• Anal canal
• Hemorrhoids
• Modified stapled hemorrhoidopexy
• Postoperative anal stenosis
• Prolapse

• Endoscopic polidocanol foam sclerobanding
• Hemorrhoids
• Hemorrhoids recurrence
• Injection sclerotherapy
• Post-operative pain
• Rubber band ligation

• Humans
• Polidocanol/administration & dosage
• Polidocanol/therapeutic use
• Hemorrhoids/therapy
• Hemorrhoids/surgery
• Hemorrhoids/diagnosis
• Sclerotherapy/methods
• Sclerotherapy/adverse effects
• Sclerosing Solutions/administration & dosage
• Sclerosing Solutions/therapeutic use
• Treatment Outcome
• Patient Satisfaction
• Recurrence
• Pain, Postoperative/etiology
• Pain, Postoperative/diagnosis
• Pain, Postoperative/prevention & control
• Randomized Controlled Trials as Topic
• Ligation/methods
• Polyethylene Glycols/therapeutic use
• Polyethylene Glycols/administration & dosage
• Endoscopy/methods
• Cost-Benefit Analysis

• Anal canal
• Hemorrhoids
• Modified stapled hemorrhoidopexy
• Postoperative anal stenosis
• Prolapse
• Stapled hemorrhoidopexy

• Anal symptoms
• Haemorrhoids
• Maternal health
• Pregnancy
• Social media

• Humans
• Female
• Pregnancy
• Hemorrhoids/epidemiology
• Adult
• Pregnancy Complications/epidemiology
• Pregnancy Complications/psychology
• Surveys and Questionnaires
• Retrospective Studies
• Risk Factors
• Incidence
• Dietary Fiber/administration & dosage
• Young Adult
• Social Media/statistics & numerical data
• Constipation/epidemiology
• Diagnostic Self Evaluation

• Hemorrhoid disease
• Randomized controlled trial
• Sodium pentaborate pentahydrate

• Doctors
• Hemorrhoidal disease
• MPFF
• Oral medication
• Survey

• Humans
• Hemorrhoids/therapy
• Hemorrhoids/drug therapy
• Tertiary Care Centers
• Cities
• Surveys and Questionnaires
• Internet
• China/epidemiology

• 2022-PUMCH-C-005 National High Level Hospital Clinical Research Funding
• 2022-PUMCH-C-005 National High Level Hospital Clinical Research Funding
• 2022-PUMCH-C-005 National High Level Hospital Clinical Research Funding
• 2022-PUMCH-C-005 National High Level Hospital Clinical Research Funding

• Humans
• Hemorrhoids/surgery
• Polidocanol/therapeutic use
• Sclerotherapy
• Prospective Studies
• Pilot Projects
• Arteries

• HeLP
• diode laser
• haemorrhoidectomy
• haemorrhoidplasty
• haemorrhoids

• Hemorrhoidal artery ligation
• Hemorrhoids
• Milligan–Morgan hemorrhoidectomy
• Rectoanal repair

Hemorrhoids are abnormal collections of engorged blood vessels and tissue within the anal canal or surrounding the anus. Management consists of conservative treatment or a hemorrhoidectomy, dependent on disease severity, duration, and physician discretion. Reported is a case of a 44-year-old, African American female initially treated conservatively for intero-external hemorrhoids, that later abscessed into the ischio-anal fossa and was further complicated by an infection of the deep pelvic space. This report explores conservative and surgical management of hemorrhoids, and offers recommendations for symptom management, and reducing disease progression and complications.

• Hemorrhoidal disease
• VEINES-Sym questionnaire
• chronic venous disease
• varicose vein
• venous leg symptoms

• epidemiology
• hemorrhoid
• online survey
• prevalence
• treatment pathway
• venoactive drug

This report presents a 74-year-old renal transplant patient suffering of polymorphic-post-transplant-associated lymphoproliferative disease (P-PTLD) within an Eppstein-Barr Virus (EBV) associated mucocutaneous rectal ulcer (MCU). He was initially treated by stapled hemorrhoidopexy for a symptomatic grade III hemorrhoidal prolapse refractory to conservative treatment and rubber band ligations. This leads to severe urge, frequency and stool fragmentation. The symptoms were investigated with a number of interventions until a proctoscopy with biopsies finally revealed the diagnosis. The patient had triple therapy of tacrolimus, mycophenolate mofetil and prednisone initially after transplant several years ago with recent reduction to mycophenolate. The MCU was successfully treated with Retuximab and there was no sign of relaps after 6 months. As EBV-associated PTLD is a well known complication after renal transplant, rectum-MCU seems a rare and only recently described subform of this disease that should be excluded in case of ulcerating lesions in immunosuppressed patients.

