OBJECTIVE: To explore effective treatments that can alleviate postoperative complications in patients with procedure for prolapsed and hemorrhoids (PPH). METHODS: Sixty patients with pre-mixed hemorrhoids PPH were randomly divided into a simple operation group and a preoperative electroacupuncture intervention group, 30 cases in each group. PPH routine treatment was given in the simple operation group. Electroacupuncture (EA) was applied at point 30 min before PPH in the preoperative electroacupuncture intervention group, and EA was applied at Ciliao (BL 32) and Xialiao (BL 34) for 30 min. The scores of anus pendant, pain degree and persistent time and first urination time were compared within 24 h after operation between the two groups. RESULTS: The scores of anal pendant and pain degree in the 6 h, 12 h, 18 h, the persistent time of anal pendant and pain degree within 24 h and first urination time were better in the preoperative electroacupuncture intervention group than those in the simple operation group, and there were statistically significant differences (all <0.05). CONCLUSION Electroacupuncture at point 30 min before PPH can not only decrease the degrees of anal pendant and pain in the 6 h, 12 h, 18 h, but also shorten the persistent time of anal pendant and pain within 24 h after surgery and promote the first urination.
Acupuncture Points ; Electroacupuncture ; Hemorrhoids ; therapy ; Humans ; Postoperative Complications ; Preoperative Care

OBJECTIVETo explore the efficacy of Ruiyun procedure for hemorrhoids (RPH) combined with Xiaozhiling injection in the treatment of hemorrhoids complicated with human immunodeficiency virus (HIV) infection and its influence on cellular immune function.

METHODSClinical data of 76 hemorrhoid patients, including 36 positive HIV and 40 negative HIV, undergoing RPH combined with Xiaozhiling injections in our center from January 2010 to December 2012 were retrospectively analyzed. Clinical efficacy and cellular immune function preoperative day 1, postoperative day 7, 30 were compared between positive and negative groups.

RESULTSRecurrence rates of positive group and negative group postoperative 6 months were 22.2% (8/36) and 22.5% (9/40), postoperative 1 year were 30.6% (11/36) and 30.0% (12/40) without significant differences (all P>0.05). Morbidity of postoperative complication was also not significantly different between two groups (P>0.05). According to HIV classification, peripheral lymph cell ratio, CD4 count, CD4/CD8, white blood cell count and neutrophil ratio were not significantly different between preoperative day 1 and postoperative day 7 in both groups (all P>0.05). Decreasing velocity and amplitude of CD4 in both groups from high to low was HIV III, HIV II, HIV I, HIV-, while after 30 days the increase of CD4 from high to low was HIV-, HIV I, HIV II, HIV III, which were significantly different as compared to postoperative day 7 (all P<0.05).

CONCLUSIONSRPH combined with Xiaozhiling injection in the treatment of hemorrhoids complicated with HIV infection is effective and safe. Postoperative inhibited cellular immune function can recover quickly.

CD4 Lymphocyte Count ; HIV Infections ; complications ; Hemorrhoids ; drug therapy ; surgery ; Humans ; Postoperative Complications ; Recurrence ; Retrospective Studies

PURPOSE: The circular stapled hemorrhoidectomy is a newly introduced treatment modality for hemorrhoids. This study was aimed to prove the clinical efficacy of a stapled hemorrhoidectomy. METHODS: This prospective study analyzed 100 patients who underwent a hemorrhoidectomy from Jan 2002 to June 2004 at Ajou University Hospital. Among them, 50 patents underwent a stapled hemorrhoidectomy and the remaining patients underwent Ferguson's closed hemorrhoidectomy. The surgical severity and the postoperative complications were analyzed based on the medical records. RESULTS: Neither groups showed significant postoperative complications. In the stapled hemorrhoidectomy group, the hospital stay and the mean operation time were shorten during the postoperative period, and the analagesic requirement was lower (P<0.05). CONCLUSIONS: The circular stapled hemorrhoidectomy is safe, less painful, and those related easy to perform. Also, the complications related to this procedure are similar to those related to a conventional hemorrhoidectomy. Considering the advantages, the circular stapled hemorrhoidectomy is an acceptable modalities for hemorrhoids requiring surgical treatment.
Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Medical Records ; Postoperative Complications ; Postoperative Period ; Prospective Studies

