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Gravante G. Sclerotherapy for hemorrhoidal disease: Recent evolutions of an oldies goldy. World J Gastroenterol 2025; 31:98704. [PMID: 40062327 PMCID: PMC11886522 DOI: 10.3748/wjg.v31.i8.98704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 12/19/2024] [Accepted: 12/30/2024] [Indexed: 01/23/2025] Open
Abstract
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.
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Affiliation(s)
- Gianpiero Gravante
- Department of General Surgery, Azienda Sanitaria Locale (ASL) Lecce, Casarano 73042, Lecce, Italy
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Wang X, Wu X, Wen Q, Cui B, Zhang F. Shifting Paradigms in Hemorrhoid Management: The Emergence and Impact of Cap-Assisted Endoscopic Sclerotherapy. J Clin Med 2024; 13:7284. [PMID: 39685741 PMCID: PMC11641974 DOI: 10.3390/jcm13237284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 11/26/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024] Open
Abstract
Hemorrhoidal disease (HD) is a prevalent proctological condition that has puzzled people since ancient times, and the most common symptom is painless bleeding. Traditional treatments include conservative treatment, nonsurgical office-based treatments, and surgery. Sclerotherapy is one of the oldest forms of nonoperative intervention and is widely used to treat internal hemorrhoids with the development of endoscopy technology. However, sclerotherapy is always accompanied by complications such as bleeding, pain, abscess, etc., when the sclerosant is injected into the wrong site. Cap-assisted endoscopic sclerotherapy (CAES), a new minimally invasive technology, was first time coined in 2015 for the treatment of hemorrhoidal disease. The left-posterior-right-anterior (LPRA) anus positioning method under endoscopy provides reliable methodological support for advancing hemorrhoidal treatment via endoscopy. The current trend is that treatment for HD has shifted from being performed predominantly by the Department of Proctology Surgery to being managed mostly by the Department of Gastroenterology. This review reviewed the shifting paradigms of sclerotherapy for HD and discussed the emerging development of CAES.
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Affiliation(s)
- Xianglu Wang
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; (X.W.); (X.W.); (Q.W.); (B.C.)
- Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Xia Wu
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; (X.W.); (X.W.); (Q.W.); (B.C.)
- Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Quan Wen
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; (X.W.); (X.W.); (Q.W.); (B.C.)
- Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Bota Cui
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; (X.W.); (X.W.); (Q.W.); (B.C.)
- Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
| | - Faming Zhang
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China; (X.W.); (X.W.); (Q.W.); (B.C.)
- Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China
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Xu W, Xia G, Dong L, Zhu Y. Effect of lidocaine on postoperative analgesia of endoscopic rubber band ligation combined with injection sclerotherapy for treatment of internal hemorrhoids: A retrospective study (with video). Arab J Gastroenterol 2024; 25:165-169. [PMID: 38403495 DOI: 10.1016/j.ajg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 10/28/2023] [Accepted: 01/06/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic minimally invasive treatment of internal hemorrhoids may cause postoperative pain. The aim of the study is to investigate the analgesic effect of lidocaine plus lauromacrogol on postoperative pain caused by endoscopic rubber band ligation (ERBL) combined with injection sclerotherapy (IS) for internal hemorrhoids treatment. PATIENTS AND METHODS Clinical data of grade Ⅲ internal hemorrhoids patients who underwent ERBL combined with IS in department of Digestive Medicine, Shenzhen Hospital of Southern Medical University, were retrospectively analyzed. According to difference in the composition of sclerosing solution, the patients were divided into control group (lauromacrogol group, 46 patients) and study group (lidocaine plus lauromacrogol group, 20 patients). Postoperative pain (quantized by Visual Analogue Scale, VAS), pain relief time and postoperative adverse reactions were compared. The therapeutic effect was followed up 1 month after operation. RESULTS VAS of postoperative pain was 0.80 ± 0.42 points and pain relief time was 0.90 ± 0.56 days in the study group, while VAS of postoperative pain was 4.11 ± 1.37 points and pain relief time was 2.57 ± 0.83 days in the control group, there was statistical difference between them (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions and follow-up therapeutic effect between the control group and the study group. CONCLUSION Lidocaine plus lauromacrogol is useful for pain alleviation on ERBL combined with IS for internal hemorrhoids treatment because of its convenient procedure, low adverse reaction incidence and good therapeutic effect, which is worthy of promotion.
