }, { "id": "pmid:41047429", "pmid": "41047429", "doi": "10.1007/s00384-025-04999-3", "nctId": null, "pmcid": "PMC12497663", "title": "Modified sclerobanding versus rubber band ligation for grade II/III hemorrhoidal disease: a retrospective study", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "retrospective", "n": 307, "nField": "reported", "population": "patients with grade II/III hemorrhoidal disease", "intervention": "modified sclerobanding (rubber band ligation combined with polidocanol foam sclerotherapy)", "comparator": "traditional rubber band ligation alone", "primaryOutcome": "treatment failure rate and delayed massive bleeding after the procedure", "result": "modified sclerobanding had no delayed major bleeding cases versus five in the rubber band ligation group, lower recurrence (6.8% vs 17.0%) and lower treatment failure (6.8% vs 18.6%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective, non-randomized comparison from one hospital, so other differences between groups could explain the results.", "directness": "direct", "limitations": "retrospective design, single center, baseline differences in anticoagulant history and hospital stay length between groups", "followUp": "One-year follow-up", "plainFinding": "Less bleeding, fewer treatment failures.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41047429/", "sourceText": "PURPOSE: This study aimed to evaluate the efficacy and safety of a modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS), for treating grade II/III hemorrhoidal disease (HD). METHODS: We retrospectively included patients with grade II/III HD who underwent RBL from January to December 2021 and mSB from January 2022 to February 2023 at Ningbo Medical Center Lihuili Hospital. The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB), while the secondary outcomes included postoperative complications such as pain, swelling, anal edema, and variations in bleeding grade. Long-term follow-up evaluated the HD Symptom Score (HDSS), Short Health Scale for HD (SHS-HD), and Patient Satisfaction (PS). RESULTS: Among the 307 patients, 162 received mSB and 125 underwent traditional RBL. The baseline characteristics were similar, except for the anticoagulant history and hospital stay length (P < 0.05). The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05). Postoperative complications were comparable between the groups, but the mSB group showed greater improvement in bleeding by the seventh day (P < 0.05). One-year follow-up revealed no significant differences in the HDSS, SHS-HD, or PS. CONCLUSIONS: The modified sclerobanding procedure reduces the number of ligation sessions, lowers the risk of delayed bleeding, and decreases treatment failure rates without increasing the risk of postoperative complications.", "provenance": [ { "field": "n", "quote": "Among the 307 patients, 162 received mSB and 125 underwent traditional RBL." }, { "field": "population", "quote": "patients with grade II/III HD who underwent RBL" }, { "field": "intervention", "quote": "modified sclerobanding (mSB) procedure, which combines rubber band ligation (RBL) with 3% polidocanol foam sclerotherapy (PFS)" }, { "field": "comparator", "quote": "traditional RBL" }, { "field": "primaryOutcome", "quote": "The primary outcomes assessed were treatment failure rates and the incidence of delayed massive bleeding (DMB)" }, { "field": "result", "quote": "The mSB group had no cases of delayed major bleeding, compared to five cases in the RBL group. The recurrence (6.8% vs. 17.0%) and treatment failure (6.8% vs. 18.6%) rates were significantly lower in the mSB group (P < 0.05)." } ] }, { "id": "pmid:41004811", "pmid": "41004811", "doi": "10.15403/jgld-6306", "nctId": null, "pmcid": null, "title": "The Combination of Fluocinolone Acetonide and Ketocaine Hydrochloride in the Conservative Management of Symptomatic Hemorrhoidal Disease: An Overview of Preclinical and Clinical Data", "firstAuthor": "Chiarioni", "multipleAuthors": true, "journal": "J Gastrointestin Liver Dis", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease", "intervention": "topical fluocinolone acetonide and ketocaine hydrochloride combination", "comparator": "", "primaryOutcome": "relief of hemorrhoid symptoms such as pain, itching, and inflammation", "result": "the combination provided rapid symptom relief and was well tolerated, with mostly mild and temporary side effects", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative overview citing unspecified preclinical and clinical data without describing study design, size, or statistics, so it carries limited weight.", "directness": "indirect", "limitations": "abstract does not describe study methodology, number of patients, comparator treatment, or specific data on bleeding outcomes", "followUp": "", "plainFinding": "Eases pain and swelling", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41004811/", "sourceText": "Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population. It is characterized by symptomatic enlargement and displacement of anal cushions, frequently associated with pain, bleeding, and reduced quality of life. The pathophysiology of HD includes vascular congestion, venous stasis, and vascular dilatation, promoted by increased nitric oxide activity. Inflammatory responses are considered crucial in HD, with NF-κB playing a major role. Treatment strategies for HD vary from conservative approaches to office-based and surgical interventions. Conservative therapies, such as topical agents and flavonoid-based systemic treatments, serve as the mainstay of low-grade HD management, while invasive procedures are reserved for refractory cases. 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. FLA exerts potent anti-inflammatory effects by inhibiting NF-κB and induces vasoconstrictive activity by reducing nitric oxide levels, while KH provides localized analgesia by blocking sodium channels. Collectively, these agents mitigate vascular congestion, inflammation, and HD symptoms. Clinical evidence supports the efficacy of this combination in alleviating acute symptoms, reducing recurrence, and improving patient outcomes. The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events. Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD. Furthermore, its combination with flavonoid-based supplements, which improve venous tone and reduce capillary permeability, may aid in preventing recurrence. This combined approach leverages the rapid symptom relief provided by topical agents and the long-term benefits of systemic therapies, promoting comprehensive HD management and reducing the risk of recurrence.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population." }, { "field": "intervention", "quote": "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." }, { "field": "primaryOutcome", "quote": "providing rapid and sustained relief from pain, itching, and inflammation" }, { "field": "result", "quote": "Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD." }, { "field": "result", "quote": "The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events." } ] }, { "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", "intervention": "combined HIFU rectoanal lifting (HIFU-RAL) and ALTA sclerotherapy", "comparator": "", "primaryOutcome": "reduction or resolution of the prolapsed hemorrhoid or rectal mucosal lesion", "result": "prolapsed lesions were visibly reduced or resolved immediately after the procedure, with no adverse events or recurrences during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a very small case series of only 10 patients with no control group, so it cannot reliably show whether the treatment works better than other options.", "directness": "indirect", "limitations": "Small sample size, no comparator group, and the abstract does not specifically address hemorrhoid bleeding or why hemorrhoids bleed.", "followUp": "16.0 months", "plainFinding": "Prolapse shrank, no bleeding data given.", "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": "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." }, { "field": "followUp", "quote": "median: 16.0 months; interquartile range: 10.5-25.8 months" } ] }, { "id": "pmid:40877526", "pmid": "40877526", "doi": "10.1007/s00384-025-04944-4", "nctId": null, "pmcid": "PMC12394367", "title": "Outcomes of embolization therapy of superior rectal arteries for the management of grade 1 to 3 internal hemorrhoids: a systematic Review of clinical studies", "firstAuthor": "Al Jnainati", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2025, "design": "systematic-review", "n": 810, "nField": "reported", "population": "adults with grade I-III internal hemorrhoids, often when office treatments failed or surgery was not wanted", "intervention": "superior rectal artery embolization (the \"Emborrhoid\" procedure)", "comparator": "mostly no direct comparison group; only two small studies compared it with rubber-band ligation or sclerotherapy", "primaryOutcome": "whether the procedure technically worked, whether bleeding/symptoms improved, complications, and return of symptoms", "result": "technical success in 93-100% of procedures, symptom/bleeding improvement in 63-94%, mild self-limited side effects, and symptoms returning in 8-20% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "the review combined small, differently-designed studies without a pooled statistical analysis and had very few studies comparing embolization to other treatments.", "directness": "direct", "limitations": "small single-center studies, inconsistent techniques, heterogeneity prevented meta-analysis, and few comparative trials against standard treatments", "followUp": "", "plainFinding": "Embolization reduced hemorrhoid bleeding in most.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40877526/", "sourceText": "BACKGROUND: Superior rectal artery embolization (\"Emborrhoid\") offers a catheter-based alternative for grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable. METHODS: Following PRISMA 2020, PubMed and Embase were searched (Jan 2014-Jan 2024). Two reviewers independently screened records, extracted data, and applied RoB 2, ROBINS-I, or an adapted Newcastle-Ottawa Scale. Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence. Substantial heterogeneity blocked meta-analysis; results were narratively synthesized. RESULTS: Twenty-two studies encompassing 810 procedures qualified. Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief. Reported complications were mild and self-limited (pelvic discomfort, nausea, and low-grade fever); no ischemic injury, continence disturbance, or mortality occurred. Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted. Patient-reported satisfaction exceeded 80% in every series. Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis. CONCLUSIONS: Current evidence suggests Emborrhoid is a safe, effective bridge between office procedures and surgery-particularly valuable for frail or anticoagulated patients. Yet small single-center cohorts, disparate techniques, and scarce head-to-head trials limit external validity. Multicenter randomized studies with harmonized outcomes and ≥ 24-month follow-up are required to confirm long-term efficacy, cost-effectiveness, and optimal patient selection.", "provenance": [ { "field": "population", "quote": "grade I-III internal hemorrhoids when office therapies fail or surgery is undesirable" }, { "field": "intervention", "quote": "Superior rectal artery embolization (\"Emborrhoid\") offers a catheter-based alternative" }, { "field": "comparator", "quote": "Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis." }, { "field": "primaryOutcome", "quote": "Prespecified outcomes were technical success, clinical success (≥ 2-point fall in bleeding score or equivalent), adverse events, and recurrence." }, { "field": "result", "quote": "Technical success reached 93-100%. Clinical success ranged from 63 to 94%, yielding marked bleeding control and symptom relief." }, { "field": "result", "quote": "Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted." }, { "field": "n", "quote": "Twenty-two studies encompassing 810 procedures qualified." } ] }, { "id": "pmid:40856750", "pmid": "40856750", "doi": "10.1007/s00464-025-12120-6", "nctId": null, "pmcid": null, "title": "Multicenter analysis of the efficacy and factors related to recurrence of endoscopic sclerotherapy for internal hemorrhoids: a large-sample, retrospective cohort study", "firstAuthor": "Zhu", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2025, "design": "retrospective", "n": 1147, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "endoscopic sclerotherapy", "comparator": "none (before/after comparison across hemorrhoid grades)", "primaryOutcome": "treatment effectiveness, complications, and recurrence rate", "result": "92.85% of patients had an effective response, with 12.21% recurrence overall", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective study without a control group, so it cannot prove the treatment itself caused the improvement compared to no treatment.", "directness": "indirect", "limitations": "Retrospective design with no comparison group; abstract does not report how bleeding stopped mechanistically, only recurrence rates after treatment.", "followUp": "3 to 49 months (mean: 25.61 ± 13.23 months)", "plainFinding": "Sclerotherapy effective, low recurrence short-term", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40856750/", "sourceText": "BACKGROUND: Internal hemorrhoids are common, and while endoscopic sclerotherapy is emerging as a treatment, large-scale, multi-center data on its efficacy, safety, and recurrence rates are lacking. We summarized three-center large-sample endoscopic hemorrhoid sclerotherapy data, assess efficacy, complications, recurrence, and analyze recurrence factors (severity, lifestyle). METHODS: A retrospective analysis of patients with internal hemorrhoids treated with endoscopic sclerotherapy at three centers from December 2018 to December 2022 was conducted. Clinical and follow-up data were collected to assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates. The recurrence rate, recurrence time, and related factors for different hemorrhoid grades were analyzed. RESULTS: A total of 1147 patients underwent the procedure: 637 at Shenzhen Hospital of Southern Medical University, 177 at No. 964 Hospital, and 333 at Third Affiliated Hospital, Army Medical University. The overall effective rate was 92.85% (1065/1147). Postoperative safety measures showed the effective group had significantly lower pain (1 (0,1) vs. 2 (2,3)), bleeding (0 (0,1) vs. 2 (1,3)), and urination scores (0 (0,0) vs. 0 (0,1)) compared to the ineffective group. The overall recurrence rate was 12.21% (130/1065), with follow-up periods ranging from 3 to 49 months (mean: 25.61 ± 13.23 months). Recurrence time was earlier with increasing hemorrhoid grade (p < 0.05). Temporal analysis revealed that for Grades I, II, and III, recurrence rates within one year were 28, 39.78, and 75%, respectively, vs 72, 60.22, and 25% beyond 1 year. Multivariate logistic regression indicated higher BMI and lack of exercise were associated with increased recurrence (p < 0.05), while lower hemorrhoid grade, working position, and dietary habits were protective factors (p < 0.05). CONCLUSION: Endoscopic sclerotherapy is a safe and effective treatment for internal hemorrhoids with a low short-term recurrence rate. Key factors influencing recurrence include BMI, exercise, hemorrhoid grade, working position, and dietary habits, providing insights for optimizing treatment strategies.", "provenance": [ { "field": "n", "quote": "A total of 1147 patients underwent the procedure" }, { "field": "population", "quote": "patients with internal hemorrhoids treated with endoscopic sclerotherapy" }, { "field": "intervention", "quote": "endoscopic sclerotherapy" }, { "field": "comparator", "quote": "The recurrence rate, recurrence time, and related factors for different hemorrhoid grades were analyzed." }, { "field": "primaryOutcome", "quote": "assess hemorrhoid grading, treatment efficacy, complications, and recurrence rates" }, { "field": "result", "quote": "The overall effective rate was 92.85% (1065/1147)." }, { "field": "followUp", "quote": "follow-up periods ranging from 3 to 49 months (mean: 25.61 ± 13.23 months)" } ] }, { "id": "pmid:40581923", "pmid": "40581923", "doi": "10.1556/650.2025.33303", "nctId": null, "pmcid": null, "title": "[Treatment of hemorrhoids with rectal artery embolization]", "firstAuthor": "Sipos", "multipleAuthors": true, "journal": "Orv Hetil", "year": 2025, "design": "case-series", "n": 15, "nField": "reported", "population": "patients with stage 2 or 3 hemorrhoids (most with pain and bleeding)", "intervention": "superior rectal artery embolization (blocking blood flow to hemorrhoid vessels via a groin puncture)", "comparator": "none (before-and-after in same patients)", "primaryOutcome": "hemorrhoidal bleeding scale score at 12-week follow-up", "result": "bleeding scale score dropped to an average of 0.23, and 14 of 15 patients became symptom-free", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, uncontrolled case series of only 15 patients with no comparison group, so results could be due to other factors.", "directness": "direct", "limitations": "Small sample size, no control group, first experience of operators, short follow-up period.", "followUp": "12-week", "plainFinding": "Bleeding and symptoms mostly resolved.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40581923/", "sourceText": "Introduction: Hemorrhoids are the most common anorectal diseases, with a prevalence of 4–35%. Endovascular treatment of hemorrhoid patients was first performed in 2014, and since then the evidence for this intervention has been confirmed by numerous reviews and meta-analyses. Objective: We were the first in Hungary to start using this treatment. In our publication, we present the arterial blood supply of hemorrhoids, the causes of their development, pathophysiology, conservative, surgical and endovascular treatment. We present the technical details of superior rectal artery embolization. In addition to the radiological and clinical results of our first 15 treated patients, we present the literature and evidence of the treatment procedure. Method: The analysis of our clinical study was performed based on a prospective clinical design and with ethical approval. According to Goligher classification, 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, and a third had itching and discomfort due to their hemorrhoids. One patient was treated for very severe anemia and one patient for severe anemia. In our angiography laboratory, we performed superselective embolization of the superior mesenteric artery branches with hairy coils under local anesthesia from a femoral puncture. Results: All our interventions were technically successful, and no complications were observed in any case. 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. 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. Discussion: The advantage of endovascular intervention is that it is painless, complication-free and can be performed as a one-day procedure without anesthesia. Patients can live a full life from the day after the intervention. Our technical and clinical results achieved during the treatment of our first 15 patients show similar success rates to international results. Conclusion: Superior rectal artery embolization is a minimally invasive procedure that is considered an alternative to surgical procedures in the treatment of grade 2 and 3 hemorrhoidal disease. Orv Hetil. 2025; 166(26): 1025–1030.", "provenance": [ { "field": "n", "quote": "our first 15 treated patients" }, { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "superselective embolization of the superior mesenteric artery branches with hairy coils under local anesthesia from a femoral puncture" }, { "field": "comparator", "quote": "The analysis of our clinical study was performed based on a prospective clinical design" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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" }, { "field": "followUp", "quote": "during the 12-week control" } ] }, { "id": "pmid:40576944", "pmid": "40576944", "doi": "10.1007/s13304-025-02302-1", "nctId": null, "pmcid": null, "title": "Operative versus nonoperative treatment of thrombosed external hemorrhoids: a systematic review and meta-analysis", "firstAuthor": "Martins", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 851, "nField": "reported", "population": "patients with thrombosed external hemorrhoids", "intervention": "surgical treatment (excision surgery)", "comparator": "nonoperative (conservative) management", "primaryOutcome": "risk of recurrence and risk of bleeding", "result": "Surgery lowered recurrence risk but showed no significant difference in bleeding risk compared to conservative treatment", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pooled six studies with moderate-to-high variability between them (I2 up to 60%), and bleeding results had a very wide confidence interval, limiting confidence.", "directness": "direct", "limitations": "Heterogeneity between studies (I2 = 54% and 60%), and the bleeding comparison had a wide confidence interval crossing no effect", "followUp": "", "plainFinding": "Less recurrence with surgery, no bleeding difference.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40576944/", "sourceText": "Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement. Treatment options remain controversial, with limited evidence guiding the choice between surgical and conservative approaches. PubMed, Embase, and Cochrane Library databases were searched from inception to December 2024 to identify clinical trials comparing surgery with conservative treatment in thrombosed external hemorrhoids. Statistical analyses were performed using Review Manager 5.4.1 with a random-effects model. Heterogeneity was assessed using the I2 test. We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment. Surgical treatment was associated with a lower risk of recurrence compared to conservative management (RR 0.49; 95% CI 0.26-0.91; P < 0.05; I2 = 54%). However, there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I2 = 60%). Subgroup analyses of the excision surgery group revealed no differences between approaches. Our main findings indicated no significant difference in bleeding between surgery and conservative treatment groups. However, operative management is associated with significantly lower recurrences, which should be the preferred choice.", "provenance": [ { "field": "n", "quote": "We included six studies with a total of 851 patients, of whom 390 (45.8%) underwent surgical treatment." }, { "field": "population", "quote": "Thrombosed external hemorrhoids are a complication of hemorrhoids characterized by severe pain, swelling, and lump formation due to acute venous engorgement." }, { "field": "intervention", "quote": "Surgical treatment was associated with a lower risk of recurrence compared to conservative management" }, { "field": "comparator", "quote": "identify clinical trials comparing surgery with conservative treatment in thrombosed external hemorrhoids" }, { "field": "primaryOutcome", "quote": "there were no significant differences in the risk of bleeding between the groups (RR 0.96; 95% CI 0.27-3.44; P = 0.95; I2 = 60%)" }, { "field": "result", "quote": "Our main findings indicated no significant difference in bleeding between surgery and conservative treatment groups. However, operative management is associated with significantly lower recurrences, which should be the preferred choice." } ] }, { "id": "pmid:40576418", "pmid": "40576418", "doi": "10.4103/aam.aam_226_24", "nctId": null, "pmcid": "PMC12588432", "title": "The Outcome of Laser Ablation Hemorrhoidoplasty versus Conventional Hemorrhoidectomy", "firstAuthor": "Alessa", "multipleAuthors": true, "journal": "Ann Afr Med", "year": 2025, "design": "retrospective", "n": 100, "nField": "reported", "population": "patients with hemorrhoids (piles) undergoing surgical treatment", "intervention": "laser ablation hemorrhoidoplasty", "comparator": "conventional surgical hemorrhoidectomy", "primaryOutcome": "postoperative pain and bleeding after surgery", "result": "Laser hemorrhoidoplasty patients had milder pain and less bleeding than conventional hemorrhoidectomy patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison with unequal disease severity between groups, so differences could be due to patient selection rather than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design, groups differed in hemorrhoid severity (laser group had more second-degree, conventional group more severe third/fourth-degree), which could bias outcome comparisons.", "followUp": "", "plainFinding": "Less pain and bleeding after laser", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40576418/", "sourceText": "CONTEXT: Hemorrhoids affect a significant proportion of the population, and the choice between laser hemorrhoidoplasty and conventional hemorrhoidectomy remains a crucial clinical decision. AIMS: The aim of this study was to compare the outcomes of piles management with laser hemorrhoidoplasty versus conventional surgical hemorrhoidectomy. SETTINGS AND DESIGN: A retrospective data collection from hospital registry about 50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy. SUBJECTS AND METHODS: Demographic and clinical data were analyzed using descriptive and inferential statistics. Data were meticulously collected and analyzed, employing SPSS statistical software. STATISTICAL ANALYSIS USED: SPSS statistical software was used for statistical analysis. RESULTS: The mean age was 40.45 years, with a balanced gender distribution. While no significant difference in age was observed between treatment groups, notable variations in gender and hemorrhoid degree distribution were evident. Laser hemorrhoidoplasty exhibited a higher percentage of patients with second-degree hemorrhoids, while conventional hemorrhoidectomy had a higher prevalence of more severe hemorrhoids (degree 3 or 4). Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding. Notably, all laser patients reported mild pain (1-3), while the conventional group exhibited a broader spectrum, including severe pain (7-9) in 96% of cases. Furthermore, 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. CONCLUSIONS: The observed advantages of laser hemorrhoidoplasty in terms of reduced postoperative pain and bleeding suggest its potential as a favorable alternative, particularly in less severe cases.", "provenance": [ { "field": "n", "quote": "50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy" }, { "field": "population", "quote": "50 patients who underwent laser hemorrhoidoplasty and another 50 patients who underwent conventional hemorrhoidectomy" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty" }, { "field": "comparator", "quote": "conventional surgical hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Clinical outcomes revealed that laser hemorrhoidoplasty was associated with less postoperative pain and bleeding." }, { "field": "result", "quote": "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." } ] }, { "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": "retrospective", "n": 32, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "endoscopic ligation", "comparator": "cap-assisted endoscopic sclerotherapy (CAES)", "primaryOutcome": "treatment effect on bleeding, prolapse, constipation, complications, psychological condition and anorectal function", "result": "no significant difference in treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups, though CAES showed some advantage for bleeding", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Very small, non-randomized comparative study with short 3-month follow-up, so results are uncertain.", "directness": "direct", "limitations": "Small sample size (n=32), not randomized, short follow-up of 3 months", "followUp": "3-month follow-up", "plainFinding": "Both treatments similar; sclerotherapy slightly better for bleeding.", "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": "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." }, { "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:40399727", "pmid": "40399727", "doi": "10.1007/s13304-025-02255-5", "nctId": null, "pmcid": null, "title": "SHAPE-skin-sparing hemorrhoidectomy and PExy: a novel technique for the surgical treatment of hemorrhoidal disease", "firstAuthor": "Grossi", "multipleAuthors": true, "journal": "Updates Surg", "year": 2025, "design": "case-series", "n": 21, "nField": "reported", "population": "adults with advanced (grade III-IV) hemorrhoidal disease needing surgery", "intervention": "new surgical technique combining skin-sparing hemorrhoidectomy with tissue fixation (SHAPE)", "comparator": "none - single group, before-and-after comparison", "primaryOutcome": "change in hemorrhoid symptom severity scores one month after surgery", "result": "symptom severity scores dropped sharply after surgery (HDSS from 16 to 0, SHS from 20 to 4), with few complications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is 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 the surgery works long-term or compared to other treatments.", "directness": "indirect", "limitations": "no control group, very short follow-up, small sample size, and the study measures overall symptom scores rather than directly explaining or testing why bleeding occurs or stops.", "followUp": "1-month follow-up", "plainFinding": "Symptoms sharply improved 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": "n", "quote": "A prospective analysis was conducted on 21 consecutive patients with grade III-IV HD" }, { "field": "population", "quote": "21 consecutive patients with grade III-IV HD who underwent SHAPE" }, { "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": "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" }, { "field": "result", "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": "followUp", "quote": "At 1-month follow-up" } ] }, { "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/IV hemorrhoids", "intervention": "Doppler-guided hemorrhoid artery ligation (DG-HAL)", "comparator": "tissue-selecting technique (TST) surgery", "primaryOutcome": "post-operative pain, bleeding, complications, and recurrence rate", "result": "DG-HAL caused less pain, fewer complications and less bleeding after surgery, but had a higher rate of prolapse coming back after 3 years compared to TST", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective comparison without randomization, so differences between groups could be due to factors other than the treatment itself.", "directness": "direct", "limitations": "Retrospective cohort study design, not randomized.", "followUp": "3 years", "plainFinding": "Less pain, but more recurrence.", "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": "n", "quote": "We conducted a retrospective analysis of 251 patients with grade III/IV hemorrhoids between January 2019 and January 2021." }, { "field": "population", "quote": "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." }, { "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." } ] }, { "id": "pmid:40176588", "pmid": "40176588", "doi": "10.7417/CT.2025.5204", "nctId": null, "pmcid": null, "title": "Tips and tricks of anorectal care with topical lidocaine (octose-dan) administration: retrospective, anecdotical, spontaneous, and observational study", "firstAuthor": "Palmieri", "multipleAuthors": true, "journal": "Clin Ter", "year": 2025, "design": "case-series", "n": 30, "nField": "reported", "population": "patients with grade 1, 2 or 3 hemorrhoids, anal fissures, or anal fistulas", "intervention": "5% lidocaine ointment (Octosedan) applied around the anus before and after bowel movements for two months", "comparator": "no control group; some had previously tried flavonoid or heparinoid treatments", "primaryOutcome": "relief of pain, itching, soiling and discomfort around bowel movements", "result": "28 of 30 patients had significant symptom improvement", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a small, uncontrolled, self-described anecdotal study without a comparison group, so it cannot reliably show the treatment caused the improvement.", "directness": "indirect", "limitations": "Described by the authors themselves as anecdotical, spontaneous and observational, with no control group and mixed anorectal conditions (hemorrhoids, fissures, fistulas) lumped together.", "followUp": "two months", "plainFinding": "Topical lidocaine eased anorectal symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40176588/", "sourceText": "BACKGROUND: The local symptomatic treatment of anorectal diseases encloses a wide variety of creams, ointments, suppositories, irrigation fluids etc, based essentially on anaesthetics, antioedema, phlebotomids, keratolytic and coating agents, anti-inflammatories, steroids, aiming at achieving fast improvement and at least partial pain remission especially soon after stool. Unfortunately, the method of blending different chemicals pooled in a single formulation often prevents the full curative effect of each active principle: in fact, the stechiometric balance of these melting pots does not achieve the full dose-effect of each one; furtherly the patients would be warned to use only effective evidence-based products, preventing the risk of skin and mucosa sen-sitization in the long run when different chemical or herbal compounds are together administered. On the basis of the literature review, we focused our study on a single drug-medication whose properties go beyond the classic anaesthetic claim: lidocaine 5%. MATERIALS AND METHODS: In our anecdotical, spontaneous, and observational study, 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) treatment with a 5% lidocaine ointment (Octosedan Laboratori Baldacci S.p.A., Italy) for two months; 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. The most commonly reported symptom was bleeding, present in 20 patients with prevalence in women. In 13 patients (43,33%) the \"wet anus\" with or without soiling was present, while 12 patients (40%) complained of intermittent itching. In 7 patients (23,33%) hemorrhoidal thrombosis with prevalent (6/ 7) heavy pain, was recorded. RESULTS: 28/30 treated patients had significantly symptom impro-vement (p<0.0001), 10 (33,33%) patients were addressed to surgical therapy for persistence of symptoms, (7 at the end of the therapeutic cycle 3, spontaneously asking to anticipate surgery before the end of the trial) 4 clinical cases fairly improved but accepted a further surgical revaluation three months later. Of the 19 patients previously treated with flavonoids or heparinoid therapy with unsatisfactory results, 9 (30%) participants found benefit from the new treatment. Of the 5 patients whose anal fissures healed primarily, only 1 patient developed a recurrent fissure within 6 months. Octosedan administration relieved the pain after 5 days with a tolerable life quality and promoted fissures healing in one month. No adverse effects of the treatment were recorded. CONCLUSIONS: The local symptomatic treatment of haemorrhoids grade one, two, three and of the fissures, and the fistulas with the plain formula: lidocaine 5%; excipient: cetilic acid macrogol, water;( gently administered into and around the anal verge 3-5 minutes before voiding the bowel and reapplied soon after having cleaned and rinsed the anus&perineal area with neutral liquid soap for two months of treatment,) showed highly significant effect (p<0.0001) and highlights the quality of monotherapy on multiple steps of anorectal care.", "provenance": [ { "field": "population", "quote": "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)" }, { "field": "intervention", "quote": "5% lidocaine ointment (Octosedan Laboratori Baldacci S.p.A., Italy) for two months" }, { "field": "comparator", "quote": "Of the 19 patients previously treated with flavonoids or heparinoid therapy with unsatisfactory results, 9 (30%) participants found benefit from the new treatment." }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "28/30 treated patients had significantly symptom impro-vement (p<0.0001)" }, { "field": "n", "quote": "30 patients both sexes (15 males and 15 females)" } ] }, { "id": "pmid:40103253", "pmid": "40103253", "doi": "10.17116/hirurgia2025031112", "nctId": null, "pmcid": null, "title": "[Treatment of acute hemorrhoids according to the results of a multicenter observational study]", "firstAuthor": "Groshilin", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2025, "design": "prospective-cohort", "n": 220, "nField": "reported", "population": "adults aged 18 to 64 with grade I-II acute hemorrhoids (including bleeding) seen in outpatient clinics", "intervention": "oral diosmin (Phlebodia 600) taken daily for at least 36 days", "comparator": "no comparison group; outcomes compared to patients' own baseline before treatment", "primaryOutcome": "resolution of hemorrhoid symptoms (pain, bleeding, itching, swelling) and quality of life", "result": "By day 7, pain, discomfort, itching and blood streaks during defecation were reduced compared with baseline, and 73% of patients had smaller hemorrhoidal nodes; by day 30 most complaints had resolved and quality of life scores improved, with no reported side effects.", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a single-arm observational study with no control group, so improvements over time cannot be separated from natural healing or other factors.", "directness": "direct", "limitations": "No control or placebo group was used, so it cannot show whether diosmin itself caused the improvement rather than natural resolution of acute hemorrhoids.", "followUp": "30 days", "plainFinding": "Less bleeding, pain with diosmin", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40103253/", "sourceText": "BACKGROUND: The issue of improving hemorrhoid treatment outcomes in outpatient practice is one of the most pressing in the daily work of coloproctologists today. Advances in the treatment of hemorrhoidal disease, the most common pathological condition in general proctology, in recent decades have been associated not only with the adoption of minimally invasive surgical techniques but also with the enhancement of pharmacological therapy. A key component of systemic pharmacotherapy for chronic and acute hemorrhoids is the use of venotonic drugs, including flavonoids which are included in the clinical guidelines. Therefore, a comprehensive and reliable evaluation of the clinical efficacy of diosmin is an important area of research, especially in cases of acute hemorrhoids. OBJECTIVE: The study aimed to assess the effectiveness of using Phlebodia 600 and evaluate the dynamics of patients' quality of life with acute hemorrhoids of grades I-II in outpatient practice without employing minimally invasive surgical methods. MATERIAL AND METHODS: A Russian multicenter prospective observational study was conducted involving an adult population of patients with grade I-II acute hemorrhoids in the city of Rostov-on-Don and the Rostov region. Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids (thrombosis of external or internal hemorrhoidal nodes, including those with bleeding) established through standardized clinical examination were included. Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms, which included a dominant set of symptoms such as enlarged hemorrhoidal nodes, pain, bleeding, anal itching, burning, or discomfort. The total sample size analyzed was 220 patients, and the medication was administered for at least 36 days. RESULTS: The use of Phlebodia 600 for grade I-II acute hemorrhoids allowed for the resolution of complaints and stabilization of all key clinical parameters within the timeframes set by the study design. Following the proposed treatment regimen, 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. In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period. The proposed treatment regimen can be considered rational since, 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). No cases of intolerance to Phlebodia 600 or adverse reactions associated with its use were identified, indicating a high safety profile. CONCLUSIONS: A 35-40 day course of Phlebodia 600 administered continuously according to the manufacturer's recommended regimen effectively reduces the severity and frequency of major complaints in patients with grade I-II acute hemorrhoids. This is achieved through improved microcirculation, venotonic, anti-inflammatory, and anti-edema effects. Diosmin (Phlebodia 600) favourable safety profile has been demonstrated. in acute hemorrhoids.", "provenance": [ { "field": "n", "quote": "The total sample size analyzed was 220 patients" }, { "field": "population", "quote": "Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids" }, { "field": "intervention", "quote": "Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms" }, { "field": "intervention", "quote": "the medication was administered for at least 36 days" }, { "field": "comparator", "quote": "compared to baseline" }, { "field": "primaryOutcome", "quote": "resolution of complaints and stabilization of all key clinical parameters" }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period." }, { "field": "result", "quote": "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)" } ] }, { "id": "pmid:40062327", "pmid": "40062327", "doi": "10.3748/wjg.v31.i8.98704", "nctId": null, "pmcid": "PMC11886522", "title": "Sclerotherapy for hemorrhoidal disease: Recent evolutions of an oldies goldy", "firstAuthor": "Gravante", "multipleAuthors": false, "journal": "World J Gastroenterol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with internal hemorrhoids, grade II-III", "intervention": "sclerotherapy with polidocanol foam, including combined with rubber-band ligation (sclerobanding), delivered endoscopically", "comparator": "endoscopic rubber band ligation", "primaryOutcome": "treatment effectiveness/outcomes for hemorrhoids", "result": "the editorial states results are promising but does not give specific outcome data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an editorial commentary discussing other studies, not original research with its own data.", "directness": "indirect", "limitations": "This is an editorial/commentary piece without original patient data, sample size, or detailed outcome statistics reported.", "followUp": "", "plainFinding": "New foam technique looks promising.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40062327/", "sourceText": "Treatments for low degree hemorrhoids (I-III degree) are numerous and so are their counterparts for higher degrees. These treatments present nebulous differences in terms of indications and outcomes among techniques. Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications: Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol, which is more effective than the liquid one. Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation (the historical counterpart of sclerotherapy) in a technique called \"sclerobanding\". In this article, we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids, and present results compared with endoscopic rubber band ligation. The results achieved are promising.", "provenance": [ { "field": "population", "quote": "patients with grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "endoscopic delivery for patients with grade II-III internal hemorrhoids" }, { "field": "intervention", "quote": "the combination of polidocanol foam with rubber-band ligation (the historical counterpart of sclerotherapy) in a technique called \"sclerobanding\"" }, { "field": "comparator", "quote": "present results compared with endoscopic rubber band ligation" }, { "field": "result", "quote": "The results achieved are promising." }, { "field": "primaryOutcome", "quote": "present results compared with endoscopic rubber band ligation" } ] }, { "id": "pmid:39969619", "pmid": "39969619", "doi": "10.1007/s10103-025-04355-5", "nctId": null, "pmcid": null, "title": "Multilayered numerical modelling of bio-thermal aspects during laser assisted treatment of internal haemorrhoid developed in rectum", "firstAuthor": "Dutta", "multipleAuthors": false, "journal": "Lasers Med Sci", "year": 2025, "design": "lab", "n": null, "nField": "not-reported", "population": "Computer model of rectal tissue layers (muscle, submucosa, mucosa) representing an internal hemorrhoid, not real patients", "intervention": "Simulated laser-assisted therapy using a Gaussian laser beam as heat source", "comparator": "A previously published numerical model used for verification", "primaryOutcome": "Temperature changes across the layers of rectal tissue during simulated laser treatment", "result": "Temperature drops were seen at the interfaces between tissue layers, and the model matched a previously published numerical model with negligible variation", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a theoretical mathematical/computer model of tissue heating, not a study in real patients, so it cannot show whether bleeding is actually stopped.", "directness": "indirect", "limitations": "Purely computational modeling of heat transfer, no human or animal data, no bleeding outcome measured, no patient numbers.", "followUp": "", "plainFinding": "Computer model of laser heat in tissue.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39969619/", "sourceText": "Haemorrhoids are swollen blood vessels developed around the anus. Internal haemorrhoids are generally not visible from outside due to its growth inside the rectum and it is generally considered as painless. However, a prolapsed internal haemorrhoid may cause discomfort, pain and irritation. For the treatment of internal haemorrhoid, laser assisted therapy would be helpful due to its rooted advantages such as post-surgery minimal pain, lesser bleeding, quicker healing, shorter recovery period, shorter surgical and overall treatment duration, lower risk of recurrence and least risk of post-surgical infections. The genesis of present research work deals with the development of mathematical modelling to capture the bio-thermal response during laser assisted therapy of internal haemorrhoid developed in the rectum. The explicit form of finite difference method is employed as numerical tool for the mathematical study and the physical domain is considered as multilayered tissue (three different layers of rectum: muscle, submucosa and mucosa). A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum. Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate. Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue. The research outcome is verified with the published numerical model with negligible variation.", "provenance": [ { "field": "population", "quote": "the physical domain is considered as multilayered tissue (three different layers of rectum: muscle, submucosa and mucosa)" }, { "field": "intervention", "quote": "A Gaussian laser beam is considered as heat source to destroy the abnormal growth inside the rectum." }, { "field": "comparator", "quote": "The research outcome is verified with the published numerical model with negligible variation." }, { "field": "primaryOutcome", "quote": "Temperature variation in multi-layered tissue is investigated for laser heat input and absorption radius along the temporal and spatial coordinate." }, { "field": "result", "quote": "Temperature drop has been evidenced in the interfaces of multi-layered rectum tissue." }, { "field": "result", "quote": "The research outcome is verified with the published numerical model with negligible variation." } ] }, { "id": "pmid:39934277", "pmid": "39934277", "doi": "10.1007/s00464-025-11601-y", "nctId": null, "pmcid": null, "title": "Clinical effects of endoscopic resection of hypertrophied anal papillae combined with internal hemorrhoid ligation therapy: a retrospective study", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2025, "design": "retrospective", "n": 47, "nField": "reported", "population": "patients with enlarged (hypertrophic) anal papillae", "intervention": "endoscopic removal of enlarged anal papillae plus internal hemorrhoid ligation", "comparator": "endoscopic removal of enlarged anal papillae alone", "primaryOutcome": "postoperative pain, bleeding, swelling, and treatment success at 3 months", "result": "combined treatment caused more pain but similar rates of bleeding and swelling as resection alone", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, retrospective study without randomization, so it can't reliably separate true treatment effects from chance or bias.", "directness": "indirect", "limitations": "Retrospective design, small sample size (47 patients), no randomization, and the abstract does not address why hemorrhoids bleed or the general mechanism of bleeding control.", "followUp": "3 months", "plainFinding": "More pain, same bleeding rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39934277/", "sourceText": "OBJECTIVES: To explore the postoperative complications and efficacy of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoid ligation. METHODS: A retrospective study was conducted on 47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation. The patients were divided into two groups based on the surgical procedure: the anal papillae resection group and the anal papillae resection + internal hemorrhoid ligation group. The analysis included patient age, gender, anal papillae diameter, postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively. RESULTS: There were no statistically significant differences in age, gender, or anal papillae diameter among the two patient groups. The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day. Both the pain intensity and duration showed statistically significant differences (P < 0.05). However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema. At the 3-month follow-up, the effective rates were 90.9% and 80.0%, respectively, and there were no statistically significant differences among the groups. CONCLUSION: The complication rate of endoscopic resection of hypertrophic anal papillae combined with internal hemorrhoids ligation is low, and the therapeutic effect is good.", "provenance": [ { "field": "population", "quote": "47 patients from our center who underwent endoscopic resection of hypertrophic anal papillae, with or without internal hemorrhoids ligation" }, { "field": "intervention", "quote": "the anal papillae resection + internal hemorrhoid ligation group" }, { "field": "comparator", "quote": "the anal papillae resection group" }, { "field": "primaryOutcome", "quote": "postoperative pain intensity and duration, postoperative bleeding severity, presence of anal edema, and follow-up outcomes at 3 months postoperatively" }, { "field": "result", "quote": "The postoperative pain intensity was higher in the group undergoing anal papillae resection combined with internal hemorrhoid ligation, with a median Visual Analog Scale (VAS) score of 1 (0, 2), and the duration of pain was longer, with a median of 1 (0, 2) day." }, { "field": "result", "quote": "However, there were no statistically significant differences in the incidence of postoperative bleeding or anal edema." }, { "field": "n", "quote": "A retrospective study was conducted on 47 patients" } ] }, { "id": "pmid:39923169", "pmid": "39923169", "doi": "10.33314/jnhrc.v22i03.5135", "nctId": null, "pmcid": null, "title": "Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid", "firstAuthor": "Sapkota Upadhya", "multipleAuthors": true, "journal": "J Nepal Health Res Counc", "year": 2024, "design": "case-series", "n": 28, "nField": "reported", "population": "patients with lower gastrointestinal bleeding caused by hemorrhoids", "intervention": "colonoscopic rubber band ligation of hemorrhoids", "comparator": "none (single-arm study, no comparison group)", "primaryOutcome": "resolution of bleeding and other hemorrhoid symptoms after treatment", "result": "bleeding resolved in 96.4% and prolapse in 92% of patients at 3 months, with high patient satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, one-year, single-center study with no comparison group and over half the patients had complications, so it can't prove the treatment works better than alternatives.", "directness": "direct", "limitations": "No control group, small sample size (28 of 108 patients), single center, post-procedure complications in 53.5% of cases, and authors call for multicenter research with longer follow-up.", "followUp": "3 months", "plainFinding": "Bleeding stopped in most patients", "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": "Lower gastrointestinal bleeding due to hemorrhoids" }, { "field": "intervention", "quote": "Colonoscopic Rubber band ligation" }, { "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." } ] }, { "id": "pmid:39775512", "pmid": "39775512", "doi": "10.14744/tjtes.2024.79406", "nctId": null, "pmcid": "PMC11843397", "title": "Emborrhoid technique in hemorrhoidal disease: Retrospective analysis of data from a single center", "firstAuthor": "Baş", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2025, "design": "retrospective", "n": 18, "nField": "reported", "population": "patients with severe (grade 4) bleeding hemorrhoids who could not have surgery", "intervention": "coil embolization (blocking) of the superior rectal artery", "comparator": "none; before-and-after comparison within same patients", "primaryOutcome": "severity of rectal bleeding, measured before and after treatment", "result": "bleeding severity score dropped from 6.6 before treatment to about 3.4-3.8 at 1, 3, and 6 months, with recurrence in 2 patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small, retrospective study of only 18 patients with no comparison group, so it cannot prove the procedure itself caused the improvement.", "directness": "direct", "limitations": "small sample size, retrospective design, no control group, single center", "followUp": "6 months", "plainFinding": "Less bleeding after artery embolization.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39775512/", "sourceText": "BACKGROUND: This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated. METHODS: Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at 1, 3, and 6 months. RESULTS: All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. 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. Clinical success was 95% at the first month and 85% at the third and sixth months. Re-embolization was not performed in patients with recurrence. CONCLUSION: In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention.", "provenance": [ { "field": "n", "quote": "18 patients (11 males, 7 females)" }, { "field": "population", "quote": "rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated" }, { "field": "intervention", "quote": "coil embolization of the superior rectal artery" }, { "field": "comparator", "quote": "The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month" }, { "field": "primaryOutcome", "quote": "rectal bleeding grading was assessed using the Paris bleeding severity score" }, { "field": "result", "quote": "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." } ] }, { "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 in Nigeria", "intervention": "LigaSure hemorrhoidectomy (vessel-sealing device surgery)", "comparator": "conventional Milligan-Morgan hemorrhoidectomy", "primaryOutcome": "blood loss, pain, surgery duration, and symptom resolution after hemorrhoid removal surgery", "result": "LigaSure caused less blood loss (10.0 mL vs 26.5 mL), lower pain scores at 2 weeks (5.5 vs 6.0), and shorter surgery time (18.04 vs 34.19 min) than Milligan-Morgan", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small randomized trial with only 52 patients and short follow-up, so results may not be reliable or generalizable.", "directness": "indirect", "limitations": "Small sample size; abstract does not describe blinding; outcomes assessed only up to 3 months", "followUp": "3 months", "plainFinding": "Less bleeding and pain with LigaSure surgery", "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": "n", "quote": "Fifty-two patients were randomized equally into the two arms." }, { "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": "the 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). 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)." } ] }, { "id": "pmid:39565131", "pmid": "39565131", "doi": "10.1080/03639045.2024.2432595", "nctId": null, "pmcid": null, "title": "Co-administration of Ayurvedic medicines Arshogrit and Jatyadi Ghrit, attenuate croton oil-induced hemorrhoids in rat model of recto-anal inflammation by modulating TNF-α and IL-1β levels", "firstAuthor": "Balkrishna", "multipleAuthors": true, "journal": "Drug Dev Ind Pharm", "year": 2024, "design": "animal", "n": null, "nField": "not-reported", "population": "rats with chemically induced hemorrhoid-like inflammation in the rectal/anal area", "intervention": "oral Ayurvedic medicine Arshogrit plus topical Jatyadi Ghrit", "comparator": "standard steroid drug (prednisolone) and untreated croton oil exposure", "primaryOutcome": "reduction in swelling, bleeding, tissue damage and inflammation markers in the recto-anal area", "result": "the combination reduced swelling, hemorrhage, tissue damage and inflammatory markers compared to untreated animals", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an early-stage animal experiment, not a human study, so it cannot show whether this works in people with hemorrhoids", "directness": "indirect", "limitations": "study was done in rats with chemically induced disease, not in humans with naturally occurring hemorrhoids; number of animals not stated", "followUp": "", "plainFinding": "Reduced bleeding and swelling in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39565131/", "sourceText": "OBJECTIVE: To study the efficacy of co-administration of Arshogrit (AG) and Jatyadi Ghrit (JG), two herb-based Ayurvedic medicines, in rat model of croton oil-induced hemorrhoids. SIGNIFICANCE: Hemorrhoids refer to a pathological condition affecting the recto-anal region causing pain, swelling, bleeding and protrusion. The available therapies for hemorrhoids are symptomatic or invasive but are expensive and associated with adverse effects. Hence, there exists a need for efficacious and safer pharmacotherapies. METHODS: Ultra high performance liquid chromatography detected nine phytocompounds in AG and seven in JG. Seven fatty acids were additionally identified in JG by Gas Chromatography-Mass Spectrometry analysis. The in-vivo efficacy of the co-administration of 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) was evaluated in Wistar rats by inducing hemorrhoids development with the application of croton oil preparation (COP) in the recto-anal area. Prednisolone was employed as the standard drug and was administered orally at the dose of 1 mg/kg/day. RESULTS: AG and JG were able to attenuate the croton oil-induced macro and microscopic anomalies. Gross pathological observation demonstrated remarkable decrease in croton oil-induced swelling, hemorrhage and formation of pseudomembrane, with the escalating doses of AG. Microscopic observation revealed alleviation in the histopathological lesions (necrosis, inflammation, hemorrhage/congestion, degeneration and dilatation of blood vessels). AG and JG additionally reduced COP-induced increase in the serum levels of pro-inflammatory cytokines. CONCLUSION: This study convincingly demonstrates that co-administration of AG and JG is a potential therapy against hemorrhoids, warranting further investigations.", "provenance": [ { "field": "population", "quote": "Wistar rats by inducing hemorrhoids development with the application of croton oil preparation (COP) in the recto-anal area" }, { "field": "intervention", "quote": "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)" }, { "field": "comparator", "quote": "Prednisolone was employed as the standard drug and was administered orally at the dose of 1 mg/kg/day" }, { "field": "primaryOutcome", "quote": "Gross pathological observation demonstrated remarkable decrease in croton oil-induced swelling, hemorrhage and formation of pseudomembrane" }, { "field": "result", "quote": "AG and JG were able to attenuate the croton oil-induced macro and microscopic anomalies." } ] }, { "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": "prolapse recurrence and post-procedural pain/bleeding", "result": "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", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a commentary discussing another study rather than reporting its own original data or specific results.", "directness": "indirect", "limitations": "future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings", "followUp": "one-year", "plainFinding": "New method needs more study.", "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:39563747", "pmid": "39563747", "doi": "10.3748/wjg.v30.i42.4569", "nctId": null, "pmcid": "PMC11572626", "title": "Does hemorrhoidal artery embolization really benefit patients with hemorrhoids?", "firstAuthor": "Lei", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with severe hemorrhoidal bleeding needing treatment", "intervention": "hemorrhoidal artery embolization", "comparator": "", "primaryOutcome": "safety and effectiveness of the embolization procedure", "result": "The letter discusses patient selection, materials, and methods needed to improve safety and effectiveness, without reporting specific outcome data.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an opinion letter/commentary with no original patient data or results reported.", "directness": "indirect", "limitations": "No original data; commentary only, discusses factors like patient selection and technique that may affect outcomes without providing results.", "followUp": "", "plainFinding": "Commentary only, no results given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39563747/", "sourceText": "This letter offers commentary on an article published in a recent issue of the World Journal of Gastroenterology. Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment, but inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications. In this article, the most appropriate candidate patients, embolization materials, embolization methods, and clinical evaluation methods are discussed to improve the safety and effectiveness of the procedure.", "provenance": [ { "field": "intervention", "quote": "Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment" }, { "field": "population", "quote": "severe hemorrhoidal bleeding treatment" }, { "field": "primaryOutcome", "quote": "improve the safety and effectiveness of the procedure" }, { "field": "result", "quote": "inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications" } ] }, { "id": "pmid:39268736", "pmid": "39268736", "doi": "10.17116/hirurgia202409152", "nctId": null, "pmcid": null, "title": "[The effectiveness of flavonoids in the postoperative treatment of patients with hemorrhoids]", "firstAuthor": "Voinov", "multipleAuthors": false, "journal": "Khirurgiia (Mosk)", "year": 2024, "design": "rct", "n": 135, "nField": "reported", "population": "adults with stage III or IV hemorrhoids who had surgery to remove them (hemorrhoidectomy)", "intervention": "purified micronized flavonoid fraction taken after surgery", "comparator": "no flavonoid treatment after surgery", "primaryOutcome": "patient-reported severity of pain, bleeding, itching and tenesmus after surgery", "result": "Lower pain, bleeding and tenesmus at days 7, 21, 40 and 60 compared to the control group, but no difference in itching", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It was a single-center randomized trial using simple envelope randomization without mention of blinding, and symptoms were self-assessed by patients, which limits confidence in the result.", "directness": "indirect", "limitations": "Single-center study, randomization method may allow prediction of group assignment, no blinding described, and outcomes were patient-reported.", "followUp": "60 days", "plainFinding": "Less post-surgery bleeding with flavonoids.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39268736/", "sourceText": "OBJECTIVE: Evaluation of the effectiveness of flavonoids in the postoperative management of patients with hemorrhoids. MATERIAL AND METHODS: A single-center randomized controlled clinical trial was conducted. Patients with stage III and IV hemorrhoids aged over 18 years who patients who underwent hemorrhoidectomy were included. UNLABELLED: The patients were divided into 2 groups - main and control. Patients in the main group were recommended to use a purified micronized flavonoid fraction - 65 patients. In the control group (70 patients), the use of this group of drugs was not expected. UNLABELLED: The observation period was 60 days. After discharge from the hospital, 5 patient visits were scheduled: on the 3rd, 7th, 21st, 40th and 60th day after surgery. Patients independently assessed the intensity of symptoms - pain, tenesmus, itching and bleeding. UNLABELLED: The randomization procedure was carried out using the method of simple randomization using envelopes. RESULTS: 135 patients were randomized. There were no patients who dropped out of the study. The number of participants whose data were included in the analysis was 65 patients in the main group and 70 patients in the control group. UNLABELLED: Assessment of symptoms in the first 3 days of the postoperative period did not show a significant difference in the condition of the patients. Over time, we found significant changes in the dynamics of complaints between groups. 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. This trend was not detected in the assessment of itching. There were no undesirable effects. CONCLUSION: The use of purified micronized flavonoid fraction in the postoperative management of patients with hemorrhoids can significantly reduce the degree and duration of pain, bleeding and tenesmus.", "provenance": [ { "field": "population", "quote": "Patients with stage III and IV hemorrhoids aged over 18 years who patients who underwent hemorrhoidectomy were included." }, { "field": "intervention", "quote": "Patients in the main group were recommended to use a purified micronized flavonoid fraction" }, { "field": "comparator", "quote": "In the control group (70 patients), the use of this group of drugs was not expected." }, { "field": "primaryOutcome", "quote": "Patients independently assessed the intensity of symptoms - pain, tenesmus, itching and bleeding." }, { "field": "result", "quote": "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." }, { "field": "n", "quote": "135 patients were randomized." } ] }, { "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": "adults with grade II-III internal hemorrhoids", "intervention": "percutaneous superselective superior rectal artery embolization", "comparator": "before vs after treatment in 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 embolization", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small retrospective study of only 22 patients with no comparison group, so improvement cannot be clearly attributed to the treatment alone.", "directness": "direct", "limitations": "Retrospective design, small sample size, no control group, and common side effects like tenesmus and anal bulge in most patients.", "followUp": "12 months", "plainFinding": "Less bleeding after artery embolization.", "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 who underwent superselective superior rectal artery embolization" }, { "field": "population", "quote": "22 patients with grades Ⅱ-Ⅲ internal hemorrhoids who underwent superselective superior rectal artery embolization" }, { "field": "intervention", "quote": "percutaneous superselective superior rectal artery embolization in the treatment of grades Ⅱ-Ⅲ internal hemorrhoids" }, { "field": "comparator", "quote": "The clinical scores before and after treatment were compared by the nonparametric rank sum test" }, { "field": "primaryOutcome", "quote": "French bleeding score,quality of life score,prolapse score" }, { "field": "result", "quote": "Compared with those prior to operation, the French bleeding score,quality of life score,and prolapse score were significantly improved (all P<0.05)." } ] }, { "id": "pmid:39132755", "pmid": "39132755", "doi": "10.57264/cer-2024-0070", "nctId": null, "pmcid": "PMC11426285", "title": "An international observational study assessing conservative management in hemorrhoidal disease: results of CHORALIS (aCute HemORrhoidal disease evALuation International Study)", "firstAuthor": "Godeberge", "multipleAuthors": true, "journal": "J Comp Eff Res", "year": 2024, "design": "prospective-cohort", "n": 3505, "nField": "reported", "population": "adults with acute hemorrhoid symptoms, mostly mild to moderate grade", "intervention": "venoactive drugs, mainly micronized purified flavonoid fraction (MPFF)", "comparator": "diosmin (another venoactive drug)", "primaryOutcome": "improvement in hemorrhoid symptoms (pain, bleeding, swelling, itching, soiling) and quality of life", "result": "Venoactive drugs improved symptoms and quality of life overall, with MPFF showing significantly better symptom relief and faster improvement than diosmin", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was an observational study without a placebo or randomization, so it cannot prove the drugs caused the improvement.", "directness": "direct", "limitations": "Observational design with no control group or randomization; relied on patient-reported questionnaires.", "followUp": "4 weeks", "plainFinding": "Flavonoid drugs eased bleeding and pain faster", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39132755/", "sourceText": "Aim: Real-world evidence on the management of hemorrhoidal disease (HD) is limited. This international study collected clinical practice data on the effectiveness of conservative treatments for acute HD on symptoms and quality of life (QoL), providing perspectives of treatment modalities from different continents. Patients & methods: The 4-week observational prospective CHORALIS study involved adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification) and prescribed conservative treatments according to usual clinical practice. Assessments were: anal pain/discomfort (visual analog scale [VAS]), other signs/symptoms (patient questionnaire), Patient Global Impression of Change (PGI-C) questionnaire and disease-specific QoL (HEMO-FISS-QoL questionnaire). Results: Of 3592 participants, 3505 were analyzed (58.4% male; age 40.5 ± 13.7 years; history of HD in 48.4%; 72.1% Goligher grade I and II). Pain and discomfort were the most common symptoms. Most treatments were venoactive drugs (VADs; 90.9%), particularly micronized purified flavonoid fraction (MPFF; 73.7%) and diosmin (14.6%). All VAD-based therapies improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL. MPFF was associated with a significantly greater proportion of patients with no symptoms (48.8 vs diosmin 34.4%, p < 0.001), pain disappearance (69.7 vs diosmin 52.8%, p < 0.001), treatment impact at 1 week rated on PGI-C as 'very much better' (30.5 vs diosmin 17.9%, p < 0.001) and shorter times to improvement (mean ± SD 3.9 ± 1.5 days vs diosmin 4.2 ± 1.7 days). Conclusion: In this prospective real-world study of patients with acute HD, conservative therapies consisting mainly of VADs, including MPFF, improved the clinical signs and symptoms of disease, as well as QoL. This study evidence supports clinical advantages associated with VADs, mostly MPFF, for effectively managing acute HD.", "provenance": [ { "field": "n", "quote": "Of 3592 participants, 3505 were analyzed" }, { "field": "population", "quote": "adult outpatients consulting for spontaneous complaints of hemorrhoids (graded using Goligher classification)" }, { "field": "intervention", "quote": "particularly micronized purified flavonoid fraction (MPFF; 73.7%)" }, { "field": "comparator", "quote": "and diosmin (14.6%)" }, { "field": "primaryOutcome", "quote": "improved signs/symptoms (number/intensity/frequency of pain, discomfort, bleeding, swelling, itching and soiling) and QoL" }, { "field": "result", "quote": "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)" }, { "field": "followUp", "quote": "The 4-week observational prospective CHORALIS study" } ] }, { "id": "pmid:39105571", "pmid": "39105571", "doi": "10.1080/00365521.2024.2386451", "nctId": null, "pmcid": null, "title": "Comparison of gastrointestinal bleeding in patients with and without liver cirrhosis", "firstAuthor": "Daðadóttir", "multipleAuthors": true, "journal": "Scand J Gastroenterol", "year": 2024, "design": "retrospective", "n": 493, "nField": "reported", "population": "patients with liver cirrhosis", "intervention": "A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB.", "comparator": "matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB", "primaryOutcome": "The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics.", "result": "hemorrhoids 40% vs. 6% (p = 0.002)", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective, matched comparison study without any treatment tested, so it can't show what stops hemorrhoid bleeding.", "directness": "indirect", "limitations": "Retrospective design, matched cohort, no information on hemorrhoid treatment or bleeding mechanism, and no randomization.", "followUp": "45 days", "plainFinding": "Hemorrhoids more common bleeding cause in cirrhosis.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39105571/", "sourceText": "OBJECTIVES: Upper gastrointestinal bleeding (GIB) in patients has been well-characterized in liver cirrhosis but studies on lower GIB are limited. The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics. METHODS: A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB. Patients with overt bleeding leading to hospitalization were included. RESULTS: Overall, 396 patients had cirrhosis, 267 (67%) men, median age 62, alcoholic etiology 177/396 (45%), median MELD 12 (range 6-32). Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics. Overall 87 (85%) cirrhotic patients had upper and 15% lower GIB. Compared to non-cirrhotics, the cause of GIB was more commonly acute variceal bleeding (AVB) (42% vs. 1%), hemorrhoids 40% vs. 6% (p = 0.002), less commonly gastric ulcer 13% vs. 31% (p < 0.001), duodenal ulcer 9% vs. 29% (p < 0.001), 5% of cirrhotics used NSAIDs vs. 26% of controls (p < 0.001). Rebleeding occurred in 14% of cirrhotics vs. 3% in controls (p < 0.001). Only one cirrhotic patient (1%) died from GIB vs. 0.8% of controls within 45 days. Overall mortality 45 days after hospitalization was 10% in cirrhotics vs. 5% in controls (p < 0.001). CONCLUSIONS: Bleeding from gastric and duodenal ulcers were less common in cirrhotics than in controls. Bleeding from hemorrhoids was more common in cirrhotics. Mortality due to GIB was low in both groups but overall mortality was significantly higher in cirrhotics.", "provenance": [ { "field": "n", "quote": "Overall 102 cirrhotics had GIB, matched with 391 non-cirrhotics" }, { "field": "population", "quote": "cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB" }, { "field": "intervention", "quote": "A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB." }, { "field": "comparator", "quote": "matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB" }, { "field": "primaryOutcome", "quote": "The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics." }, { "field": "result", "quote": "hemorrhoids 40% vs. 6% (p = 0.002)" } ] }, { "id": "pmid:38955875", "pmid": "38955875", "doi": "10.1007/s10151-024-02940-4", "nctId": null, "pmcid": null, "title": "Clinical outcomes of laser hemorrhoidoplasty with feeding vessels suture ligation: a retrospective study in a single center", "firstAuthor": "Chen", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2024, "design": "retrospective", "n": 323, "nField": "reported", "population": "patients with symptomatic grade II-III hemorrhoids", "intervention": "laser hemorrhoidoplasty with suture ligation of the feeding blood vessels", "comparator": "traditional Milligan-Morgan hemorrhoidectomy surgery", "primaryOutcome": "postoperative pain and complications after surgery", "result": "the laser surgery group had significantly less pain after surgery and fewer cases of urinary retention than the traditional surgery group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison of two surgeries, so differences in pain could be influenced by factors other than the treatment itself.", "directness": "indirect", "limitations": "Retrospective study design without randomization; focuses on postoperative pain rather than directly measuring bleeding or recurrence outcomes.", "followUp": "", "plainFinding": "Less pain than traditional surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38955875/", "sourceText": "BACKGROUND: Laser hemorrhoidoplasty has demonstrated significant therapeutic effectiveness. To diminish postoperative bleeding and enhance overall outcomes, we have additionally adopted suture ligating the feeding vessels. This study aimed to understand the treatment outcomes and any associated complications. METHODS: This study comprised patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy between 1 September 2020, and 31 August 2022. Surgical-related details, postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications were collected from inpatient records, outpatient follow-ups, and telephone interviews. Initially, we will analyze the distinctions between the laser group and the traditional group, followed by an investigation into complications and satisfaction within the laser surgery subgroup. RESULTS: The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy. Regarding pain assessment, the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences. Additionally, the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences. CONCLUSIONS: Laser hemorrhoidoplasty with feeding vessels suture ligation has been shown to reduce postoperative pain and appears to be a promising minimally invasive treatment option for symptomatic grade II and III hemorrhoids.", "provenance": [ { "field": "population", "quote": "patients with symptomatic grade II-III hemorrhoids who underwent laser hemorrhoidoplasty with feeding vessel suture ligation and Milligan-Morgan hemorrhoidectomy" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty with feeding vessel suture ligation" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "postoperative pain, discomfort after discharge, hemorrhoid recurrence, and any complications" }, { "field": "result", "quote": "the LHP group exhibited superior performance compared to traditional surgery at postoperative 4 h, before discharge, and during the first and second outpatient visits, with statistically significant differences" }, { "field": "result", "quote": "the LHP group had a lower rate of urinary retention and experienced significantly less pain, with statistically significant differences" }, { "field": "n", "quote": "The study included 323 patients, with 173 undergoing laser hemorrhoidoplasty (LHP) and 150 undergoing Milligan-Morgan hemorrhoidectomy." } ] }, { "id": "pmid:38944729", "pmid": "38944729", "doi": null, "nctId": null, "pmcid": null, "title": "Gold Standard yet Inconspicuous- Our Experience of Conventional Haemorrhoid Surgeries in a Peripheral Free of Cost Hospital of Bangladesh", "firstAuthor": "Sazal", "multipleAuthors": true, "journal": "Mymensingh Med J", "year": 2024, "design": "case-series", "n": 64, "nField": "reported", "population": "adults with hemorrhoidal disease, mostly grade 3-4, treated at a free hospital in Bangladesh", "intervention": "conventional haemorrhoid surgery", "comparator": "none (single group, no comparison treatment)", "primaryOutcome": "complications and recurrence after surgery over 12 months", "result": "most patients had complication-free recovery, with only rare cases of delayed healing, pain, urinary retention, infection, or bleeding", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, single-group study with no comparison treatment, so it cannot show what caused bleeding or compare it to other options", "directness": "indirect", "limitations": "no control group, small sample size, single hospital setting, late patient presentation", "followUp": "12 months", "plainFinding": "Surgery gave low complication rates.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38944729/", "sourceText": "Recent advancement in surgical treatment of haemorrhoidal disease is not accessible by low socio-economic group of patient in a peripheral hospital of an underdeveloped country, where we aimed to evaluate the outcome of conventional surgeries. This descriptive, prospective, observational study was performed from diagnosis of haemorrhoidal disease to surgical intervention and followed up 12 months post operatively. Clinico-pathological data and outcome in the form of complications and recurrence within follow-up period was studied. Total 64 adult patients with mean age 38.6 years and male female ratio 1.7:1 were included in this study. Mean duration of symptoms was 13 months, reflects late presentation. Two (2) piles mass was seen most frequent in 36(56.3%) cases and most of the patients i.e. 44(68.8%) had haemorrhoids only on primary sites (3, 7 and 11 o'clock) of anal canal, but 18(28.1%) had mixed primary and secondary position of haemorrhoids. Similarly among those who had more than one haemorrhoid, grade 4 was commonest 35(53.1%) followed by only grade 3 in 15(23.4%) cases but mixed grade 3 and 4 was seen in 10(15.6%) patient. 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. Mean hospital stay was 4 days. Conventional surgeries are equally efficacious and cost effective option for management of operable haemorrhoidal disease at any setup.", "provenance": [ { "field": "n", "quote": "Total 64 adult patients with mean age 38.6 years" }, { "field": "population", "quote": "Total 64 adult patients with mean age 38.6 years and male female ratio 1.7:1 were included in this study" }, { "field": "intervention", "quote": "evaluate the outcome of conventional surgeries" }, { "field": "comparator", "quote": "This descriptive, prospective, observational study was performed from diagnosis of haemorrhoidal disease to surgical intervention" }, { "field": "primaryOutcome", "quote": "Clinico-pathological data and outcome in the form of complications and recurrence within follow-up period was studied" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:38940246", "pmid": "38940246", "doi": "10.5604/01.3001.0054.6443", "nctId": null, "pmcid": null, "title": "The influence of supportive therapy with a six-component myophlebotropic preparation on the reduction of symptoms in patients with symptoms of hemorrhoidal disease", "firstAuthor": "Kwiatkowska", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2024, "design": "rct", "n": 61, "nField": "reported", "population": "patients with stage II and III hemorrhoidal disease with symptoms like pain, burning, itching and bleeding", "intervention": "six-component myophlebotropic dietary supplement added to standard local treatment", "comparator": "standard local treatment plus placebo", "primaryOutcome": "severity of hemorrhoid symptoms (pain, burning, itching, bleeding) and overall symptom relief", "result": "the supplement group had significantly less pain, burning, itching, bleeding during defecation, and more overall symptom relief after 30 days than the placebo group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small number of patients split into two small groups and relies partly on subjective symptom scales, which limits confidence in the findings.", "directness": "direct", "limitations": "Small sample size (29 vs 32 patients); outcomes partly based on subjective VAS and yes/no symptom reporting; no mention of blinding details beyond placebo control.", "followUp": "30 days", "plainFinding": "Less pain, itching, and bleeding with defecation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38940246/", "sourceText": "<b>Introduction:</b> Hemorrhoidal disease is the most common disease treated in proctology ambulatories. Conservative treatment is the basic form of treatment for this disease. One of the elements of treatment may be preparations with myoand phlebotropic effects.<b>Aim:</b> 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.<b>Material and method:</b> Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study. The patients were divided into two groups. 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. Symptoms were analyzed at the time of inclusion in the study (day 0), after 4 and 10 days of therapy. The severity of hemorrhoidal disease and the feeling of relief were assessed on the day of inclusion (W0) and after 30 days of therapy.<b>Results:</b> There were no statistical differences between the groups in terms of disease advancement, age, gender, and duration of symptoms. Compared to the moment of inclusion in the study (W0), after 4 days (W1), after 10 days (W2) of taking the multi- -component product, there was a statistically significant improvement in the VAS scale: spontaneous pain and pain during defecation. In the qualitative assessment (yes/no), there were statistically significantly fewer cases of burning in the anus and itching. 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. 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. Relief after a month of the study (one-question method) was noted in the group of patients receiving the tested product.<b>Conclusions:</b> The tested six-component myophlebotropic product proved to be effective in reducing the severity of symptoms such as spontaneous pain, pain during defecation, burning/burning in the anus and bleeding during defecation. Statistical significance was demonstrated in the symptom's relief and reduction in the severity of hemorrhoidal disease.", "provenance": [ { "field": "n", "quote": "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." }, { "field": "population", "quote": "Patients with stage II and III hemorrhoidal disease with clinical symptoms such as pain, burning, itching and bleeding were qualified for the study." }, { "field": "intervention", "quote": "the study group (Group II) of 32 patients receiving the same local treatment and a six-component myophlebotropic product" }, { "field": "comparator", "quote": "The control group (Group I) of 29 patients receiving standard local treatment plus placebo" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "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." }, { "field": "followUp", "quote": "after 30 days of therapy" } ] }, { "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": "adults with grade II to III mixed hemorrhoids having hemorrhoid surgery (modified Milligan-Morgan hemorrhoidectomy)", "intervention": "nonpressure wound dressing after surgery", "comparator": "pressure wound dressing after surgery", "primaryOutcome": "postoperative complications including urinary retention, pain, skin injury, swelling, and bleeding control", "result": "nonpressure dressings caused less urinary retention, less pain, less skin injury and swelling, but no difference in bleeding, length of stay or cost, and no bleeding occurred in either group", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized trial with a reasonable number of patients, but it was only single-blind and focused on post-surgical dressing type rather than on bleeding itself.", "directness": "indirect", "limitations": "Single-blind design, population limited to surgical hemorrhoidectomy patients excluding those with cardiovascular/cerebrovascular disease, and bleeding was not the main focus of comparison.", "followUp": "", "plainFinding": "Less pain and retention, not bleeding.", "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": "population", "quote": "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" }, { "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": "No primary bleeding was observed in both groups." }, { "field": "result", "quote": "there were no significant differences between both groups in terms of anal edema scores, length of stay, or hospitalization expenses" }, { "field": "n", "quote": "A total of 186 patients with grade II to III mixed hemorrhoids" } ] }, { "id": "pmid:38847122", "pmid": "38847122", "doi": "10.1111/ans.19116", "nctId": null, "pmcid": null, "title": "Flavonoids and post haemorrhoidectomy recovery: a systematic review and meta-analysis", "firstAuthor": "Pitesa", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2024, "design": "meta-analysis", "n": 775, "nField": "reported", "population": "patients having surgery to remove hemorrhoids (haemorrhoidectomy) for severe symptomatic hemorrhoids", "intervention": "flavonoid medication given around the time of hemorrhoidectomy surgery", "comparator": "non-flavonoid treatment (implied control group in the pooled trials)", "primaryOutcome": "pain after hemorrhoidectomy surgery", "result": "flavonoids significantly reduced post-operative pain and reduced bleeding compared to the non-flavonoid groups", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it pools multiple randomized trials, which is strong evidence, but the abstract does not describe how consistent the studies were or address bias, and the findings are about surgical recovery rather than bleeding from untreated hemorrhoids.", "directness": "indirect", "limitations": "abstract does not report heterogeneity, bias assessment, or details of flavonoid regimens used; only mentions this is about post-surgical recovery, not natural hemorrhoid bleeding", "followUp": "", "plainFinding": "Less pain and bleeding after hemorrhoid surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38847122/", "sourceText": "BACKGROUND: Haemorrhoidectomy is the gold standard for definitive treatment of high-grade symptomatic haemorrhoids but is often associated with substantial pain. This systematic review aims to explore the potential of flavonoids in alleviating the postoperative symptom burden following excisional haemorrhoidectomy. METHODS: A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD42023472711). Randomized controlled trials (RCTs) published PubMed, MEDLINE, Embase, and Scopus from inception to 1st December 2023 were retrieved. The primary outcome investigated was post-operative pain. Meta-analysis was performed using Review Manager version 5.4.1. RESULTS: Ten articles with 775 patients were included. The meta-analysis identified 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). CONCLUSION: Flavonoids show promise as a means of reducing pain associated with excisional haemorrhoidectomy. Further research is required to investigate topical routes of administration and standardize regimes.", "provenance": [ { "field": "population", "quote": "following excisional haemorrhoidectomy" }, { "field": "intervention", "quote": "the potential of flavonoids in alleviating the postoperative symptom burden following excisional haemorrhoidectomy" }, { "field": "comparator", "quote": "in favour of the flavonoid groups" }, { "field": "primaryOutcome", "quote": "The primary outcome investigated was post-operative pain." }, { "field": "result", "quote": "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)" }, { "field": "n", "quote": "Ten articles with 775 patients were included." } ] }, { "id": "pmid:38813050", "pmid": "38813050", "doi": "10.3748/wjg.v30.i17.2332", "nctId": null, "pmcid": "PMC11130570", "title": "Transanal eco-Doppler evaluation after hemorrhoidal artery embolization", "firstAuthor": "Tutino", "multipleAuthors": true, "journal": "World J Gastroenterol", "year": 2024, "design": "prospective-cohort", "n": 11, "nField": "reported", "population": "patients with bleeding hemorrhoids (score ≥4, Goligher grade II or III) who failed non-surgical treatment", "intervention": "hemorrhoidal artery embolization (Emborrhoid procedure)", "comparator": "before vs after treatment (same patients, no control group)", "primaryOutcome": "change in arterial blood flow to hemorrhoids measured by ultrasound Doppler", "result": "blood flow to hemorrhoids significantly decreased after embolization, but this flow reduction only weakly matched improvement in bleeding scores", "resultDirection": "mixed", "quality": "low", "qualityWhy": "very small pilot study of only 11 patients with no comparison group, so the findings are preliminary and could be due to chance.", "directness": "direct", "limitations": "Pilot study with small sample size; weak correlation between flow changes and symptom scores; no control group.", "followUp": "1 month", "plainFinding": "Reduced hemorrhoid blood flow, but symptom link weak.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38813050/", "sourceText": "BACKGROUND: Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%. AIM: To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding. METHODS: This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS. RESULTS: Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o'clock and 15.88 cm/s at 3 o'clock) and in the posterior right lateral (14.62 cm/s at 7 o'clock and 16.71 cm/s at 9 o'clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found. CONCLUSION: The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.", "provenance": [ { "field": "n", "quote": "Eleven patients underwent Emborrhoid." }, { "field": "population", "quote": "consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included" }, { "field": "intervention", "quote": "Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding." }, { "field": "comparator", "quote": "Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure." }, { "field": "primaryOutcome", "quote": "The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment." }, { "field": "result", "quote": "After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570)." } ] }, { "id": "pmid:38797851", "pmid": "38797851", "doi": "10.1186/s12893-024-02425-z", "nctId": null, "pmcid": "PMC11129420", "title": "Laser hemorrhoidoplasty vs. rubber band ligation: a randomized trial comparing 2 mini-invasive treatment for grade II hemorrhoids", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "BMC Surg", "year": 2024, "design": "rct", "n": 70, "nField": "reported", "population": "patients with grade II hemorrhoids", "intervention": "laser hemorrhoidoplasty (LHP)", "comparator": "Rubber Band Ligation (RBL)", "primaryOutcome": "postoperative pain, bleeding, and feeling of anal distension after surgery", "result": "LHP improved pain, bleeding, and anal distension more than RBL within 2 weeks, but recurrence rates were similar at 1 year", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small single-center trial of only 70 patients with short-term outcome measures and no mention of blinding.", "directness": "direct", "limitations": "Small sample size (n=70), single-center design, and no mention of blinding or long-term bleeding outcomes beyond 1 year recurrence.", "followUp": "1 year after surgery", "plainFinding": "Less bleeding and pain with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38797851/", "sourceText": "PURPOSE: As a minimally invasive procedure, laser hemorrhoidoplasty (LHP) can not only relieve the symptoms of hemorrhoids, but also protect the anal cushion structure. This study aimed to investigate the clinical efficacy of LHP in the treatment of grade II hemorrhoids. METHODS: A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group) in 2019 from a single center. The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups. RESULTS: The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P < 0.01). Both methods can relieve the symptoms of grade II hemorrhoids. There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05). The patients in LHP group took less time to return to normal activities (P < 0.001). CONCLUSIONS: As a minimally invasive treatment, LHP is easy and not traumatic and results in mild postoperative pain and few complications. It is an ideal choice for grade II hemorrhoids.", "provenance": [ { "field": "n", "quote": "A total of 70 patients with grade II hemorrhoids were randomly assigned to receive LHP or Rubber Band Ligation (RBL) (n = 35 per group)" }, { "field": "population", "quote": "70 patients with grade II hemorrhoids" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty (LHP)" }, { "field": "comparator", "quote": "Rubber Band Ligation (RBL)" }, { "field": "primaryOutcome", "quote": "The postoperative pain, bleeding, feeling of anal distension(local falling, swelling, foreign body sensation, stool) and postoperative recurrence rate were compared between the two groups." }, { "field": "result", "quote": "The postoperative pain, bleeding, and feeling of anal distension in the LHP group were improved significantly as compared with the RBL group within 2 weeks after surgery (P < 0.01)." }, { "field": "result", "quote": "There was no difference in the recurrence rate between the two groups at 1 year after surgery (P > 0.05)." } ] }, { "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 applied twice daily", "comparator": "none; before-and-after comparison with no control group", "primaryOutcome": "patient-reported hemorrhoid symptom severity score (mSSS)", "result": "symptom severity score improved significantly from baseline in both treatment groups", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was an uncontrolled observational study with no placebo or comparator group, so improvement could be due to natural healing rather than the treatment, and it also excluded bleeding hemorrhoids, the condition in question.", "directness": "indirect", "limitations": "No control group, not randomized or blinded, and study explicitly excluded bleeding hemorrhoids.", "followUp": "", "plainFinding": "Eased non-bleeding hemorrhoid symptoms, uncontrolled study", "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": "n", "quote": "Five investigators enrolled 60 patients" }, { "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": "Patients were administered treatment twice per day for at least 1 week until symptom resolution and/or for a maximum of 4 weeks." }, { "field": "comparator", "quote": "The primary endpoint was patient-assessed effectiveness on a modified Symptom Severity Score (mSSS, range 0 to 14)." }, { "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)." } ] }, { "id": "pmid:38704632", "pmid": "38704632", "doi": "10.12659/MSM.943126", "nctId": null, "pmcid": "PMC11080662", "title": "Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients", "firstAuthor": "Deng", "multipleAuthors": true, "journal": "Med Sci Monit", "year": 2024, "design": "retrospective", "n": 128, "nField": "reported", "population": "patients with severe anemia caused by bleeding hemorrhoids, requiring blood transfusion before surgery", "intervention": "restrictive blood transfusion (transfusing to a lower hemoglobin target before surgery)", "comparator": "liberal blood transfusion (transfusing to a higher hemoglobin target before surgery)", "primaryOutcome": "transfusion amount, transfusion reactions, hospital costs, and surgery time", "result": "the restrictive-transfusion group had fewer transfusion reactions and lower costs, but longer surgery time, compared to the liberal-transfusion group", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective study without randomization, so differences between groups could be due to other factors, not just the transfusion strategy.", "directness": "indirect", "limitations": "retrospective design, no randomization, only looked at surgical hemorrhoid patients with severe anemia needing transfusion rather than hemorrhoid bleeding in general", "followUp": "", "plainFinding": "Lower transfusion threshold had fewer reactions.