• Classification system
• Colorectal surgery
• Pilonidal sinus disease

• Humans
• Pilonidal Sinus/classification
• Pilonidal Sinus/surgery
• Prognosis

• HTA/17/17/02 Department of Health

• Hemorrhoids
• Meta-analysis
• Randomized clinical trials
• Stapled hemorrhoidopexy
• Transanal hemorrhoidal dearterialization

• acupuncture
• hemorrhoidectomy
• hemorrhoids
• postoperative pain

• anal disorders
• guidelines
• hemorrhoidectomy
• hemorrhoids

Controversies and disagreement exist on conventional treatment strategies of hemorrhoids due to relapse, inefficacy, and complications. We intend to evaluate the role of individualized homeopathic treatment in hemorrhoids.

In this prospective, open, observational trial, hemorrhoids patients were treated using five standardized scales measuring complaints severity and anoscopic score. It was conducted at two homeopathic hospitals in India, during from mid-July 2014 to mid-July 2015. Patients were intervened as per individualized homeopathic principles and followed up every month up to 6 months.

Total 73 were screened, 52 enrolled, 38 completed, 14 dropped out. Intention to treat population (n: = 52) was analyzed in the end. Statistically significant reductions of mean bleeding (month 3: −21.8, 95% confidence interval [CI]: −30.3, −13.3, P: < 0.00001, d = 0.787; month 6: −25.5, 95% CI −35.4, −15.6, P: < 0.00001, d = 0.775), pain (month 3: −21.3, 95% CI −28.6, −14.0, P: < 0.00001, d = 0.851; month 6: −27.6, 95% CI −35.6, −19.6, P: < 0.00001, d = 1.003), heaviness visual analog scales (VASs) (month 3: −8.1, 95% CI −13.9, −2.3, P: = 0.008, d = 0.609; month 6: −12.1, 95% CI −19.1, −5.1, P: = 0.001, d = 0.693), and anoscopic score (month 3: −0.4, 95% CI −0.6, −0.2, P: < 0.0001, d = 0.760; month 6: −0.5, 95% CI −0.7, −0.3, P: < 0.0001, d = 0.703) were achieved. Itching VASs reduced significantly only after 6 months (−8.1, 95% CI −14.6, −1.6, P: = 0.017, d = 0.586). No significant lowering of discharge VASs was achieved after 3 and 6 months.

Under classical homeopathic treatment, hemorrhoids patients improved considerably in symptoms severity and anoscopic scores. However, being observational trial, our study cannot provide efficacy data. Controlled studies are required. Trial Reg. CTRI/2015/07/005958.

• Hemorrhoids
• homeopathy
• observational trial
• visual analog scales

• Abscess/diagnosis
• Abscess/therapy
• Anal Canal/pathology
• Anus Diseases/diagnosis
• Anus Diseases/therapy
• Defecation
• Dietary Fiber
• Fecal Incontinence/diagnosis
• Fecal Incontinence/therapy
• Fissure in Ano/diagnosis
• Fissure in Ano/therapy
• Hemorrhoids/diagnosis
• Hemorrhoids/therapy
• Humans
• Physical Examination
• Pruritus Ani/diagnosis
• Pruritus Ani/therapy
• Rectal Diseases/diagnosis
• Rectal Diseases/therapy
• Rectal Fistula/diagnosis
• Rectal Fistula/therapy
• Rectum/pathology

