Objective To explore the clinical treatment of Doppler guided hemorrhoid artery ligation (DG-HAL) combined with ultrasound-knife excision for severe hemorrhoids. Methods Eighty-seven patients with sever hemorrhoids were divided into 2 groups by the different admission months, the patients in group A (odd-numbered month) were treated by DG-HAL combined with ultrasound-knife excision, and the patients in Group B (bimonthly) were treated by procedure for prolaps and hemorrhoids. The clinical date were compared between 2 groups. Results There were no statistical differences in postoperative pain score and total efficient rate between 2 groups (P>0.05). The operating time, total hospitalization expenses and the incidences of postoperative bleeding, long term postoperative anal discomfort in group A were significantly lower than those in group B: (25.5 ± 2.8) min vs. (36.8 ± 4.6) min, (7 859 ± 564) yuan vs. (10 728 ± 733) yuan, 0 vs. 12.8%(5/39) and 2.1%(1/48) vs. 17.9%(7/39), the patient satisfaction score was significantly higher than that in group B: (9.3 ± 0.7) scores vs. (8.1 ± 0.6) scores, and there were statistical differences (P<0.05). Conclusions DG-HAL combined with ultrasound-knife excision to treat severe hemorrhoids has the definite treatment, less trauma, fewer complications and cheaper hospitalization expenses.

Objective To explore the clinical treatment of procedure for prolapse and hemorrhoids (PPH) combined with transrectal Block for rectocele (Block procedure).Methods Eighty-six hospitalized patients with rectocele were divided into two groups according the odevity of month:A group (odd month,PPH combined with Block procedure group,49 cases) and B group [even month,stapled trans-anal rectal resection (STARR),37 cases].The treatment conditions were compared between two groups.Results There were no statistical differences in degree of postoperative pain,healing rate between two groups (P ＞ 0.05).The operating time,postoperative hemorrhage rate,cost of hospitalization,patient satisfaction score and rectocele depth after 1 year in A group were significantly better than those in B group [(25.5 ± 2.8) min vs.(36.8 ± 4.6) rmin,2.0％(1/49) vs.13.5％(5/37),(7 359 ± 580) yuan vs.(10 928 ± 610) yuan,(9.1 ± 0.8) scores vs.(8.2 ± 0.7) scores,(5.02 ± 0.71) mm vs.(9.73 ± 1.31) mm],there were statistical differences (P ＜ 0.05).Conclusions PPH combined with Block procedure for rectocele had a significant clinical effect,it is a safe new method with small surgical trauma,a better choice to prevent the recurrence of rectocele,reduces the patients economic pressure obviously.So it is worth to clinical promotion.

Objective To study the therapeutic effect of improved STARR (Sehapayak as a control)in the treatment of moderate and severe rectocele.Methods 70 patients diagnosed with rectocele from Jan.2015 to Oct. 2015 were selected and randomly divided into 2 groups,35 cases in each group.They were treated with either improved STARR or Sehapayak surgery.The operation time,intraoperative blood loss,postoperative pain scores, patients'satisfaction and hospitalization days were compared between 2 groups.The ODS scores and therapeutic effects were compared in 1st week,1st month,3rd month and 6th month after treatment.The defecography was implemented and compared between 2 groups before treatment and 1st week and 6th month after treatment.Results The operation time,intraoperative blood loss,postoperative pain scores,hospitalization days and time to return to work were signifi-cantly lower in STARR group than those in Sehapayak group[(29.76 ±8.40)min vs (48.38 ±9.04)min;(14.43 ± 8.16)mL vs (77.80 ±20.58)mL;(4.29 ±1.76)points vs (6.71 ±2.04)points;(6.71 ±1.22)d vs (11.23 ± 3.64)d;(7.20 ±1.36)d vs (13.14 ±2.60)d;t =8.934,16.935,5.338,6.955,11.959,all P <0.05],and the patients'satisfaction was significantly higher in STARR group[(8.83 ±0.98)points vs (7.54 ±1.20)points,t =4.908,P <0.05].There were no significant differences in efficacy between 2 groups at any time point (P >0.05). The ODS score was (20.97 ±4.38)points before treatment,(4.71 ±1.30)points 1week after treatment,(2.94 ± 0.91)points 1month later,(1.68 ±1.04)points 3months later and (0.97 ±0.88)points 6mons later in the observa-tion group.The ODS scores in the control group were (19.88 ±4.09)points,(4.65 ±1.28)points,(3.51 ±1.15) points,(2.88 ±1.67)points,(1.85 ±1.31)points,respectively.The postoperative ODS scores of the two groups of patients were compared with the preoperative decreased significantly (t =20.666,23.904,26.127,26.401,all P <0. 05;t =22.882,24.081,24.032,25.015,all P <0.05),but at 1 week after operation of the two groups of ODS score had no statistically significant difference (P >0.05);1 month,3 months and 6 months after surgery,the differences of ODS score of the two groups were statistically significant(t =2.313,3.585,323.3,all P <0.05).The depth of recto-cele in the observation group was (33.09 ±6.79)mm before treatment,(5.54 ±1.96)mm 1month after treatment and (6.67 ±1.95 )mm 6months after treatment;while (33.57 ±6.46)mm,(7.65 ±2.11 )mm and (9.32 ± 2.74)mm in the control group,respectively.There was no difference between the two groups in the depth of rectocele before treatment (P >0.05).After treatment,they were all significantly decreased (t =21.779,20.646,all P <0.05;t =25.261,20.768,all P <0.05)in the two groups,and compared with the control group,the observation group decreased more significantly(t =4.339,4.565,all P <0.05 ).The two groups of patients at months after the 6th month of the rectal protrusion were significantly higher than the 1st months after the surgery (t =2.864,3.113,all P <0.05).The incidence rate of side effects was significantly higher in STARR group than that in Sehapayak group 1st week after treatment (48.6% vs.22.9%,χ2 =5.040,P =0.025),but there was no difference in 6th month after treatment (8.1% vs.3.0%,P >0.05).Conclusion Compared with Sehapayak,improved STARR surgery has the advantage of excellent curative effects,less trauma,shorter hospitalization,less complications and higher patient satis-faction.Improved STARR surgery is conducive to the prevention of rectocele relapse.