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Affiliation(s)
- Wen Xu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Guili Xia
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ling Dong
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China
| | - Ying Zhu
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong, China.
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Pata F, Tutino R, Picciariello A, Cantarella F. Editorial: Colorectal surgery and proctology: past, present, and future. Front Surg 2024; 11:1373867. [PMID: 38371881 PMCID: PMC10870640 DOI: 10.3389/fsurg.2024.1373867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Department of Surgery, AO Annunziata, Cosenza, Italy
| | - Roberta Tutino
- Department of General and Emergency Surgery, AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | | | - Francesco Cantarella
- CPEP (Centre for Proctology and Perineology), Ospedali Privati Forlì, Forlì, Italy
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Pata F, Bracchitta LM, Nardo B, Gallo G, D’Ambrosio G, Bracchitta S. Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study. Front Surg 2023; 10:1290706. [PMID: 38026482 PMCID: PMC10657801 DOI: 10.3389/fsurg.2023.1290706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Around 20% of population in western countries is under anticoagulant treatment. However, there is paucity of evidence about the treatment of HD in patients under anticoagulant/antiplatelet therapy, although both suspension and continuation in the perioperative period may increase the risk of severe complications. The aim of this pilot study was to confirm the feasibility and safety of sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy), an office-based procedure, for the treatment of second-and third-degree HD in patients under anticoagulant/antiplatelet therapy without suspension. MATERIALS AND METHODS Patients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled between November 2019 and October 2021. Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated. RESULTS Fifty-one patients were recruited, 23 female (45.1%) and 28 male (54.9%), with an average age of 65 years ± 11.4 SD (range 42-90). Twenty-seven patients (52.9%) had II-degree haemorrhoidal disease, and 24 (47.1%) had grade III-degree. The most frequently taken medications were dual antiplatelet therapy (51%) and new oral anticoagulants (NOACs) (21.6%). The mean follow-up was 23 months. No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported. Postoperative complications were not statistically significantly associated with the number of nodules treated (1, 2, or 3), the disease grade (2nd vs. 3rd) or the specific anticoagulant/antiplatelet regimen. During follow-up, 2 patients (4%) required a new procedure for recurrent bleeding: one an infrared photocoagulation as outpatient, and another a haemorrhoidectomy after 3 months. No cases of intraoperative or postoperative mortality occurred. CONCLUSIONS Sclerobanding is a safe and effective technique in treating intermediate-grade haemorrhoidal disease in patients at high risk on anticoagulant/antiplatelet therapy. Sclerobanding is repeatable, usually does not require anaesthesia, and is cost-effective. Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results.
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Affiliation(s)
- Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- PhD Program in Arterial Hypertension and Vascular Biology, Sapienza University, Rome, Italy
| | | | - Bruno Nardo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Gaetano Gallo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Giancarlo D’Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, Sapienza University of Rome, Rome, Italy
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Abstract
Injection sclerotherapy for all grades of interhemorrhoids in various situations and co-morbidities has become popular method of treatment. Several types of surgical operations both conventional and stapled hemorrhoidectomy has many and serious described side effects. On the contrary, proctoscopic injection sclerotherapy using some of the modern sclerosants and thin bore needle injections is an office-based ambulatory method of treatment of internal hemorrhoids; it is low in cost, devoid of any major complications besides it is quite successful as reported. Its safety and efficacy has been published in recent years. This manuscript is a result of thorough systemic review using PRISMA guidelines on various sclerosing agents, their merits and demerits, methods of administration, and outcome in internal hemorrhoids.
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Affiliation(s)
- Anling He
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mingkai Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
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Pata F, Bracchitta LM, D’Ambrosio G, Bracchitta S. Sclerobanding Is a Novel Technique for the Treatment of Second- and Third-Degree Hemorrhoidal Disease. Reply to Jongen et al. Comment on “Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218”. J Clin Med 2022; 11:jcm11113078. [PMID: 35683464 PMCID: PMC9180989 DOI: 10.3390/jcm11113078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, 87064 Corigliano-Rossano, Italy
- La Sapienza University, 00185 Rome, Italy
- Correspondence:
| | | | - Giancarlo D’Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, La Sapienza University, 00161 Rome, Italy;
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Comment on Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218. J Clin Med 2022; 11:jcm11092495. [PMID: 35566621 PMCID: PMC9104443 DOI: 10.3390/jcm11092495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2022] Open
Abstract
Dr. Pata kindly tweeted the publication of the above-mentioned paper [...]
