To evaluate the diagnostic value of different sonographic methods in hemorrhoids.

Forty-two healthy volunteers and sixty-two patients with grades I-IV hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades III and IV hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen’s kappa coefficient.

All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a “mosaic pattern”. In patients with grades III and IV hemorrhoids, the number of patients with “mosaic pattern” as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a “mosaic pattern” in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz’s muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen’s kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between “mosaic pattern” in the TPUS and arteriovenous fistula in pathology was very good (ĸ = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05).

Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a “mosaic pattern” in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. “Mosaic pattern” may be a parameter for surgical indication of grades III and IV hemorrhoids.

• Hemorrhoids
• anal cushion
• transperianal
• transrectal
• transvaginal
• sonography

• Adult
• Aged
• Anal Canal/diagnostic imaging
• Anal Canal/surgery
• Case-Control Studies
• Female
• Hemorrhoids/diagnostic imaging
• Hemorrhoids/surgery
• Humans
• Male
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Treatment Outcome
• Ultrasonography
• Young Adult

In cases of haemorrhoidal disease resistant to conservative treatment, surgical treatment is necessary to relieve the symptoms.

To investigate the current methods used by Polish surgeons.

Surveys were distributed to members of the Association of Polish Surgeons (APS), in which participants were asked a number of closed-ended questions regarding haemorrhoidal disease and the way they treated suffering patients

Out of the 1523 members of APS who received questionnaires, responses were received from 807 (52.9%) members. The Milligan-Morgan technique was indicated by 72.5% of surgeons as a leading surgical treatment, followed by Ligasure (15.5%), Ferguson (3.5%), DGHL (3.5%), other methods (3.5%), Parks (1.7%), and Longo (0%). The majority of participants (93%) indicated from 0 to 1 life threatening complications, 5% – from 2 to 3, and 2% > 4. A total of 83% of participants use a single dose of antibiotics prior to surgery.

The Milligan-Morgan technique is the preferred method. The majority of procedures are performed in regional hospitals and university departments, and less commonly in private practices. The vast majority of surgeons in Poland are not convinced about the stapler technique, justifying this fact with the possibility of developing serious complications

• haemorrhoids
• surgery
• treatment

• Doppler
• HemorPex System (HPS)
• Hemorrhoids
• Muco-hemorrhoidopexy

• Adult
• Aged
• Anal Canal/surgery
• Digestive System Surgical Procedures/instrumentation
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/psychology
• Equipment Design
• Follow-Up Studies
• Hemorrhoids/pathology
• Hemorrhoids/psychology
• Hemorrhoids/surgery
• Humans
• Ligation/instrumentation
• Ligation/methods
• Ligation/psychology
• Male
• Middle Aged
• Operative Time
• Pain, Postoperative/epidemiology
• Pain, Postoperative/etiology
• Patient Satisfaction
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Period
• Rectal Prolapse/epidemiology
• Rectal Prolapse/etiology
• Reoperation/statistics & numerical data
• Time Factors
• Treatment Outcome
• Young Adult

To describe patients developing grade III and IV hemorrhoids requiring surgery after laparoscopic ventral mesh rectopexy (LVMR) and to explore the relationship between developing such hemorrhoids and recurrence of rectal prolapse after LVMR.

All consecutive patients receiving LVMR at the Meander Medical Centre, Amersfoort, the Netherlands, between 2004 and 2013 were analyzed. Kaplan–Meier estimates were calculated for recurrences.

A total of 420 patients underwent LVMR. Sixty-five of these patients (actuarial 5-year incidence 24.3, 95 % confidence interval (CI) 18.6–30.0) developed symptomatic grade III/IV hemorrhoids requiring stapled or excisional hemorrhoidectomy. Re-do surgery for recurrent grade III/IV hemorrhoids was required for 15 of the 65 patients (actuarial 5-year recurrence rate 40.6, 95 % CI 23.2–58.0) after the primary hemorrhoidectomy. Three of the 65 patients developed an external rectal prolapse (ERP) recurrence and eight an internal rectal prolapse (IRP) recurrence. This generated a 5-year recurrence rate of 25.3 % (95 % CI 0–53.9) for ERP recurrence and 24.4 % (95 % CI 9.1–39.7) for IRP recurrence. The rest of the LVMR cohort not receiving additional surgery for hemorrhoids (n = 355) showed significantly lower actuarial 5-year ERP (0.8 %, p = 0.011) and IRP (11 %, p = 0.020) recurrence rates.

High-grade hemorrhoids requiring surgery may be common after LVMR. The development of high-grade hemorrhoids after LVMR might be considered a predictor of rectal prolapse recurrence.

• Hemorrhoidectomy
• Hemorrhoids
• Laparoscopic ventral mesh rectopexy
• Rectal prolapse
• Recurrence

Procedure for prolapse and hemorrhoids (PPH) is a new surgical technique that was developed based on the modern concept of internal hemorrhoids. It has gained wide acceptance as the treatment of choice for grade III and IV internal hemorrhoids, because of less postoperative pain and faster return to normal activities. Here we perform a systematic review on the recent advances in PPH for grade III and IV internal hemorrhoids.

• Procedure for prolapse and hemorrhoids
• Internal hemorrhoids
• Efficacy

• Adult
• Aged
• Anal Canal/blood supply
• Anal Canal/diagnostic imaging
• Anal Canal/pathology
• Blood Flow Velocity
• Case-Control Studies
• Dilatation, Pathologic
• Female
• Hemorrhoids/physiopathology
• Hemorrhoids/surgery
• Humans
• Immunohistochemistry
• Intestinal Mucosa/pathology
• Male
• Microscopy, Electron, Scanning
• Middle Aged
• Muscle, Smooth/blood supply
• Muscle, Smooth/pathology
• Rectum/blood supply
• Rectum/diagnostic imaging
• Rectum/pathology
• Ultrasonography
• Veins/pathology

• Fissure in Ano/diagnosis
• Fissure in Ano/etiology
• Fissure in Ano/therapy
• Hemorrhoids/diagnosis
• Hemorrhoids/etiology
• Hemorrhoids/therapy
• Humans

• Diagnosis, Differential
• Global Health
• Hemorrhoids/diagnosis
• Hemorrhoids/epidemiology
• Hemorrhoids/therapy
• Humans
• Incidence
• Ligation/methods
• Proctoscopy
• Sclerotherapy/methods
• Vascular Surgical Procedures/methods