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38704632/", "sourceText": "BACKGROUND Severe anemia caused by hemorrhoidal hematochezia is typically treated preoperatively with reference to severe anemia treatment strategies from other etiologies. This retrospective cohort study included 128 patients with hemorrhoidal severe anemia admitted to 3 hospitals from September 1, 2018, to August 1, 2023, and aimed to evaluate preoperative blood transfusion requirements. MATERIAL AND METHODS Of 5120 patients with hemorrhoids, 128 (2.25%; male/female: 72/56) experienced hemorrhoidal severe anemia, transfusion, and Milligan-Morgan surgery. Patients were categorized into 2 groups based on their preoperative hemoglobin (PHB) levels after transfusion: PHB ≥70 g/L as the liberal-transfusion group (LG), and PHB <70 as the restrictive-threshold group (RG). The general condition, bleeding duration, hemoglobin level on admission, transfusion volume, length of stay, immune transfusion reaction, surgical duration, and hospitalization cost were compared between the 2 groups. RESULTS Patients with severe anemia (age: 41.07±14.76) tended to be younger than those with common hemorrhoids (age: 49.431±15.59 years). The LG had a significantly higher transfusion volume (4.77±2.22 units), frequency of immune transfusion reactions (1.22±0.58), and hospitalization costs (16.69±3.31 thousand yuan) than the RG, which had a transfusion volume of 3.77±2.09 units, frequency of immune transfusion reactions of 0.44±0.51, and hospitalization costs of 15.00±3.06 thousand yuan. Surgical duration in the LG (25.69±14.71 min) was significantly lower than that of the RG (35.24±18.72 min). CONCLUSIONS Patients with hemorrhoids with severe anemia might require a lower preoperative transfusion threshold than the currently recognized threshold, with an undifferentiated treatment effect and additional benefits.", "provenance": [ { "field": "n", "quote": "This retrospective cohort study included 128 patients with hemorrhoidal severe anemia" }, { "field": "population", "quote": "patients with hemorrhoidal severe anemia admitted to 3 hospitals" }, { "field": "intervention", "quote": "PHB <70 as the restrictive-threshold group (RG)" }, { "field": "comparator", "quote": "PHB ≥70 g/L as the liberal-transfusion group (LG)" }, { "field": "primaryOutcome", "quote": "The general condition, bleeding duration, hemoglobin level on admission, transfusion volume, length of stay, immune transfusion reaction, surgical duration, and hospitalization cost were compared between the 2 groups." }, { "field": "result", "quote": "The LG had a significantly higher transfusion volume (4.77±2.22 units), frequency of immune transfusion reactions (1.22±0.58), and hospitalization costs (16.69±3.31 thousand yuan) than the RG" } ] }, { "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 followed from first trimester through six weeks after delivery in Bamako, Mali", "intervention": "treatment based on counseling on hygiene and diet, laxatives, local topicals, analgesics, and perineal rehabilitation", "comparator": "none reported", "primaryOutcome": "occurrence of anal pathologies (hemorrhoidal disease, anal fissure, anal incontinence) and their risk factors", "result": "38.4% (546) of women had anal pathologies, including hemorrhoidal disease in 13% (192), with identified risk factors such as age ≥30, chronic constipation, newborn weight >3500 g, and prolonged fetal expulsion time", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive observational study without a comparison group, so it cannot show whether any treatment actually works or how bleeding is stopped.", "directness": "indirect", "limitations": "no control group or outcome data on whether treatments relieved symptoms such as bleeding; study focuses on epidemiology and risk factors rather than treatment efficacy", "followUp": "6 weeks after delivery", "plainFinding": "Describes risk factors, not what stops bleeding.", "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": "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)" }, { "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; 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." } ] }, { "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 treatment", "intervention": "medical, instrumental, or surgical treatment for hemorrhoids", "comparator": "different treatment types compared to each other (medical vs instrumental vs surgical)", "primaryOutcome": "change in bleeding and prolapse scores and patient satisfaction after treatment", "result": "bleeding and prolapse scores decreased significantly after treatment, with greater improvement and higher satisfaction in the surgery group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-center observational study without randomization, so differences between treatment groups could be due to patient selection rather than the treatment itself.", "directness": "indirect", "limitations": "Single-center, non-randomized comparison of treatment groups; abstract does not describe why bleeding occurs or isolate a specific intervention tested against a control.", "followUp": "", "plainFinding": "Surgery reduced bleeding more than other treatments.", "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": "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": "improvement was more marked in the surgery group with a better rate of \"very good satisfaction\" (73% vs. 54%, P=0.003)" }, { "field": "primaryOutcome", "quote": "the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively)" }, { "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:38480640", "pmid": "38480640", "doi": "10.1007/s13304-024-01798-3", "nctId": null, "pmcid": null, "title": "Sclerotherapy with 3% polidocanol foam for the treatment of mucocutaneous bridges and/or residual piles after open excisional hemorrhoidectomy", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "retrospective", "n": 18, "nField": "reported", "population": "adults aged 18-75 with grade IV hemorrhoidal disease", "intervention": "open excisional hemorrhoidectomy combined with 3% polidocanol foam sclerotherapy on remaining tissue bridges/piles", "comparator": "no comparator group; before-after comparison within same patients", "primaryOutcome": "symptom score (HDSS) and quality of life (SHS-HD) at 3 months after surgery", "result": "77.8% of patients were symptom-free at 3 months, with significant drop in symptom scores from 16 to 2, and no bleeding or complications occurred", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study of only 18 patients with no comparison group, so it's hard to know how much the sclerotherapy itself helped versus the surgery alone.", "directness": "indirect", "limitations": "single-center retrospective study; small sample size; short follow-up; no control group for comparison", "followUp": "3 months", "plainFinding": "Fewer symptoms, no bleeding after combined treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38480640/", "sourceText": "Injection sclerotherapy is an effective and safe treatment in selected cases. It might be used as the first treatment for I-III degree hemorrhoidal disease (HD), but also as a bridge therapy for more severe cases not amenable to invasive treatments. However, concerning the long-term recurrence rate, open excisional hemorrhoidectomy remains the gold standard in cases of III- and IV-degree HD. In this context, it is recommended to perform the excision of no more than three piles and to preserve the muco-cutaneous bridges to avoid post-operative anal stenosis. The aim of this study is to evaluate surgical outcomes and efficacy of the combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles. This was a single-center retrospective study and a total of 18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification, were enrolled between January 2023 and June 2023 and their follow-up continued until October 2023 after reaching 3 months of follow-up. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms and their impact on quality of life and continence. A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months. Moreover, a statistically significant decrease in the median HDSS and short health scale for HD (SHS-HD) score was registered from 16 preoperatively (T0) to 2 at 3-month follow-up (T3). Neither post-operative bleeding nor any type of complications occurred. The use of sclerotherapy in combination with the traditional open excisional hemorrhoidectomy has shown promising results. Further structured studies are needed and greater dissemination and education of the general surgeon on the subject is necessary.", "provenance": [ { "field": "n", "quote": "a total of 18 patients with IV-degree HD, aged between 18 and 75 years" }, { "field": "population", "quote": "18 patients with IV-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification" }, { "field": "intervention", "quote": "combined treatment of open excisional hemorrhoidectomy and the use of ST on the remnant muco-cutaneous bridges/residual piles" }, { "field": "comparator", "quote": "from 16 preoperatively (T0) to 2 at 3-month follow-up (T3)" }, { "field": "primaryOutcome", "quote": "The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey Incontinence Score were used to assess symptoms" }, { "field": "result", "quote": "A total of 77.8% (14/18) of the patients were symptom-free (hemorrhoidal disease symptom score (HDSS) score = 0) after 3 months." }, { "field": "result", "quote": "Neither post-operative bleeding nor any type of complications occurred." } ] }, { "id": "pmid:38356039", "pmid": "38356039", "doi": "10.1007/s13304-024-01776-9", "nctId": null, "pmcid": "PMC10995001", "title": "Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Updates Surg", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic venous disease or hemorrhoid disease", "intervention": "oral mesoglycan (a glycosaminoglycan supplement)", "comparator": "standard postoperative care alone / usual treatment", "primaryOutcome": "severity of hemorrhoid symptoms and risk of rectal bleeding", "result": "mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing multiple trials without reporting their design details, sample sizes, or statistical rigor, so it cannot be weighed like a single controlled study.", "directness": "indirect", "limitations": "The abstract does not describe study designs, sample sizes, blinding, or statistical results for the cited trials, and it combines findings across two different diseases (CVD and HD).", "followUp": "", "plainFinding": "Less rectal bleeding with mesoglycan.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38356039/", "sourceText": "Chronic venous disease (CVD) and hemorrhoidal disease (HD) are among the most common vascular diseases in the world, with CVD affecting 22-41% of the population in Europe and HD having a point prevalence of 11-39%. The burden is substantial in terms of the effect of symptoms on patients' health-related quality of life (HRQoL) and direct/indirect medical costs. Treatment begins with lifestyle changes, compression in CVD and topical therapies in HD, and escalates as needed through oral therapies first and eventually to surgery for severe disease. CVD and HD share etiological features and pathological changes affecting the structure and function of the tissue extracellular matrix. Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate, has been demonstrated to positively impact the underlying causes of CVD and HD, regenerating the glycocalyx and restoring endothelial function, in addition to having antithrombotic, profibrinolytic, anti-inflammatory, antiedema and wound-healing effects. In clinical trials, oral mesoglycan reduced the severity of CVD signs and symptoms, improved HRQoL, and accelerated ulcer healing. In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding. In patients undergoing excisional hemorrhoidectomy, 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. The clinical effects of mesoglycan in patients with CVD or HD are consistent with the agent's known mechanisms of action.", "provenance": [ { "field": "population", "quote": "In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding." }, { "field": "intervention", "quote": "oral mesoglycan reduced the severity of CVD signs and symptoms" }, { "field": "comparator", "quote": "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" }, { "field": "primaryOutcome", "quote": "mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding" }, { "field": "result", "quote": "In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding." } ] }, { "id": "pmid:38174849", "pmid": "38174849", "doi": "10.1308/rcsann.2023.0097", "nctId": null, "pmcid": "PMC11658878", "title": "Injection sclerotherapy for the treatment of haemorrhoids in anticoagulated patients", "firstAuthor": "Batra", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2025, "design": "retrospective", "n": 20, "nField": "reported", "population": "patients with symptomatic hemorrhoids who were on blood thinners (anticoagulation)", "intervention": "injection sclerotherapy", "comparator": "", "primaryOutcome": "no bleeding for at least six months", "result": "90% of patients had no more bleeding after injection treatment, while staying on blood thinners", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small retrospective study of only 20 patients with no comparison group, so results could be due to chance or other factors.", "directness": "direct", "limitations": "Retrospective case note review, small sample size, no control group, single center.", "followUp": "6 months", "plainFinding": "Bleeding stopped in most patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38174849/", "sourceText": "BACKGROUND: Symptomatic haemorrhoids (SH) are a common condition; however, conventional outpatient treatment, including rubber band ligation, is contraindicated in patients receiving concurrent anticoagulation. Injection sclerotherapy (IST) has been proposed as a treatment option for these patients. METHODS: A retrospective review of case notes was performed in a colorectal surgery department that sits alongside a tertiary cardiothoracic surgical unit. Patients treated with an IST for SH between 1 April 2014 and 30 November 2021 were identified. Anticoagulation was not stopped in these patients as they were at high risk of developing thromboembolism, except in two patients who required alternative procedures. The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months. The secondary outcomes were patient-reported complications, number of IST procedures and number of other procedures performed to achieve symptom resolution. RESULTS: A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified. Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions. Ten patients (50%) required only one IST procedure, and three patients (15%) required two procedures. The remaining five (25%) patients required three or four interventions. The median time between IST treatments was 32 weeks (range 8-133). No complications were reported. CONCLUSION: Our study demonstrates that IST can be considered as a potential treatment option for patients with SH who are at a high risk of thromboembolic disease requiring anticoagulation.", "provenance": [ { "field": "n", "quote": "A total of 20 patients with a median age of 64 years (range 35-86, 14 male) who underwent 32 IST treatments were identified." }, { "field": "population", "quote": "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" }, { "field": "intervention", "quote": "Injection sclerotherapy (IST) has been proposed as a treatment option for these patients." }, { "field": "primaryOutcome", "quote": "The primary outcome was symptom resolution, defined as no patient reporting bleeding for at least six months." }, { "field": "result", "quote": "Symptom resolution was achieved in 18 (90%) patients using IST while continuing anticoagulation treatment, with two (10%) patients requiring alternative interventions." } ] }, { "id": "pmid:38131339", "pmid": "38131339", "doi": null, "nctId": null, "pmcid": null, "title": "Stapled hemorrhoidopexy. A single-center study on over 600 patients with long term follow-up", "firstAuthor": "Eminoğlu", "multipleAuthors": false, "journal": "Ann Ital Chir", "year": 2023, "design": "case-series", "n": 646, "nField": "reported", "population": "people with stage 2 or 3 hemorrhoid disease", "intervention": "stapled hemorrhoidopexy surgery", "comparator": "none (single group followed over time)", "primaryOutcome": "recurrence and complications after surgery, including bleeding", "result": "11% had grade 3 or 4 recurrence, 7% needed drug therapy for hemorrhoidal bleeding, and some needed band ligation or repeat surgery", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a single-center case series without a comparison group, so it cannot show whether the surgery itself caused the improvement or how it compares to other treatments.", "directness": "indirect", "limitations": "No control group, single surgeon, single center, and follow-up relied partly on phone calls rather than exams.", "followUp": "one year", "plainFinding": "Recurrent bleeding in some patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38131339/", "sourceText": "UNLABELLED: OBJECTIVE; The aim of this study is to evaluate the results of patients treated by stapler hemorrhoidopexy for hemorrhoidal disease with a long term foloow up. MATERIAL AND METHOD: Patients who were operated with stapled hemorrhoidopexy (SH) technique between 01/01/2009 and 01/01/2019 in the general surgery department were included. Patients with stage 2 and stage 3 hemorrhoidal disease included. All patients were operated by the same surgeon using a 33-mm circular PPH stapler. All patients were evaluated on the 7 th day with physical examination, at the second month with physical exam and flexible rectoscopy and at one year with physical examination or telephone call and then with follow up exams if they had symptoms. RESULTS: 646 patients were included. 581 of them were discharged on the same day of the operation. At 1 week after surgery,78 patients (12 %) reported urgency and occasional gas leakage, and 18 patients (3%) reported liquid leakage. 68 patients ( 11%) developed grade 3 or 4 recurrence 38 (6 %) of these patients were treated with Milligan Morgan hemorroidectomy. 19 patients with bleeding were treated with band ligation . Fourty-five patients (7%) required drug therapy for treating hemorrhoidal bleeding. 42 patients developed anal fissure and three patients had anal stenosis. CONCLUSIONS: SH provides high patient comfort and short hospital stay and is a good surgical alternative providing a low recurrence rate in the long run . This single center study with a long follow up period provides a contribution to literature. KEY WORDS: De Longo, Hemorrhoidal disease, Stapled hemorrhoidopexy.", "provenance": [ { "field": "n", "quote": "646 patients were included." }, { "field": "population", "quote": "Patients with stage 2 and stage 3 hemorrhoidal disease included." }, { "field": "intervention", "quote": "Patients who were operated with stapled hemorrhoidopexy (SH) technique" }, { "field": "comparator", "quote": "RESULTS: 646 patients were included." }, { "field": "primaryOutcome", "quote": "68 patients ( 11%) developed grade 3 or 4 recurrence" }, { "field": "result", "quote": "68 patients ( 11%) developed grade 3 or 4 recurrence 38 (6 %) of these patients were treated with Milligan Morgan hemorroidectomy. 19 patients with bleeding were treated with band ligation . Fourty-five patients (7%) required drug therapy for treating hemorrhoidal bleeding." } ] }, { "id": "pmid:37659951", "pmid": "37659951", "doi": "10.1016/j.asjsur.2023.08.194", "nctId": null, "pmcid": null, "title": "A retrospective comparative study of hemorrhoidal artery ligation versus ligasure hemorrhoidectomy for the third degree hemorrhoidal disease", "firstAuthor": "Onder", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2023, "design": "retrospective", "n": 91, "nField": "reported", "population": "patients with third degree hemorrhoidal disease", "intervention": "Doppler-guided ligation of hemorrhoidal arteries (ADHL)", "comparator": "Ligasure hemorrhoidectomy (LH)", "primaryOutcome": "postoperative bleeding duration, pain, hospital stay, and recurrence", "result": "ADHL had shorter hospital stay and quicker resolution of postoperative bleeding than LH, with similar recurrence rates", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, non-randomized comparison of two surgical techniques without blinding or control for confounders.", "directness": "indirect", "limitations": "Retrospective design; authors state prospective randomized controlled studies are needed", "followUp": "", "plainFinding": "Artery ligation healed faster than Ligasure surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37659951/", "sourceText": "BACKGROUND: Hemorrhoidal disease (HD) is the most common disease of the anorectal region. Excision of pathological hemorrhoidal structures by providing bipolar energy transfer with Ligasure, which is basically an electrosurgical device, is one of the treatment methods Ligasure hemorrhoidectomy (LH). In another method applied for the first time by Morinaga, the vascular plexus is provided by Doppler-guided ligation of the hemorrhoidal arteries (ADHL). In our study, we aimed to compare and evaluate the results of these two minimally invasive treatment methods. MATERIALS AND METHODS: Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study. Demographic data, complaints, number of hemorrhoidal structures, location, complications, operation time, bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results were evaluated from the patient files. RESULTS: The number of patients included in the study was 91. While 54 patients were treated with ADHL (group 1), 37 patients (group 2) were treated with LH. Although the gender distribution between the groups was similar, there was male predominance in both groups. The mean operative time was shorter in group 1. The number of packages was 2.7 in group 1 and 2.4 in group 2. The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group. In the postoperative period, bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2. While recurrence occurred in 4 patients in the ADHL group, recurrence developed in 3 patients who underwent LH. CONCLUSION: ADHL and LH techniques have advantages and disadvantages over each other. Although the ADHL technique seems to be superior to LH in terms of post-defecation pain and shorter hospital stay, prospective randomized controlled studies are needed to determine which method should be chosen in which patient.", "provenance": [ { "field": "n", "quote": "The number of patients included in the study was 91." }, { "field": "population", "quote": "Patients treated with ADHL and LH for HD in our Surgery Clinic were included in the study." }, { "field": "intervention", "quote": "Doppler-guided ligation of the hemorrhoidal arteries (ADHL)" }, { "field": "comparator", "quote": "Ligasure hemorrhoidectomy (LH)" }, { "field": "primaryOutcome", "quote": "bleeding during and after the operation, length of hospital stay, postoperative pain scoring, and postoperative results" }, { "field": "result", "quote": "In the postoperative period, bleeding was not observed after an average of 1.4 days in group 1, while this period was 4.9 days in group 2." }, { "field": "result", "quote": "The mean hospital stay was 1.5 days in the ADHL-treated group, compared to. 3.05 days in the LH group." } ] }, { "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": "patients with grade III/IV hemorrhoids", "intervention": "hemorrhoid removal surgery combined with tying off the hemorrhoid artery (no ultrasound guidance)", "comparator": "hemorrhoid removal surgery alone", "primaryOutcome": "pain, bleeding, swelling, and recurrence after surgery", "result": "combined surgery had less bleeding, less pain, fewer complications, and lower recurrence than surgery alone", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective, single-center study comparing two patient groups rather than a randomized trial, so bias cannot be ruled out.", "directness": "indirect", "limitations": "Retrospective design, single center, not randomized", "followUp": "12 months", "plainFinding": "Less bleeding with artery ligation added.", "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": "received MMH" }, { "field": "primaryOutcome", "quote": "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" }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "At follow-up by telephone or outpatient 12 months after surgery" } ] }, { "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 after surgery", "result": "M-TST-CACP group showed a higher cure rate, lower recurrence, lower anal incontinence score, and lower rate of anal stenosis than the PPH group", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial but only the statistical analyst was blinded, and it was conducted at a single center, which limits confidence in the results.", "directness": "indirect", "limitations": "Single-center study with blinding limited to the statistical analyst; postoperative bleeding was tracked as a safety measure but no specific data or comparison on bleeding were given.", "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": "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": "higher cure rate (6 months: 74.51% vs. 64.71%, P = 0.044)" }, { "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." }, { "field": "n", "quote": "A total of 306 patients were finally included for analysis." }, { "field": "followUp", "quote": "12 months: 0.65% vs. 5.88%, P = 0.010" } ] }, { "id": "pmid:37530049", "pmid": "37530049", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment of haemorrhoids in pregnancy: A retrospective review", "firstAuthor": "Fiordaliso", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "pregnant women with hemorrhoids", "intervention": "various hemorrhoid treatments (fiber, stool softeners, laxatives, topical medication, phlebotonics, anal packing, hemorrhoidectomy)", "comparator": "no formal comparator; narrative synthesis of treatment options", "primaryOutcome": "safe and effective management of hemorrhoids in pregnancy, including bleeding control", "result": "Fiber, stool softeners and mild laxatives are considered safe; topical medication and oral phlebotonics need caution due to lack of safety/efficacy evidence; anal packing can help with massive bleeding; surgery reserved for severe cases", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a non-systematic literature review without pooled data, numbers of patients, or quality assessment of included studies.", "directness": "direct", "limitations": "No language selection or systematic methodology described, no participant numbers given, and abstract notes lack of strong evidence for several treatments in pregnancy.", "followUp": "", "plainFinding": "Fiber and stool softeners considered safest option.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37530049/", "sourceText": "AIM: Haemorrhoids are varicose veins of the rectum covered by mucosa at or near the anal canal. They are normally asymptomatic, can occur at any age and affect both males and females. Haemorrhoids are common in young women and commoner during pregnancy and the puerperium. In this review, we address the issue of the approach of the obstetrician and surgeons to haemorrhoids and their management. This is significant because there are currently no recommendations for pregnant patients with hemorrhoids. METHODS: The literature search comprised all the inherent published original papers; also abstract were included. No language selection was done. Search terms used were: \"hemorrhoid\", \"hemorrhoid therapy\", \"hemorrhoid in pregnancy\", \"hemorrhoid complication\". Data research was conducted using MEDLINE, EMBASE, Web of Sciences, Scopus, Clinical Trial. gov, OVID and Cochrane Library querying for all articles related to treatment of hemorrhoidis in pregnancy. RESULTS: Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking. In case of massive bleeding, anal packing could be a simple and useful maneuver. Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding. KEY WORDS: Hemorrhoid, Hemorrhoid Therapy, Hemorrhoid in Pregnancy, Hemorrhoid Complication.", "provenance": [ { "field": "population", "quote": "commoner during pregnancy and the puerperium" }, { "field": "intervention", "quote": "Fiber supplement, stool softener and mild laxatives are generally safe for pregnant women. Topical medication or oral phlebotonics may be used with special caution" }, { "field": "comparator", "quote": "Hemorrhoidectomy is reserved in strangulated or extensively thrombosed hemorrhoids, and hemorrhoids with intractable bleeding." }, { "field": "primaryOutcome", "quote": "treatment of hemorrhoidis in pregnancy" }, { "field": "result", "quote": "In case of massive bleeding, anal packing could be a simple and useful maneuver." }, { "field": "result", "quote": "Topical medication or oral phlebotonics may be used with special caution because the strong evidence of their safety and efficacy in pregnancy is lacking." } ] }, { "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, grade I-III (mild to moderate)", "intervention": "catheter-directed embolization of the rectal artery using microcoils", "comparator": "none (before-after comparison within same patients)", "primaryOutcome": "absence of rectal bleeding after treatment", "result": "68.7% had no rectal bleeding at 12 months; 31.3% had bleeding come back", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group registry study without a comparison group, so improvement can't be separated from natural changes over time.", "directness": "direct", "limitations": "No control group, so it's unclear how much of the improvement is due to the procedure itself.", "followUp": "12 months", "plainFinding": "Fewer bleeding episodes after embolization.", "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": "In all cases, microcoils were used to embolize the superior rectal artery(SRA), and microspheres if recurrence of bleeding occurred." }, { "field": "comparator", "quote": "VAS and QL improved 4 points and 1.5 respectively after embolization." }, { "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." } ] }, { "id": "pmid:37349572", "pmid": "37349572", "doi": "10.1007/s00423-023-02990-6", "nctId": null, "pmcid": null, "title": "Quality of life and outcomes after rubber band ligation for haemorrhoidal disease", "firstAuthor": "Pastor Peinado", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2023, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "patients with symptomatic grade II-III hemorrhoids who did not improve after 6 months of conservative treatment", "intervention": "rubber band ligation", "comparator": "before vs after treatment, no control group", "primaryOutcome": "quality of life scores (symptom severity and health status)", "result": "significant improvement in symptom and quality of life scores, 89% success rate, 76% high satisfaction", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a single-group observational study without a comparison group, so improvement cannot be clearly credited to the treatment alone", "directness": "indirect", "limitations": "no control group; observational design; abstract does not describe how bleeding specifically was assessed or why it stops", "followUp": "6 months", "plainFinding": "Fewer symptoms after banding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37349572/", "sourceText": "PURPOSE: The main objective of this study was to assess the impact on quality of life after rubber band ligation (RBL) in patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment, using quality of life scores. METHODS: This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included between December 2019 and December 2020. RBL was offered as first-line treatment in this group. Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale).Secondary objectives were: to evaluate the rate of patients requiring one or more RBL procedures, to establish the overall success rate of RBL and to analyse complications. RESULTS: A total of 100 patients were finally included. Regarding the impact on quality of life after RBL, a significant reduction was found in the HDSS and SHS scores (p < 0.001). The main improvement was found in the first month and it was maintained until the sixth month. A high degree of satisfaction with the procedure was reported by 76% of patients. The overall success rate of banding was 89%. A 12% complication rate was detected, the most frequent complication was severe anal pain (58.3%) and self-limiting bleeding (41.7%). CONCLUSION: Rubber band ligation, as a treatment for symptomatic grade II-III haemorrhoids that do not respond to medical treatment, leads to a significant improvement in patients' symptoms and quality of life. It also has a high degree of satisfaction between patients.", "provenance": [ { "field": "n", "quote": "A total of 100 patients were finally included." }, { "field": "population", "quote": "patients with symptomatic grade II-III haemorrhoids who did not improve after 6 months of conservative treatment" }, { "field": "intervention", "quote": "rubber band ligation (RBL)" }, { "field": "comparator", "quote": "This was a prospective cohort observational study where patients with haemorrhoidal disease and indication for RBL were included" }, { "field": "primaryOutcome", "quote": "Patient´s quality of life was assessed by scores: HDSS (Hemorrhoidal Disease Symptom Score) and SHS (Short Health Scale)" }, { "field": "result", "quote": "a significant reduction was found in the HDSS and SHS scores (p < 0.001)" }, { "field": "result", "quote": "The overall success rate of banding was 89%." } ] }, { "id": "pmid:37312422", "pmid": "37312422", "doi": "10.1111/ans.18568", "nctId": null, "pmcid": null, "title": "Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II-III hemorrhoidal disease: a retrospective analysis", "firstAuthor": "Tümer", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2023, "design": "retrospective", "n": null, "nField": "not-reported", "population": "patients with grade II-III hemorrhoidal disease", "intervention": "laser hemorrhoidoplasty", "comparator": "LigaSure hemorrhoidectomy", "primaryOutcome": "postoperative pain measured by Visual Analog Scale", "result": "laser group had lower pain and less intraoperative bleeding but higher recurrence (9.4% vs 2.5%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a retrospective study without a reported sample size, which limits how much confidence we can place in the comparison.", "directness": "direct", "limitations": "Retrospective design; number of patients not reported; higher recurrence rate in the laser group than the comparator.", "followUp": "", "plainFinding": "Less pain, more recurrence with laser.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37312422/", "sourceText": "BACKGROUND: Hemorrhoidal disease is a common ailment that presents a challenge in terms of standard treatment methods. Although surgical hemorrhoidectomy is often considered the gold standard, new surgical techniques have emerged, such as laser hemorrhoidoplasty and LigaSure hemorrhoidectomy, to address postoperative pain, bleeding, and extended return-to-work times. This study aims to compare the outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in patients with grade II-III hemorrhoidal disease. METHODS: A retrospective analysis was conducted on a cohort of patients who underwent laser hemorrhoidoplasty or LigaSure hemorrhoidectomy. Data were collected on postoperative pain, complications, recurrence rates, and return-to-work times. The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS). RESULTS: Patients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%). Return to work and normal activities time after laser hemorrhoidoplasty was shorter than after LigaSure hemorrhoidectomy. CONCLUSION: Laser hemorrhoidoplasty is a minimally invasive technique that can be safely applied in suitable grade II-III patients, offering lower postoperative pain rates, fewer complications, and shorter return to work and normal activity times compared to LigaSure hemorrhoidectomy. However, recurrence rates are still higher for laser hemorrhoidoplasty. Future studies should explore the potential of combining laser hemorrhoidoplasty with other surgical treatments.", "provenance": [ { "field": "population", "quote": "patients with grade II-III hemorrhoidal disease" }, { "field": "intervention", "quote": "laser hemorrhoidoplasty" }, { "field": "comparator", "quote": "LigaSure hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS)." }, { "field": "result", "quote": "Patients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%)." } ] }, { "id": "pmid:37267978", "pmid": "37267978", "doi": "10.1055/a-2068-4409", "nctId": null, "pmcid": null, "title": "[Hemorroids Therapy: a Tailored Approch]", "firstAuthor": "Pfeil", "multipleAuthors": true, "journal": "Zentralbl Chir", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with symptomatic haemorrhoids", "intervention": "conservative treatment, sclerotherapy, and various surgical options (e.g., Fergusson, Milligan-Morgan, Longo haemorrhoidopexy, HAL-RAR, IRT, LT, RFA)", "comparator": "different treatment options within the tailored approach", "primaryOutcome": "symptom control and quality of life", "result": "most patients improve with conservative treatment and sclerotherapy controls symptoms well, with surgery offering further options if these fail", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative overview describing treatment options without presenting specific trial data or outcome statistics.", "directness": "direct", "limitations": "No quantitative data, patient numbers, or comparative outcomes are reported; the abstract is descriptive rather than evidence-based.", "followUp": "", "plainFinding": "Various treatments relieve symptoms well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37267978/", "sourceText": "One of the most common reasons to consult a coloproctologist is symptomatic haemorrhoids. Typical signs and symptoms as well as a specialised examination, including proctoscopy, are essential for the correct diagnosis. The vast majority of patients can be treated conservatively with excellent results in terms of quality of life. Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease. If conservative treatment fails, there are various surgical options. A tailored approach is mandatory. Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA. Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.", "provenance": [ { "field": "population", "quote": "symptomatic haemorrhoids" }, { "field": "intervention", "quote": "Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA." }, { "field": "comparator", "quote": "A tailored approach is mandatory." }, { "field": "primaryOutcome", "quote": "The vast majority of patients can be treated conservatively with excellent results in terms of quality of life." }, { "field": "result", "quote": "Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease." } ] }, { "id": "pmid:37188908", "pmid": "37188908", "doi": "10.1007/s00464-023-10108-8", "nctId": null, "pmcid": null, "title": "Efficacy of two endoscopic rubber band ligation methods for symptomatic hemorrhoids: a randomized controlled trial", "firstAuthor": "Tian", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2023, "design": "rct", "n": 70, "nField": "reported", "population": "patients with symptomatic grade I to III hemorrhoids", "intervention": "rubber band ligation of the hemorrhoid plus nearby normal tissue (combined ligation)", "comparator": "rubber band ligation of the hemorrhoid alone", "primaryOutcome": "overall therapeutic success rate (complete or partial resolution of symptoms)", "result": "no significant difference in overall efficacy, recurrence, or symptom improvement (including bleeding) between the two ligation methods, but combined ligation caused more pain afterward", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, open-label (not blinded), and some patients were lost to follow-up.", "directness": "direct", "limitations": "open-label design, small sample size (70 randomized, 62 completed follow-up)", "followUp": "12 months", "plainFinding": "Both banding methods worked similarly for bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37188908/", "sourceText": "BACKGROUND: Endoscopic rubber band ligation (ERBL) is considered an effective nonsurgical treatment for symptomatic grade I to III hemorrhoids; however, it is unclear whether ligation of hemorrhoids or simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation) is safer and more effective. This controlled, open-label, and prospective study aimed to evaluate the efficacy and safety of both methods for symptomatic grade I to III hemorrhoids. METHODS: Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group). Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence. The primary outcome was overall therapeutic success rate (complete resolution and partial resolution rates). The secondary outcomes included recurrence rate and efficacy for each symptom. Complications and patient satisfaction were also assessed. RESULTS: Sixty-two patients (31 in each group) completed the 12-month follow-up; 42 (67.8%) experienced complete resolution, 17 (27.4%) experienced partial resolution, and 3 (4.8%) experienced no change in overall efficacy. The rates of complete resolution, partial resolution, and no change in the hemorrhoid ligation and combined ligation groups were 71.0 and 64.5%, 22.6 and 32.3%, and 6.5 and 3.2%, respectively. No significant differences in overall efficacy, recurrence rate, or efficacy for each symptom (including bleeding, prolapse, pain, anal swelling, itching, soiling, and constipation) were observed between groups. No life-threatening events requiring surgical intervention occurred. The incidence of postoperative pain was higher in the combined ligation group (74.2% vs. 45.2%, P = 0.02). No significant differences between groups in terms of incidences of other complications or patient satisfaction were observed. CONCLUSION: Both methods achieved satisfactory therapeutic effects. No significant differences in efficacy and safety of the two ligation methods were observed; however, combined ligation resulted in a higher incidence of postprocedural pain.", "provenance": [ { "field": "n", "quote": "Seventy patients with symptomatic grade I to III hemorrhoids were randomly assigned to the hemorrhoid and combined ligation groups (35 in each group)." }, { "field": "population", "quote": "symptomatic grade I to III hemorrhoids" }, { "field": "intervention", "quote": "simultaneous ligation of hemorrhoids and proximal normal mucosa (combined ligation)" }, { "field": "comparator", "quote": "ligation of hemorrhoids" }, { "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": "followUp", "quote": "Patients were followed up at 3, 6, and 12 months to assess symptom improvement, complications, and recurrence." } ] }, { "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": "newer drug molecules and treatments for hemorrhoids", "comparator": "", "primaryOutcome": "safety, clinical efficacy, and marketed formulation effectiveness", "result": "not reported numerically; review summarizes recent developments and studies without stating specific outcome results", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review summarizing literature without presenting its own trial data or statistical results.", "directness": "indirect", "limitations": "Abstract does not report study design details, sample sizes, or specific outcome data; it is a general literature summary.", "followUp": "", "plainFinding": "No clear result reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37106517/", "sourceText": "BACKGROUND: Hemorrhoid disease (HD) is an anal-rectal ailment that is commonly painful or may be painless and causes rectal bleeding with or without prolapsing anal tissue. It is generally associated with bleeding, prolapse, pruritus, and discomfort, which results in a diminished quality of life and well-being. OBJECTIVE: To highlight the recent developments in terms of safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids. METHOD: Reported literature available on Scopus, PubMed, Science Direct, Clinicaltrails.gov, and from many reputed foundations has been studied to summarize the recent development and clinical studies for the management of hemorrhoids. RESULTS AND CONCLUSION: The high incidence of hemorrhoids obliges the development of new molecules; therefore, safe and efficient drugs to confer protection against hemorrhoids are urgently needed. This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past.", "provenance": [ { "field": "population", "quote": "Hemorrhoid disease (HD) is an anal-rectal ailment" }, { "field": "intervention", "quote": "newer molecules to overcome hemorrhoids" }, { "field": "primaryOutcome", "quote": "safety, clinical efficacy, and marketed formulation for the effective management of hemorrhoids" }, { "field": "result", "quote": "This review article mainly focuses on the newer molecules to overcome hemorrhoids and also emphasizes various studies carried out in the past." } ] }, { "id": "pmid:37005961", "pmid": "37005961", "doi": "10.1007/s10151-023-02787-1", "nctId": null, "pmcid": "PMC10485119", "title": "French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease", "firstAuthor": "Laurain", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2023, "design": "prospective-cohort", "n": 129, "nField": "reported", "population": "adults with grade II-III hemorrhoids", "intervention": "radiofrequency ablation (Rafaelo) of hemorrhoids", "comparator": "", "primaryOutcome": "quality of life score related to hemorrhoid disease at 3 months", "result": "quality of life score dropped from 17.4/100 to 0/100, and bleeding reports fell from 84% to 21% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This study had no comparison group and measured change before and after treatment in the same patients, so it can't rule out natural improvement over time.", "directness": "direct", "limitations": "No control group; some patients required reoperation for relapse or complications; abstract does not report loss to follow-up.", "followUp": "3 months (with some outcomes to 1 year)", "plainFinding": "Fewer symptoms, including less bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37005961/", "sourceText": "PURPOSE: The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. METHOD: This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. RESULTS: A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale). CONCLUSION: RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. CLINICAL TRIAL REGISTRATION AND DATE: Clinical trial NCT04229784 (18/01/2020).", "provenance": [ { "field": "population", "quote": "outpatients with grade II-III haemorrhoids" }, { "field": "intervention", "quote": "RFA (Rafaelo©)" }, { "field": "n", "quote": "A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres." }, { "field": "primaryOutcome", "quote": "Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery." }, { "field": "result", "quote": "Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months." }, { "field": "result", "quote": "the rate of patients reporting bleeding (21% vs. 84%, p < 0.001)" } ] }, { "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-IV hemorrhoids", "intervention": "laser hemorrhoidoplasty surgery", "comparator": "hemorrhoid grade groups compared to each other (grade II vs III vs IV)", "primaryOutcome": "post-operative symptom relief and complications, including bleeding, readmission, and reoperation", "result": "Most patients had symptom relief, but grade IV hemorrhoids had much higher rates of post-operative bleeding, readmission, and recurrence than grade II or III", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study without a control group or randomization, so it cannot reliably prove cause and effect.", "directness": "indirect", "limitations": "Retrospective analysis; no comparison to other treatments or untreated hemorrhoids; the question concerns why hemorrhoids bleed and what stops it, while this abstract reports outcomes of a specific laser surgery technique.", "followUp": "", "plainFinding": "Laser surgery works, but grade IV risks more bleeding.", "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": "all patients who underwent LHP surgery between September 2018 and October 2021" }, { "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": "we aimed to evaluate the post-operative outcomes of patients undergoing LHP surgery based on hemorrhoid grade" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:36849385", "pmid": "36849385", "doi": "10.55519/JAMC-01-10975", "nctId": null, "pmcid": null, "title": "Comparison Of Outcome Between Open Haemorrhoidectomy Versus Trans-Anal Doppler Guided Hemorrhoidal Artery Ligation With Recto-Anal Repair In 3rd And 4th Degree Haemorrhoids", "firstAuthor": "Saleem", "multipleAuthors": true, "journal": "J Ayub Med Coll Abbottabad", "year": 2023, "design": "rct", "n": 70, "nField": "reported", "population": "adults with 3rd and 4th degree haemorrhoids undergoing surgery", "intervention": "Doppler guided hemorrhoidal artery ligation with recto-anal repair (HAL RAR)", "comparator": "open haemorrhoidectomy", "primaryOutcome": "post-operative pain, bleeding, and hospital stay", "result": "no significant difference in post-op pain or bleeding, but shorter hospital stay with HAL RAR", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small randomized trial of only 70 patients with no mention of blinding or how bleeding was measured", "directness": "indirect", "limitations": "small sample size; abstract does not mention blinding or long-term follow-up", "followUp": "", "plainFinding": "Similar pain and bleeding; shorter hospital stay.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36849385/", "sourceText": "BACKGROUND: Haemorrhoids are very common but their exact prevalence is not known as most of the people suffering from them do not seek medical or surgical advice. The literature states their prevalence to be about 39% and commonly affect people aged between 45-65 years of age. Objective of the study was to compare the outcomes of open haemorrhoidectomy Vs Trans anal Doppler ultrasound guided hemorrhoidal artery ligation with recto-anal repair in 3rd and 4th degree haemorrhoids. It was a Randomized control trial, conducted at the Department of Surgery, King Edward Medical University, Lahore; from October 2019 to March 2021. METHODS: This was a randomized control trial study where the results of 70 patients of haemorrhoids including 3rd and 4th degree disease fulfilling the selection criteria, who underwent open haemorrhoidectomy (OH) and Doppler guided haemorrhoidal artery ligation with rectoanal repair (HAL RAR) procedure on elective and emergency operating lists, were analyzed with regards to post-operative pain, bleeding and hospital stay. RESULTS: From our seventy patients the minimum age was 23 and maximum age limit was 55 years (mean: 35.09±7.47). There were 49 (70%) males and 21 (30%) females. Mean post-op pain on day 7 for OH was 1.12±0.72 and for HAL RAR it was 1.06±0.52. Post-op bleeding (POB) occurred in 4 (10%) patients in OH group and 2(6.66%) patients in HAL RAR group. Mean hospital stay for OH group was 2±0.45 and for HAL RAR it was 1.20±0.40, for POB, it was 1.9±0.30 in OH group and 1.86±0.34 in HAL-RAR group. CONCLUSIONS: There was no significant difference in mean post-op pain on day seven, and post-op bleeding, but there was significant difference in terms of mean hospital stay between the two groups.", "provenance": [ { "field": "n", "quote": "results of 70 patients of haemorrhoids" }, { "field": "population", "quote": "3rd and 4th degree disease fulfilling the selection criteria" }, { "field": "intervention", "quote": "Doppler guided haemorrhoidal artery ligation with rectoanal repair (HAL RAR) procedure" }, { "field": "comparator", "quote": "open haemorrhoidectomy (OH)" }, { "field": "primaryOutcome", "quote": "post-operative pain, bleeding and hospital stay" }, { "field": "result", "quote": "There was no significant difference in mean post-op pain on day seven, and post-op bleeding, but there was significant difference in terms of mean hospital stay between the two groups." } ] }, { "id": "pmid:36757069", "pmid": "36757069", "doi": "10.1111/codi.16514", "nctId": null, "pmcid": null, "title": "The efficacy of laser haemorrhoidoplasty (LHP) in the treatment of symptomatic haemorrhoidal disease: An observational cohort study", "firstAuthor": "Boerhave", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "prospective-cohort", "n": 200, "nField": "reported", "population": "Patients with symptomatic hemorrhoids (grades 1-4)", "intervention": "Laser hemorrhoidoplasty (LHP), a laser procedure that seals off blood vessels feeding the hemorrhoids", "comparator": "None - single group, no comparison treatment", "primaryOutcome": "Patient satisfaction and/or complete recovery of symptoms (bleeding, pain, itching, soiling, prolapse)", "result": "Most patients were satisfied, but about a quarter still had bleeding afterward and over a quarter had hemorrhoids return within a year", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This study only followed one group of patients without comparing them to another treatment, so it can't show whether the laser itself caused the improvement.", "directness": "direct", "limitations": "No control or comparison group; single-center design; relies on patient-reported outcomes", "followUp": "6-7 weeks postoperatively; recurrence assessed within 1 year", "plainFinding": "High satisfaction, but bleeding often persisted.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36757069/", "sourceText": "AIM: Laser haemorrhoidoplasty (LHP) is an emerging nonexcisional surgical procedure in which the arteriovenous flow of the haemorrhoidal plexus is interrupted through laser coagulation. The aim of this cohort study was to assess efficacy of LHP in treating symptomatic haemorrhoidal disease through patient satisfaction, remission of symptoms (blood loss, pain, itching, soiling, mucosal prolapse) and recurrence of haemorrhoids. METHODS: Patients who underwent treatment for symptomatic haemorrhoids (degrees 1-4) through an LHP procedure between 2015 and 2021 were included in the study. A 1470 nm-diode laser was used. A total of 200 patients (71% male, average age 51 years) were analysed. Primary outcomes were patient satisfaction and/or complete recovery of symptoms. Secondary outcomes were operating time, complications and recurrence rates. Patient satisfaction, postoperative blood loss, pain and complications were evaluated 6-7 weeks postoperatively. Room turnover time and operating time were documented. Recurrence of haemorrhoids following LHP treatment within 1 year was evaluated. RESULTS: Patient satisfaction regarding LHP treatment was reached in 155 (84,7%) patients. Postoperative blood loss was reported by 44 (24,0%) patients during time of evaluation. Twenty-four (13,1%) patients reported postoperative pain after 6-7 weeks. Postoperative complications occurred in seven patients (3 anal fissures, 2 perianal abscess, 1 perianal fistula, 1 postoperative anaemia). Room turnover time (patient in to patient out) was 21 min with an average operating time of 7 min. Recurrence of haemorrhoids within 1 year occurred in 50 (27,3%) patients. CONCLUSIONS: Laser haemorrhoidoplasty appears to be a promising and effective nonexcisional surgical procedure in the treatment of symptomatic haemorrhoidal disease with high patient satisfaction, acceptable postoperative symptoms, minimal complications and short operating times.", "provenance": [ { "field": "population", "quote": "Patients who underwent treatment for symptomatic haemorrhoids (degrees 1-4)" }, { "field": "intervention", "quote": "Laser haemorrhoidoplasty (LHP) is an emerging nonexcisional surgical procedure in which the arteriovenous flow of the haemorrhoidal plexus is interrupted through laser coagulation." }, { "field": "comparator", "quote": "A total of 200 patients (71% male, average age 51 years) were analysed." }, { "field": "primaryOutcome", "quote": "Primary outcomes were patient satisfaction and/or complete recovery of symptoms." }, { "field": "result", "quote": "Patient satisfaction regarding LHP treatment was reached in 155 (84,7%) patients. Postoperative blood loss was reported by 44 (24,0%) patients during time of evaluation." }, { "field": "result", "quote": "Recurrence of haemorrhoids within 1 year occurred in 50 (27,3%) patients." }, { "field": "n", "quote": "A total of 200 patients (71% male, average age 51 years) were analysed." } ] }, { "id": "pmid:36736822", "pmid": "36736822", "doi": "10.1016/j.jvir.2023.01.023", "nctId": null, "pmcid": null, "title": "Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center", "firstAuthor": "Bagla", "multipleAuthors": true, "journal": "J Vasc Interv Radiol", "year": 2023, "design": "retrospective", "n": 134, "nField": "reported", "population": "patients with symptomatic internal hemorrhoids that hadn't responded to other treatment", "intervention": "blocking the hemorrhoid blood vessels (embolization) using particles and coils", "comparator": "before-and-after comparison, no control group", "primaryOutcome": "improvement in hemorrhoid symptoms, pain, bleeding score, and quality of life at 1 month", "result": "significant improvement in symptom scores, pain, bleeding, and quality of life at 1 month, with 93% clinical success", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective study without a comparison group, only followed patients for one month, so it can't rule out natural improvement or placebo effect.", "directness": "direct", "limitations": "retrospective design, no control group, very short follow-up of only 1 month", "followUp": "1 month", "plainFinding": "Less bleeding and pain after embolization.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36736822/", "sourceText": "PURPOSE: To evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids. MATERIALS AND METHODS: Retrospective analysis of 134 patients who underwent hemorrhoidal artery embolization (HAE) for symptomatic internal hemorrhoids between August 2021 and June 2022 (76 men and 58 women) was performed. The mean age was 54.9 years, with a mean Goligher hemorrhoid grade (HG) of 2.1. Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils. Standard-of-care evaluations were performed at baseline and the 1 month follow-up, which included 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). Clinical success was defined as improvement of symptoms without additional treatment. RESULTS: Embolization of at least 1 hemorrhoidal artery was achieved in 133 (99%) of the 134 patients. The mean number of SRA branches embolized per patient was 2.9 ± 1.0. Clinical success was seen in 93% (124 of 134) of patients at the 1-month follow-up, with 10 patients requiring repeat embolization. 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). There were no severe adverse events. CONCLUSIONS: HAE is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids in the short term.", "provenance": [ { "field": "n", "quote": "Retrospective analysis of 134 patients" }, { "field": "population", "quote": "symptomatic refractory internal hemorrhoids" }, { "field": "intervention", "quote": "Branches of the superior rectal artery (SRA) or middle rectal artery supplying the corpus cavernosum recti were embolized with both spherical particles and microcoils." }, { "field": "comparator", "quote": "Standard-of-care evaluations were performed at baseline and the 1 month follow-up" }, { "field": "primaryOutcome", "quote": "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)" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:36736690", "pmid": "36736690", "doi": "10.1016/j.jvir.2023.01.022", "nctId": null, "pmcid": null, "title": "Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial", "firstAuthor": "Falsarella", "multipleAuthors": true, "journal": "J Vasc Interv Radiol", "year": 2023, "design": "rct", "n": 29, "nField": "reported", "population": "adults with symptomatic hemorrhoid disease, grades 2 and 3", "intervention": "embolization of the superior rectal arteries", "comparator": "closed surgical hemorrhoidectomy (Ferguson technique)", "primaryOutcome": "pain after the procedure and recurrence of hemorrhoid symptoms (including bleeding) over 12 months", "result": "Embolization caused far less pain and need for pain medication than surgery, and bleeding improved in most embolization patients (83.3%), but overall symptom frequency at 12 months was similar between the two treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a very small randomized trial (29 patients, 4 excluded) with short follow-up, so its findings could easily be due to chance or not apply broadly.", "directness": "direct", "limitations": "Small sample size, 4 of 29 randomized patients excluded from analysis, and only 12 months of follow-up.", "followUp": "12 months", "plainFinding": "Similar bleeding relief, far less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36736690/", "sourceText": "PURPOSE: To compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. MATERIAL AND METHODS: This study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months. RESULTS: The mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups. CONCLUSIONS: Despite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment.", "provenance": [ { "field": "population", "quote": "33 patients with symptomatic hemorrhoidal disease Grades 2 and 3" }, { "field": "intervention", "quote": "superior rectal artery embolization" }, { "field": "comparator", "quote": "Ferguson closed hemorrhoidectomy surgical group" }, { "field": "n", "quote": "33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14)" }, { "field": "result", "quote": "The mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001)." }, { "field": "result", "quote": "In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients." }, { "field": "result", "quote": "The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691)." }, { "field": "primaryOutcome", "quote": "Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months." }, { "field": "followUp", "quote": "the subsequent first, third, sixth, and twelfth months" } ] }, { "id": "pmid:36474223", "pmid": "36474223", "doi": "10.1186/s12893-022-01861-z", "nctId": null, "pmcid": "PMC9724411", "title": "Milligan-Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study", "firstAuthor": "Symeonidis", "multipleAuthors": true, "journal": "BMC Surg", "year": 2022, "design": "retrospective", "n": 116, "nField": "reported", "population": "adults with hemorrhoidal disease who underwent surgery", "intervention": "hemorrhoidal artery ligation and recto-anal repair (HAL-RAR)", "comparator": "Milligan-Morgan (MM) hemorrhoidectomy", "primaryOutcome": "rate of hemorrhoid recurrence and patient satisfaction after surgery", "result": "Overall recurrence rates were similar between the two techniques; in patients whose main symptom was bleeding, satisfaction was significantly higher with HAL-RAR, while in patients with pain, itching or discomfort, MM gave fewer recurrences and better satisfaction", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison with subgroup analyses and no blinding, so the findings are less reliable.", "directness": "direct", "limitations": "Retrospective design, loss to follow-up of 8 patients, and comparisons were based on subgroup analyses by presenting symptom", "followUp": "41 months", "plainFinding": "Better satisfaction with artery ligation for bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36474223/", "sourceText": "BACKGROUND: Several surgical techniques for the treatment of hemorrhoidal disease (HD) have been proposed. However, the selection of the most proper technique for each individual case scenario is still a matter of debate. The purpose of the present study was to compare the Milligan-Morgan (MM) hemorrhoidectomy and the hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) technique. METHODS: A retrospective analysis of the prospectively collected database of patients submitted to HD surgery in our department was conducted. Patients were divided into two groups, the MM group and the HAL-RAR group. Primary end points were recurrence rates and patients' satisfaction rates. The Unpaired t test was used to compare numerical variables while the x2 test for categorical variables. RESULTS: A total of 124 patients were identified, submitted either to HAL-RAR or MM hemorrhoidectomy. Eight (8) patients were lost to follow up and were excluded from the analysis. Of the remaining 116 patients, 69 patients (54 males and 15 females-male / female ratio: 3.6) with a median age of 47 years old (range 18-69) were included in the HAL-RAR group while 47 patients (40 males and 7 females-male / female ratio: 5.7) with a median age of 52 years old (range 32-71) comprised the MM group. At a median follow up of 41 months (minimum 24 months-maximum 72 months), we recorded 20 recurrences (28.9%) in the HAL-RAR group and 9 recurrences in the MM group (19.1%) (p 0.229). The mean time from the procedure to the recurrence was 14.1 ± 9.74 months in the HAL-RAR group and 21 ± 13.34 months in the MM group. Patients with itching, pain or discomfort as the presenting symptoms of HD experienced statistically significantly lower recurrences (p 0.0354) and reported statistically significantly better satisfaction rates (6.72 ± 2.15 vs. 8.11 ± 1.99-p 0.0111) when submitted to MM. In the subgroup of patients with bleeding as the presenting symptom, patients satisfaction rates were significantly better (8.59 ± 1.88 vs. 6.45 ± 2.70-p 0.0013) in the HAL-RAR group. CONCLUSIONS: In patients with pain, itching or discomfort as the presenting symptoms of HD, MM was associated with less recurrences and better patients satisfaction rates compared to HAL-RAR. In patients with bleeding as the main presenting symptom of HD, HAL-RAR was associated with better patients' satisfaction rates and similar recurrence rates compared to MM.", "provenance": [ { "field": "n", "quote": "Of the remaining 116 patients" }, { "field": "population", "quote": "patients submitted to HD surgery in our department" }, { "field": "intervention", "quote": "hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) technique" }, { "field": "comparator", "quote": "Milligan-Morgan (MM) hemorrhoidectomy" }, { "field": "primaryOutcome", "quote": "Primary end points were recurrence rates and patients' satisfaction rates." }, { "field": "result", "quote": "In the subgroup of patients with bleeding as the presenting symptom, patients satisfaction rates were significantly better (8.59 ± 1.88 vs. 6.45 ± 2.70-p 0.0013) in the HAL-RAR group." }, { "field": "result", "quote": "Patients with itching, pain or discomfort as the presenting symptoms of HD experienced statistically significantly lower recurrences (p 0.0354) and reported statistically significantly better satisfaction rates (6.72 ± 2.15 vs. 8.11 ± 1.99-p 0.0111) when submitted to MM." }, { "field": "followUp", "quote": "At a median follow up of 41 months (minimum 24 months-maximum 72 months)" } ] }, { "id": "pmid:36331754", "pmid": "36331754", "doi": "10.1007/s12325-022-02351-7", "nctId": null, "pmcid": "PMC9859842", "title": "Recurrence Rates and Pharmacological Treatment for Hemorrhoidal Disease: A Systematic Review", "firstAuthor": "Lohsiriwat", "multipleAuthors": true, "journal": "Adv Ther", "year": 2023, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoidal disease", "intervention": "pharmacological treatments (including micronized purified flavonoid fractions) and surgery for hemorrhoids", "comparator": "other pharmacological treatments or different interventions for hemorrhoids", "primaryOutcome": "recurrence of hemorrhoidal disease and symptom improvement", "result": "recurrence rates ranged from 0 to 56.5% after surgery or phlebotonics, with most studies reporting 20% or less, and micronized purified flavonoid fractions significantly improved main symptoms compared to other pharmacological treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "The review combined many different real-world studies with inconsistent data collection and found no studies on recurrence after medical treatment, making the evidence patchy and hard to rely on.", "directness": "indirect", "limitations": "Consistent data were limited on the epidemiology of HD or HD recurrence; no RWE studies reporting recurrence in patients receiving systemic or topical treatments were identified.", "followUp": "", "plainFinding": "Flavonoid treatment eased symptoms; recurrence data limited.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36331754/", "sourceText": "INTRODUCTION: Hemorrhoidal disease (HD) is characterized by prolapse of the inflamed and bleeding vascular tissues of the anal canal. Although HD is associated with a high recurrence rate, there is a lack of understanding around interventions that can reduce recurrence and improve outcomes for patients. As such, a systematic literature review (SLR) was conducted to summarize evidence on epidemiology, recurrence, and efficacy of interventions in HD. METHODS: Real-world evidence (RWE) studies evaluating the incidence, prevalence, or recurrence of HD, as well as SLRs including a meta-analytic component reporting on the efficacy of systemic or topical pharmacological treatments for adults with HD, were included. Systematic searches were conducted in MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Database of Systematic Reviews. RESULTS: The SLR identified 44 eligible publications. Consistent data were limited on the epidemiology of HD or HD recurrence. Specifically, incidence and prevalence reported across geographies were impacted by differences in data collection. Reported risk factors for HD were sedentary behavior, constipation, male gender, and age. Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less. In addition to time since treatment, risk factors for recurring disease were similar to those for HD in general. With respect to treatment, micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments. CONCLUSION: The SLRs did not identify any RWE studies reporting recurrence in patients receiving systemic or topical treatments, highlighting the need for future research in this area. Further, more studies are needed to understand the optimum duration of medical treatment to prevent recurrence.", "provenance": [ { "field": "population", "quote": "adults with HD" }, { "field": "intervention", "quote": "micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments" }, { "field": "comparator", "quote": "other pharmacological treatments" }, { "field": "primaryOutcome", "quote": "evaluating the incidence, prevalence, or recurrence of HD" }, { "field": "result", "quote": "Twenty-three RWE studies and one meta-analysis reported HD recurrence rates ranging from 0 to 56.5% following surgery or phlebotonics, with most (n = 19) reporting rates of 20% or less." }, { "field": "result", "quote": "micronized purified flavonoid fractions significantly improved the main symptoms of HD compared to other pharmacological treatments" }, { "field": "n", "quote": "The SLR identified 44 eligible publications." } ] }, { "id": "pmid:36268758", "pmid": "36268758", "doi": "10.1111/codi.16380", "nctId": null, "pmcid": null, "title": "Sclerotherapy with 3% polidocanol foam to treat second-degree haemorrhoidal disease: Three-year follow-up of a multicentre, single arm, IDEAL phase 2b trial", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2023, "design": "case-series", "n": 183, "nField": "reported", "population": "Patients aged 18-75 with symptomatic grade II hemorrhoid disease that had not responded to medical treatment", "intervention": "Sclerotherapy injection using 3% polidocanol foam", "comparator": "None — single-arm study with no control group", "primaryOutcome": "Complete absence of bleeding episodes 7 days after treatment", "result": "Success rate was 95.6% (175/183) at 1 year, falling to 90.2% (165/183) at 3 years; recurrence of bleeding ranged from 12% to 28%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm trial with no comparison group, so it cannot show whether the improvement was due to the treatment itself.", "directness": "direct", "limitations": "Open label, single-arm design with no control group; some patients were converted to surgery and excluded from later symptom-free calculations.", "followUp": "3 year", "plainFinding": "Bleeding stopped in most patients long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36268758/", "sourceText": "BACKGROUND: Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I-II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow-up of more than 1 year. The purpose of this study was to analyse the long-term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II-degree HD. METHODS: This was an open label, single-arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS-HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score. RESULTS: 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). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow-up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10-13) and 18 (15-20) to 0 (0-2) and 4 (0-4), respectively. Symptom-free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo-sclerotherapy nor additional adverse events (AEs) compared to the first 12 months. CONCLUSIONS: Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate.", "provenance": [ { "field": "n", "quote": "A total of 183 patients with II-degree HD" }, { "field": "population", "quote": "aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment" }, { "field": "intervention", "quote": "underwent sclerotherapy with 3% polidocanol foam" }, { "field": "comparator", "quote": "This was an open label, single-arm, phase 2b trial" }, { "field": "primaryOutcome", "quote": "Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:36229826", "pmid": "36229826", "doi": "10.1186/s12893-022-01802-w", "nctId": null, "pmcid": "PMC9563943", "title": "Risk factors of delayed hemorrhage after LigaSure hemorrhoidectomy", "firstAuthor": "Cheng", "multipleAuthors": true, "journal": "BMC Surg", "year": 2022, "design": "retrospective", "n": 437, "nField": "reported", "population": "patients with grade II to IV hemorrhoids who had hemorrhoidectomy using LigaSure devices", "intervention": "LigaSure hemorrhoidectomy, analyzed for factors linked to bleeding afterward", "comparator": "earlier surgeon cases versus later, more experienced cases; male versus female patients", "primaryOutcome": "delayed bleeding after the hemorrhoidectomy surgery", "result": "male sex was an independent risk factor for delayed bleeding, and the bleeding rate dropped from about 10% to about 5% as the surgeon gained experience", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective study from a single surgeon with only 22 bleeding events, so the risk-factor findings are not strong evidence.", "directness": "indirect", "limitations": "retrospective design, single surgeon, small number of bleeding events (22), no separate comparison group reported in this analysis", "followUp": "", "plainFinding": "Male sex, less surgeon experience raised bleeding risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36229826/", "sourceText": "BACKGROUND: As one of the most popular methods for treating hemorrhoidal diseases, hemorrhoidectomy with LigaSure devices has been proven to have less postoperative pain and has gained in popularity among surgeons. However, our previous study found higher incidence of delayed post-hemorrhoidectomy bleeding (DPHB) in patients who underwent LigaSure hemorrhoidectomy compared to those who underwent the traditional Ferguson's method. This follow-up study aimed to reveal the relationship between DPHB and the surgeon's experience. METHODS: This retrospective study included 437 consecutive patients with symptomatic grade II to IV hemorrhoids who received hemorrhoidectomy by LigaSure devices from March 2009 to December 2017. Twenty-two patients who experienced DPHB were analyzed to identify risk factors. Cumulative incidence of DPHB were calculated and visualized to assess the improvement of DPHB rate by time. RESULTS: All operations were performed by a single surgeon. The most common postoperative complication was constipation, followed by urinary retention. DPHB developed in 22 patients (5%). Multivariate analysis showed that the male sex was an independent risk factor for DPHB in patients who underwent hemorrhoidectomy with LigaSure devices. The cumulative incidence was initially higher (about 10%) in the earlier cases and stabilized at around 5% with more cases. The change in cumulative incidence indicated a lower complication rate as the surgeon's experience increased. CONCLUSION: Male sex is an independent risk factor for DHBP. The risk of DPHB is higher in patients undergoing hemorrhoidectomy with LigaSure in a surgeon's earlier cases, and decreases to a rate similar to that for the traditional hemorrhoidectomy once the surgeon becomes more familiar with the procedure and postoperative care.", "provenance": [ { "field": "n", "quote": "included 437 consecutive patients with symptomatic grade II to IV hemorrhoids who received hemorrhoidectomy by LigaSure devices" }, { "field": "population", "quote": "437 consecutive patients with symptomatic grade II to IV hemorrhoids who received hemorrhoidectomy by LigaSure devices" }, { "field": "intervention", "quote": "hemorrhoidectomy by LigaSure devices" }, { "field": "comparator", "quote": "The cumulative incidence was initially higher (about 10%) in the earlier cases and stabilized at around 5% with more cases." }, { "field": "primaryOutcome", "quote": "DPHB developed in 22 patients (5%)." }, { "field": "result", "quote": "Multivariate analysis showed that the male sex was an independent risk factor for DPHB in patients who underwent hemorrhoidectomy with LigaSure devices." }, { "field": "result", "quote": "The cumulative incidence was initially higher (about 10%) in the earlier cases and stabilized at around 5% with more cases." } ] }, { "id": "pmid:36190848", "pmid": "36190848", "doi": "10.1148/rg.220014", "nctId": null, "pmcid": null, "title": "Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques", "firstAuthor": "Panneau", "multipleAuthors": true, "journal": "Radiographics", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with chronic hemorrhoid disease causing rectal bleeding", "intervention": "embolization of the rectal arteries (emborrhoid procedure)", "comparator": "standard treatments such as diet/hygiene measures, medications, banding, or surgery", "primaryOutcome": "improvement in bleeding and other hemorrhoid symptoms", "result": "Studies have shown improvement in symptoms and high technical success rates after treatment.", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a general review describing technique and summarizing other studies rather than presenting its own controlled data.", "directness": "direct", "limitations": "The abstract does not describe study design, sample sizes, or comparison groups for the 'published results' it mentions.", "followUp": "", "plainFinding": "Embolization reported to improve bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/36190848/", "sourceText": "Chronic hemorrhoidal disease is a common anorectal condition that leads to hemorrhoidal hyperplasia, which affects millions of people worldwide and is a significant medical and socioeconomic issue. Rectal bleeding is one of the main chronic symptoms. Recurrent rectal bleeding can alter an individual's quality of life and, more rarely, cause anemia. Pain is less common, occurring only in the event of complications such as congestive exacerbation, external hemorrhoidal thrombosis, or fissures. The most standard treatment involves dietary and hygiene measures, use of phlebotonic drugs, and nonsurgical treatment such as infrared photocoagulation or elastic band ligation. Excisional treatments such as hemorrhoidectomy and hemorrhoidopexy are the reference standards for treatment of hemorrhoidal disease. Embolization of the rectal arteries (ie, emborrhoid) has recently emerged as an effective treatment option, with few reported adverse effects, minimal blood loss, and a same-day hospital procedure. Hemorrhoid embolization is performed by using femoral or radial access. The inferior mesenteric artery and then the superior rectal arteries are catheterized with a microcatheter. Embolization can be performed by using different agents. Studies have shown improvement in symptoms and high technical success rates after treatment. The basic principles of hemorrhoid embolization that must be understood to achieve effective treatment, including those related to patient evaluation, the arterial anatomy, basic embolization, and published results, are reviewed. An invited commentary by Thompson and Kelley is available online. ©RSNA, 2022.", "provenance": [ { "field": "population", "quote": "Chronic hemorrhoidal disease is a common anorectal condition that leads to hemorrhoidal hyperplasia" }, { "field": "intervention", "quote": "Embolization of the rectal arteries (ie, emborrhoid) has recently emerged as an effective treatment option" }, { "field": "comparator", "quote": "The most standard treatment involves dietary and hygiene measures, use of phlebotonic drugs, and nonsurgical treatment such as infrared photocoagulation or elastic band ligation." }, { "field": "primaryOutcome", "quote": "Studies have shown improvement in symptoms and high technical success rates after treatment." }, { "field": "result", "quote": "Studies have shown improvement in symptoms and high technical success rates after treatment." } ] }, { "id": "pmid:36048039", "pmid": "36048039", "doi": "10.1177/00031348221124332", "nctId": null, "pmcid": null, "title": "The Impact of Antithrombotic Medications on Postoperative Bleeding Events Following Hemorrhoidectomy", "firstAuthor": "Dean", "multipleAuthors": true, "journal": "Am Surg", "year": 2023, "design": "retrospective", "n": 1152, "nField": "reported", "population": "patients who had hemorrhoid removal or banding procedures", "intervention": "being on blood-thinning medications (anticoagulants/antiplatelets, including newer DOACs)", "comparator": "not being on blood-thinning medications", "primaryOutcome": "bleeding complications after the procedure (postoperative bleeding events)", "result": "patients on blood thinners had more postoperative bleeding events (5.92%) than those not on blood thinners (2.66%), about 2.3 times higher odds, but severe bleeding needing hospital admission or repeat procedure was not more common in the blood-thinner group", "resultDirection": "harm", "quality": "low", "qualityWhy": "it is a retrospective chart review from one hospital, which cannot fully rule out other explanations for the difference seen", "directness": "indirect", "limitations": "retrospective single-institution design, possible confounding by indication, and it studies surgical bleeding risk rather than why hemorrhoids themselves bleed or how to stop that bleeding", "followUp": "", "plainFinding": "More post-surgery bleeding on blood thinners.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36048039/", "sourceText": "BACKGROUND: Bleeding complications are a risk associated with hemorrhoid procedures. Despite the prevalence of anticoagulant and antiplatelet therapies, including newer direct oral anticoagulants (DOACs) in the aging patient population there is a paucity of data regarding the impact of the use of antithrombotic therapy (AT) especially DOACs, on bleeding complications of hemorrhoid procedures. METHODS: We retrospectively reviewed charts of patients who had undergone a total of 1152 procedures, including hemorrhoid excision and ligation, at a single institution in the years 2016-2018. We noted whether they were prescribed AT, the indication for therapy, perioperative medication management, whether a PBE occurred, and how the PBE was managed. RESULTS: PBE's were noted in 5.92% of patients on ATs, as opposed to 2.66% of patients not on ATs (P = .014.) The odds ratio of having a PBE when on ATs vs not on ATs is 2.3 (95% CI 1.21 to 4.38, P = .011). Seven out of 40 (17.5%) total PBE's required hospital admission or repeat procedure, and this was not associated with AT use. Surprisingly, although males represented most of the patients on ATs, females were statistically more likely to have a PBE following a hemorrhoidectomy if on ATs. DISCUSSION: Patients on AT have an elevated risk of PBE compared to patients not on AT. No significant difference was found between the two groups when considering only those PBE's severe enough to require hospital admission or repeat procedure. Further research is required to establish clear guidelines regarding the perioperative management of AT for hemorrhoid procedures.", "provenance": [ { "field": "population", "quote": "patients who had undergone a total of 1152 procedures, including hemorrhoid excision and ligation" }, { "field": "intervention", "quote": "whether they were prescribed AT" }, { "field": "comparator", "quote": "2.66% of patients not on ATs" }, { "field": "primaryOutcome", "quote": "whether a PBE occurred" }, { "field": "result", "quote": "PBE's were noted in 5.92% of patients on ATs, as opposed to 2.66% of patients not on ATs (P = .014.) The odds ratio of having a PBE when on ATs vs not on ATs is 2.3 (95% CI 1.21 to 4.38, P = .011)." }, { "field": "n", "quote": "a total of 1152 procedures, including hemorrhoid excision and ligation" } ] }, { "id": "pmid:35961908", "pmid": "35961908", "doi": "10.1016/j.asjsur.2022.07.149", "nctId": null, "pmcid": null, "title": "Tissue-selecting-technique mega-window stapler combined with anal canal epithelial preservation operation in prolapsed hemorrhoids", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2023, "design": "rct", "n": 204, "nField": "reported", "population": "patients with prolapsed hemorrhoids undergoing surgery", "intervention": "tissue selecting technique with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation", "comparator": "prolapse and hemorrhoids (PPH) combined with the external hemorrhoidectomy and inferior internal hemorrhoid ligation", "primaryOutcome": "anal function, recurrence, and surgical complications including bleeding", "result": "No significant difference in bleeding or blood loss between the two surgical techniques, though the TST-MS group had better anal function scores and satisfaction", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized, evaluator-blinded trial but done at only one hospital, so the results may not generalize widely.", "directness": "direct", "limitations": "Single-center trial design was noted implicitly by the study being described as single-center.", "followUp": "", "plainFinding": "No difference in bleeding between techniques.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35961908/", "sourceText": "OBJECTIVE: This study aimed to compare the efficiency of these two combined surgeries [prolapse and hemorrhoids (PPH) combined with the external hemorrhoidectomy and inferior internal hemorrhoid ligation; tissue selecting technique with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation]. METHODS: This is a single-center, evaluator-blinded randomized controlled trial (RCT). A total of 204 participants were randomly divided into the two groups. The anal function, reoccurrence, intraoperative variables, and operative complications were assessed. The measurement data were compared by paired t test and rank sum test. Chi-squared or Fisher's exact test was used for count data and rank sum test for ranked data. To assess differences within each group in different time points, the repeated-measures analysis of variance was conducted. RESULTS: TST-MS combined with anal canal epithelial preservation operation had lower Wexner score of anal incontinence (Z = 3.062, P = 0.002), higher patients' satisfaction degree (t = 7.32, P < 0.001), less residual skin tags (χ2 = 18.141, P < 0.001), longer operative time (Z = -2.281, P = 0.023), and bigger volume of excised rectal mucosa (t = 2.35, P = 0.020). There was no significant difference between the two groups in the anal canal circumference, recurrence, intraoperative blood loss, weight of excised rectal mucosa, anal pain, bleeding, urinary retention, anal edge edema, and anatomical anal stenosis (all P > 0.05). CONCLUSIONS: TST-MS combined with anal canal epithelial preservation operation showed better clinical efficiency in the treatment of prolapsed hemorrhoids. TRIAL REGISTRATION: This study has been registered in Chinese Clinical Trial Registry (ChiCTR2000038533).", "provenance": [ { "field": "n", "quote": "A total of 204 participants were randomly divided into the two groups." }, { "field": "population", "quote": "treatment of prolapsed hemorrhoids" }, { "field": "intervention", "quote": "tissue selecting technique with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation" }, { "field": "comparator", "quote": "prolapse and hemorrhoids (PPH) combined with the external hemorrhoidectomy and inferior internal hemorrhoid ligation" }, { "field": "primaryOutcome", "quote": "The anal function, reoccurrence, intraoperative variables, and operative complications were assessed." }, { "field": "result", "quote": "There was no significant difference between the two groups in the anal canal circumference, recurrence, intraoperative blood loss, weight of excised rectal mucosa, anal pain, bleeding, urinary retention, anal edge edema, and anatomical anal stenosis (all P > 0.05)." } ] }, { "id": "pmid:35944106", "pmid": "35944106", "doi": "10.24875/CIRU.21000703", "nctId": null, "pmcid": null, "title": "Emergency surgical treatment for active bleeding and anemia in patients with hemorrhoidal disease", "firstAuthor": "Güemes-Quinto", "multipleAuthors": true, "journal": "Cir Cir", "year": 2022, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients with hemorrhoid disease who had active bleeding and anemia needing emergency surgery", "intervention": "emergency hemorrhoid surgery (mainly the Ferguson hemorrhoidectomy technique)", "comparator": "no comparison group reported; different surgical techniques were compared only in frequency of use", "primaryOutcome": "description of which surgical technique was used to treat active bleeding and anemia from hemorrhoids", "result": "most patients (92.5%) were treated with Ferguson hemorrhoidectomy, fewer with an advanced energy device or Milligan-Morgan technique, and the authors conclude emergency hemorrhoidectomy is the treatment of choice for severe active bleeding", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a retrospective, descriptive case series with no comparison group, so it cannot show whether surgery actually stopped bleeding better than any alternative.", "directness": "direct", "limitations": "retrospective design, no control group, no reported outcomes after surgery such as rebleeding or healing rates", "followUp": "", "plainFinding": "Emergency surgery used for severe bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35944106/", "sourceText": "INTRODUCTION: The purpose of the study is to describe the clinical and surgical characteristics of patients with hemorrhoidal disease (HD), anemia, and active bleeding in need of urgent surgery. METHODS: It is a descriptive, retrospective study of 510 patients between 2015 and 2019. Male and female patients diagnosed with HD. The records of these patients were reviewed, and we identified those who underwent emergency surgery due to active bleeding, anemia, shock, and other clinical problems. Statistical analysis was carried out with the SPSS version 24 software. RESULTS: Fifty-three (10.3%) patients met the criteria for presenting active hemorrhoidal bleeding at the time of review and clinical and biochemical data of anemia. Patients presented a mean hemoglobin of 7.5 g/dl. The most frequent degree of HD was Grade II. The treatment received in 92.5% of the cases was hemorrhoidectomy with the Ferguson technique; in 5.7% (3), a hemorrhoidectomy was performed with an advanced energy device, and 1.9% (1) underwent the Milligan-Morgan technique. CONCLUSIONS: Emergency hemorrhoidectomy is the treatment of choice for patients with severe active bleeding from HD.", "provenance": [ { "field": "n", "quote": "Fifty-three (10.3%) patients met the criteria for presenting active hemorrhoidal bleeding at the time of review and clinical and biochemical data of anemia." }, { "field": "population", "quote": "patients with hemorrhoidal disease (HD), anemia, and active bleeding in need of urgent surgery" }, { "field": "intervention", "quote": "The treatment received in 92.5% of the cases was hemorrhoidectomy with the Ferguson technique" }, { "field": "comparator", "quote": "in 5.7% (3), a hemorrhoidectomy was performed with an advanced energy device, and 1.9% (1) underwent the Milligan-Morgan technique" }, { "field": "primaryOutcome", "quote": "The purpose of the study is to describe the clinical and surgical characteristics of patients with hemorrhoidal disease (HD), anemia, and active bleeding in need of urgent surgery." }, { "field": "result", "quote": "Emergency hemorrhoidectomy is the treatment of choice for patients with severe active bleeding from HD." } ] }, { "id": "pmid:35752073", "pmid": "35752073", "doi": "10.1016/j.phymed.2022.154244", "nctId": null, "pmcid": null, "title": "Efficacy and safety of micronized purified flavonoid fractions for the treatment of postoperative hemorrhoid complications: A systematic review and meta-analysis", "firstAuthor": "Fu", "multipleAuthors": true, "journal": "Phytomedicine", "year": 2022, "design": "meta-analysis", "n": 2335, "nField": "reported", "population": "patients recovering from hemorrhoid surgery", "intervention": "micronized purified flavonoid fractions (MPFF)", "comparator": "", "primaryOutcome": "post-surgery bleeding, pain, swelling and overall clinical improvement", "result": "MPFF reduced bleeding rate, pain score and edema score and improved clinical efficacy, without clear effect on adverse reactions", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It pools 22 randomized trials with over 2000 patients, but the abstract notes small sample sizes limited the ability to define a standard dose, so confidence is only moderate.", "directness": "indirect", "limitations": "Small sample size prevented establishing a standardized treatment regimen; heterogeneity addressed only via subgroup and sensitivity analysis.", "followUp": "", "plainFinding": "Less post-surgery bleeding and pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35752073/", "sourceText": "BACKGROUND: Hemorrhoids, a common anorectal disease, seriously affects patients' quality of life. Micronized purified flavonoid fractions (MPFF) have been shown to improve hemorrhoid symptoms. PURPOSE: To evaluate the efficacy and safety of MPFF in treating postoperative hemorrhoid complications. STUDY DESIGN: A systematic review and meta-analysis of existing literature on natural compounds for treating postoperative complications of hemorrhoids. METHODS: A literature search was conducted using five databases, namely PubMed, WanFang, CNKI, Embase, and the Cochrane Library, to identify randomized controlled trials (RCTs) on the effects of MPFF treatment on hemorrhoids. Stata 15.1 and Revman 15.4 were used to assess the data, while subgroup and sensitivity analyses were performed to evaluate potential heterogeneity, and trial sequential analysis (TSA) and Egger test were used to evaluate the reliability of each trial. RESULTS: A total of 22 RCTs, including 2,335 participants were included in the analysis. 