Background. We aimed to evaluate the effectiveness of a suture-fixation mucopexy procedure by comparing with Doppler-guided hemorrhoidal artery ligation (DGHAL) in the management of patients with grade III hemorrhoids. Methods. This was a randomized controlled trial. One hundred patients with grade III hemorrhoids were randomly assigned to receive suture-fixation mucopexy (n = 50) or DGHAL (n = 50). Outcome assessments were performed at 2 weeks, 12 months, and 24 months. Assessments included resolution of clinical symptoms, postoperative complications, duration of hospitalization, and total costs. Results. At 2 weeks, one (2%) patient in suture-fixation group and four (8%) patients in DGHAL group had persistent prolapsing hemorrhoids. Postoperative bleeding was observed in two patients (4%) in suture-fixation group and one patient in DGHAL group. There was no significant difference in short-term recurrence between groups. Postoperative complications and duration of hospitalization were comparable between the two groups. Rates of recurrence of prolapse or bleeding at 12 months did not differ between groups. However, recurrence of prolapse at 24 months was significantly more common in DGHAL group (19.0% versus 2.3%, p = 0.030). Conclusions. Compared with DGHAL, the suture-fixation mucopexy technique had comparable short-term outcomes and favorable long-term outcomes.

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

AIM: To describe the anal cushion lifting (ACL) method with preliminary clinical results.

METHODS: Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher’s classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or the ligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery.

RESULTS: A total of 127 patients were enrolled. Their median age was 42 (19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median follow-up period was 26 (0-88) mo, and the median operative time was 15 (4-30) min. After surgery, analgesics were used for a median period of three days (0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients’ postoperative hospital stay was 7 (2-13) d. A total of 10 complications (7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred.

CONCLUSION: We consider that the ACL method might be better than all other current methods for managing hemorrhoids.

• Hemorrhoidectomy
• Anal stenosis
• Anal cushion lifting method

Hemorrhoids is recognized as one of the most common medical conditions in general population. It is clinically characterized by painless rectal bleeding during defecation with or without prolapsing anal tissue. Generally, hemorrhoids can be divided into two types: internal hemorrhoid and external hemorrhoid. External hemorrhoid usually requires no specific treatment unless it becomes acutely thrombosed or causes patients discomfort. Meanwhile, low-graded internal hemorrhoids can be effectively treated with medication and non-operative measures (such as rubber band ligation and injection sclerotherapy). Surgery is indicated for high-graded internal hemorrhoids, or when non-operative approaches have failed, or complications have occurred. Although excisional hemorrhoidectomy remains the mainstay operation for advanced hemorrhoids and complicated hemorrhoids, several minimally invasive operations (including Ligasure hemorrhoidectomy, doppler-guided hemorrhoidal artery ligation and stapled hemorrhoidopexy) have been introduced into surgical practices in order to avoid post-hemorrhiodectomy pain. This article deals with some fundamental knowledge and current treatment of hemorrhoids in a view of a coloproctologist - which includes the management of hemorrhoids in complicated situations such as hemorrhoids in pregnancy, hemorrhoids in immunocompromised patients, hemorrhoids in patients with cirrhosis or portal hypertension, hemorrhoids in patients having antithrombotic agents, and acutely thrombosed or strangulated hemorrhoids. Future perspectives in the treatment of hemorrhoids are also discussed.

• Hemorrhoids
• Pathophysiology
• Treatment
• Outcome
• Complication

• Hemorrhoidectomy/adverse effects
• Hemorrhoids/diagnosis
• Hemorrhoids/physiopathology
• Hemorrhoids/surgery
• Humans
• Ligation
• Risk Factors
• Risk Reduction Behavior
• Sclerotherapy
• Treatment Outcome

• Dietary Fiber/administration & dosage
• Female
• Hemorrhoids/classification
• Hemorrhoids/diagnosis
• Hemorrhoids/therapy
• Humans
• Ligation
• Middle Aged
• Practice Guidelines as Topic
• Sclerotherapy
• Thrombectomy

This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs. Non-operative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when non-operative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are thoroughly discussed.

• Hemorrhoids
• Pathophysiology
• Treatment
• Management
• Outcome

• Anus Neoplasms/pathology
• Carcinoma in Situ/pathology
• Hemorrhoids/pathology
• Hemorrhoids/surgery
• Humans
• Terminology as Topic