PURPOSE: The present study was designed to evaluate the efficacy and the outcome when using the Starion(TM) and the Harmonic Scalpel(TM) vessel sealing systems for a sutureless hemorrhoidectomy. METHODS: This study is a randomized, controlled trial. Patients with Grade 3 and 4 hemorrhoids were categorized into two groups: the Starion(TM) hemorrhoidectomy (30 patients) group and the Harmonic Scalpel(TM) hemorrhoidectomy (30 patients) group. The measures of the primary outcomes were the operating time, the postoperative pain score, and the patient satisfaction score. Secondary outcome criteria included early and delayed complications: postoperative bleeding, anal stenosis, urinary difficulty, and skin tag. RESULTS: The satisfaction scores 4 wk postoperatively were not significantly different between the two groups (P=0.186). However, the operating time was reduced (P=0.019), the pain score was lower (P=0.009), and the satisfaction score 1 wk postoperatively (P=0.001) was lower in the Starion(TM) hemorrhoidectomy group. In addition, there were no differences in early and delayed postoperative complications between the two groups (all P>0.05). CONCLUSION: Both methods were found to be surprisingly equivalent in all major aspects analyzed. A Starion(TM) hemorrhoidectomy with submucosal dissection can provide a safe, fast, bloodless, reduced-pain, and low-priced surgical alternative to hemorrhoidal surgery. More studies are needed to determine whether similar favorable results can be attained in patients with more severe, strangulated hemorrhoids.
Constriction, Pathologic ; Glycosaminoglycans ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Skin

PURPOSE: A circular stapled hemorrhoidectomy involves the simultaneous excision of hemorrhoids and wound closure without perianal dissection, thereby eliminating a potential contamination of the anal wound. This study was designed to investigate whether a closed hemorrhoidectomy using the circular stapled technique offers any advantage over the conventional technique. METHODS: Twenty-three patients with prolapsed symptomatic hemorrhoids were treated by either a conventional (n=13) (conventional group) or a circular stapled (n=11) hemorrhoidectomy (stapled group). The operation time was recorded and the excised tissue was examined histologically. The pain score, any complications, the number of days before returning to normal activity and the patients' satisfaction were recorded. A follow up was done using a questionnaire or by telephone interview a week after the operation, and satisfaction was checked a month after the operation. RESULTS: The conventional operation was quicker to perform (mean 23.1 min vs 26.8 min), but did not reach a significant value (P>0.05). In the stapled group, the analgesic requirement was less than for the conventional group (4.4 times vs 6.9 times), but again did not reach a significant value (P>0.05). There were 4 cases of postoperative complications in the conventional group (30.7%) and 3 cases in the stapled group (27.3%) with no significant difference between two groups (P>0.05). The mean pain score was lower in the stapled group (3.5 vs 4.8)(P<0.05). The stapled group returned to normal activity sooner (13.7 days vs 24.4 days) (P<0.05). The patients' satisfaction was the same for the two groups (conventional group 69.2% vs stapled group 81.8%) (P>0.05). CONCLUSION: A circular stapled hemorrhoidectomy is an effective treatment for third and forth degree prolapsed hemorrhoids, offering the significant advantages of reduced postoperative pain and an earlier return to normal activity.
Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Pain, Postoperative ; Postoperative Complications ; Surveys and Questionnaires ; Wounds and Injuries

PURPOSE:Hemorrhoidectomy is considered to be a painful operation, therefore some patients with symptomatic hemorrhoids conceal their symptoms to defer a much-needed surgical procedure. Patients who have undergone hemorrhoidectomy have experienced constipation or urinary retention due to postoperative pain. Several interventions have been used to relieve postoperative pain after hemorrhoidectomy. Nevertheless, the results are unsatisfactory. Hemorrhoidectomy with ultrasonic dissector have less thermal injury and can avoid ligation and suture. This study compared conventional semi-open Milligan hemorrhoidectomy with open ultrasonic dissector hemorrhoidectomy. METHODS:One hundred patients with prolapsed symptomatic hemorrhoids were randomly assigned to semi-open Milligan (n=50) or open ultrasonic dissector (n=50) hemorrhoidectomy. Operation time, postoperative complication, hospital stay, degree and duration of postoperative pain, pain on bowel movement, and urinary retention were recorded and analyzed. RESULTS:There was no significant difference in excised pile number. Operation time of open ultrasonic dissector hemorrhoidectomy was shorter than that of semi-open Milligan hemorrhoidectomy (P<0.05). The open ultrasonic dissector hemorrhoidectomy group resulted in less postoperative pain (P<0.05) and shorter duration of pain (P<0.05) and postoperative hospital stay (P<0.05) than semi-open Milligan hemorrhoidectomy. Urinary retention did not occur in both groups. CONCLUSIONS:Despite the higher cost, open ultrasonic dissector hemorrhoidectomy results in less postoperative pain, shorter operation time and hospital stay than the conventional hemorrhoidectomy.
Constipation ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Ligation ; Pain, Postoperative ; Postoperative Complications ; Sutures ; Ultrasonics* ; Urinary Retention