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. Subgroup analyses showed a significant reduction in pain score and bleeding rate in trials with duration of 4-10 days and an improvement in clinical efficacy. Treatment for ≥ 10 days significantly improved the edema score; a dosage range of 1,800-2,700 mg/day of MPFF significantly reduced edema and pain scores, whereas < 1,800 mg/day significantly improved clinical efficacy. CONCLUSIONS: Based on searching the relevant literatures, this is the first meta-analysis on MPFF treatment of postoperative hemorrhoid complications. Our findings, validated by TSA, suggest that MPFF is safe and effective in reducing postoperative hemorrhoid complications, and that dose and duration are key factors in its efficacy, as illustrated by subgroup analysis. However, due to the small sample size, the standardized treatment regimen of MPFF could not be obtained; therefore, further research is warranted.", "provenance": [ { "field": "n", "quote": "A total of 22 RCTs, including 2,335 participants were included in the analysis." }, { "field": "population", "quote": "treating postoperative hemorrhoid complications" }, { "field": "intervention", "quote": "Micronized purified flavonoid fractions (MPFF) have been shown to improve hemorrhoid symptoms." }, { "field": "primaryOutcome", "quote": "MPFF improved the clinical efficacy of post-hemorrhoidectomy and reduced the bleeding rate, pain score, and edema score" }, { "field": "result", "quote": "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." }, { "field": "limitations", "quote": "due to the small sample size, the standardized treatment regimen of MPFF could not be obtained; therefore, further research is warranted." } ] }, { "id": "pmid:35725452", "pmid": "35725452", "doi": "10.1186/s12893-022-01688-8", "nctId": null, "pmcid": "PMC9210638", "title": "Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation-a retrospective study", "firstAuthor": "Yu", "multipleAuthors": true, "journal": "BMC Surg", "year": 2022, "design": "retrospective", "n": 274, "nField": "reported", "population": "patients with grade II or III internal hemorrhoids", "intervention": "modified rubber band ligation", "comparator": "conventional rubber band ligation", "primaryOutcome": "delayed bleeding and recurrence after treatment", "result": "modified technique had no delayed bleeding cases and lower recurrence rate than conventional banding", "resultDirection": "benefit", "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, not randomized, single center, authors call for larger studies with different design to confirm results", "followUp": "3 months", "plainFinding": "Fewer bleeding and recurrence cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35725452/", "sourceText": "BACKGROUND: Massive, delayed bleeding (DB) is the most common major complication of Rubber Band Ligation (RBL) for internal hemorrhoids caused by premature band slippage. In this study we modified conventional RBL to prevent early rubber band slippage and evaluated its clinical efficacy and safety. METHODS: Study participants were consecutive patients with grade II or III internal hemorrhoids treated with RBL at Ningbo Medical Center of Lihuili Hospital from January 2019 to December 2020. Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed. RESULTS: A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL. There was no statistically significant difference between the two groups at baseline. 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). Within three months after surgery, 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). The VAS score, edema, and incidence of sensation of prolapse between the two groups were not significantly different at 3 and 7 days after surgery (P < 0.05). There were also no significant differences in HDSS and SHS scores between the two groups after surgery (P > 0.05). CONCLUSION: Modified RBL may be associated with a lower rate of complications, especially with lower DB rate in comparison with standard RBL. Further studies in larger samples and different design are necessary to confirm these results.", "provenance": [ { "field": "n", "quote": "A total of 274 patients were enrolled, including 149 patients treated with modified RBL and 125 treated with conventional RBL." }, { "field": "population", "quote": "consecutive patients with grade II or III internal hemorrhoids treated with RBL" }, { "field": "intervention", "quote": "modified RBL" }, { "field": "comparator", "quote": "conventional RBL" }, { "field": "primaryOutcome", "quote": "Postoperative minor complications such as pain, swelling, anal edema, prolapse recurrence and major complications like DB were retrospectively reviewed." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:35638762", "pmid": "35638762", "doi": "10.17235/reed.2022.8568/2022", "nctId": null, "pmcid": null, "title": "3% polidocanol foam sclerotherapy versus hemorrhoidal artery ligation with recto anal repair in hemorrhoidal disease grades II-III: a randomized, pilot trial", "firstAuthor": "Neves", "multipleAuthors": true, "journal": "Rev Esp Enferm Dig", "year": 2023, "design": "rct", "n": 46, "nField": "reported", "population": "patients with grade II-III hemorrhoids", "intervention": "polidocanol foam sclerotherapy (injection treatment)", "comparator": "doppler-guided hemorrhoidal artery ligation with recto-anal repair (surgical procedure)", "primaryOutcome": "treatment success based on symptom and bleeding scores", "result": "complete success was higher with sclerotherapy (91.7% vs 68.2%) and fewer complications (25% vs 68.2%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small pilot trial with only 46 patients, which limits confidence in the results.", "directness": "direct", "limitations": "small pilot trial size", "followUp": "8 weeks", "plainFinding": "Foam injection worked better, fewer complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35638762/", "sourceText": "PURPOSE: Polidocanol foam sclerotherapy (SP) versus doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR) in the treatment of hemorrhoidal disease (HD) was analyzed. METHODS: A prospective, randomized study including patients with HD grades II and III was performed. Participants were randomly assigned (1:1) into SP or HAL-RAR, during a recruitment period between September 2019 and February 2020. Therapeutic success (Sodergren's and bleeding scores) was the primary outcome. Other outcomes evaluated included complications and implication in the professional life. Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session. RESULTS: Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24). Most patients achieved therapeutic success (SP 100% vs. HAL-RAR 90.9%, p=0.131). 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). HAL-RAR had a greater negative impact on work activity of the patient. CONCLUSION: SP was more effective and safer than HAL-RAR. SP patients had less impact on their work activity. Clinical trials identifier NCT04675177.", "provenance": [ { "field": "n", "quote": "Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24)." }, { "field": "population", "quote": "patients with HD grades II and III" }, { "field": "intervention", "quote": "Polidocanol foam sclerotherapy (SP)" }, { "field": "comparator", "quote": "doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR)" }, { "field": "primaryOutcome", "quote": "Therapeutic success (Sodergren's and bleeding scores) was the primary outcome." }, { "field": "result", "quote": "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)." }, { "field": "followUp", "quote": "Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session." } ] }, { "id": "pmid:35551442", "pmid": "35551442", "doi": "10.1007/s00270-022-03154-7", "nctId": null, "pmcid": null, "title": "Clinical Outcomes Following Rectal Artery Embolisation for the Treatment of Internal Haemorrhoids: A Systematic Review and Meta-Analysis", "firstAuthor": "Nguyenhuy", "multipleAuthors": true, "journal": "Cardiovasc Intervent Radiol", "year": 2022, "design": "meta-analysis", "n": 381, "nField": "reported", "population": "adults with internal hemorrhoids causing bleeding and other symptoms", "intervention": "rectal artery embolisation (blocking the blood supply to hemorrhoids)", "comparator": "", "primaryOutcome": "bleeding score, pain score, quality of life score, and prolapse grade", "result": "bleeding scores, pain scores, and quality of life all improved after embolisation, though hemorrhoid grade slightly worsened and clinical success was only 82%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it pools small, mostly uncontrolled studies without a comparison group, so improvement could be due to other factors rather than the procedure itself.", "directness": "direct", "limitations": "studies lacked control groups, procedural details varied widely, and clinical efficacy was lower than technical success", "followUp": "", "plainFinding": "Less bleeding and pain after embolisation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35551442/", "sourceText": "OBJECTIVES: Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life. Rectal artery embolisation (RAE) is a recently described technique for the management of HD, however, its clinical efficacy and safety are unclear at present. The objective of this systematic review and meta-analysis is to evaluate the clinical outcomes following RAE. METHODS: The PubMed, MEDLINE and EMBASE databases were searched for studies specifying the management of haemorrhoids with RAE from January 2000 to October 2021. 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). Secondary outcomes were technical success, clinical success, postoperative complications, and technical outcomes. A random-effects meta-analysis was conducted. Study heterogeneity was evaluated, and sensitivity analysis was performed. RESULTS: Thirteen eligible studies were identified including 381 patients. 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). Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%). Procedural duration and radiation exposure were heterogeneous. No major complications occurred. CONCLUSION: RAE demonstrates early clinical efficacy with low rates of peri-procedural complications or morbidity. RAE is a promising addition to the treatment options available for HD and warrants ongoing research.", "provenance": [ { "field": "n", "quote": "Thirteen eligible studies were identified including 381 patients." }, { "field": "population", "quote": "Haemorrhoidal disease (HD) is a common anorectal disorder which can substantially impair quality of life." }, { "field": "intervention", "quote": "Rectal artery embolisation (RAE) is a recently described technique for the management of HD" }, { "field": "primaryOutcome", "quote": "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)." }, { "field": "result", "quote": "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)." }, { "field": "result", "quote": "Technical success was achieved in almost all procedures (99%; 95% CI 94-100%) however clinical efficacy was lower (82%; 95% CI 73-89%)." } ] }, { "id": "pmid:35334004", "pmid": "35334004", "doi": "10.1007/s10151-022-02609-w", "nctId": null, "pmcid": "PMC8949823", "title": "A multicentre, open-label, single-arm phase II trial of the efficacy and safety of sclerotherapy using 3% polidocanol foam to treat second-degree haemorrhoids (SCLEROFOAM)", "firstAuthor": "Gallo", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "case-series", "n": 183, "nField": "reported", "population": "patients with second-degree bleeding hemorrhoids", "intervention": "sclerotherapy injection with 3% polidocanol foam", "comparator": "none (single-arm, before-after comparison)", "primaryOutcome": "complete stopping of hemorrhoid bleeding one week after treatment", "result": "68.3% had bleeding completely stop at one week, rising to 95.6% success at one year after repeat sessions", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study with no comparison group, so it can't rule out that patients would have improved anyway.", "directness": "direct", "limitations": "Open-label, single-arm design with no control group; some patients needed repeat sessions.", "followUp": "1 year", "plainFinding": "Stopped bleeding in most patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35334004/", "sourceText": "BACKGROUND: The aim of the present study was to evaluate the efficacy and safety of 3% polidocanol foam for treating 2nd-degree haemorrhoids. METHODS: A multicentre, open-label, single-arm, phase 2 trial involving 10 tertiary referral centres for haemorrhodal disease (HD) was performed. Between January and June 2019, patients with 2nd-degree haemorrhoids were prospectively included in this study. 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. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey incontinence score were used to assess symptoms and their impact on quality of life and continence. Pain after the procedure, subjective symptoms and the amount and type of painkillers used were recorded. Patients were followed up for 1 year. RESULTS: There were 183 patients [111 males; 60.7%, mean age 51.3 ± 13.5 (18-75) years]. Complete resolution of bleeding was reached in 125/183 patients (68.3%) at 1 week and the recurrence rate was 12% (15/125). Thirteen patients (7.4%) underwent a second sclerotherapy session, while only 1 patient (1.8%) had to undergo a third session. The overall 1-year success rate was 95.6% (175/183). The HDSS and the SHS score significantly improved from a median preoperative value of 11 and 18 to 0 and 0, respectively (p < 0.001). There were 3 episodes of external thrombosis. No serious adverse events occurred. CONCLUSIONS: Sclerotherapy with 3% polidocanol foam is a safe, effective, painless, repeatable and low-cost procedure in patients with bleeding haemorrhoids.", "provenance": [ { "field": "n", "quote": "There were 183 patients" }, { "field": "population", "quote": "patients with 2nd-degree haemorrhoids" }, { "field": "intervention", "quote": "The aim of the present study was to evaluate the efficacy and safety of 3% polidocanol foam for treating 2nd-degree haemorrhoids." }, { "field": "comparator", "quote": "A multicentre, open-label, single-arm, phase 2 trial" }, { "field": "primaryOutcome", "quote": "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." }, { "field": "result", "quote": "Complete resolution of bleeding was reached in 125/183 patients (68.3%) at 1 week and the recurrence rate was 12% (15/125)." }, { "field": "result", "quote": "The overall 1-year success rate was 95.6% (175/183)." } ] }, { "id": "pmid:35217937", "pmid": "35217937", "doi": "10.1007/s10151-022-02600-5", "nctId": null, "pmcid": "PMC8879173", "title": "Polidocanol foam sclerotherapy in the treatment of hemorrhoidal disease in patients with bleeding disorders: a multicenter, prospective, cohort study", "firstAuthor": "Salgueiro", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2022, "design": "prospective-cohort", "n": 228, "nField": "reported", "population": "Adults with symptomatic internal hemorrhoids (grades I-III), some with bleeding disorders and some without", "intervention": "Polidocanol foam sclerotherapy (PFS)", "comparator": "Patients without bleeding disorders receiving the same sclerotherapy treatment", "primaryOutcome": "Treatment success and hemorrhoid recurrence over 1 year, plus safety complications", "result": "No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate.", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a non-randomized, uncontrolled cohort study comparing two patient subgroups rather than testing the treatment against a placebo or alternative, so it cannot prove the treatment itself works, only that it performs similarly in both groups.", "directness": "direct", "limitations": "No control group without treatment; not randomized; subgroup comparison only", "followUp": "1-year follow-up period", "plainFinding": "Sclerotherapy worked equally well despite bleeding disorders.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35217937/", "sourceText": "BACKGROUND: The management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD. METHODS: This prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I-III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded. RESULTS: We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate. CONCLUSIONS: Patients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD.", "provenance": [ { "field": "n", "quote": "We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years)." }, { "field": "population", "quote": "patients with (group B) and without (group A) BD, with symptomatic internal HD grades I-III over an 18-month period" }, { "field": "intervention", "quote": "All patients were treated with PFS." }, { "field": "comparator", "quote": "compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD" }, { "field": "primaryOutcome", "quote": "Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period." }, { "field": "result", "quote": "No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate." }, { "field": "followUp", "quote": "during a 1-year follow-up period" } ] }, { "id": "pmid:34941209", "pmid": "34941209", "doi": "10.17116/hirurgia202112149", "nctId": null, "pmcid": null, "title": "[Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease]", "firstAuthor": "Popovtsev", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2021, "design": "rct", "n": 120, "nField": "reported", "population": "patients with stage II-III hemorrhoids", "intervention": "hemorrhoidal artery ligation without Doppler ultrasound guidance (using palpation)", "comparator": "hemorrhoidal artery ligation with Doppler ultrasound guidance", "primaryOutcome": "recurrence of bleeding, prolapse, and pain after surgery", "result": "no significant difference between Doppler-guided and non-Doppler ligation in bleeding recurrence, prolapse, pain, or complications", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but single-center with modest size and short follow-up of under a year.", "directness": "indirect", "limitations": "short follow-up period (about 8 months) and single-center design", "followUp": "8.3±2.1 and 8.1±1.9 months", "plainFinding": "No benefit of Doppler guidance over palpation.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34941209/", "sourceText": "OBJECTIVE: To compare the immediate and long-term results of surgical treatment of hemorrhoidal disease (GD) stage II-III using two methods of identification of hemorrhoidal arteries (HA) with their subsequent ligation and mucopexy. MATERIAL AND METHODS: A prospective, randomized, controlled, single-center study was conducted to evaluate the effectiveness of HA ligation with and without Doppler navigation. The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60). RESULTS: GD stage II was found in 27 patients of the group A and 30 patients of the group B (p=0.4). Mean number of ligated HA in the group A was 3.36, in the group B - 2.83 (p=0.062). Mean number of mucopexy was 3.2 and 3.5, respectively (p=0.8). Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96). Relapse of all preoperative symptoms was registered in 1 patient (1.6%) in the group A. Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74). VAS score of pain syndrome after 2 months and later was 0 - 1 points (p=1.0). Most of patients in both groups (group A - 89%, group B - 94%; p=0.7) noted that surgery did not disrupt their usual lifestyle and relieved from symptoms of GD. CONCLUSION: There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71). Pain syndrome (p=0.24), incidence of postoperative complications (p=0.51) and relapses (p=0.31) showed comparable safety of both techniques.", "provenance": [ { "field": "n", "quote": "The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60)." }, { "field": "population", "quote": "surgical treatment of hemorrhoidal disease (GD) stage II-III" }, { "field": "intervention", "quote": "group B - ligation without ultrasound (n=60)" }, { "field": "comparator", "quote": "group A - Doppler-guided ligation (n=60)" }, { "field": "primaryOutcome", "quote": "Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74)." }, { "field": "result", "quote": "There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71)." }, { "field": "followUp", "quote": "Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96)." } ] }, { "id": "pmid:34906095", "pmid": "34906095", "doi": "10.1186/s12876-021-02046-3", "nctId": null, "pmcid": "PMC8670118", "title": "Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "BMC Gastroenterol", "year": 2021, "design": "retrospective", "n": 41, "nField": "reported", "population": "patients with recurring internal hemorrhoid bleeding and chronic anemia", "intervention": "artery-blocking procedure (embolization) using coils plus gelfoam particles", "comparator": "artery-blocking procedure (embolization) using coils plus microparticles", "primaryOutcome": "percentage of patients without further rectal bleeding", "result": "no significant difference in bleeding-free rate between gelfoam (87.0%) and microparticle (88.9%) groups", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small retrospective study comparing two similar treatments without a no-treatment comparison, so it can't show whether embolization itself works, only that two particle types work similarly.", "directness": "indirect", "limitations": "retrospective design, small sample size, short follow-up", "followUp": "range 6-15 months", "plainFinding": "Both particle types worked equally well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34906095/", "sourceText": "BACKGROUND: Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids. METHODS: Patients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2-3 mm) + gelfoam particles at 350-560 μm (Group A, n = 23), embolization with coils (2-3 mm) + microparticles at 300-500 μm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed. RESULTS: A total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25-72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6-15 months). CONCLUSIONS: Both gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.", "provenance": [ { "field": "n", "quote": "A total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study" }, { "field": "population", "quote": "Patients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE" }, { "field": "intervention", "quote": "embolization with coils (2-3 mm) + gelfoam particles at 350-560 μm (Group A, n = 23)" }, { "field": "comparator", "quote": "embolization with coils (2-3 mm) + microparticles at 300-500 μm (Group B, n = 18)" }, { "field": "primaryOutcome", "quote": "preliminary clinical efficacy (percentage of patients without hematochezia)" }, { "field": "result", "quote": "the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098)" }, { "field": "followUp", "quote": "follow-up period (range 6-15 months)" } ] }, { "id": "pmid:34840045", "pmid": "34840045", "doi": "10.1016/j.asjsur.2021.11.032", "nctId": null, "pmcid": null, "title": "Outcome of a modified Park's submucosal hemorrhoidectomy versus Milligan-Morgan for grade III-IV circumferential prolapsed hemorrhoids", "firstAuthor": "Song", "multipleAuthors": true, "journal": "Asian J Surg", "year": 2022, "design": "rct", "n": 186, "nField": "reported", "population": "patients with grade III or IV circumferential prolapsed hemorrhoids", "intervention": "modified Park's submucosal hemorrhoidectomy (MPSH)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH)", "primaryOutcome": "postoperative pain, bleeding, and recurrence of hemorrhoids after surgery", "result": "no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis, but the cumulative relapse-free rate was substantially higher in the MPSH group", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized trial with a reasonable sample size and long follow-up, but details on blinding and generalizability are limited.", "directness": "indirect", "limitations": "Additional clinical studies are needed to validate these conclusions.", "followUp": "24 months", "plainFinding": "No difference in bleeding, fewer recurrences", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34840045/", "sourceText": "BACKGROUND: This prospective randomized controlled study compared the short- and long-term efficacy and advantages of modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of grade III and IV circumferential prolapsed hemorrhoids (CPH). METHODS: A total of 186 consecutive patients with grade III or IV CPH were enrolled. The patients were randomized to MPSH (n = 93) or MMH (n = 93) treatment groups. Patient data included demographics, clinical characteristics, surgical parameters, underlying or arising complications, and CPH recurrence. The patients were closely followed up for at least 24 months. RESULTS: The patient demographic data and clinical parameters were comparable in the two groups (P > 0.05). MPSH took significantly longer operative time (P < 0.05). Although there was no significant difference in mean postoperative pain between the two groups at days 3 and 14, pain at day 7 was significantly more frequent and severe in the MMH group (P < 0.05). There were no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis (P > 0.05). However, the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05). CONCLUSION: MPSH and MMH are both practical and safe techniques for treating grade III and IV CPH disease. However, MPSH is safer, easier, and faster to perform and is associated with fewer recurrences within 24 months of surgery. Additional clinical studies are needed to validate these conclusions.", "provenance": [ { "field": "n", "quote": "A total of 186 consecutive patients with grade III or IV CPH were enrolled." }, { "field": "population", "quote": "patients with grade III or IV CPH" }, { "field": "intervention", "quote": "modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH)" }, { "field": "comparator", "quote": "Milligan-Morgan hemorrhoidectomy (MMH)" }, { "field": "primaryOutcome", "quote": "postoperative bleeding, intraoperative blood loss, or development of anal stenosis" }, { "field": "result", "quote": "There were no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis (P > 0.05). However, the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05)." } ] }, { "id": "pmid:34794188", "pmid": "34794188", "doi": "10.1055/a-1662-5487", "nctId": null, "pmcid": null, "title": "Embolization of Hemorrhoidal Arteries: A Novel Endovascular Therapy Option for the Treatment of Hemorrhoidal Disease", "firstAuthor": "Feyen", "multipleAuthors": true, "journal": "Rofo", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids, including some who cannot have surgery", "intervention": "blocking the hemorrhoidal arteries (embolization)", "comparator": "open surgery or no mention of a direct comparator", "primaryOutcome": "symptom control and safety, especially for bleeding", "result": "embolization was described as safe and effective at controlling symptoms, particularly bleeding", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a narrative literature review without original patient data or a controlled comparison, so it can't reliably show the treatment works.", "directness": "indirect", "limitations": "not a systematic or statistical review; based on a selective PubMed search; no patient numbers or study details given", "followUp": "", "plainFinding": "Artery-blocking may reduce bleeding, unproven.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34794188/", "sourceText": "BACKGROUND: Hemorrhoids are a widespread disease. Treatment options range from dietary measures to open surgery. A novel treatment approach is the embolization of the hemorrhoidal arteries. METHOD: A review was performed based on a selective literature search in PubMed representing the current state of research. The keywords \"hemorrhoid\" and \"embolization\" and \"emborrhoid\" were used. In addition, technical details of the hemorrhoidal embolization procedure are explained. RESULTS AND CONCLUSION: Embolization of hemorrhoidal arteries is a safe treatment, which allows efficient symptom control even in patients with contraindications for open surgery. KEY POINTS: · Embolization of hemorrhoidal arteries is a new approach to the treatment of hemorrhoids.. · Embolization of hemorrhoidal arteries is feasible in patients with contraindications for open surgery such as hypercoaguable states and contraindications for general anesthesia.. · The endovascular approach causes no rectal and anal trauma and associated complications can be avoided.. · The treatment of bleeding hemorrhoids seems to be particularly effective.. · No ischemic complications have been reported so far when coils as well as particles were used.. CITATION FORMAT: · Feyen L, Freyhardt P, Schott P et al. Hämorrhoidenembolisation: Eine neue minimalinvasive endovaskuläre Therapieoption bei Hämorrhoidalleiden. Fortschr Röntgenstr 2022; 194: 266 - 271.", "provenance": [ { "field": "population", "quote": "patients with contraindications for open surgery" }, { "field": "intervention", "quote": "embolization of the hemorrhoidal arteries" }, { "field": "comparator", "quote": "Treatment options range from dietary measures to open surgery." }, { "field": "primaryOutcome", "quote": "allows efficient symptom control even in patients with contraindications for open surgery" }, { "field": "result", "quote": "The treatment of bleeding hemorrhoids seems to be particularly effective." }, { "field": "result", "quote": "Embolization of hemorrhoidal arteries is a safe treatment" } ] }, { "id": "pmid:34669884", "pmid": "34669884", "doi": "10.1590/0102-672020210002e1594", "nctId": null, "pmcid": "PMC8521818", "title": "A NEW MIXED SURGICAL TREATMENT FOR GRADES III AND IV HEMORRHOIDS: MODIFIED SELECTIVE HEMORRHOIDECTOMY COMBINED WITH COMPLETE ANAL EPITHELIAL RETENTION", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2021, "design": "rct", "n": 200, "nField": "reported", "population": "adults with grade III and IV hemorrhoids", "intervention": "modified tissue-selecting stapler surgery with complete anal canal epithelium preservation", "comparator": "Milligan-Morgan hemorrhoidectomy", "primaryOutcome": "differences in surgical outcomes between the two techniques, including bleeding, pain, anal stenosis, incontinence and recurrence", "result": "The new technique caused more bleeding and pain during surgery, but led to less anal stenosis, a larger anal canal diameter, better continence scores, no relapses at 6 months (vs 4 in the other group), and higher patient satisfaction, while operation time was longer than the standard surgery.", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It was a randomized trial, but nearly a third of enrolled patients were missing from the final analysis and follow-up was only six months, which weakens confidence in the findings.", "directness": "indirect", "limitations": "31 of 200 enrolled patients were not included in the final analysis (loss unexplained), follow-up was limited to six months, and the abstract does not mention blinding of outcome assessors.", "followUp": "six months", "plainFinding": "Mixed surgical results, no clear winner.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34669884/", "sourceText": "BACKGROUND: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. AIM: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. METHODS: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. RESULTS: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. CONCLUSIONS: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.", "provenance": [ { "field": "population", "quote": "enrolling 200 patients with grade III and IV hemorrhoids" }, { "field": "intervention", "quote": "the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery" }, { "field": "comparator", "quote": "The control received Milligan-Morgan surgery" }, { "field": "n", "quote": "enrolling 200 patients with grade III and IV hemorrhoids" }, { "field": "primaryOutcome", "quote": "All patients were followed for six months to evaluate the treatment differences." }, { "field": "result", "quote": "The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group." }, { "field": "result", "quote": "Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins." }, { "field": "result", "quote": "In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls." }, { "field": "followUp", "quote": "All patients were followed for six months to evaluate the treatment differences." } ] }, { "id": "pmid:34633439", "pmid": "34633439", "doi": "10.1093/bjsopen/zrab091", "nctId": null, "pmcid": "PMC8504447", "title": "Interventional treatments for prolapsing haemorrhoids: network meta-analysis", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "BJS Open", "year": 2021, "design": "meta-analysis", "n": 9232, "nField": "reported", "population": "patients with grade II-III (prolapsing) hemorrhoids", "intervention": "various procedural treatments for hemorrhoids (e.g., hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation, Doppler-guided artery ligation)", "comparator": "other procedural treatments compared head-to-head across studies", "primaryOutcome": "symptom recurrence, post-procedure pain, and complications (bleeding, urinary retention, bowel incontinence)", "result": "Surgical removal methods (open/closed hemorrhoidectomy, stapled hemorrhoidopexy) had the lowest recurrence but caused more pain, bleeding, urinary retention, and bowel incontinence than less invasive options.", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Most of the included trials (73%) were judged high risk of bias, and there was notable inconsistency between studies.", "directness": "direct", "limitations": "59 of 79 RCTs (73%) were at high risk of bias, with variable heterogeneity in direct comparisons, especially for recurrence and pain outcomes.", "followUp": "minimum follow-up of 6 weeks", "plainFinding": "Surgery cuts recurrence but causes more bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34633439/", "sourceText": "BACKGROUND: Multiple treatments for early-moderate grade symptomatic haemorrhoids currently exist, each associated with their respective efficacy, complications, and risks. The aim of this study was to compare the relative clinical outcomes and effectiveness of interventional treatments for grade II-III haemorrhoids. METHODS: A systematic review was conducted according to PRISMA criteria for all the RCTs published between 1980 and 2020; manuscripts were identified using the MEDLINE, Embase, and CENTRAL databases. Inclusion criteria were RCTs comparing procedural interventions for grade II-III haemorrhoids. Primary outcomes of interest were: symptom recurrence at a minimum follow-up of 6 weeks, postprocedural pain measured on a visual analogue scale (VAS) on day 1, and postprocedural complications (bleeding, urinary retention, and bowel incontinence). After bias assessment and heterogeneity analysis, a Bayesian network meta-analysis was performed. RESULTS: Seventy-nine RCTs were identified, including 9232 patients. Fourteen different treatments were analysed in the network meta-analysis. Overall, there were 59 RCTs (73 per cent) judged as being at high risk of bias, and the greatest risk was in the domain measurement of outcome. Variable amounts of heterogeneity were detected in direct treatment comparisons, in particular for symptom recurrence and postprocedural pain. Recurrence of haemorrhoidal symptoms was reported by 54 studies, involving 7026 patients and 14 treatments. Closed haemorrhoidectomy had the lowest recurrence risk, followed by open haemorrhoidectomy, suture ligation with mucopexy, stapled haemorrhoidopexy, and Doppler-guided haemorrhoid artery ligation (DG-HAL) with mucopexy. Pain was reported in 34 studies involving 3812 patients and 11 treatments. Direct current electrotherapy, DG-HAL with mucopexy, and infrared coagulation yielded the lowest pain scores. Postprocedural bleeding was recorded in 46 studies involving 5696 patients and 14 treatments. Open haemorrhoidectomy had the greatest risk of postprocedural bleeding, followed by stapled haemorrhoidopexy and closed haemorrhoidectomy. Urinary retention was reported in 30 studies comparing 10 treatments involving 3116 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had significantly higher odds of urinary retention than rubber band ligation and DG-HAL with mucopexy. Nine studies reported bowel incontinence comparing five treatments involving 1269 participants. Open haemorrhoidectomy and stapled haemorrhoidopexy had the highest probability of bowel incontinence. CONCLUSION: Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence. The risks and benefits of each treatment should be discussed with patients before a decision is made.", "provenance": [ { "field": "population", "quote": "grade II-III haemorrhoids" }, { "field": "intervention", "quote": "Fourteen different treatments were analysed in the network meta-analysis" }, { "field": "comparator", "quote": "RCTs comparing procedural interventions for grade II-III haemorrhoids" }, { "field": "primaryOutcome", "quote": "Primary outcomes of interest were: symptom recurrence at a minimum follow-up of 6 weeks, postprocedural pain measured on a visual analogue scale (VAS) on day 1, and postprocedural complications (bleeding, urinary retention, and bowel incontinence)." }, { "field": "result", "quote": "Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence." }, { "field": "n", "quote": "Seventy-nine RCTs were identified, including 9232 patients." }, { "field": "followUp", "quote": "symptom recurrence at a minimum follow-up of 6 weeks" } ] }, { "id": "pmid:34414451", "pmid": "34414451", "doi": "10.3892/mmr.2021.12376", "nctId": null, "pmcid": "PMC8404094", "title": "Polyherbal formulation Anoac‑H suppresses the expression of RANTES and VEGF for the management of bleeding hemorrhoids and fistula", "firstAuthor": "Porwal", "multipleAuthors": true, "journal": "Mol Med Rep", "year": 2021, "design": "lab", "n": null, "nField": "not-reported", "population": "fibroblast and immune cells (RAW 264.7), and human hemorrhoid and fistula tissue samples", "intervention": "Anoac-H polyherbal formulation", "comparator": "untreated cells and tissues", "primaryOutcome": "expression of RANTES and VEGF proteins linked to inflammation and blood vessel growth", "result": "Anoac-H reduced cell migration and lowered RANTES and VEGF expression and inflammation in treated tissues compared to untreated ones", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a laboratory study on cells and tissue samples, not a clinical trial measuring bleeding or patient outcomes.", "directness": "indirect", "limitations": "Abstract does not report number of patients or tissue samples, no clinical bleeding outcome measured, findings based on in vitro and ex vivo tissue analysis only.", "followUp": "", "plainFinding": "Reduced inflammation markers in tissue samples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34414451/", "sourceText": "Hemorrhoids and fistula are considered the most common anorectal conditions in the general population. These conditions affect the quality of a patient's life by causing pain and bleeding during defecation or even in the resting state. Lower grades of hemorrhoids may be controlled by traditional measures. However, surgery is an effective treatment option in recurrent‑lower and higher‑grade hemorrhoids. Surgical procedures are associated with various complications, including pain and delayed wound healing. Recurrence of hemorrhoids is also a major concern in the post‑operative period. An anal fistula is the connection between the anus and the skin and causes severe pain, swelling, as well as blood and pus discharge. Fistula has serious social and economic consequences. Hence, it is important to understand the pathophysiology and molecular pathology of hemorrhoids and fistula, to identify the molecular targets and to develop pharmacological‑interventions. In a previous study by our group, the polyherbal formulation Anoac‑H was developed for the treatment of different stages of hemorrhoids and fistula, and it was demonstrated that Anoac‑H is an effective formulation for treating hemorrhoids. However, the molecular mode of action of Anoac‑H on hemorrhoids and fistula had remained elusive. In the present study, it was determined that this formulation reduces the migration of mesenchymal (fibroblasts) and immune (RAW 264.7) cells without affecting their viability. It was also observed that Anoac‑H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages. Inflammation and elevated expression of RANTES and VEGF were observed in hemorrhoids and fistula. However, 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.", "provenance": [ { "field": "population", "quote": "this formulation reduces the migration of mesenchymal (fibroblasts) and immune (RAW 264.7) cells" }, { "field": "population", "quote": "treated human hemorrhoid and fistula tissues as compared to untreated ones" }, { "field": "intervention", "quote": "polyherbal formulation Anoac‑H" }, { "field": "comparator", "quote": "treated human hemorrhoid and fistula tissues as compared to untreated ones" }, { "field": "primaryOutcome", "quote": "Anoac‑H suppresses the expression of regulated upon activation, normal T cell expressed and presumably secreted (RANTES) and VEGF in fibroblasts and macrophages" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:34331606", "pmid": "34331606", "doi": "10.1007/s10103-021-03333-x", "nctId": null, "pmcid": null, "title": "Laser utility in the treatment of hemorrhoidal pathology: a review of literature", "firstAuthor": "Trigui", "multipleAuthors": true, "journal": "Lasers Med Sci", "year": 2022, "design": "systematic-review", "n": 1179, "nField": "reported", "population": "adults with hemorrhoids, ages 18 to 74", "intervention": "laser treatment (HeLP or LHP procedures)", "comparator": "surgical treatment of hemorrhoids", "primaryOutcome": "postoperative pain, disease downgrading, bleeding, satisfaction, and operative duration", "result": "Laser treatment showed less pain, less bleeding, shorter operative time, and higher satisfaction than surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This review pooled mostly small comparative studies without statistical meta-analysis and excluded retrospective data, so the evidence is not strong enough to be fully confident.", "directness": "indirect", "limitations": "Retrospective studies and case reports were excluded; abstract notes 'more rigorous studies will be needed to better evaluate this technique'", "followUp": "", "plainFinding": "Laser treatment less painful, less bleeding than surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34331606/", "sourceText": "Hemorrhoidal disease is a common reason for consultation in proctology. It can be treated in several ways (medical, endoscopic, and surgical). Laser treatment has been described since 1960 and has developed in recent years. The purpose of this literature review was to study the results of laser treatment of hemorrhoids and to compare them with those of surgical methods. We performed a systematic search of the literature by querying the Medline, Google Scholar, and Cochrane Library databases. Retrospective studies and case reports were excluded. We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure). The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies. The age of the patients varies between 18 and 74 years old. HeLP laser treatment was significantly superior to surgical treatment in terms of postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001). Similarly, 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). The laser represents a revolution in the field of proctology mainly in the treatment of hemorrhoidal pathology. It is a safe, effective, and less painful mini-invasive technique. More rigorous studies will be needed to better evaluate this technique.", "provenance": [ { "field": "n", "quote": "The total number of patients was 1179 including 1059 patients treated with laser and 120 treated surgically within the context of comparative studies." }, { "field": "population", "quote": "The age of the patients varies between 18 and 74 years old." }, { "field": "intervention", "quote": "We selected 11 studies both techniques HeLP (hemorrhoid laser procedure) and LHP (laser hemorrhoidoplasty procedure)." }, { "field": "comparator", "quote": "HeLP laser treatment was significantly superior to surgical treatment" }, { "field": "primaryOutcome", "quote": "postoperative pain (p < 0.001), hemorrhoidal disease downgrading (p < 0.001), and postoperative satisfaction (p < 0.001)" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:34252247", "pmid": "34252247", "doi": "10.1111/codi.15808", "nctId": null, "pmcid": null, "title": "LigaSure™ haemorrhoidectomy and the risk of postoperative bleeding", "firstAuthor": "Wlodarczyk", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "retrospective", "n": 127, "nField": "reported", "population": "patients who had surgery to remove hemorrhoids", "intervention": "LigaSure (electro-surgical device) hemorrhoidectomy", "comparator": "Ferguson (closed) hemorrhoidectomy", "primaryOutcome": "rate of postoperative bleeding (ER visits, transfusions, readmissions within 30 days)", "result": "similar rates of postoperative bleeding visits between LigaSure and Ferguson groups (20% vs. 11%, not statistically significant), and LigaSure use was not independently associated with bleeding risk", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "This was a small retrospective single-hospital study, so it can't reliably rule out differences between the two surgery types.", "directness": "indirect", "limitations": "Retrospective cohort design, single academic hospital, relatively small sample size", "followUp": "30 days", "plainFinding": "No difference in post-surgery bleeding risk.