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Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review. BMC Surg 2022; 22:124. [PMID: 35365158 PMCID: PMC8973564 DOI: 10.1186/s12893-022-01553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Hemophilia is a recessive hemorrhagic disease relevant to X chromosome. In mild hemophilia cases, spontaneous bleeding is rare and the blood clotting function is normal, but severe bleeding may occur after trauma or surgery. Therefore, missed diagnosis of hemophilia before operation may contribute to bleeding after hemorrhoid operation. Case presentation A 21-year-old male was hospitalized in the anorectal department because of repeated bleeding after hemorrhoid surgery. Despite several suture hemostasis procedures, the patient still suffered from recurrent bleeding. He had no family history of hemophilia or bleeding tendency, and had not been diagnosed with hemophilia before this admission. The diagnosis of mild hemophilia B was made after further examination of coagulation indexes. By using frozen plasma and coagulation factor complex to supplement coagulation factors, the patient’s bleeding was stopped and he was discharged after 23 days in hospital. During the follow-up, lower-than-normal coagulation factors were still found in him, but no bleeding occurred again. Conclusions The undiagnosed patient with mild hemophilia B has an increased risk of bleeding after hemorrhoid surgery because of the consumption of coagulation factors. This case report aims to address the importance of hemophilia screening before operation and reduce the risk of postoperative bleeding. For patients with recurrent bleeding after hemorrhoid surgery, hemophilia should be further excluded. Wound bleeding may recur in hemophilia patients after suture hemostasis. Therefore, prompt supplementation of coagulation factors is needed to help stop bleeding once the diagnosis of hemophilia is made.
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Pata F, Bracchitta LM, D’Ambrosio G, Bracchitta S. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J Clin Med 2021; 11:218. [PMID: 35011962 PMCID: PMC8745462 DOI: 10.3390/jcm11010218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/29/2021] [Accepted: 12/29/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. METHODS A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. RESULTS 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20-84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1-26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. CONCLUSIONS Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique.
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Affiliation(s)
- Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, 87064 Corigliano-Rossano, Italy
- La Sapienza University, 00185 Rome, Italy
| | | | - Giancarlo D’Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, La Sapienza University, 00161 Rome, Italy;
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Pata F, Gallo G, Pellino G, Vigorita V, Podda M, Di Saverio S, D'Ambrosio G, Sammarco G. Evolution of Surgical Management of Hemorrhoidal Disease: An Historical Overview. Front Surg 2021; 8:727059. [PMID: 34527700 PMCID: PMC8435716 DOI: 10.3389/fsurg.2021.727059] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 01/22/2023] Open
Abstract
Hemorrhoidal disease (HD) is the symptomatic enlargement and/or distal displacement of the normal hemorrhoidal cushions and is one of the most frequent diseases in colorectal surgery. Several surgical or office-based therapies are currently available, with the aim of being a more tailored approach. This article aimed to elucidate the historical evolution of surgical therapy for HD from ancient times, highlighting the crucial steps, controversies, and pioneers in the field. In contrast with the previous literature on the topic that is often updated to the 1990s, with the introduction of stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization, this article describes all new surgical and office-based treatments introduced in the first 20 years of the 2000s.
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Affiliation(s)
- Francesco Pata
- General surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
- La Sapienza University, Rome, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Science, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Vincenzo Vigorita
- Coloproctology Unit and General and Digestive Surgery Unit, Vigo University Hospital Complex, Vigo, Spain
| | - Mauro Podda
- Department of emergency surgery, Cagliari University Hospital “Policlinico D. Casula”, Cagliari, Italy
| | - Salomone Di Saverio
- Department of General Surgery, University Hospital of Varese, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation, La Sapienza University, Rome, Italy
| | - Giuseppe Sammarco
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
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