PURPOSE: A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids. METHODS: We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common. CONCLUSIONS: A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.
Female ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Length of Stay ; Male ; Pain, Postoperative ; Postoperative Complications ; Return to Work ; Vision, Ocular

PURPOSE: Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids. METHODS: A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences. RESULTS: Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009). CONCLUSION: The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.
Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Pain, Postoperative ; Postoperative Complications ; Recurrence ; Retrospective Studies

OBJECTIVETo evaluate the efficacy and necessity of retained rectal posterior mucosa in procedure for prolapse and hemorrhoids (PPH).

METHODSClinical data of 260 cases with severe hemorrhoids in our hospital from January 2010 to May 2012 were analyzed retrospectively. A total of 132 cases with severe hemorrhoids excluding in rectal posterior wall were enrolled in retained rectal posterior mucosa in PPH (improvement group), other 128 cases of severe hemorrhoids were assigned to PPH (conventional group). Operative parameters, efficacy and complication after operation were compared.

RESULTSTwo groups of patients received successful operations. Postoperative pain duration, frequency of analgesic drugs and postoperative hospital stay in improvement group were significantly reduced [(1.3 ± 0.5) d vs. (4.8 ± 0.7) d, 1.1 ± 0.3 vs. 5.9 ± 0.6, (5.2 ± 0.8) d vs. (5.8 ± 0.5) d, all P<0.01]. Incidence of anastomotic stenosis, heavy feeling in the anus and delayed bleeding in improvement group were significantly lower than those in conventional group (0 vs. 7.8%, 0.8% vs. 14.1%, 0 vs.7.8%, all P<0.01).

CONCLUSIONSThe application of retained rectal posterior mucosa in PPH to patients with severe hemorrhoids excluding in rectal posterior wall can significantly reduce postoperative complications. But long-term efficacy needs further observation.

Constriction, Pathologic ; Hemorrhoids ; epidemiology ; surgery ; Humans ; Incidence ; Mucous Membrane ; Pain, Postoperative ; Postoperative Complications ; Postoperative Period ; Prolapse ; Retrospective Studies

PURPOSE: Urinary retention is a frequent postoperative complication after benign anorectal surgery. Factors, known to affect postoperative urinary retention, are age, sex, anesthetics, operative method, operative time and perioperative fluid injection. This study was performed to know whether the incidence of urinary retention might be controlled by reducing the amount of perioperative fluid. METHODS: Eighty patients underwent surgery for hemorrhoids and chronic anal fissures were allocated into two groups, fluid restriction group (n=37) and hydration group (n=43). All patients were consecutively randomized from May 1998 to January 1999 and they were under 50 years old without urologic abnormality. Fluid was infused at 100 ml/h from the midnight then it's rate was changed into 10 ml/h for 4 hours from the beginning of the anesthesia for the restriction group, whereas 1000 ml/h only during operation for the hydration group. Thereafter it was changed into the same rate with 100 ml/h on both groups. RESULTS: There was no significant differences with regard to age, sex, operation time, degree of pain and use of analgesics between two groups. Although there was a significant difference in the total volume of the infused fluid (Restriction group: 53.4 119.5 ml versus Hydration group: 778.6 319.0 ml, mean SD, p<0.001). Catheterization was done in 29 patients of the restriction group (78.4%) and 37 patients of the hydration group (86.0%), respectively. The frequency of catheterization was 1.3 0.7 times in the former and 1.6 0.7 times in the latter group. CONCLUSIONS: A strict restriction of fluid infusion appeared to be unnecessary for the purpose of preventing the urinary retention during surgery of benign anorectal diseases with spinal anesthesia.
Analgesics ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Catheterization ; Catheters ; Hemorrhoids ; Humans ; Incidence ; Middle Aged ; Operative Time ; Postoperative Complications ; Prospective Studies* ; Urinary Retention*