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34252247/", "sourceText": "AIM: LigaSure™ is an electro-surgical device that has increasingly been utilized in haemorrhoid surgery. However, recent literature has highlighted a possible increased risk of delayed postoperative bleeding following LigaSure haemorrhoidectomy (LH). We aim to evaluate the rates of postoperative bleeding following LigaSure compared to Ferguson (closed) haemorrhoidectomy (FH). METHODS: A retrospective cohort study was undertaken at our single academic safety-net county hospital from August 2016 through July 2019 evaluating patients who received FH or LH. Patient demographics, surgical data, postoperative emergency department visit for pain or bleeding within 30 days and resulting transfusion requirement, and rates of readmission and interventions within 30 days were collected. RESULTS: Sixty-one FH and 66 LH patients were identified. The groups had no difference in demographics. The LH group and FH group had similar rates of postoperative emergency department visits (29% vs. 23%, P = 0.454), as well as visits for bleeding (20% vs. 11%, P = 0.204). The average operating time was also significantly shorter with LH (14.5 min vs. 24.9 min, P ≤ 0.001). On multivariate analysis, male sex (OR 7.28, 95% CI 1.88-28.25) and haemorrhoid grade ≤2 (OR 4.64, 95% CI 1.31-16.49) were significantly associated with postoperative bleeding on multivariate analysis. Use of LH was not independently associated with postoperative bleeding risk (OR 1.89, 95% CI 0.70-5.11). CONCLUSIONS: LH and FH have similar risks for postoperative bleeding and other complications. Male sex and haemorrhoid Grades 1 or 2 may be associated with increased postoperative bleeding risk. Excisional haemorrhoidectomy should be undertaken with caution for male patients with lower internal haemorrhoid grades.", "provenance": [ { "field": "n", "quote": "Sixty-one FH and 66 LH patients were identified." }, { "field": "population", "quote": "evaluating patients who received FH or LH" }, { "field": "intervention", "quote": "LigaSure™ is an electro-surgical device that has increasingly been utilized in haemorrhoid surgery" }, { "field": "comparator", "quote": "Ferguson (closed) haemorrhoidectomy (FH)" }, { "field": "primaryOutcome", "quote": "postoperative emergency department visit for pain or bleeding within 30 days and resulting transfusion requirement, and rates of readmission and interventions within 30 days" }, { "field": "result", "quote": "The LH group and FH group had similar rates of postoperative emergency department visits (29% vs. 23%, P = 0.454), as well as visits for bleeding (20% vs. 11%, P = 0.204)." }, { "field": "result", "quote": "Use of LH was not independently associated with postoperative bleeding risk (OR 1.89, 95% CI 0.70-5.11)." } ] }, { "id": "pmid:34247216", "pmid": "34247216", "doi": "10.7417/CT.2021.2337", "nctId": null, "pmcid": null, "title": "Colour Doppler-guided Haemorrhoidal Artery Ligation: a possible evolution of Transanal Haemorrhoidal Dearterialisation", "firstAuthor": "Palumbo", "multipleAuthors": true, "journal": "Clin Ter", "year": 2021, "design": "retrospective", "n": 408, "nField": "reported", "population": "patients with grade III-IV haemorrhoids", "intervention": "Colour Doppler-Guided Haemorrhoidal Artery Ligation (ligating the arteries under direct ultrasound vision)", "comparator": "standard Doppler-Guided Haemorrhoidal Artery Ligation", "primaryOutcome": "post-operative pain, early complications (including bleeding), patient satisfaction, and recurrence rate", "result": "no significant differences in pain, bleeding, or satisfaction between the two techniques, but recurrence was significantly higher with the standard method", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a non-randomized comparison of two surgical techniques without blinding, so differences could be due to bias rather than the treatment itself.", "directness": "indirect", "limitations": "No randomization or blinding described; comparison focuses on surgical technique differences rather than directly explaining bleeding mechanism.", "followUp": "one-year follow-up", "plainFinding": "New technique fewer recurrences, same bleeding control.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34247216/", "sourceText": "INTRODUCTION: Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet found. In 1995, Doppler-guided haemorrhoidal artery ligation was introduced, aiming to reduce postoperative pain and complications. In this work, an evolu-tion of the aforementioned surgical technique was described. MATERIALS AND METHODS: 183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation. The procedures were performed under local anaes-thesia with patients in lithotomy position. A special proctoscope and a dedicated Colourdoppler US probe were employed in the second group. Superior haemorrhoidal artery terminal branches were con-secutively ligated according to provided technique in the first group and under vision in the second. In all cases, each ligation was followed by mucopexy. RESULTS: No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated. Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL. No late complications (after one-year follow-up) were registered in both groups. CONCLUSIONS: Colour Doppler-Guided Haemorrhoidal Artery Li-gation represents an ideal management for 1-day surgery, and fulfils the requirements of minimally invasive surgery in patients with III-IV grade haemorrhoids. The absence of complications and the evidence of significant wellness of patients are the best advantages. Colour Doppler-Guided Haemorrhoidal Artery Ligation is a safe and easy procedure with good results and a very short-time training. It could be considered an easy and reliable method to treat symptomatic haemorrhoids.", "provenance": [ { "field": "n", "quote": "183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation." }, { "field": "population", "quote": "patients with III-IV grade haemorrhoids" }, { "field": "intervention", "quote": "Colour Doppler-Guided Haemorrhoidal Artery Ligation" }, { "field": "comparator", "quote": "standard Doppler-Guided Haemorrhoidal Artery Ligation" }, { "field": "primaryOutcome", "quote": "No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated." }, { "field": "result", "quote": "Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL." }, { "field": "followUp", "quote": "No late complications (after one-year follow-up) were registered in both groups." } ] }, { "id": "pmid:34166805", "pmid": "34166805", "doi": "10.1016/j.jvir.2021.06.005", "nctId": null, "pmcid": null, "title": "Superior Rectal Artery Embolization for Symptomatic Grades 2 and 3 Hemorrhoidal Disease: 6-Month Follow-up among 43 Patients", "firstAuthor": "Stecca", "multipleAuthors": true, "journal": "J Vasc Interv Radiol", "year": 2021, "design": "prospective-cohort", "n": 43, "nField": "reported", "population": "adults with symptomatic Grade 2 or 3 hemorrhoids", "intervention": "blocking the blood supply to hemorrhoids via superior rectal artery embolization", "comparator": "no comparison group; before-and-after same patients", "primaryOutcome": "change in bleeding score, prolapse, pain, and quality of life", "result": "bleeding score significantly reduced in Grade 3 patients, and quality of life improved significantly in both groups", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small single-group study without a comparison group, so it can't rule out improvement happening on its own.", "directness": "direct", "limitations": "no control group, small sample size, only 6 months of follow-up", "followUp": "6 months", "plainFinding": "Less bleeding, better quality of life.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34166805/", "sourceText": "PURPOSE: To assess the technical and clinical success rates of superior rectal artery embolization in the treatment of symptomatic Grades 2 and 3 hemorrhoidal disease. MATERIALS AND METHODS: Since March 2019, 43 patients (24 men and 19 women; mean age, 52 years [18-77 years]) with symptomatic hemorrhoidal disease have been treated and completed the 6-month follow-up with anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life. Clinical success was assessed at 7 days, 1 month, and 6 months of follow-up by updating the clinical scores. Statistical analysis was performed using SPSS 25.0. RESULTS: In all, 25 patients had Grade 2 prolapse and 18 patients had Grade 3 prolapse, with 96% and 77%, respectively, having bleeding as a symptom. All patients were discharged within 24 hours. 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). No serious complications were registered. CONCLUSIONS: Hemorrhoidal embolization was a safe and effective technique in the treatment of symptomatic hemorrhoidal disease with minimal hospitalization, pain, and disruption of daily activities. It can be offered to patients unwilling to undergo a surgical procedure but can also be indicated in the emergency setting for patients on anticoagulant therapy or those unfit for surgery.", "provenance": [ { "field": "n", "quote": "43 patients (24 men and 19 women; mean age, 52 years [18-77 years])" }, { "field": "population", "quote": "symptomatic Grades 2 and 3 hemorrhoidal disease" }, { "field": "intervention", "quote": "superior rectal artery embolization" }, { "field": "comparator", "quote": "Clinical success was assessed at 7 days, 1 month, and 6 months of follow-up by updating the clinical scores." }, { "field": "primaryOutcome", "quote": "anamnestic questionnaire and disease scores, including French bleeding, Goligher prolapse, visual analog scale for pain, and quality of life" }, { "field": "result", "quote": "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)." } ] }, { "id": "pmid:34057643", "pmid": "34057643", "doi": "10.1007/s10151-021-02465-0", "nctId": null, "pmcid": null, "title": "Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: a randomized double-blind clinical trial", "firstAuthor": "Rabelo", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "rct", "n": 68, "nField": "reported", "population": "patients who had surgical removal of hemorrhoids (excisional hemorrhoidectomy)", "intervention": "flavonoids and/or metronidazole taken after surgery", "comparator": "placebo", "primaryOutcome": "pain, bleeding, swelling, itching and straining after surgery", "result": "Flavonoids reduced pain in all periods and reduced bleeding between week 1 and week 2 after surgery; combining flavonoids with metronidazole helped pain even more in the first two weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small study with only 17 patients per group, so the results may not be reliable.", "directness": "indirect", "limitations": "Small sample size (17 per group); studies post-surgical bleeding rather than bleeding from untreated hemorrhoids.", "followUp": "30 days", "plainFinding": "Flavonoids cut post-surgery pain and bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34057643/", "sourceText": "BACKGROUND: Excisional hemorrhoidectomy remains the most effective treatment for a significant group of patients with hemorrhoids, despite the potential for postoperative pain. The purpose of this study was to evaluate the effects of flavonoid and metronidazole use in the postoperative period on patients undergoing excisional hemorrhoidectomy. METHODS: A double-blind randomized clinical study was performed. Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each to receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period. A standard analgesic protocol was offered equally for all groups. Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated during the following three periods: from immediately after the operation until postoperative day (POD)7, from POD 8 to POD 14, and from POD 15 to POD 30. The patients were required to complete symptom questionnaires and to attend postoperative follow-up on PODs 7, 14 and 30. The effect of each drug was assessed for each symptom, and the groups were compared with each other and over time. RESULTS: There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001), with an observed synergistic effect of flavonoids combined with metronidazole during the first 14 days after surgery (p < 0.0001). Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks CONCLUSIONS: The use of flavonoids alone and in combination with metronidazole resulted in a reduction of most symptoms, particularly pain, after excisional hemorrhoidectomy. TRIAL REGISTRATION: The present study was registered in the SISNEP (document CAAE-0035.0.240.000-11), after approval by the research ethics committee (CEP) of the Hospital Felício Rocho (protocol nº393 / 11).", "provenance": [ { "field": "n", "quote": "Sixty-eight patients underwent excisional hemorrhoidectomy and were randomized into 4 groups of 17 patients each" }, { "field": "population", "quote": "patients undergoing excisional hemorrhoidectomy" }, { "field": "intervention", "quote": "receive double-placebo (G1), metronidazole plus placebo (G2), flavonoids plus placebo (G3) or metronidazole plus flavonoids (G4) in the postoperative period" }, { "field": "comparator", "quote": "double-placebo (G1)" }, { "field": "primaryOutcome", "quote": "Postoperative pain, bleeding, edema, pruritus and tenesmus were evaluated" }, { "field": "result", "quote": "Flavonoid use was also associated with decreased bleeding (G3, p = 0.031 and G4, p = 0.016) between the first and second postoperative weeks" }, { "field": "result", "quote": "There was less severe pain in all postoperative periods in the groups using flavonoids (G3 and G4, both p < 0.0001)" } ] }, { "id": "pmid:34008704", "pmid": "34008704", "doi": "10.1590/0102-672020210001e1560", "nctId": null, "pmcid": "PMC8121048", "title": "A NEW APPROACH FOR HEMORRHOID DISEASE: SELECTIVE DEARTERIALIZATION AND MUCOPEXY WITHOUT DOPPLER GUIDANCE", "firstAuthor": "Sobrado", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2021, "design": "case-series", "n": 20, "nField": "reported", "population": "patients with grade II and III hemorrhoids", "intervention": "selective dearterialization and mucopexy of the symptomatic hemorrhoid without Doppler guidance", "comparator": "none (single-arm case series)", "primaryOutcome": "control of prolapse and bleeding, postoperative complications, recurrence", "result": "all patients achieved control of prolapse and bleeding, with some postoperative complications and no recurrences after follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small uncontrolled case series of only 20 patients with no comparison group, so the result could be due to natural healing or bias rather than the procedure.", "directness": "direct", "limitations": "small sample size, no control group, single-arm design", "followUp": "13 months", "plainFinding": "Bleeding and prolapse controlled after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34008704/", "sourceText": "BACKGROUND: The surgical procedure: three dearterializations and three mucopexies.Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. AIM: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. METHODS: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. RESULTS: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. CONCLUSION: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.", "provenance": [ { "field": "n", "quote": "Twenty consecutive patients with grade II and III hemorrhoids" }, { "field": "population", "quote": "Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach" }, { "field": "intervention", "quote": "selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance" }, { "field": "comparator", "quote": "METHODS: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence." }, { "field": "primaryOutcome", "quote": "evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding" }, { "field": "result", "quote": "Control of prolapse and bleeding was achieved in all patients (n=20)." }, { "field": "followUp", "quote": "After a mean follow-up of 13 months no recurrences were diagnosed." } ] }, { "id": "pmid:33971251", "pmid": "33971251", "doi": "10.1016/j.jvir.2021.03.548", "nctId": null, "pmcid": null, "title": "Catheter-Directed Hemorrhoidal Dearterialization Technique for the Management of Hemorrhoids: A Meta-Analysis of the Clinical Evidence", "firstAuthor": "Makris", "multipleAuthors": true, "journal": "J Vasc Interv Radiol", "year": 2021, "design": "meta-analysis", "n": 362, "nField": "reported", "population": "patients with bleeding hemorrhoids (grades I-III, chronic bleeding)", "intervention": "catheter-directed hemorrhoidal artery embolization (dearterialization), with coils alone or coils plus particles", "comparator": "before vs after treatment comparison; also coils-only vs coils-and-particles subgroups", "primaryOutcome": "reduction in bleeding score and clinical success/rebleeding after the procedure", "result": "Bleeding scores significantly improved after treatment, with 78.9% average clinical success, but rebleeding was more common with coils alone (21.5%) than coils plus particles (10.05%)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This pools small, mostly uncontrolled studies without a true comparison group, so the benefit seen could be due to the procedure itself or to other factors.", "directness": "direct", "limitations": "The authors call this 'preliminary clinical evidence' and say standardization of technique and higher level evidence are still needed to compare with surgical options.", "followUp": "12.1 months", "plainFinding": "Less bleeding after artery-blocking procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33971251/", "sourceText": "PURPOSE: To assess the efficacy and safety of a catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding. MATERIALS AND METHODS: A systematic review and meta-analysis of pubmed, cochrane, and scopus databases was conducted according to the preferred reporting items for systematic reviews and meta-Analysis (PRISMA) guidelines. Clinical studies reporting on catheter-directed hemorrhoidal dearterialization for rectal bleeding were analyzed. RESULTS: Fourteen studies (n = 362) were identified. The mean maximum follow-up duration was 12.1 months (SD, 7.31; range, 1-28; median, 12), and the mean length of hospital stay was 1.5 days (SD, 1.1; range, 0-2.5). The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5). A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004). In subgroup analysis, when the coils-only group was compared with the coils and particles group, 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). No bowel ischemia/necrosis or anorectal complications were reported. CONCLUSIONS: The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure for the treatment of hemorrhoidal bleeding. The standardization of the technique and the generation of higher level evidence will be required to compare this minimally invasive procedure with more invasive surgical options for patients with grades I-III hemorrhoids and chronic bleeding.", "provenance": [ { "field": "n", "quote": "Fourteen studies (n = 362) were identified." }, { "field": "population", "quote": "patients with grades I-III hemorrhoids and chronic bleeding" }, { "field": "intervention", "quote": "catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoidal bleeding" }, { "field": "comparator", "quote": "when the coils-only group was compared with the coils and particles group" }, { "field": "primaryOutcome", "quote": "A statistically significant reduction in the french bleeding score before and after embolization was noted (P = .004)." }, { "field": "result", "quote": "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)" }, { "field": "result", "quote": "The mean technical success was 97.8% (SD, 3.5), and the mean clinical success was 78.9% (SD, 10.5)." }, { "field": "limitations", "quote": "The current preliminary clinical evidence suggests that catheter-directed hemorrhoidal dearterialization is an effective and safe procedure" }, { "field": "followUp", "quote": "The mean maximum follow-up duration was 12.1 months" } ] }, { "id": "pmid:33959805", "pmid": "33959805", "doi": "10.1007/s00423-021-02190-0", "nctId": null, "pmcid": null, "title": "Safety and effectiveness of hemorrhoidal artery ligation using the HAL-RAR technique for hemorrhoidal disease", "firstAuthor": "Karkalemis", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2021, "design": "retrospective", "n": 105, "nField": "reported", "population": "adults with grade II (not helped by non-surgical treatment), III, or IV hemorrhoids", "intervention": "hemorrhoidal artery ligation with rectoanal repair (HAL-RAR) surgery", "comparator": "none - single group followed over time", "primaryOutcome": "symptom resolution, pain, complications, and recurrence after surgery", "result": "most patients had symptoms resolve, with low complication and recurrence rates at 12 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a retrospective study of one treatment with no comparison group, so it can't show whether another approach would have worked as well or better.", "directness": "indirect", "limitations": "retrospective design, no control group, and the authors note long-term follow-up is lacking", "followUp": "12 months", "plainFinding": "Most patients improved after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33959805/", "sourceText": "PURPOSE: A wide variety of methods has been proposed for treating hemorrhoidal disease. The aim of the study is to assess the safety and effectiveness of hemorrhoidal artery ligation with rectoanal repair (HAL-RAR). METHODS: Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease. Demographics, degree of disease, hospital stay, postoperative pain, complications, and recurrence were recorded. Patients were followed up at postoperative days 1 and 8 and at 1, 6, and 12 months. RESULTS: A total of 105 patients (60 men, 45 women) underwent HAL-RAR. Median age was 49 (range, 20-86) years. Two patients with hemorrhoidal thrombosis underwent emergent excision of the hemorrhoid. Median length of hospital stay was 2 (range, 1-13) days. Patients reported median visual analog scale pain score 3 (range, 1-5) on the 1st postoperative day. At 1 month, no patient reported pain, 84.76% of patients confirmed complete resolution of symptoms, while complication rate was 7.61%: 2 patients presented urinary retention, 3 dyschezia, 2 bleeding, and 1 hemorrhoidal necrosis. At 6 months, 2 patients presented mild symptoms and 7 recurrence. At 12 months, 92.4% of patients experienced complete resolution of symptoms, 2 patients intermittent bleeding, and 2 recurrence. Overall recurrence and re-intervention rate were 8.57% rate and 10.5%, respectively. CONCLUSION: HAL-RAR is a safe and effective minimal invasive operative technique related to a high percentage of success, low complication, and recurrence rates. Long-term follow-up is lacking and would better establish the results of this technique. TRIAL REGISTRATION: Trial registration number NCT04778124 Date of registration 26/02/2021 \"retrospectively registered\".", "provenance": [ { "field": "n", "quote": "A total of 105 patients (60 men, 45 women) underwent HAL-RAR." }, { "field": "population", "quote": "patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease" }, { "field": "intervention", "quote": "hemorrhoidal artery ligation with rectoanal repair (HAL-RAR)" }, { "field": "comparator", "quote": "Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR" }, { "field": "primaryOutcome", "quote": "Demographics, degree of disease, hospital stay, postoperative pain, complications, and recurrence were recorded." }, { "field": "result", "quote": "At 12 months, 92.4% of patients experienced complete resolution of symptoms, 2 patients intermittent bleeding, and 2 recurrence." }, { "field": "limitations", "quote": "Long-term follow-up is lacking and would better establish the results of this technique." } ] }, { "id": "pmid:33928786", "pmid": "33928786", "doi": "10.2217/cer-2021-0038", "nctId": null, "pmcid": null, "title": "Micronized purified flavonoid fraction in the treatment of hemorrhoidal disease", "firstAuthor": "Godeberge", "multipleAuthors": true, "journal": "J Comp Eff Res", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "adults with hemorrhoidal disease, including those having surgery", "intervention": "micronized purified flavonoid fraction (MPFF), a venoactive drug", "comparator": "standard care without MPFF (used as postoperative adjunct)", "primaryOutcome": "hemorrhoid symptoms such as bleeding, pain, discomfort, discharge, itching, and postoperative recovery measures", "result": "MPFF reduced symptoms like bleeding and pain, shortened hospital stay, and may prevent recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a narrative review summarizing prior studies without presenting numbers, statistics, or study-by-study details, so it's hard to judge how strong the evidence really is.", "directness": "direct", "limitations": "The abstract gives no information on study designs, sample sizes, statistical results, or how studies were selected, so the strength and consistency of evidence can't be assessed.", "followUp": "", "plainFinding": "Less bleeding and pain, faster recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33928786/", "sourceText": "Hemorrhoidal disease (HD) is common in adults. Treatment is largely conservative, although more invasive procedures may be required. Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used, but a recent and comprehensive review of supporting evidence is lacking. In acute HD, MPFF can reduce HD symptoms such as bleeding, pain, anal discomfort, anal discharge and pruritus. In patients undergoing surgery, postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia. MPFF treatment is appropriate and effective both as a first-line conservative treatment and as a postoperative adjunct treatment. MPFF reduces the duration of hospital stay following surgery, facilitating a return to normal activity and improving quality of life. MPFF may also prevent HD recurrence.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease (HD) is common in adults." }, { "field": "population", "quote": "In patients undergoing surgery, postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia." }, { "field": "intervention", "quote": "Venoactive drugs such as micronized purified flavonoid fraction (MPFF) are widely used" }, { "field": "comparator", "quote": "postoperative adjunct MPFF consistently reduces pain, bleeding duration and use of analgesia." }, { "field": "primaryOutcome", "quote": "In acute HD, MPFF can reduce HD symptoms such as bleeding, pain, anal discomfort, anal discharge and pruritus." }, { "field": "result", "quote": "MPFF reduces the duration of hospital stay following surgery, facilitating a return to normal activity and improving quality of life." }, { "field": "result", "quote": "MPFF may also prevent HD recurrence." } ] }, { "id": "pmid:33830810", "pmid": "33830810", "doi": "10.1177/15533506211007292", "nctId": null, "pmcid": null, "title": "Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients", "firstAuthor": "Landolfi", "multipleAuthors": true, "journal": "Surg Innov", "year": 2022, "design": "retrospective", "n": 433, "nField": "reported", "population": "patients with grade III-IV hemorrhoids and asymmetric mucosal prolapse", "intervention": "sectorial longitudinal augmented prolapsectomy (SLAP) surgery, one or two columns", "comparator": "before vs after surgery (no control group)", "primaryOutcome": "recurrence of hemorrhoid symptoms, prolapse, and rectal narrowing", "result": "low rates of symptom recurrence and prolapse recurrence, but some patients needed emergency reoperation for bleeding after surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective observational study without a comparison group, so it cannot reliably prove the surgery caused the improvement.", "directness": "indirect", "limitations": "Retrospective design, no control/comparator group, and some patients required emergency surgery for post-operative bleeding.", "followUp": "", "plainFinding": "Surgery reduced recurrence but risked bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33830810/", "sourceText": "PURPOSE: Hemorrhoidal disease (HD) is a widespread condition severely influencing patients' quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. METHODS: Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. RESULTS: We enrolled 433 patients (277 SLAP1 and 156 SLAP2). 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. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. CONCLUSIONS: The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse.", "provenance": [ { "field": "n", "quote": "We enrolled 433 patients (277 SLAP1 and 156 SLAP2)." }, { "field": "population", "quote": "Patients affected by III-IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP" }, { "field": "intervention", "quote": "sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse" }, { "field": "comparator", "quote": "The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery." }, { "field": "primaryOutcome", "quote": "Mean outcome was evaluation of medium-long-term outcomes as the occurrence of recurrence and anal or rectal stenosis." }, { "field": "result", "quote": "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." }, { "field": "result", "quote": "An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2." } ] }, { "id": "pmid:33825411", "pmid": "33825411", "doi": null, "nctId": null, "pmcid": null, "title": "Efficacy and safety of Hemoheal cream in patients with hemorrhoids: a randomized double-blind placebo controlled clinical trial", "firstAuthor": "Mehdi", "multipleAuthors": true, "journal": "J Tradit Chin Med", "year": 2021, "design": "rct", "n": 52, "nField": "reported", "population": "patients with symptomatic hemorrhoids", "intervention": "Hemoheal cream (herbal preparation with Allium ampeloprasum, Commiphora mukul, Sesamum indicum oil)", "comparator": "placebo cream", "primaryOutcome": "severity of anal irritation, bleeding, itching, pain, defecation discomfort, swelling, and overall subjective improvement", "result": "After 3 weeks, bleeding, anal irritation, pain and swelling sense were significantly improved with the cream compared to placebo, but anal itching and defecation discomfort were not significantly different", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Small trial of only 52 patients with short follow-up, so the results may not be reliable or lasting.", "directness": "direct", "limitations": "Small sample size, short 3-week duration, one adverse event reported (rash at application site)", "followUp": "3 weeks", "plainFinding": "Less bleeding and pain with cream", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33825411/", "sourceText": "OBJECTIVE: To evaluate the efficacy and safety of Hemoheal cream, an anti-hemorrhoid herbal preparation, (inspired by Persian medicine literatures in a double-blind, randomized placebo-controlled trial. METHODS: Hemoheal cream consists of aqueous extract of Allium ampeloprasum L., Commiphora mukul (Hook. Ex Stocks) Engl and the oil of Sesamum indicum L. Fifty-two patients with symptomatic hemorrhoids were randomized to receive hemoheal cream or placebo for 3 weeks. The patients were evaluated before and after the intervention in terms of the severity of anal irritation, bleeding, anal itching, pain, defecation discomfort and swelling sense, and overall subjective improvement (%), as well as any reported adverse events. RESULTS: The results showed that after 3 weeks of treatment, distribution of anal irritation, bleeding, pain as well as swelling sense were significantly different (P < 0.05), while the analysis showed no significant differences between two groups for anal itching and defecation discomfort (P > 0.05). Furthermore, a significant difference was observed between the overall subjective improvement of Hemoheal cream and placebo groups (P = 0.012). One patient in the treatment group complained of rashes on the application site. CONCLUSION: The present study showed a positive effect of Hemoheal cream in improving clinical signs and symptoms in patients with hemorrhoids.", "provenance": [ { "field": "n", "quote": "Fifty-two patients with symptomatic hemorrhoids were randomized to receive hemoheal cream or placebo for 3 weeks." }, { "field": "population", "quote": "Fifty-two patients with symptomatic hemorrhoids" }, { "field": "intervention", "quote": "Hemoheal cream consists of aqueous extract of Allium ampeloprasum L., Commiphora mukul (Hook. Ex Stocks) Engl and the oil of Sesamum indicum L." }, { "field": "comparator", "quote": "receive hemoheal cream or placebo for 3 weeks" }, { "field": "primaryOutcome", "quote": "evaluated before and after the intervention in terms of the severity of anal irritation, bleeding, anal itching, pain, defecation discomfort and swelling sense, and overall subjective improvement (%)" }, { "field": "result", "quote": "after 3 weeks of treatment, distribution of anal irritation, bleeding, pain as well as swelling sense were significantly different (P < 0.05), while the analysis showed no significant differences between two groups for anal itching and defecation discomfort (P > 0.05)" } ] }, { "id": "pmid:33682485", "pmid": "33682485", "doi": "10.1177/0300060521997325", "nctId": null, "pmcid": "PMC7944536", "title": "Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids", "firstAuthor": "Yu", "multipleAuthors": true, "journal": "J Int Med Res", "year": 2021, "design": "retrospective", "n": 126, "nField": "reported", "population": "patients with grade III or IV mixed hemorrhoids", "intervention": "a large C suture used during a hemorrhoid surgery called PPH (procedure for prolapse and hemorrhoids)", "comparator": "no comparison group (single-arm retrospective study)", "primaryOutcome": "rates of narrowing of the surgical join and bleeding from it after surgery", "result": "none of the patients developed stricture at the join, but two patients had bleeding from it afterward", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one group of patients with no comparison group, so it can't show whether this technique works better than other methods.", "directness": "indirect", "limitations": "Retrospective design, no control group, and it studies a surgical technique's complications rather than why hemorrhoids bleed or how to stop that bleeding directly.", "followUp": "6 months", "plainFinding": "Low bleeding after this surgery technique.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33682485/", "sourceText": "OBJECTIVE: To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. METHODS: Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. RESULTS: The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. CONCLUSION: Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.", "provenance": [ { "field": "n", "quote": "The study population comprised 126 patients" }, { "field": "population", "quote": "Patients with mixed hemorrhoids (grade III or IV)" }, { "field": "intervention", "quote": "a large C suture during PPH" }, { "field": "comparator", "quote": "this retrospective study" }, { "field": "primaryOutcome", "quote": "The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed." }, { "field": "result", "quote": "None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding." } ] }, { "id": "pmid:33661360", "pmid": "33661360", "doi": "10.1007/s00384-021-03895-w", "nctId": null, "pmcid": null, "title": "Analysis of risk factors for delayed bleeding after semi-closed hemorrhoidectomy", "firstAuthor": "Jeong", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "retrospective", "n": 1645, "nField": "reported", "population": "patients with symptomatic grade II to IV hemorrhoids undergoing surgery", "intervention": "semi-closed hemorrhoidectomy with submucosal feeding vessel ligation", "comparator": "none (risk factor analysis within same procedure group)", "primaryOutcome": "delayed bleeding after hemorrhoid surgery", "result": "1.5% of patients had delayed bleeding; male sex, drinking history, more than four hemorrhoid piles, and laxative use raised the risk", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective study of one surgical technique without a comparison group, so it can identify risk factors but not prove what prevents bleeding.", "directness": "indirect", "limitations": "Retrospective design, single center, no comparator group, and does not directly address what stops bleeding once it occurs.", "followUp": "", "plainFinding": "Identifies risk factors for bleeding after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33661360/", "sourceText": "PURPOSE: The aim of this study was to determine the incidence of delayed post-hemorrhoidectomy bleeding (DPHB) after hemorrhoidectomy using a semi-closed procedure. We also investigated risk factors associated with DPHB. METHODS: This retrospective study enrolled a total of 1645 consecutive patients with symptomatic grade II to IV hemorrhoids who underwent a semi-closed procedure at the Seoul Songdo Hospital between September 2018 and May 2019. All patients underwent a semi-closed procedure with submucosal feeding vessel ligation, a method commonly performed at our institution. RESULTS: A total of 1645 patients (mean age: 48.67 (±14.38) years, 823 (50.0%) male/822 (50.0%) female) underwent semi-closed hemorrhoidectomy. Critically, 24 (1.5%) patients experienced DPHB. Of these patients, 13 (0.8%) experienced stump bleeding, whereas 11 (0.7%) experienced marginal bleeding. The mean bleeding period was 8.21±4.45 days. Multivariate analysis showed that male sex, drinking history, more than four hemorrhoid piles, and laxative agents were independent risk factors for DPHB. The risk of stump bleeding was significantly associated with male sex (OR=5.55, 95% CI 1.23-25.14, p=0.026), more than four hemorrhoid piles (OR=5.90, 95% CI 1.62-21.53, p=0.007), and laxative usage (OR=3.92, 95% CI 1.31-11.74, p=0.015). Conversely, the risk of marginal bleeding were significantly associated with drinking history (OR=10.48, 95% CI 1.34-82.03, p=0.025) and more than four hemorrhoid piles (OR=4.71, 95% CI 1.24-17.81, p=0.023). CONCLUSION: Male sex, drinking history, more than four hemorrhoid piles, and laxative usage were independent risk factors for DPHB in patients undergoing semi-closed hemorrhoidectomy. The risk factors for stump bleeding included male sex, more than four hemorrhoid piles, and laxative usage. In contrast, the risk factors for marginal bleeding were drinking history and more than four hemorrhoid piles.", "provenance": [ { "field": "n", "quote": "This retrospective study enrolled a total of 1645 consecutive patients with symptomatic grade II to IV hemorrhoids who underwent a semi-closed procedure" }, { "field": "population", "quote": "1645 consecutive patients with symptomatic grade II to IV hemorrhoids who underwent a semi-closed procedure at the Seoul Songdo Hospital" }, { "field": "intervention", "quote": "All patients underwent a semi-closed procedure with submucosal feeding vessel ligation" }, { "field": "primaryOutcome", "quote": "The aim of this study was to determine the incidence of delayed post-hemorrhoidectomy bleeding (DPHB) after hemorrhoidectomy using a semi-closed procedure." }, { "field": "result", "quote": "Multivariate analysis showed that male sex, drinking history, more than four hemorrhoid piles, and laxative agents were independent risk factors for DPHB." }, { "field": "comparator", "quote": "This retrospective study enrolled a total of 1645 consecutive patients with symptomatic grade II to IV hemorrhoids who underwent a semi-closed procedure" } ] }, { "id": "pmid:33640516", "pmid": "33640516", "doi": "10.1016/j.jvir.2021.02.011", "nctId": null, "pmcid": null, "title": "Superior Rectal Artery Embolization with Tris-Acryl Gelatin Microspheres: A Randomized Comparison of Particle Size", "firstAuthor": "Küçükay", "multipleAuthors": true, "journal": "J Vasc Interv Radiol", "year": 2021, "design": "rct", "n": 42, "nField": "reported", "population": "adults with symptomatic hemorrhoid disease (various grades)", "intervention": "superior rectal artery embolization using tris-acryl gelatin microspheres of different particle sizes", "comparator": "different microsphere particle sizes (500-700 μm vs 700-900 μm vs 900-1,200 μm) within the embolization procedure", "primaryOutcome": "clinical success rate at 12 months after embolization", "result": "93% clinical success rate overall, with the greatest reduction in bleeding score seen in the group treated with the largest (900-1,200 μm) particles", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, with only 14 patients per group and no comparison to a non-embolization control.", "directness": "direct", "limitations": "small sample size per arm, minor complication rate of 54%, and no Goligher score improvement despite other gains", "followUp": "12 months", "plainFinding": "Embolization reduced bleeding, bigger particles worked best", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33640516/", "sourceText": "PURPOSE: To evaluate the safety and efficacy of superior rectal artery embolization (SRAE) with different-sized tris-acryl gelatin microspheres in symptomatic hemorrhoidal disease (HD). MATERIALS AND METHODS: Forty-two patients (male, 30; female, 12; median age, 45 years) with symptomatic HD (2 grade I, 8 grade II, 17 grade III, and 15 grade IV) were divided into 3 experimental arms (500-700 μm, 700-900 μm, and 900-1,200 μm groups; each had 14 patients) in a prospective randomized style to perform SRAE. Follow-up was performed by rectoscopy, clinical examination, and questionnaires. The primary outcome measure was the clinical success rate at 12 months. Secondary outcome measures were technical success rate, recurrence rate, procedure-related mortality, procedure-related complications, and any outcome changes between particle sizes. RESULTS: No procedure-related deaths or major morbidities were observed. There was a 54% minor complication rate (n = 23/42) in the treated zone: 45% sustained small superficial ulcerations (n = 19/42), 7% small rectosigmoid junction ulcerations (n = 3/42), and 2% small fibrotic scar tissue (n = 1/42). The clinical success rate was 93%. Of the groups, the best French bleeding score decrease was obtained in the 900-1,200 μm group. There were improvements in the quality of life score and visual analogue scale score after the SRAE procedure, although not in the Goligher score. No recurrent disease was observed. CONCLUSIONS: SRAE with tris-acryl gelatin microspheres for symptomatic HD is a safe and efficient treatment, with results favoring the use of larger microspheres.", "provenance": [ { "field": "n", "quote": "Forty-two patients (male, 30; female, 12; median age, 45 years) with symptomatic HD" }, { "field": "population", "quote": "symptomatic hemorrhoidal disease (HD)" }, { "field": "intervention", "quote": "superior rectal artery embolization (SRAE) with different-sized tris-acryl gelatin microspheres" }, { "field": "comparator", "quote": "divided into 3 experimental arms (500-700 μm, 700-900 μm, and 900-1,200 μm groups; each had 14 patients)" }, { "field": "primaryOutcome", "quote": "The primary outcome measure was the clinical success rate at 12 months." }, { "field": "result", "quote": "The clinical success rate was 93%. Of the groups, the best French bleeding score decrease was obtained in the 900-1,200 μm group." } ] }, { "id": "pmid:33639701", "pmid": "33639701", "doi": "10.51821/84.1.497", "nctId": null, "pmcid": null, "title": "Belgian consensus guideline on the management of hemorrhoidal disease", "firstAuthor": "De Schepper", "multipleAuthors": true, "journal": "Acta Gastroenterol Belg", "year": 2021, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with hemorrhoids", "intervention": "fiber supplements, venotropic drugs, infrared coagulation, rubber band ligation, or surgery", "comparator": "different treatments compared to each other across severity grades", "primaryOutcome": "control of hemorrhoid symptoms and prolapse", "result": "treatment should be matched to severity; conventional hemorrhoidectomy was said to be the most effective option overall", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an expert consensus guideline summarizing existing literature rather than a new study with its own data on bleeding.", "directness": "indirect", "limitations": "abstract does not describe the studies underlying the recommendations, their quality, or specific results for bleeding control", "followUp": "", "plainFinding": "Guideline, not direct bleeding evidence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33639701/", "sourceText": "INTRODUCTION: Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. METHODS: A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. RESULTS: Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. CONCLUSIONS: The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.", "provenance": [ { "field": "population", "quote": "Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal." }, { "field": "intervention", "quote": "conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases." }, { "field": "comparator", "quote": "Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations." }, { "field": "primaryOutcome", "quote": "symptoms can arise" }, { "field": "result", "quote": "Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids." } ] }, { "id": "pmid:33638331", "pmid": "33638331", "doi": "10.21614/chirurgia.116.1.102", "nctId": null, "pmcid": null, "title": "Stapled Hemorrhoidopexy: Technique and Long Term Results", "firstAuthor": "Puia", "multipleAuthors": true, "journal": "Chirurgia (Bucur)", "year": 2021, "design": "case-series", "n": 35, "nField": "reported", "population": "patients with symptomatic second- and third-degree hemorrhoids", "intervention": "stapled hemorrhoidopexy (Longo operation) using a PPH03 stapler", "comparator": "", "primaryOutcome": "", "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; global satisfaction rate was 94%.", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It is a small retrospective single-arm case series with no comparison group, so the results can't be fully trusted.", "directness": "indirect", "limitations": "Retrospective data collection, small sample of 35 patients, no comparator group.", "followUp": "6 (1-9) years", "plainFinding": "Few complications, high patient satisfaction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33638331/", "sourceText": "Background: Stapled hemorrhoidopexy (Longo operation) is a infrequent technique in our area. A different concept from hemorrhoidectomy, a proportionally important raise in cost and a special training may have contributed to it. We report our long-term results with the standard technique. Methods: The data of 35 patients with symptomatic second- and third-degree hemorrhoids who had stapled hemorrhoidopexy using a PPH03 stapler, from 01 January 2012 to 04 December 2020, were retrospectively collected. The sex ratio male: female was 3:4 and the mean age 45 (range 28-60) years. The follow-up consisted in a rectal exam and evaluated anatomical recurrence or prolapse. Results: The mean operative time was 42 (30-70) min. The mean parenteral analgesic doses during the first 24 h were 1,52. The mean postoperative hospital stay was 1.55 (1-2) days. 