Thirteen patients with colorectal lesions underwent laparoscopic surgery from January to December 2019. Before surgery, 5.0 ml autogenous blood was injected under colonoscopy into the inferior margin and opposite sides of the lesion for localization. The operation time，success rate，complications，location efficiency and postoperative pathology were evaluated. The autologous blood tattooing was easily applied for all patients without complication. At laparoscopic surgery，the lesions of all patients were clearly visualized except one obese patients with rectal tumors, because the tumor was located below the retroperitoneal fold. No blood diffusion and leakage，and local inflammatory responses were observed. The surgical margins of all samples were tumor negative. Preoperative tattooing with autologous blood is recommended as an easy，safe and economical procedure for colonoscopic surgery in patients with colorectal lesions.

Twelve patients with complex anal fistulas were treated in the Affiliated Hospital of Medical School of Ningbo University from June to December 2018. All the patients were successfully operated, and after the operation the wound was rinsed twice a day by buried drainage tube. Patients were followed up for 3 months, the wound was healed in 11 cases and relapsed in 1 case with a mean wound healing time of (25.2±7.0) d; the pain scores at 1 d, 3 d and 5 d after surgery were 3.21±1.27, 2.34±1.22 and 1.89±0.78, respectively. There was no significant difference in preoperative and postoperative Wexner scores, anal resting pressure, and anal maximum systolic pressure (P>0.05).This innovative technique with buried drainage tube is safe and effective, which can shorten the recovery time and reduce the recurrence rate.

Seventy seven patients with complicated anal fistula were randomly assigned to receive tunnel fistulectomy with multiseton drainage (group A, n=38) or traditional fistulectomy (group B, n=39) for treatment.The clinical data and the treatment outcomes of two groups were compared.There was no significant difference in operation time between two groups (P>0.05). However, group A was significantly superior to group B in postoperative pain Numerical Pain Rating Scak (NPRS) score [(2.2±0.84) vs. (4.2±1.3), P<0.05)], wound surface area [(3.7±0.84) cm² vs. (7.28±1.83) cm^2, P<0.05], wound healing time [(23.4±2.41) d vs. (38.8±3.49) d, P<0.05 ], cure rate(97.4% vs. 79.5%, P<0.05) and recurrent rate 1 year after surgery(5.3% vs. 25.6%, P<0.05). The postoperative anorectal dynamic parameters of group A were also better than those of group B (P<0.05). Compared to traditional fistulectomy, the tunnel fistulectomy with multiseton drainage has advantages of less pain, faster recovery, less disturbance in anal function and better long-term clinical effect in treatment of complicated anal fistula.

Objective:To describe a new technique for chronic anal fissure surgery aimed at minimal invasion and reducing pain, and to evaluate the preliminary results concerning non-healing and intact anal function.Methods:A prospective observational study in twenty-five chronic anal fissure patients treated by Intersphincteric Lateral Internal Sphincterotomy (ILIS) technique from February to June 2018 in the Affiliated Hospital of Medical School of Ningbo University were conducted.Results:Chronic anal fissure in twenty-five patients healed primarily (96%, 24/25). There was one non-healing case. The mean healing time was(14.66 ± 5.63) d. Pain scores of 1, 3 and 5 d after surgery were (2.32 ± 0.82), (1.66 ± 0.74), (1.22 ± 0.63) scores. None had disturbance in clinical anal continence. Wexner score was 0.Conclusions:The early outcome of the ILIS technique is quite impressive. This technique is minimally invasive, with shorter healing time and less pain. It has the potential to become a viable option for chronic anal fissure surgery.