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. No hematoma, anastomotic stenosis, persistent anal pain, tenesmus, or impaired anal continence was recorded. One patient mentioned discomfort related to the presence of staples. Patients were followed-up for 6 (1-9) years. Global satisfaction rate was 94%. Conclusion: Stapled hemorrhoidopexy procedure is a safe and feasible procedure, which necessitates few analgesics and allows an early discharge. A rigorous selection of cases and a correct surgical technique allow to obtain good long-term results and offer a high level of patients satisfaction.", "provenance": [ { "field": "n", "quote": "The data of 35 patients with symptomatic second- and third-degree hemorrhoids" }, { "field": "population", "quote": "35 patients with symptomatic second- and third-degree hemorrhoids" }, { "field": "intervention", "quote": "stapled hemorrhoidopexy using a PPH03 stapler" }, { "field": "result", "quote": "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" }, { "field": "result", "quote": "Global satisfaction rate was 94%." }, { "field": "followUp", "quote": "Patients were followed-up for 6 (1-9) years." } ] }, { "id": "pmid:33496474", "pmid": "33496474", "doi": "10.1097/DCR.0000000000001883", "nctId": null, "pmcid": null, "title": "Evaluation of a Minimally Invasive Bipolar Coagulation System for the Treatment of Grade I and II Internal Hemorrhoids", "firstAuthor": "Studniarek", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2021, "design": "case-series", "n": 35, "nField": "reported", "population": "adults with chronic symptomatic grade I and II internal hemorrhoids who failed conservative treatment", "intervention": "bipolar coagulation (hemorrhoid energy therapy) applied in a single office visit", "comparator": "none (no comparison group; pre- vs post-treatment scores)", "primaryOutcome": "change in hemorrhoid symptom score and safety/complications", "result": "symptom scores dropped from an average of 5.5 to 1.4 after treatment, with low pain levels", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, single-center study with no comparison group, so it can't show whether the improvement was due to the treatment itself.", "directness": "direct", "limitations": "lack of comparative groups, single-center design, and small cohort of patients", "followUp": "14 days", "plainFinding": "Fewer symptoms, including bleeding, after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33496474/", "sourceText": "BACKGROUND: Hemorrhoids are common and affect mainly the young and middle-aged populations. Current guidelines recommend treating grade I and II hemorrhoids with office-based procedures. These therapies usually require multiple applications. Hemorrhoid energy therapy treats the hemorrhoids at 1 treatment session. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of hemorrhoid energy therapy. DESIGN: This was a prospective pilot study evaluating patients with symptomatic grade I and II internal hemorrhoids. SETTINGS: The study was conducted at a tertiary academic center. PATIENTS: Patients over the age of 18 years with chronic, symptomatic grade I and II internal hemorrhoids who failed 2 weeks of conservative therapy were enrolled between July 2015 and January 2019. Exclusion criteria included patients with grade III or IV internal hemorrhoids, external hemorrhoids, nonhemorrhoidal GI bleeding, active proctitis, and IBD. INTERVENTIONS: Hemorrhoid energy therapy was administered in clinic, and 2 postprocedure visits were completed. A pretreatment hemorrhoid symptom score was obtained from each patient. A visual analog score was assessed posttreatment. MAIN OUTCOME MEASURES: The primary end point was to evaluate the effect of hemorrhoid energy therapy on hemorrhoid symptoms and its safety. The secondary end point was evaluation of postprocedural pain. RESULTS: A total of 35 patients were enrolled. The mean duration of hemorrhoid symptoms was 3.3 ± 6.4 years, and rectal bleeding and hemorrhoidal prolapse were the most common symptoms. After the procedure, patient hemorrhoid symptom scores decreased from mean 5.5 to 1.4. The mean immediate postprocedural visual analog score was 2.4 ± 2.1 and decreased to <1.0 after 14 days. LIMITATIONS: The limitations include lack of comparative groups, single-center design, and small cohort of patients. CONCLUSIONS: The application of hemorrhoid energy therapy in the treatment of grade I and II internal hemorrhoids is safe and results in reduction of symptoms, low rate of short-term complications, and minimal pain. See Video Abstract at http://links.lww.com/DCR/B491. EVALUACIÓN DE UN SISTEMA DE COAGULACIÓN BIPOLAR MÍNI-INVASIVA PARA EL TRATAMIENTO DE HEMORROIDES INTERNAS GRADOS I Y II: La enfermedad hemorroidal es muy común y afecta principalmente poblaciones jóvenes y de mediana edad. Las guías actuales recomiendan tratar las hemorroides de grado I y II con procedimientos en el consultorio. Estos tratamientos suelen requerir múltiples aplicaciones. La aplicación de energía para tratar las hemorroides requiere de una sola sesión.Evaluar la seguridad y eficacia del tratamiento hemorroidal con una fuente de energía.Estudio piloto prospectivo que evalúa los pacientes con hemorroides internas de grado I y II sintomáticas.El estudio se realizó en un centro académico terciario.Entre julio de 2015 y enero de 2019 se inscribieron pacientes mayores de 18 años con hemorroides intomáticas internas crónicas grado I y II que fracasaron luego de 2 semanas de tratameinto conservador. Los criterios de exclusión incluyeron pacientes con hemorroides internas de grado III o IV, hemorroides externas, sangrado de orígen gastrointestinal no hemorroidal, proctitis activa y enfermedad inflamatoria intestinal.Se realizó la aplicación de energía sobre las hemorroides en el consultorio y se completó el procedimiento con dos visitas posteriores. Se obtuvo una puntuación analógica de síntomas hemorroidarios en cada paciente antes del tratamiento. Se evaluó la puntuación analógica visual luego del procedimiento.El principal criterio final fué evaluar el efecto de la terapia energética hemorroidaria con relación a los síntomas y la seguridad del dispositivo. El segundo criterio final fué el evaluar el dolor posoperatorio.Se registraron un total de 35 pacientes. La duración media de los síntomas hemorroidarios fué de 3,3 ± 6,4 años, el sangrado rectal y el prolapso hemorroidal fueron los síntomas más frecuentes. Después del procedimiento, las puntuaciones de los síntomas hemorroidarios disminuyeron en una media de 5,5 a 1,4. La puntuación analógica visual media inmediatamente posterior al procedimiento fue de 2,4 ± 2,1 y disminuyó a <1 después de 14 días.Las limitaciones incluyen la falta de grupos comparativos, el diseño de un solo centro y una pequeña cohorte de pacientes.La aplicación de energía como tratamiento de la enfermedad hemorroidal interna grado I y II es segura y da como resultados la reducción de los síntomas, una baja tasa de complicaciones a corto plazo y mínimo dolor. Consulte Video Resumen en http://links.lww.com/DCR/B491. (Traducción-Dr Xavier Delgadillo).", "provenance": [ { "field": "n", "quote": "A total of 35 patients were enrolled." }, { "field": "population", "quote": "Patients over the age of 18 years with chronic, symptomatic grade I and II internal hemorrhoids who failed 2 weeks of conservative therapy" }, { "field": "intervention", "quote": "Hemorrhoid energy therapy was administered in clinic, and 2 postprocedure visits were completed." }, { "field": "comparator", "quote": "The limitations include lack of comparative groups, single-center design, and small cohort of patients." }, { "field": "primaryOutcome", "quote": "The primary end point was to evaluate the effect of hemorrhoid energy therapy on hemorrhoid symptoms and its safety." }, { "field": "result", "quote": "After the procedure, patient hemorrhoid symptom scores decreased from mean 5.5 to 1.4." }, { "field": "followUp", "quote": "decreased to <1.0 after 14 days" } ] }, { "id": "pmid:33452908", "pmid": "33452908", "doi": "10.1007/s00384-021-03848-3", "nctId": null, "pmcid": "PMC7811334", "title": "Sclerotherapy with 3% polidocanol foam for third- and fourth-degree hemorrhoids as \"bridge treatment\" during the COVID-19 pandemic in Italy", "firstAuthor": "Lisi", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "case-series", "n": 10, "nField": "reported", "population": "patients with third- and fourth-degree hemorrhoids", "intervention": "sclerotherapy injection with 3% polidocanol foam", "comparator": "no comparator, used as a temporary bridge treatment before surgery", "primaryOutcome": "resolution of hemorrhoid bleeding and itching", "result": "all patients had resolution of bleeding and pruritus with low pain scores", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a tiny, uncontrolled case series of only 10 patients with no comparison group, so it can't reliably show the treatment caused the improvement.", "directness": "direct", "limitations": "Very small sample size, no control group, described as preliminary experience, and performed only as an interim measure during pandemic restrictions.", "followUp": "", "plainFinding": "Bleeding and itching stopped.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33452908/", "sourceText": "PURPOSE: In Italy, colorectal surgery has been strongly affected with the vast majority (90%) of operations treating benign diseases, with an estimated overall 12-week cancellation rate of 72%. Little is known on how to best manage patients with benign diseases and the consequences this interruption of care will have in post-pandemic times. Proctologic diseases have social, psychological, and healthcare repercussions for their high incidence and great impact on the quality of life. METHODS: We decided to treated 10 urgent cases affected from III- and IV-degree hemorrhoids with 3% polidocanol foam in attempt to reduce hemorrhoidal symptoms while waiting for surgery so called \"bridge treatment\". RESULTS: During the follow-up no complications were occurred, and all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1). CONCLUSIONS: This treatment could reduce the bleeding that is the main symptom from which patients suffer and for which they underwent proctological evaluation and surgery. According to our preliminary experience in the impossibility of accessing the surgery during the COVID-19 pandemic, ST could be considered as the treatment of choice in those patients who are suffering from grade III- and IV-degree hemorrhoids while waiting for surgery.", "provenance": [ { "field": "n", "quote": "We decided to treated 10 urgent cases" }, { "field": "population", "quote": "III- and IV-degree hemorrhoids" }, { "field": "intervention", "quote": "3% polidocanol foam" }, { "field": "comparator", "quote": "\"bridge treatment\"" }, { "field": "primaryOutcome", "quote": "resolution of bleeding and pruritus" }, { "field": "result", "quote": "all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1)" } ] }, { "id": "pmid:33415419", "pmid": "33415419", "doi": "10.1007/s00464-020-08248-2", "nctId": null, "pmcid": null, "title": "Doppler-guided hemorrhoidal dearterialization with laser (HeLP): indications and clinical outcome in the long-term. Results of a multicenter trial", "firstAuthor": "Giamundo", "multipleAuthors": true, "journal": "Surg Endosc", "year": 2022, "design": "prospective-cohort", "n": 284, "nField": "reported", "population": "patients with hemorrhoids suffering from bleeding, pain and recurrent symptoms", "intervention": "Doppler-guided laser closure of the arteries feeding the hemorrhoids (HeLP procedure)", "comparator": "none (before-after comparison within same patients)", "primaryOutcome": "resolution of hemorrhoid symptoms (including bleeding) at 2 years", "result": "89.9% of patients had resolution of symptoms, with significant improvement in bleeding, pain, and quality of life", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study without a comparison group, so improvement cannot be clearly attributed to the laser procedure itself.", "directness": "direct", "limitations": "No control group; some patients lost to follow-up; failure more common in constipated patients and those with higher-grade hemorrhoids.", "followUp": "2-year", "plainFinding": "Bleeding and symptoms improved long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33415419/", "sourceText": "BACKGROUND: Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy. Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up. Primary endpoint was resolution of symptoms and secondary endpoints were recurrence rate, type of recurrences, re-operation rate, and potential predictive factors for failure. METHODS: Bleeding was assessed on a score from 0 to 4 (none = 0; < 1/month = 1; 1/week = 2; > 1/week = 3; 3-4/week = 4), frequency of hemorrhoid-related symptoms with a score of 0-3 (2/year = 1; 3-5/year = 2; < 5/year = 3). Constipation and fecal incontinence were assessed by means of validated scores. Quality of life and pain at defecation were assessed using a visual analog scale of 0-10 (0 = worst possible-10 = best possible quality of life and 0 = no pain-10 = worst pain imaginable, respectively). Recurrence rate and need for re-operation were reported. Potential predictive factors of failure were analyzed by means of univariate analysis. RESULTS: Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial; 8 patients were lost at follow-up. 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. Of 28 patients with persistent or recurrent symptoms, 12 had pain (4.35%), 10 had bleeding (3.6%) and 6 had increasing prolapse at defecation (2.2%). Eleven out of twenty-eight patients required additional surgery. Constipation and III-IV grade hemorrhoids were associated with statistically significant higher failure rates (p = 0.046 and 0.012, respectively). Better results were reported in patients reporting preoperative high-grade pain at evacuation. CONCLUSIONS: The Doppler-guided hemorrhoidal laser procedure showed efficacy at long-term follow-up. It can be considered as 'first-line' treatment in patients with low-grade hemorrhoids suffering from bleeding, pain and recurrent acute symptoms in whom conservative treatment failed.", "provenance": [ { "field": "n", "quote": "Two-hundred-eighty-four patients (183 males, 101 females; mean age: 47.5 years) were included in the trial" }, { "field": "population", "quote": "Primary endpoint was resolution of symptoms" }, { "field": "intervention", "quote": "Doppler-guided hemorrhoidal laser procedure consists of sutureless closure of terminal branches of the superior hemorrhoidal artery by laser energy" }, { "field": "comparator", "quote": "Clinical results of patients treated with this procedure were analyzed at the completion of 2-year follow-up" }, { "field": "primaryOutcome", "quote": "Primary endpoint was resolution of symptoms" }, { "field": "result", "quote": "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." } ] }, { "id": "pmid:33199263", "pmid": "33199263", "doi": "10.1016/j.jviscsurg.2020.10.003", "nctId": null, "pmcid": null, "title": "Evaluation of the efficacy and morbidity of radiofrequency thermocoagulation in the treatment of hemorrhoidal disease", "firstAuthor": "Drissi", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2021, "design": "retrospective", "n": 74, "nField": "reported", "population": "patients with grade II to IV hemorrhoidal disease (mostly grade III)", "intervention": "radiofrequency thermocoagulation of hemorrhoids", "comparator": "none (single-group before/after outcomes)", "primaryOutcome": "anatomical and functional result and postoperative complications at 3 months", "result": "more than 93% had satisfactory anatomical and functional results at 3 months, but 24.3% had a postoperative complication and 2.7% needed repeat surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one group with no comparison treatment, so it's hard to know how much benefit came from the procedure itself.", "directness": "indirect", "limitations": "Retrospective, single-arm design with no control group; only short follow-up of three months reported.", "followUp": "3 months", "plainFinding": "Mostly good results, some complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33199263/", "sourceText": "INTRODUCTION: Grade III hemorrhoidal disease may require surgical treatment. Several minimally invasive techniques can be offered to the patient, particularly ligation of the hemorrhoidal arteries/mucopexy or even stapled hemorrhoidopexy. A technique of radiofrequency thermocoagulation of hemorrhoids has recently been introduced. The aim of our study was to assess the efficacy and early morbidity of this procedure. METHODS: Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated. RESULTS: Seventy-four patients, with a mean age of 53 years, underwent operation during the study period. The major indication was grade III hemorrhoidal disease in 95% of patients. More than 80% of patients underwent operation as an outpatient. Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery for rectal bleeding and severe anal pain, respectively. Seven (9.5%) patients were re-admitted to hospital and 18 (24.3%) had an unscheduled early return visit within 30 postoperative days. At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients. CONCLUSION: Radiofrequency hemorrhoidal thermocoagulation is an effective technique in the treatment of grade III hemorrhoidal disease. Despite a non-negligible rate of minor postoperative complications requiring an early consultation or re-hospitalisation, severe complications occurred in less than 3% of operated patients.", "provenance": [ { "field": "population", "quote": "patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019" }, { "field": "intervention", "quote": "radiofrequency thermocoagulation of hemorrhoids" }, { "field": "n", "quote": "Seventy-four patients, with a mean age of 53 years, underwent operation during the study period" }, { "field": "primaryOutcome", "quote": "the anatomical and functional result was satisfactory in more than 93% of patients" }, { "field": "result", "quote": "At three months following surgery, the anatomical and functional result was satisfactory in more than 93% of patients." }, { "field": "result", "quote": "Eighteen (24.3%) patients developed a postoperative complication within 30 days, of whom two (2.7%) required revisional surgery" }, { "field": "comparator", "quote": "Data from successive patients undergoing radiofrequency thermocoagulation for grade II to IV hemorrhoidal disease between December 2017 and December 2019 were retrospectively collated." } ] }, { "id": "pmid:33111967", "pmid": "33111967", "doi": "10.1007/s00384-020-03789-3", "nctId": null, "pmcid": null, "title": "Radiofrequency thermocoagulation of haemorrhoidal bundles, an alternative technique for the management of internal haemorrhoids", "firstAuthor": "Didelot", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "case-series", "n": 39, "nField": "reported", "population": "patients with internal hemorrhoids", "intervention": "radiofrequency thermocoagulation (RFT) of hemorrhoidal tissue", "comparator": "before-and-after comparison (no control group)", "primaryOutcome": "bleeding severity and prolapse grade", "result": "bleeding dropped from 7/10 to 1/10 and stopped completely in 62% of patients; prolapse grade improved", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, uncontrolled study of only 39 patients with no comparison group, so improvement could be due to other factors.", "directness": "direct", "limitations": "No control group; small sample size; single-center experience.", "followUp": "15 months", "plainFinding": "Bleeding and prolapse much reduced.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33111967/", "sourceText": "PURPOSE: To describe our experience of radiofrequency thermocoagulation (RFT), assessing patient symptoms and quality of life (QoL) before and after the intervention. METHODS: Between April 2016 and April 2018, 42 outpatients were operated for internal haemorrhoids using RFT. Haemorrhoids were externalised to the anal margin and treated by using the Rafaelo® procedure, using the HPR45i probe (F-Care-Systems) under general anaesthesia. Assessment was performed prior to the intervention and during follow-up for prolapse degree using the Goligher scale; bleeding, improvement, and satisfaction using a verbal analogical scale; and the burden of haemorrhoidal disease using the HEMO-FISS-QoL questionnaire. RESULTS: In September 2018, 39 patients (26 males, mean age 51 [22-77]) were interviewed after an RFT intervention, during which a mean of 4.296 J was applied per patient. After a mean follow-up of 15 months, bleeding drastically decreased from 7/10 to 1/10 (p < 0.0001) and entirely stopped in 62% of patients. Prolapse significantly reduced from grade 3 to 2 (p < 0.0001) and completely disappeared in 9 out of 33 patients. Only 49% required postoperative level 2 analgesics, and 7 external thromboses were the only complication reported. Average incapacity for work was 1.72 days. All patients reported improvement of haemorrhoidal disease with a satisfaction rate mean score + 4/5. Haemorrhoidal discomfort decreased from 7/10 to 2/10 (p < 0.0001). HEMO-FISS-QoL score significantly improved, dropping from 24.91 to 5.94 (p < 0.001). Among all patients, 85% would choose RFT again if necessary and 90% would recommend it. CONCLUSION: RFT treatment reduced haemorrhoidal bleeding and prolapse, and improved patient QoL.", "provenance": [ { "field": "n", "quote": "39 patients (26 males, mean age 51 [22-77]) were interviewed after an RFT intervention" }, { "field": "population", "quote": "42 outpatients were operated for internal haemorrhoids using RFT" }, { "field": "intervention", "quote": "Radiofrequency thermocoagulation (RFT)" }, { "field": "comparator", "quote": "Assessment was performed prior to the intervention and during follow-up" }, { "field": "primaryOutcome", "quote": "bleeding, improvement, and satisfaction using a verbal analogical scale" }, { "field": "result", "quote": "bleeding drastically decreased from 7/10 to 1/10 (p < 0.0001) and entirely stopped in 62% of patients" }, { "field": "followUp", "quote": "After a mean follow-up of 15 months" } ] }, { "id": "pmid:33098443", "pmid": "33098443", "doi": "10.1007/s00595-020-02164-7", "nctId": null, "pmcid": null, "title": "A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL)", "firstAuthor": "Zenger", "multipleAuthors": true, "journal": "Surg Today", "year": 2021, "design": "retrospective", "n": 75, "nField": "reported", "population": "patients with symptomatic grade 2 or 3 hemorrhoids", "intervention": "arterial detection ligation (ADL), a Doppler-guided technique to find and tie off hemorrhoidal arteries at the right depth", "comparator": "no comparator group; single-arm case series", "primaryOutcome": "complications, recurrence, and patient satisfaction after surgery", "result": "most patients recovered without serious problems, pain scores fell over time, few had recurrence, and most were satisfied at 1 year", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, single-arm retrospective study without a comparison group, so it cannot show how ADL stacks up against other treatments.", "directness": "indirect", "limitations": "retrospective design, no control group, small sample size, short-to-moderate follow-up", "followUp": "1 year", "plainFinding": "Fewer complications, most satisfied.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33098443/", "sourceText": "PURPOSE: We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD). METHODS: The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL. RESULTS: A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19 years; mean BMI 24 ± 3 kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4 h postoperatively. Four patients (5.3%) suffered tenesmus for about 1 week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1 day postoperatively, then at 1 week, 1 month and 1 year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65). CONCLUSION: Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12 mm and running a long mucopexy suture line.", "provenance": [ { "field": "n", "quote": "A total of 75 patients were included in the study" }, { "field": "population", "quote": "patients with symptomatic grades 2 or 3 HD" }, { "field": "intervention", "quote": "the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating" }, { "field": "comparator", "quote": "We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL." }, { "field": "primaryOutcome", "quote": "We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL." }, { "field": "result", "quote": "At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65)." }, { "field": "result", "quote": "ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity." } ] }, { "id": "pmid:33087033", "pmid": "33087033", "doi": "10.2174/1574887115666201021150144", "nctId": null, "pmcid": null, "title": "Conservative Treatment of Hemorrhoidal Disease", "firstAuthor": "Stratta", "multipleAuthors": true, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoidal disease, mostly early stages", "intervention": "conservative treatments: diet/lifestyle changes, oral phlebotonic drugs, topical medications", "comparator": "", "primaryOutcome": "control of hemorrhoid symptoms including bleeding", "result": "Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "It is a narrative review based mostly on uncontrolled case series with very few randomized trials, so it cannot reliably show what works.", "directness": "direct", "limitations": "very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series", "followUp": "", "plainFinding": "Lifestyle and drug treatments may help, evidence weak.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33087033/", "sourceText": "BACKGROUND: Hemorrhoids are vascular cushions underlying the distal rectal mucosa and contributing to approximately 15-20% of the resting anal pressure with a complete closure of the anal canal. They can become pathological (hemorrhoidal disease, HD) being the most common cause of painless rectal bleeding during defecation with or without prolapsing anal tissue. The treatment of HD must be tailored to both the severity of disease and patient's expectation. METHODS: A narrative review of all the most relevant papers present on the three major databases (PUBMED, EMBASE and WEB OF SCIENCE) regarding conservative treatment was conducted. RESULTS: Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease. Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms. The use of topical medications, particularly during the acute phase or in the post-operative period can also be beneficial for all patients complaining of HD. CONCLUSION: Despite a large number of available products in the market and the high incidence of HD, very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series. Larger and better designed studies are necessary to establish the real benefit of all types of drugs for the treatment of early stages of HD.", "provenance": [ { "field": "population", "quote": "patients complaining of early stages of the disease" }, { "field": "intervention", "quote": "Dietary and lifestyle modifications are the first therapeutic step necessary to achieve a regular defecation with soft stool whereas oral phlebotonic drugs can help to control symptoms." }, { "field": "intervention", "quote": "The use of topical medications, particularly during the acute phase or in the post-operative period can also be beneficial for all patients complaining of HD." }, { "field": "primaryOutcome", "quote": "Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease." }, { "field": "result", "quote": "Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease." }, { "field": "limitations", "quote": "very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series" } ] }, { "id": "pmid:33081476", "pmid": "33081476", "doi": "10.21037/apm-19-657", "nctId": null, "pmcid": null, "title": "Efficacy of modified rubber band ligation in the treatment of grade III internal hemorrhoids", "firstAuthor": "Jin", "multipleAuthors": true, "journal": "Ann Palliat Med", "year": 2021, "design": "rct", "n": 120, "nField": "reported", "population": "patients with grade III internal hemorrhoids (hemorrhoid prolapse)", "intervention": "modified rubber band ligation (MRBL)", "comparator": "Milligan-Morgan hemorrhoidectomy (MMH) surgery", "primaryOutcome": "post-operative pain, bleeding, urine retention, anal pressure, and recurrence", "result": "MRBL caused significantly less post-operative pain, bleeding, and urine retention than MMH, with stable anal pressure; recurrence rates were similar between groups", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but surgery versus a non-surgical procedure cannot be blinded, which could bias how outcomes like pain were assessed.", "directness": "direct", "limitations": "Abstract does not mention blinding, length of overall follow-up for recurrence, or single vs multi-center design.", "followUp": "", "plainFinding": "Less post-op bleeding than surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33081476/", "sourceText": "BACKGROUND: Traditional rubber band ligation can improve the symptoms of hemorrhoids, the techniques used vary among centers and the degree of hemorrhoids may also affect the therapeutic efficacy and postoperative outcome, especially for patients with grade III hemorrhoids (hemorrhoid prolapses). This study aimed to investigate the clinical efficacy of modified rubber band ligation (MRBL) in the treatment of grade III internal hemorrhoids. METHODS: A total of 120 patients with grade III internal hemorrhoids were randomly assigned to receive MRBL or Milligan-Morgan haemorrhoidectomy (MMH) (n=60 per group). The post-operative pain, bleeding, urine retention and feeling of anal distension were recorded, and the resting anal pressure (RAP) and post-operative recurrence rate were compared between two groups. RESULTS: The post-operative pain, bleeding and urine retention in the MRBL group were improved significantly as compared with the MMH group (P<0.05), but the feeling of anal distension was similar between them (P>0.05). The RAP remained unchanged after MRBL, but the RAP at 1 month after surgery in the MMH group increased markedly (P<0.01) as compared with that before surgery and was significantly higher than that in the MRBL group (P<0.01). The post-operative recurrence rate was comparable between two groups (P>0.05). CONCLUSIONS: As compared with traditional MMH, MRBL is effective to attenuate the post-operative pain and other discomforts and stabilize the RA. Thus, MRBL is an ideal choice for the treatment of grade III internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "A total of 120 patients with grade III internal hemorrhoids were randomly assigned to receive MRBL or Milligan-Morgan haemorrhoidectomy (MMH) (n=60 per group)." }, { "field": "population", "quote": "patients with grade III internal hemorrhoids" }, { "field": "intervention", "quote": "modified rubber band ligation (MRBL)" }, { "field": "comparator", "quote": "Milligan-Morgan haemorrhoidectomy (MMH)" }, { "field": "primaryOutcome", "quote": "The post-operative pain, bleeding, urine retention and feeling of anal distension were recorded, and the resting anal pressure (RAP) and post-operative recurrence rate were compared between two groups." }, { "field": "result", "quote": "The post-operative pain, bleeding and urine retention in the MRBL group were improved significantly as compared with the MMH group (P<0.05), but the feeling of anal distension was similar between them (P>0.05)." }, { "field": "result", "quote": "The post-operative recurrence rate was comparable between two groups (P>0.05)." } ] }, { "id": "pmid:33028422", "pmid": "33028422", "doi": "10.1186/s42358-020-00153-5", "nctId": null, "pmcid": null, "title": "Anorectal diseases in patients with Antiphospholipid syndrome: a cross-sectional study", "firstAuthor": "Cunha", "multipleAuthors": true, "journal": "Adv Rheumatol", "year": 2020, "design": "case-series", "n": 41, "nField": "reported", "population": "women with antiphospholipid syndrome (APS) undergoing proctological examination", "intervention": "proctological examination to detect hemorrhoids and anorectal disease", "comparator": "APS patients without hemorrhoid disease", "primaryOutcome": "frequency of hemorrhoid disease and its complications, including bleeding, in APS patients", "result": "41.4% had hemorrhoids, mostly internal; 29.4% of those with hemorrhoids had anal bleeding, which was not related to warfarin dose; constipation was linked to more hemorrhoids", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled descriptive study of only 41 patients with no comparison to non-APS patients or any treatment tested.", "directness": "indirect", "limitations": "Small sample size, all female APS patients only, cross-sectional design without a non-APS control group, no treatment compared.", "followUp": "", "plainFinding": "Bleeding not linked to blood thinner dose.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33028422/", "sourceText": "BACKGROUND: Hemorrhoid disease (HD) is one of the most common gastrointestinal complaints worldwide, affecting 4.4% of the general population in the United States. Since antiphospholipid syndrome (APS) may lead to intra-abdominal thrombosis, one may expect that this condition can impact the risk for HD development. Additionally, as APS patients are more prone to thrombosis and treatment with anticoagulants may increase risk of bleeding, one may also infer that rates of HD complications may be higher in this scenario. Nevertheless, no data in these regards have been published until now. The objective of the present study is to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients. METHODS: We consecutively invited patients who fulfilled APS criteria to undergo proctological examination. After examination, patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile. We performed the analysis of the data, using chi-square and Mann Whitney U when applicable and considering a significance level of 0.05. Multivariate regression analysis included age and variables with p < 0.10 in the bivariate analysis. RESULTS: Forty-one APS patients agreed to undergo proctological examination. All were female and overall median age was 43 (36-49). Seventeen (41.4%) patients were diagnosed with HD, with the following frequency distribution: 7 internal (41.2%), 4 external (23.5%) and 5 mixed hemorrhoids (29.4%). Of the internal hemorrhoids, 5 patients were classified as grade I (71.4%), 1 grade II (14.3%), and 1 grade IV (14.3%). Prior gestation (p = 0.067) and constipation (p = 0.067) correlated with a higher frequency of HD. In multivariate analysis, constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2,p = 0.037). Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949). Surgical treatment was indicated for 10 patients (58.8%). Other anorectal findings were anal fissure, plicoma, condyloma and one chlamydial retitis. CONCLUSION: We found an unexpected high frequency of hemorrhoids in APS patients, with a great proportion requiring surgical treatment.", "provenance": [ { "field": "n", "quote": "Forty-one APS patients agreed to undergo proctological examination." }, { "field": "population", "quote": "patients who fulfilled APS criteria to undergo proctological examination" }, { "field": "intervention", "quote": "patients who fulfilled APS criteria to undergo proctological examination" }, { "field": "comparator", "quote": "patients were divided in two groups, based on the presence of HD, and compared regarding different clinical manifestations and antiphospholipid profile" }, { "field": "primaryOutcome", "quote": "to evaluate frequency of HD and describe its complications rates in antiphospholipid syndrome APS patients" }, { "field": "result", "quote": "Seventeen (41.4%) patients were diagnosed with HD" }, { "field": "result", "quote": "Five out of 17 patients (29.4%) reported anal bleeding, but it did not correlate with warfarin dose (p = 0.949)." }, { "field": "result", "quote": "constipation remained as an important risk factor (OR 3.92,CI95% 1.03-14.2,p = 0.037)" } ] }, { "id": "pmid:33023436", "pmid": "33023436", "doi": "10.2174/1574887115999201006201926", "nctId": null, "pmcid": null, "title": "Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience", "firstAuthor": "Rho", "multipleAuthors": true, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "retrospective", "n": 1454, "nField": "reported", "population": "patients with grade III and IV hemorrhoids", "intervention": "LigaSure hemorrhoidectomy (surgical removal using energy device)", "comparator": "", "primaryOutcome": "rate of post-operative complications including bleeding, length of stay, operating time, and return to work", "result": "0.3% of patients had postoperative bleeding, with low rates of other complications overall", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-center, retrospective, descriptive study without a comparison group, so it can only describe outcomes of this surgery, not prove what causes or stops hemorrhoid bleeding.", "directness": "indirect", "limitations": "No control group, retrospective design, single center, and the study focuses on surgical complication rates rather than the mechanism of hemorrhoid bleeding or non-surgical ways to stop it.", "followUp": "", "plainFinding": "Surgery had very low bleeding rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33023436/", "sourceText": "BACKGROUND: Hemorrhoidal disease represents one of the most common anorectal disorders in the general population. Energy devices, such as LigaSureTM scalpel, have reshaped the concept of hemorrhoid surgery and in turn, have improved patient outcomes and simplified the work of surgeon. OBJECTIVE: The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work. METHODS: In this monocentric descriptive study, from June 2001 to February 2019, 1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed. Complications were classified in early, late, and long-term if they occurred within 1 month, between 1 and 2 months or after 2 months, respectively. RESULTS: 90.2% of patients were treated in day surgery regimen and the mean operating time was 14.3 minutes. The post-operative pain decreased from 3.7 mean VAS on the 1st postoperative day to 0.1 mean VAS on 30th post-operative day. Early complications rate was 2.1%: urinary retention accounted for 1.8% of patients. 0.3%-of patients experienced postoperative bleeding and only one required reoperation. Late complications rate was 5.8%: anal stenosis, incomplete healing, and anal fissure were detected in 3.6%, 1.2%, and 1% of patients, respectively. The long term complications rate was 5.3%: anal fistula, soiling, perianal abscess, and recurrence were identified in 0.2%, 0.1%, 0.3%, and 4.8% of patients, respectively. CONCLUSION: LH is a safe and fast procedure with a proven minimal complication rate.", "provenance": [ { "field": "n", "quote": "1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed" }, { "field": "population", "quote": "1454 consecutive patients, treated with LH for grade III and IV hemorrhoids, were analyzed" }, { "field": "intervention", "quote": "LigaSureTM hemorrhoidectomy (LH)" }, { "field": "primaryOutcome", "quote": "The study aims to evaluate the outcomes of LigaSureTM hemorrhoidectomy (LH) analyzing main post-operative complications rate, length of stay, operating time, and time to return to work." }, { "field": "result", "quote": "0.3%-of patients experienced postoperative bleeding and only one required reoperation." } ] }, { "id": "pmid:32810115", "pmid": "32810115", "doi": "10.5455/JPMA.300504", "nctId": null, "pmcid": null, "title": "Experience with Haemorrhoidal artery ligation under direct vision at a tertiary care hospital: A case series", "firstAuthor": "Hussain", "multipleAuthors": true, "journal": "J Pak Med Assoc", "year": 2020, "design": "case-series", "n": 70, "nField": "reported", "population": "patients with symptomatic hemorrhoids", "intervention": "surgical tying off of the hemorrhoidal artery under direct vision plus recto anal repair", "comparator": "none", "primaryOutcome": "pain, symptoms, and patient satisfaction after surgery", "result": "all patients were pain free and symptom free at follow-up, with high satisfaction and low recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small case series with no comparison group, so it cannot show whether the procedure works better than other treatments.", "directness": "indirect", "limitations": "No control group; single case series design; cannot establish cause of bleeding or compare to other treatments.", "followUp": "6 months", "plainFinding": "Surgery relieved hemorrhoid symptoms.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32810115/", "sourceText": "This study aims to share the results of haemorrhoidal artery ligation under direct vision in the management of symptomatic haemorrhoids. We conducted a case series of 70 patients at Combined Military Hospital Rawalpindi & Quetta, from January 2015 to October 2017. All patients underwent Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR). Ligation of superior haemorrhoidal artery was done under direct vision following manual palpation. Patients were followed up postoperatively at 1, 3 and 6 months. At 1 month follow up, all 70 (100%) patients were pain free. Post operative bleeding was observed in 7 (10%) patients but did not require surgical intervention. Sixty two (89%) patients were able to return to their daily activities 1 week after surgery and 57 (81%) resumed military duties or joined their work place at 2 weeks. 70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months. 48 (69%) said that they would recommend this procedure to someone else. Prolapse recurrence was observed in 1(1.42%) patient 6 months post operatively which was dealt by band ligation. All patients completed follow-up at 1, 3 and 6 months. HAL is a simple yet safe technique with few complications, acceptable patient satisfaction and early return to work.", "provenance": [ { "field": "n", "quote": "a case series of 70 patients" }, { "field": "population", "quote": "management of symptomatic haemorrhoids" }, { "field": "intervention", "quote": "Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR)" }, { "field": "comparator", "quote": "Ligation of superior haemorrhoidal artery was done under direct vision following manual palpation." }, { "field": "primaryOutcome", "quote": "At 1 month follow up, all 70 (100%) patients were pain free." }, { "field": "result", "quote": "70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months." } ] }, { "id": "pmid:32712932", "pmid": "32712932", "doi": "10.1007/s10151-020-02312-8", "nctId": null, "pmcid": null, "title": "Superior rectal artery embolization for bleeding internal hemorrhoids", "firstAuthor": "Han", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2021, "design": "retrospective", "n": 32, "nField": "reported", "population": "Patients with stage II and III internal hemorrhoids causing chronic bleeding", "intervention": "Blocking the artery feeding the hemorrhoids (superior rectal artery embolization) using sponge particles and coils", "comparator": "No comparison group; outcomes tracked before/after procedure", "primaryOutcome": "Whether bleeding stopped and complications occurred", "result": "Bleeding resolved in 84.4% of patients; 5 needed other treatment; some had temporary pain, fever, or rebleeding that was later controlled with repeat embolization", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small retrospective study with no comparison group, so it can't prove the procedure itself caused the improvement.", "directness": "direct", "limitations": "Retrospective design, no control group, small sample size", "followUp": "at least 1 year", "plainFinding": "Artery-blocking procedure stopped most bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32712932/", "sourceText": "BACKGROUND: The aim of the present study was to evaluate clinical efficacy and safety of superselective embolization of the superior rectal artery (SRA) for the treatment of internal hemorrhoidal bleeding. METHODS: Patients with stage II and stage III internal hemorrhoids, treated by interventional embolization of the SRA in our department between January 2017 and June 2019 were retrospectively evaluated. All patients suffering from disabling chronic hematochezia and some with relative contraindications for operation (n = 17) or rejection of conventional hemorrhoidectomy (n = 15). Superselective SRA branch embolization was performed using gelatin sponge particles (350-560 μm) and metallic coils (2-3 mm). This treatment process was planned by a multidisciplinary team consisting of proctologist, gastroenterologist and radiologist. The surgical efficacy, postoperative complications and follow-up outcomes were observed. RESULTS: There were 32 patients (18 males, mean age 52 ± 12 years, range: 22-78 years), 12 (37%) with stage II hemorrhoids and 20 (63%) with stage III hemorrhoids. Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients. The remaining 5 (15.6%) patients underwent either stapled hemorrhoidopexy (n = 4) or sclerotherapy (n = 1). Some patients experienced different degrees of pain (n = 4;12.5%), low fever (n = 11;34.4%), and tenesmus (n = 17;53.1%), which all spontaneously regressed without further treatment. All patients were followed up for at least 1 year. There were no serious complications, such as infection, intestinal ischemia or massive hemorrhage. Four patients (14.8%) had rebleeding during the first months of follow-up. All patients with re-bleeding were successfully treated with internal iliac arteriography and branch embolization and did not experience further bleeds after a minimum follow up 3 months follow-up. CONCLUSIONS: The short-term efficacy of superselective SRA embolization for grade II-III internal hemorrhoids is good, and this method is safe and feasible.", "provenance": [ { "field": "n", "quote": "There were 32 patients (18 males, mean age 52 ± 12 years, range: 22-78 years)" }, { "field": "population", "quote": "Patients with stage II and stage III internal hemorrhoids, treated by interventional embolization of the SRA" }, { "field": "intervention", "quote": "Superselective SRA branch embolization was performed using gelatin sponge particles (350-560 μm) and metallic coils (2-3 mm)." }, { "field": "comparator", "quote": "retrospectively evaluated" }, { "field": "primaryOutcome", "quote": "The surgical efficacy, postoperative complications and follow-up outcomes were observed." }, { "field": "result", "quote": "Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients." }, { "field": "followUp", "quote": "All patients were followed up for at least 1 year." } ] }, { "id": "pmid:32687958", "pmid": "32687958", "doi": "10.1016/j.jep.2020.113143", "nctId": null, "pmcid": null, "title": "From nutrition to medicine: Assessing hemorrhoid healing activity of Solanum melongena L. via in vivo experimental models and its major chemicals", "firstAuthor": "Dönmez", "multipleAuthors": true, "journal": "J Ethnopharmacol", "year": 2020, "design": "animal", "n": null, "nField": "not-reported", "population": "rats with chemically induced hemorrhoids (anal area treated with croton oil)", "intervention": "methanolic extract of eggplant (Solanum melongena) calyxes", "comparator": "untreated controls and commercial Pilex tablet/cream", "primaryOutcome": "healing of hemorrhoid tissue (histological and biochemical measures) and capillary permeability", "result": "eggplant extract showed greater healing effect than controls and the commercial product, and reduced capillary permeability increase", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is an animal experiment, not a human study, so it cannot show whether this works for people with hemorrhoids.", "directness": "indirect", "limitations": "Study abstract does not report number of animals used, and findings are from an animal model not humans; does not explain bleeding mechanism directly.", "followUp": "", "plainFinding": "Eggplant extract healed hemorrhoids in rats.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32687958/", "sourceText": "ETHNOPHARMACOLOGICAL RELEVANCE: Solanum melongena L. (eggplant) is used for treatment of rheumatism, beriberi, itching, toothache, bleeding, asthma, bronchitis, cholera, neuralgia and hemorrhoids in traditional medicine (Turkish, Chinese, and Indian). Hemorrhoids from these diseases, are common illness in all over the world, which are treated with various approaches including ethnobotanicals. AIM OF THE STUDY: This study aimed to evaluate the anti-hemorrhoidal activity of eggplant, an edible plant, which is commonly utilized around the world. MATERIALS & METHODS: In vivo anti-hemorrhoidal activity of the methanolic extract prepared from eggplant was evaluated by experimental hemorrhoid model, subsequently histological and biochemical analysis. Hemorrhoid, which was induced by applying croton oil to the anal area of the rats. Furthermore, the extract was screened for anti-inflammatory activity which is based on the inhibition of acetic acid-induced increase in capillary permeability. The healing potential was comparatively assessed with a reference Pilex® tablet and cream. Phytochemical analysis performed by HPLC. The amount of the major phenolic compound (chlorogenic acid) in extract was found by using HPLC method. RESULTS: Histological and biochemical analysis demonstrated that eggplant extract is highly effective against hemorrhoid in comparison to the controls and the commercial preparation. In addition, the methanolic extract demonstrated significant inhibitory effect on acetic acid-induced increase in capillary permeability. The phytochemical studies identified major compound as chlorogenic acid (2.86%) by liquid chromatography. CONCLUSION: The eggplant calyxes, not edible, are easy to reach, by products/vast from the food sources. This is the first scientific evidence revealing that the eggplant extract has significant anti-hemorrhoidal and anti-inflammatory activity.", "provenance": [ { "field": "population", "quote": "Hemorrhoid, which was induced by applying croton oil to the anal area of the rats." }, { "field": "intervention", "quote": "In vivo anti-hemorrhoidal activity of the methanolic extract prepared from eggplant was evaluated by experimental hemorrhoid model" }, { "field": "comparator", "quote": "The healing potential was comparatively assessed with a reference Pilex® tablet and cream." }, { "field": "primaryOutcome", "quote": "Histological and biochemical analysis demonstrated that eggplant extract is highly effective against hemorrhoid in comparison to the controls and the commercial preparation." }, { "field": "result", "quote": "Histological and biochemical analysis demonstrated that eggplant extract is highly effective against hemorrhoid in comparison to the controls and the commercial preparation. In addition, the methanolic extract demonstrated significant inhibitory effect on acetic acid-induced increase in capillary permeability." } ] }, { "id": "pmid:32647985", "pmid": "32647985", "doi": "10.1007/s00268-020-05676-y", "nctId": null, "pmcid": null, "title": "Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment", "firstAuthor": "Hidalgo-Grau", "multipleAuthors": true, "journal": "World J Surg", "year": 2020, "design": "rct", "n": 119, "nField": "reported", "population": "patients with symptomatic third- and fourth-grade hemorrhoids", "intervention": "stapled anopexy with staple line height of 4.5 cm from the anal verge", "comparator": "stapled anopexy with staple line height of 6 cm from the anal verge", "primaryOutcome": "recurrence rate and postoperative disturbances after stapled anopexy", "result": "No difference in recurrence between the two staple heights, but the lower staple line group needed more stitches to control bleeding during surgery", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "It is a randomized, double-blind trial with long follow-up but is small and from a single surgical unit.", "directness": "indirect", "limitations": "Small sample size; single-center study; focuses on surgical technique variation rather than direct comparison of bleeding-control treatments.", "followUp": "11.05 ± 1.6 years", "plainFinding": "No difference in hemorrhoid recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32647985/", "sourceText": "OBJECTIVES: To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids. DESIGN: Simple randomized double-blind controlled clinical trial. Randomization with closed-envelope technique in two groups with two different SLH. SETTING: Colorectal Surgery Unit. Department of General Surgery. Hospital de Mataró (Barcelona, Spain). PARTICIPANTS: 119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included. INTERVENTION: SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge. Postoperative disturbances were evaluated by a colorectal surgeon who was blind for the randomization and pain was measured (visual analogic scale) one week and 3 months after surgery. Mean operative time, number of hemostatic stitches performed and resected mucosal area were considered as well. Mean follow-up was 11.05 ± 1.6 years. RESULTS: Differences between the operative time and resected mucosa-submucosa area were not found. The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line. We did not found differences between both groups in terms of postoperative pain neither anorectal disturbances. At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance. Neither mortality nor undesirable effects occurred in the series. CONCLUSIONS: SLH do not influence the recurrence rate neither the postoperative evolution in SA. TRIAL REGISTRATION: Clinical Trials NCT03383926.", "provenance": [ { "field": "n", "quote": "119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included." }, { "field": "population", "quote": "119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included." }, { "field": "intervention", "quote": "SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge." }, { "field": "comparator", "quote": "group B, 6 cm (61 patients) from the external anal verge." }, { "field": "primaryOutcome", "quote": "To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids." }, { "field": "result", "quote": "The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line." }, { "field": "result", "quote": "At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance." } ] }, { "id": "pmid:32519957", "pmid": "32519957", "doi": "10.5152/tjg.2020.19276", "nctId": null, "pmcid": "PMC7289163", "title": "Polidocanol versus phenol in oil injection sclerotherapy in treatment of internal hemorrhoids: A randomized controlled trial", "firstAuthor": "Mishra", "multipleAuthors": true, "journal": "Turk J Gastroenterol", "year": 2020, "design": "rct", "n": 150, "nField": "reported", "population": "patients with grade-1 and grade-2 bleeding internal hemorrhoids", "intervention": "injection sclerotherapy with 3% polidocanol", "comparator": "injection sclerotherapy with 5% phenol in oil", "primaryOutcome": "being free of rectal bleeding after treatment", "result": "polidocanol stopped bleeding in more patients after one session (60.6% vs 38.1%) and after two sessions (94.7% vs 84%), with fewer sessions needed and higher patient satisfaction", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but follow-up was only three months and details on blinding are not reported.", "directness": "direct", "limitations": "short follow-up of three months; no mention of blinding of outcome assessment", "followUp": "three months", "plainFinding": "Polidocanol stopped bleeding better than phenol", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32519957/", "sourceText": "BACKGROUND/AIMS: Management of Haemorrhoids is suboptimal and is largely based on traditional practices in the Indian population. Though injection sclerotherapy is a well-accepted treatment modality in early grade haemorrhoids, there is no consensus on the effectiveness of the drugs used for sclerotherapy. The study was done to compare the safety and efficacy of a standard sclerosant (polidocanol) and the conventionally used phenol in oil in bleeding grade-1 and 2 internal haemorrhoids. MATERIALS AND METHODS: All patients with grade-1 and 2 hemorrhoids, were selected and randomised into two groups, 3% polidocanol and 5% phenol group. All patients were followed-up for three months and observed for \"free of bleeding\" or \"persistent bleeding.\" Pain, pruritus and patient satisfaction following the procedure was also assessed. RESULTS: A total of 150 patients were enrolled, 75 in each group. At the end of the first sclerotherapy session with polidocanol, 60.6% of patients versus 38.1% in phenol group had stopped per rectal bleeding (p=0.009). After the second sclerotherapy session, 94.7% of patients in the polidocanol group and 84% of patients in the phenol group were treated successfully. Polidocanol group required significantly fewer treatment sessions than the phenol group (1.39±0.49 vs. 1.62±0.49; p=0.035), and the total volume of injected sclerosant was also less (3.30±0.96 mL vs. 4.86±1.46 mL; p=0.001). The patient satisfaction was 87% in polidocanol group versus 73% in phenol group (p=0.040). CONCLUSION: 3% polidocanol is safe and more effective than 5% phenol in oil when used as injection sclerotherapy in the treatment of first and second-degree internal hemorrhoids.", "provenance": [ { "field": "n", "quote": "A total of 150 patients were enrolled, 75 in each group." }, { "field": "population", "quote": "All patients with grade-1 and 2 hemorrhoids, were selected and randomised into two groups" }, { "field": "intervention", "quote": "3% polidocanol" }, { "field": "comparator", "quote": "5% phenol in oil" }, { "field": "primaryOutcome", "quote": "observed for \"free of bleeding\" or \"persistent bleeding.\"" }, { "field": "result", "quote": "At the end of the first sclerotherapy session with polidocanol, 60.6% of patients versus 38.1% in phenol group had stopped per rectal bleeding (p=0.009). After the second sclerotherapy session, 94.7% of patients in the polidocanol group and 84% of patients in the phenol group were treated successfully." }, { "field": "followUp", "quote": "All patients were followed-up for three months" } ] }, { "id": "pmid:32409760", "pmid": "32409760", "doi": "10.1038/s41598-020-64772-0", "nctId": null, "pmcid": "PMC7224176", "title": "Comparison of Centella with Flavonoids for Treatment of Symptoms in Hemorrhoidal Disease and After Surgical Intervention: A Randomized Clinical Trial", "firstAuthor": "Chiaretti", "multipleAuthors": true, "journal": "Sci Rep", "year": 2020, "design": "rct", "n": 195, "nField": "reported", "population": "people with hemorrhoidal disease, including some after hemorrhoid surgery or with hemorrhoidal blood clots", "intervention": "phlebotonic drugs (flavonoids or Centella) added to standard treatment", "comparator": "routine treatment alone (control group)", "primaryOutcome": "time until bleeding stopped and anal irritation score", "result": "bleeding stopped sooner and irritation scores were lower with flavonoids or Centella than with routine treatment alone, both before and after surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "It was described as randomized but the abstract gives no details on blinding, allocation concealment, or how multiple subgroups and surgery were handled, so the comparison is hard to fully trust.", "directness": "direct", "limitations": "No mention of blinding or concealment; patients were split into several different subgroups (medical and surgical) with uneven group sizes.", "followUp": "up to day 42", "plainFinding": "Flavonoids stopped bleeding faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32409760/", "sourceText": "Phlebotonics' effects were evaluated to reduce time-to-stop bleeding and anal irritation in 130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients) in the short time. Sixty patients were randomized to receive the routine treatment (both conservative and surgical) (control Group C). The treated group (both conservative and surgical) was divided into two subgroups: one treated with flavonoids (Group A, n = 73), the other with Centella (Group B, n = 66). Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42). Healing was estimated with Kaplan-Meier method, the Kruskal-Wallis test estimated changes in the VAS scores. The HD median time-to-stop bleeding was 2 weeks for Groups A and B; 3 weeks for Group C. VAS scores comparison among Groups (irritation): A vs C, p = 0.007; B vs C, p = 0.041; and A vs B, p = 0.782 resulted respectively. As for operated hemorrhoids, the time-to-stop bleeding was 3 and 4 weeks in Groups A and B and 5 in Group C. Histopathology showed an association between flavonoids and piles' fibrosis (p = 0.008). Phlebotonics in HD, as well as after surgery, showed significant beneficial effects. Flavonoids are the most effective phlebotonics against bleeding and anal irritation.", "provenance": [ { "field": "n", "quote": "evaluated to reduce time-to-stop bleeding and anal irritation in 130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients)" }, { "field": "population", "quote": "130 patients who complained of hemorrhoidal disease (HD); bleeding and pain after hemorrhoidectomy (31 patients) and hemorrhoidal thrombosis (34 patients)" }, { "field": "intervention", "quote": "The treated group (both conservative and surgical) was divided into two subgroups: one treated with flavonoids (Group A, n = 73), the other with Centella (Group B, n = 66)." }, { "field": "comparator", "quote": "Sixty patients were randomized to receive the routine treatment (both conservative and surgical) (control Group C)." }, { "field": "primaryOutcome", "quote": "Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42)." }, { "field": "result", "quote": "The HD median time-to-stop bleeding was 2 weeks for Groups A and B; 3 weeks for Group C." }, { "field": "result", "quote": "As for operated hemorrhoids, the time-to-stop bleeding was 3 and 4 weeks in Groups A and B and 5 in Group C." }, { "field": "followUp", "quote": "Time-to-stop bleeding was checked at baseline and checkups (0 up to day 42)." } ] }, { "id": "pmid:32399811", "pmid": "32399811", "doi": "10.1007/s12325-020-01353-7", "nctId": null, "pmcid": "PMC7467450", "title": "Micronized Purified Flavonoid Fraction in Hemorrhoid Disease: A Systematic Review and Meta-Analysis", "firstAuthor": "Sheikh", "multipleAuthors": true, "journal": "Adv Ther", "year": 2020, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with hemorrhoid disease (acute or after medical/surgical treatment)", "intervention": "micronized purified flavonoid fraction (MPFF; Daflon), a vein-supporting drug", "comparator": "placebo or no treatment", "primaryOutcome": "bleeding, pain, itching, discharge, and overall improvement", "result": "MPFF significantly reduced bleeding and discharge, and improved overall symptoms; pain tended to decrease but was not statistically significant", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "This pools several randomized trials, but only 4 of 11 studies could be combined numerically and the underlying trials vary in quality and design.", "directness": "direct", "limitations": "Only 4 of 11 identified studies were included in the quantitative pooling, and no treatment duration limit was set, meaning study designs and follow-up varied widely.", "followUp": "", "plainFinding": "Less bleeding with flavonoid drug.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32399811/", "sourceText": "INTRODUCTION: Hemorrhoidal disease (HD) is a common and recurrent problem for many adults worldwide. Venoactive drugs, such as micronized purified flavonoid fraction (MPFF; Daflon®), have been used to treat HD and their clinical benefits have been demonstrated in previous meta-analyses of clinical trials. The aim of this study was to evaluate the efficacy of MPFF across the broader spectrum of signs and symptoms following treatment of patients with HD. METHODS: We performed a systematic review of the literature to identify randomized clinical trials in which MPFF treatment was compared to placebo or no treatment for acute HD or for relief of symptoms after patients had undergone medical management or a surgical procedure to remove hemorrhoids. The main endpoints investigated were bleeding, pain, pruritus, discharge or leakage, and overall improvement. There was no limit on treatment duration. RESULTS: From 351 unique records retrieved, 11 studies reported in 13 articles were included. On the basis of findings from qualitative analysis, MPFF was reported in most studies to be beneficial in treating bleeding, pain, pruritus, anal discharge/leakage, and tenesmus, and in overall improvement. Quantitative meta-analysis of four studies indicated that MPFF treatment provided significant benefits for bleeding (odds ratio [OR] 0.082, 95% confidence interval [CI] 0.027-0.250; P < 0.001), discharge/leakage (OR 0.12, 95% CI 0.04-0.42; P < 0.001), and overall improvement according to patients (OR 5.25, 95% CI 2.58-10.68; P < 0.001) and investigators (OR 5.51, 95% CI 2.76-11.0; P < 0.001). MPFF also tended to decrease pain (OR 0.11, 95% CI 0.01-1.11; P = 0.06). CONCLUSION: Taken together, these results suggest that MPFF treatment can improve the most important signs and symptoms of HD.", "provenance": [ { "field": "population", "quote": "patients with HD" }, { "field": "intervention", "quote": "micronized purified flavonoid fraction (MPFF; Daflon®)" }, { "field": "comparator", "quote": "MPFF treatment was compared to placebo or no treatment for acute HD or for relief of symptoms after patients had undergone medical management or a surgical procedure to remove hemorrhoids" }, { "field": "primaryOutcome", "quote": "The main endpoints investigated were bleeding, pain, pruritus, discharge or leakage, and overall improvement." }, { "field": "result", "quote": "Quantitative meta-analysis of four studies indicated that MPFF treatment provided significant benefits for bleeding (odds ratio [OR] 0.082, 95% confidence interval [CI] 0.027-0.250; P < 0.001), discharge/leakage (OR 0.12, 95% CI 0.04-0.42; P < 0.001), and overall improvement according to patients (OR 5.25, 95% CI 2.58-10.68; P < 0.001) and investigators (OR 5.51, 95% CI 2.76-11.0; P < 0.001)." } ] }, { "id": "pmid:32342155", "pmid": "32342155", "doi": "10.1007/s00270-020-02441-5", "nctId": null, "pmcid": null, "title": "Mid-Term Results of Superior Rectal Artery and Coils for Hemorrhoidal Embolization with Particles Bleeding", "firstAuthor": "Moussa", "multipleAuthors": true, "journal": "Cardiovasc Intervent Radiol", "year": 2020, "design": "retrospective", "n": 38, "nField": "reported", "population": "patients with chronic hemorrhoidal bleeding", "intervention": "artery embolization using particles plus coils", "comparator": "artery embolization using coils alone", "primaryOutcome": "improvement in bleeding severity score without complications", "result": "no significant difference in clinical success between particles-plus-coils and coils-alone groups", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "small retrospective matched-pairs study without randomization, limiting confidence in comparing the two embolization methods.", "directness": "direct", "limitations": "Retrospective design, small sample size after matching, no randomization.", "followUp": "", "plainFinding": "No difference between embolization methods.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32342155/", "sourceText": "OBJECTIVES: To compare safety and clinical outcomes of embolization of the superior rectal arteries in patients with hemorrhoidal bleeding using particles and coils versus coils only. METHODS: We retrospectively reviewed data for patients undergoing embolization for chronic hemorrhoidal bleeding from January 2014 to April 2017. Embolization was performed with coils alone or with particles and coils. Clinical scores (Paris bleeding severity score, Goligher classification and quality of life score) were obtained, and embolization was performed with microparticles (300-500 μm) followed by fibered pushable coils. Clinical success was defined as an improvement of > 2 points in the Paris bleeding severity score, without complications. Outcomes were compared between the two groups in a matched-pairs analysis (1:1 scenario), with patients embolized with particles and coils as the study group and patients embolized with coils alone as the control. RESULTS: We treated 45 consecutive patients. After matched-pairs analysis, the final study population was 38 patients (19 study group and 19 controls). Clinical success did not differ significantly between the two populations: 63% for control group and 68% for the study group (p = 0.790). The median change in clinical score was - 3 [- 6; - 1] for the control group and - 3 [- 4; - 1] for the study group (p = 0.187). Grade 1 complications were reported in 15% of patients, with no major complications. CONCLUSIONS: Embolization was feasible, with a technical success of 100% and no major complications. Clinical success was obtained in 66% in patients with no difference when using combined embolization with particles and coils versus coils only.", "provenance": [ { "field": "n", "quote": "the final study population was 38 patients (19 study group and 19 controls)" }, { "field": "population", "quote": "patients undergoing embolization for chronic hemorrhoidal bleeding" }, { "field": "intervention", "quote": "embolization of the superior rectal arteries in patients with hemorrhoidal bleeding using particles and coils" }, { "field": "comparator", "quote": "versus coils only" }, { "field": "primaryOutcome", "quote": "Clinical success was defined as an improvement of > 2 points in the Paris bleeding severity score, without complications." }, { "field": "result", "quote": "Clinical success did not differ significantly between the two populations: 63% for control group and 68% for the study group (p = 0.790)." } ] }, { "id": "pmid:32306200", "pmid": "32306200", "doi": "10.1007/s11547-020-01194-y", "nctId": null, "pmcid": null, "title": "Emborrhoid in patients with portal hypertension and chronic hemorrhoidal bleeding: preliminary results in five cases with a new coiling release fashion \"Spaghetti technique\"", "firstAuthor": "Giurazza", "multipleAuthors": true, "journal": "Radiol Med", "year": 2020, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with liver cirrhosis causing portal hypertension and chronic anemia from internal hemorrhoid bleeding", "intervention": "embolization of hemorrhoidal arteries using coils released in a stretched 'Spaghetti technique'", "comparator": "none (no comparison group)", "primaryOutcome": "successful blocking of the bleeding artery, symptom improvement, and hemoglobin levels at 3 months", "result": "all arteries were successfully blocked, no complications, and 4 of 5 patients improved clinically with stable or improved blood counts", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a tiny uncontrolled case series of only five patients with no comparison group, so it cannot reliably show the treatment works.", "directness": "indirect", "limitations": "very small sample size, no control group, short follow-up, and patients had a specific cause of bleeding (portal hypertension) rather than typical hemorrhoids", "followUp": "3 months", "plainFinding": "Fewer bleeding symptoms after artery-blocking procedure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32306200/", "sourceText": "PURPOSE: This manuscript reports on a preliminary experience concerning emborrhoid in patients affected by cirrhotic portal hypertension; furthermore, a novel customized technique of coils release, named \"Spaghetti technique,\" is described. MATERIALS AND METHODS: Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated. Clinics and hemoglobin values were evaluated to objectively assess clinical conditions up to 3 months follow-up. Embolizations were performed with fibered coils, oversized, released stretched and not packed. RESULTS: Technical success, intended as occlusion of all superior hemorrhoidal artery branches, was 100%. In two patients, inferior hemorrhoidal arteries were embolized too. No patients reported major or minor complications. At 3-month follow-up, clinical improvement was obtained in four of the five patients; hemoglobin values improved or remained stable in the whole sample. CONCLUSIONS: Based on this limited experience, emborrhoid seems to be safe and effective at 3-month follow-up to improve symptoms in patients with cirrhotic portal hypertension and chronic anemia due to hemorroidal bleeding; the stretched fashion to release oversized coils provides effective embolization.", "provenance": [ { "field": "n", "quote": "Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated." }, { "field": "population", "quote": "patients affected by cirrhotic portal hypertension" }, { "field": "population", "quote": "Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated." }, { "field": "intervention", "quote": "Embolizations were performed with fibered coils, oversized, released stretched and not packed." }, { "field": "intervention", "quote": "a novel customized technique of coils release, named \"Spaghetti technique,\"" }, { "field": "comparator", "quote": "Five patients with chronic anemia due to internal hemorrhoidal bleeding and cirrhotic portal hypertension were treated." }, { "field": "primaryOutcome", "quote": "Clinics and hemoglobin values were evaluated to objectively assess clinical conditions up to 3 months follow-up." }, { "field": "result", "quote": "Technical success, intended as occlusion of all superior hemorrhoidal artery branches, was 100%." }, { "field": "result", "quote": "At 3-month follow-up, clinical improvement was obtained in four of the five patients; hemoglobin values improved or remained stable in the whole sample." } ] }, { "id": "pmid:32271744", "pmid": "32271744", "doi": "10.17116/hirurgia202003189", "nctId": null, "pmcid": null, "title": "[Submucosal laser ablation of internal hemorrhoids]", "firstAuthor": "Titov", "multipleAuthors": true, "journal": "Khirurgiia (Mosk)", "year": 2020, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with grade 2-3 internal hemorrhoids", "intervention": "submucosal laser ablation (SLT) of hemorrhoids", "comparator": "", "primaryOutcome": "", "result": "procedure was effective in 91.1-100% of cases at 6 months and 87.5-100% at 12 months, with some bleeding and other complications", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a review of small prospective trials without a comparison group, so it cannot reliably confirm the treatment works better than alternatives.", "directness": "indirect", "limitations": "abstract notes absence of clear recommendations on laser parameters, indications, and lack of long-term outcome data", "followUp": "12 months", "plainFinding": "Laser ablation effective for hemorrhoids", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32271744/", "sourceText": "OBJECTIVE: To analyze efficacy and safety of submucosal laser ablation of internal hemorrhoids (SLT). MATERIAL AND METHODS: Systematic review included 10 articles published in electronic databases PubMed, Cochrane Library, Elibrary until January 2019. There were only full-text publications from prospective clinical trials devoted to submucosal laser ablation in the treatment of hemorrhoids. Isolated SLT was used in 4 trials, combination with other minimally invasive procedures was reported in 6 reports. RESULTS: SLT was predominantly used in the treatment of hemorrhoids grade 2-3. Efficacy of procedure was 91.1-100% after 6 months and 87.5-100% after 12 months. Intra- and postoperative complications included intraoperative bleeding (8.4%), perianal and external piles edema (8.2%), postoperative bleeding (2.7%), urinary retention (1.2%), anal fistula (0.6%), perianal abscess (0.14%). CONCLUSION: Submucosal laser ablation is quite effective and safe option for treatment of hemorrhoids grade 2-3. However, further researches are required considering the absence of clear recommendations on laser beam parameters, indications for procedure and data on long-term outcomes.", "provenance": [ { "field": "population", "quote": "SLT was predominantly used in the treatment of hemorrhoids grade 2-3." }, { "field": "intervention", "quote": "submucosal laser ablation of internal hemorrhoids (SLT)" }, { "field": "result", "quote": "Efficacy of procedure was 91.1-100% after 6 months and 87.5-100% after 12 months." }, { "field": "result", "quote": "Intra- and postoperative complications included intraoperative bleeding (8.4%), perianal and external piles edema (8.2%), postoperative bleeding (2.7%), urinary retention (1.2%), anal fistula (0.6%), perianal abscess (0.14%)." }, { "field": "followUp", "quote": "after 12 months" }, { "field": "limitations", "quote": "further researches are required considering the absence of clear recommendations on laser beam parameters, indications for procedure and data on long-term outcomes" } ] }, { "id": "pmid:32250231", "pmid": "32250231", "doi": "10.2174/1574887115666200406121308", "nctId": null, "pmcid": null, "title": "Management of Hemorrhoidal Disease in Special Conditions: A Word of Caution", "firstAuthor": "Salusso", "multipleAuthors": true, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids who also have special conditions like inflammatory bowel disease, pregnancy, immunosuppression, bleeding disorders, liver disease with portal hypertension, or prior pelvic radiotherapy", "intervention": "various hemorrhoid treatments including medical therapy, outpatient procedures, and surgery (including hemorrhoidectomy)", "comparator": "different treatment approaches compared across these special patient subgroups", "primaryOutcome": "which treatment approach works best and is safest for hemorrhoids in these special patient groups", "result": "conservative medical treatment is recommended as first-line in most special conditions, with surgery reserved for selected or urgent cases; bleeding hemorrhoids can be treated with hemorrhoidectomy when other treatments fail, but caution is urged due to risk of serious complications", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "this is a narrative review of 'research and online contents' rather than a systematic search, and it repeatedly states there is very limited or insufficient data for these patient groups.", "directness": "indirect", "limitations": "The abstract itself states there is very limited data, a paucity of literature, and no consensus on best treatment for several of these subgroups.", "followUp": "", "plainFinding": "Conservative treatment preferred; surgery reserved for severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32250231/", "sourceText": "BACKGROUND: Hemorrhoids are a common disease that is often considered an easy problem to solve. Unfortunately, some particular clinical conditions, including Inflammatory Bowel Diseases (IBD), pregnancy, immunosuppression, coagulopathy, cirrhosis with portal hypertension, and proctitis after radiotherapy, challenge hemorrhoids management and the outcomes. METHODS: Research and online contents related to hemorrhoids' treatment in special conditions are reviewed in order to help colorectal surgeons in daily practice. RESULTS: There are very limited data about the outcomes of hemorrhoids treatment in these subgroups of patients. Patients in pregnancy can be effectively treated with medical therapy, reserving surgical intervention in highly selected and urgent cases. In case of thrombosed haemorrhoids, the excision allows a fast symptoms' resolution, with a low incidence of recurrence and a long remission interval. In case of immunosuppressed patients, there is no consensus for the best treatment, even in most HIV positive patients, a surgical procedure can be safely proposed when indicated. There is no sufficient data in the literature related to transplanted patients. The surgical treatment of hemorrhoids in patients with IBD, especially Crohn's Disease, can be unsafe, although there is a paucity of literature on this topic. In case of previous pelvic radiotherapy, it must always be considered that severe complications, like abscesses and fistulas with subsequent pelvic and retroperitoneal sepsis, can occur after surgical treatment of hemorrhoids, so a conservative treatment is advocated. Moreover, caution is recommended in treating patients with coagulopathy, considering possible complications (mostly bleeding) also after outpatient treatments. In case of portal hypertension and cirrhosis, a 'conservative treatment' is recommended. Bleeding hemorrhoids can be treated with hemorrhoidectomy when they do not respond to other treatments. CONCLUSION: International literature is very scant about the treatment of patients affected by hemorrhoids in particular situations. A word of caution and concern even about the indication for minor outpatient procedures must be expressed in these patients, in order to avoid possible life-threatening complications. The first-line treatment is the conservative medical approach associated with the treatment of the primary disease.", "provenance": [ { "field": "population", "quote": "Inflammatory Bowel Diseases (IBD), pregnancy, immunosuppression, coagulopathy, cirrhosis with portal hypertension, and proctitis after radiotherapy, challenge hemorrhoids management and the outcomes" }, { "field": "intervention", "quote": "The first-line treatment is the conservative medical approach associated with the treatment of the primary disease." }, { "field": "comparator", "quote": "Patients in pregnancy can be effectively treated with medical therapy, reserving surgical intervention in highly selected and urgent cases." }, { "field": "primaryOutcome", "quote": "There are very limited data about the outcomes of hemorrhoids treatment in these subgroups of patients." }, { "field": "result", "quote": "Bleeding hemorrhoids can be treated with hemorrhoidectomy when they do not respond to other treatments." }, { "field": "result", "quote": "In case of portal hypertension and cirrhosis, a 'conservative treatment' is recommended." }, { "field": "qualityWhy", "quote": "International literature is very scant about the treatment of patients affected by hemorrhoids in particular situations." } ] }, { "id": "pmid:32250230", "pmid": "32250230", "doi": "10.2174/1574887115666200406120245", "nctId": null, "pmcid": null, "title": "Hemorrhoidal Laser Procedure (HeLP) and Hemorrhoidal Laser Procedure + Mucopexy (HeLPexx) and Other Emerging Technologies", "firstAuthor": "Giamundo", "multipleAuthors": false, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with symptomatic hemorrhoids", "intervention": "laser closure of the artery branches feeding the hemorrhoids (HeLP), sometimes combined with stitching to lift prolapsed tissue (HeLPexx)", "comparator": "not specified in the abstract", "primaryOutcome": "relief of hemorrhoid symptoms, including bleeding", "result": "described as helping resolve symptoms, especially bleeding, when combined with mucopexy for prolapse", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive overview of procedures without any patient numbers, comparison group, or measured outcomes.", "directness": "direct", "limitations": "No study data, numbers, or controlled comparisons are given; the abstract only describes how the procedures work and when they are used.", "followUp": "", "plainFinding": "Laser artery closure may ease bleeding.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32250230/", "sourceText": "BACKGROUND: Minimally-invasive treatments for hemorrhoids should be encouraged as they cause low morbidity, reasonable discomfort and quicker return to work. According to the \"vascular theory\", hemorrhoidal disease is mainly caused by blood overflow into hemorrhoidal plexus deriving from the superior hemorrhoidal arteries. INTRODUCTION: Many different procedures have been described in the literature with the common goal of reducing the blood flow into the hemorrhoidal piles. 'HeLP' (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids. METHODS: The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform. The arteries, at that level, have variable location and distribution. Therefore, a doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required in most cases and the procedure allows a quick return to daily activities. In the case of concomitant severe mucosal prolapse, laser treatment can be combined with suture mucopexy. Three to six running sutures allow a complete lifting of hemorrhoidal piles, securing a long-term resolution of symptoms. RESULTS: 'HeLP' is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The addition of mucopexy to laser treatment (HeLPexx) contributes to the overall resolution of symptoms when mucosal prolapse is an issue. CONCLUSION: Emborrhoid is another novel, 'hi-tech' form of selective dearterialization used in selected cases of hemorrhoids where the main symptom is bleeding. It is generally used in cases where surgery is contraindicated due to severe concomitant diseases.", "provenance": [ { "field": "population", "quote": "patients suffering from symptomatic hemorrhoids" }, { "field": "intervention", "quote": "The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform." }, { "field": "comparator", "quote": "'HeLP' is indicated in patients with symptomatic hemorrhoids where conservative treatment failed" }, { "field": "primaryOutcome", "quote": "securing a long-term resolution of symptoms" }, { "field": "result", "quote": "The addition of mucopexy to laser treatment (HeLPexx) contributes to the overall resolution of symptoms when mucosal prolapse is an issue." }, { "field": "result", "quote": "Emborrhoid is another novel, 'hi-tech' form of selective dearterialization used in selected cases of hemorrhoids where the main symptom is bleeding." } ] }, { "id": "pmid:32191669", "pmid": "32191669", "doi": "10.23750/abm.v91i1.9361", "nctId": null, "pmcid": "PMC7569574", "title": "Treatment of haemorrhoidal disease with micronized purified flavonoid fraction and sucralfate ointment", "firstAuthor": "Amaturo", "multipleAuthors": true, "journal": "Acta Biomed", "year": 2020, "design": "case-series", "n": 3, "nField": "reported", "population": "people with hemorrhoidal disease (swollen rectal veins)", "intervention": "combined oral MPFF (flavonoid) tablet plus a sucralfate‑and‑herbal rectal ointment", "comparator": "", "primaryOutcome": "control of pain, itching and swelling", "result": "good results in terms of pain and itching control and in edema reduction", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a tiny report of only three patients with no control group, so it cannot reliably show the treatment works.", "directness": "indirect", "limitations": "Only three patients were described, with no comparison group and no mention of bleeding outcomes.", "followUp": "", "plainFinding": "Less pain, itching, swelling; bleeding not reported", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32191669/", "sourceText": "Hemorrhoidal disease is a very common disease characterized by the presence of a mucous prolapse of the rectum and by varicosis of the hemorrhoidal plexus. Medical therapy is mainly indicated for the treatment of symptoms such as bleeding, pain and itching. The use of the micronized purified flavonoid fraction (MPFF) has proven to be effective in treating symptoms of hemorrhoidal disease. Topical use of sucralfate has shown good results in the reduction of hemorrhoidal pain and itching. Our experience with three cases treated with combined use of MPFF and a topical medical device in the form of rectal ointment, composed by sucralfate and herbal (calendula, witch hazel leaf (hamamelis), chamomile) extracts, has shown good results in terms of pain and itching control and in edema reduction.", "provenance": [ { "field": "n", "quote": "Our experience with three cases treated with combined use of MPFF and a topical medical device" }, { "field": "population", "quote": "Hemorrhoidal disease is a very common disease characterized by the presence of a mucous prolapse of the rectum and by varicosis of the hemorrhoidal plexus." }, { "field": "intervention", "quote": "combined use of MPFF and a topical medical device in the form of rectal ointment, composed by sucralfate and herbal (calendula, witch hazel leaf (hamamelis), chamomile) extracts" }, { "field": "primaryOutcome", "quote": "has shown good results in terms of pain and itching control and in edema reduction" }, { "field": "result", "quote": "has shown good results in terms of pain and itching control and in edema reduction" } ] }, { "id": "pmid:32189597", "pmid": "32189597", "doi": "10.2174/1574887115666200319153439", "nctId": null, "pmcid": null, "title": "Excisional Haemorrhoidectomy: Where Are We?", "firstAuthor": "Sena", "multipleAuthors": true, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hemorrhoids (anal cushion enlargement/prolapse)", "intervention": "excisional hemorrhoidectomy surgery (Milligan and Morgan, Parks, Ferguson, Whitehead techniques)", "comparator": "conservative (non-surgical) treatments", "primaryOutcome": "effectiveness of treatment for hemorrhoidal disease", "result": "excisional hemorrhoidectomy techniques are the most effective treatment for grade III and IV hemorrhoids", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review describing surgical techniques without original data, numbers, or statistical comparison.", "directness": "indirect", "limitations": "abstract gives no study numbers, methodology, or data on bleeding specifically; it is a general review of surgical techniques, not a controlled comparison.", "followUp": "", "plainFinding": "Surgery works best for severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32189597/", "sourceText": "Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions and is one of the most frequent and ancient anorectal conditions. Bleeding, during or after defecation, is the most common symptom. The color of the blood is typically bright red covering the outer surface of the stools. The severity of HD is based on the degree of the prolapse. There are several excisional surgery treatments. In this review, we describe the most common techniques such as Milligan and Morgan, Parks, Ferguson and Whitehead technique. Despite significant improvements in conservative treatments, excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree.", "provenance": [ { "field": "population", "quote": "Haemorrhoidal disease (HD) is defined as the symptomatic enlargement and/or distal displacement of anal cushions" }, { "field": "intervention", "quote": "such as Milligan and Morgan, Parks, Ferguson and Whitehead technique" }, { "field": "comparator", "quote": "Despite significant improvements in conservative treatments" }, { "field": "primaryOutcome", "quote": "excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree" }, { "field": "result", "quote": "excisional haemorrhoidectomy techniques are the most effective treatment for III- and IV degree" } ] }, { "id": "pmid:32167429", "pmid": "32167429", "doi": "10.2174/1574887115666200313102246", "nctId": null, "pmcid": null, "title": "Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients", "firstAuthor": "Moggia", "multipleAuthors": true, "journal": "Rev Recent Clin Trials", "year": 2021, "design": "case-series", "n": 16, "nField": "reported", "population": "patients with chronic rectal bleeding caused by hemorrhoids", "intervention": "embolization (blocking) of the superior rectal arteries using coils", "comparator": "none (single-group outcome study)", "primaryOutcome": "reduction in rectal bleeding and quality of life, plus safety/complications", "result": "bleeding improved with better quality of life in 14 of 16 patients, no complications up to 12 months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small, uncontrolled study with no comparison group, so results could be due to chance or natural improvement.", "directness": "direct", "limitations": "Small sample of only 16 patients, no control group, described by authors as preliminary.", "followUp": "12 months", "plainFinding": "Artery-blocking procedure reduced hemorrhoid bleeding, no complications.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32167429/", "sourceText": "BACKGROUND: Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. OBJECTIVE: The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. METHODS: From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5%). RESULTS: No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). CONCLUSION: Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.", "provenance": [ { "field": "n", "quote": "a total of 16 patients" }, { "field": "population", "quote": "16 patients with chronic rectal bleeding due to hemorrhoids" }, { "field": "intervention", "quote": "super-selective embolization of the superior rectal arteries" }, { "field": "comparator", "quote": "embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids" }, { "field": "primaryOutcome", "quote": "The reduction of rectal bleeding with improvement of the quality of life" }, { "field": "result", "quote": "The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%)." }, { "field": "result", "quote": "No post-procedural and short-term complications were observed at maximum follow up (12 months)." }, { "field": "followUp", "quote": "maximum follow up (12 months)" } ] } ], "faqs": [ { "q": "Why is my hemorrhoid bleeding?", "a": "Hemorrhoids are swollen blood vessels in and around the anus, and their surface can wear thin or tear, especially as stool passes over them. The studies in this review test ways to stop that bleeding rather than explain the biology behind it, so the exact mechanism wasn't directly studied here." }, { "q": "Can internal hemorrhoids bleed?", "a": "Yes. Many of the studies in this review specifically treated internal hemorrhoids where bleeding was the main symptom, including grade I through grade IV disease, and measured whether that bleeding stopped after treatment." }, { "q": "How long do internal hemorrhoids bleed?", "a": "This varies and isn't firmly pinned down by the evidence. In one trial, injection sclerotherapy stopped bleeding in about 6 in 10 people after one session and about 9 in 10 after a second session within a few months; other studies saw improvement within one to four weeks of starting treatment. Ongoing bleeding should be checked by a doctor rather than waited out." }, { "q": "How do I stop internal hemorrhoids from bleeding?", "a": "In these studies, office-based treatments such as rubber band ligation and sclerotherapy injections stopped or reduced bleeding in most people treated, and oral vein-supporting medicines (flavonoids) also reduced bleeding compared with placebo or routine care. Surgery was used for more severe cases and controlled bleeding well, but came with more pain and its own bleeding risk." }, { "q": "When should I see a doctor about hemorrhoid bleeding?", "a": "Rectal bleeding can come from causes other than hemorrhoids, so it's worth getting checked, especially if it's heavy, persistent, painful, or you're over 45 or feel dizzy or unusually tired. The studies here only looked at people whose bleeding had already been confirmed to be from hemorrhoids." } ], "searchedAs": [ "why is my hemorrhoid bleeding", "how to stop hemorrhoids from bleeding", "how to stop internal hemorrhoids from bleeding", "can internal hemorrhoids bleed", "how to treat bleeding hemorrhoids", "how to treat internal hemorrhoids bleeding", "how long do internal hemorrhoids bleed" ], "patientTakeaway": "If a doctor has confirmed your bleeding is from hemorrhoids, several options in these studies — rubber band ligation, injection sclerotherapy, vein-supporting medicines, and surgery for more severe cases — reduced or stopped that bleeding for most people treated. Get any new or ongoing rectal bleeding checked first, since these studies only enrolled people whose diagnosis was already confirmed, then ask about banding or sclerotherapy as well-studied first steps before considering surgery.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "Hemorrhoids[Mesh] AND (Hemorrhage[Mesh] OR bleeding[tiab] OR hematochezia[tiab]) AND (therapy[Mesh] OR treatment[tiab] OR ligation[tiab] OR sclerotherapy[tiab] OR hemorrhoidectomy[tiab] OR \"infrared coagulation\"[tiab] OR fiber[tiab])" }, "pubmedQueryTranslation": "\"hemorrhoids\"[MeSH Terms] AND (\"hemorrhage\"[MeSH Terms] OR \"bleeding\"[Title/Abstract] OR \"hematochezia\"[Title/Abstract]) AND (\"therapeutics\"[MeSH Terms] OR \"treatment\"[Title/Abstract] OR \"ligation\"[Title/Abstract] OR \"sclerotherapy\"[Title/Abstract] OR \"hemorrhoidectomy\"[Title/Abstract] OR \"infrared coagulation\"[Title/Abstract] OR \"fiber\"[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. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Why Do Hemorrhoids Bleed, and What Stops It?", "description": "See what 26 randomised trials and other studies show about why hemorrhoids bleed and which treatments actually stop it, from banding to medicine." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }