Hemorrhoids is a common anorectal disease, usually occurring in middle-aged people aged 25-65 years old, clinical bleeding, swelling, prolapse, pain, itching and anal discomfort, and repeatedly attacks and aggravated gradually, seriously affecting the quality of life of patients. The treatment of hemorrhoids includes conservative, injection, ligation, and various surgical procedures. Injection therapy with a history of more than 150 years is simple to operate, easy to popularize and apply in grass-roots units, causes less intraoperative bleeding and fewer complications, and has reliable efficacy. As a result, it is favored by clinicians and patients. The injection treatment of hemorrhoids has been mentioned in various hemorrhoid treatment guidelines and consensus at home and abroad, but there is no special expert consensus for reference. Led by the Anorectal Physicians Branch of the Chinese Medical Doctor Association and the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association, experts in related fields in China were invited to review the latest evidence-based medical evidence at home and abroad and conducted evidence quality assessment and recommendation strength classification according to the GRADE system. This paper attempts to make detailed recommendations on the types and application methods of the preparations commonly used in the injection treatment of hemorrhoids at home and abroad, and form the Chinese Expert Consensus on the Treatment of hemorrhoids by anal injection (2023 edition), aiming to guide the reasonable selection of drugs and dosage forms for hemorrhoidal injection treatment, and to provide reference for standardizing the use of different drugs and dosage forms, so as to improve the effectiveness and safety of clinical application of hemorrhoidal injection treatment.
Middle Aged ; Humans ; Adult ; Aged ; Hemorrhoids/surgery* ; Quality of Life ; Consensus ; Anal Canal ; Ligation/methods* ; Treatment Outcome

OBJECTIVE: To observe the effect of preoperative, intraoperative and postoperative electroacupuncture (EA) intervention on postoperative urination function in patients with mixed hemorrhoid surgery. METHODS: A total of 240 patients with mixed hemorrhoid surgery under lumbar anesthesia were randomly divided into an EA preconditioning group (group A, 60 cases, 9 cases dropped off), an intraoperative EA group (group B, 60 cases, 4 cases dropped off), a postoperative EA group (group C, 60 cases, 6 cases dropped off), and a non-acupuncture group (group D, 60 cases, 3 cases dropped off). In the groups A, B and C, EA was exerted at Zhongliao (BL 33) and Huiyang (BL 35) , with disperse-dense wave, 4 Hz/20 Hz in frequency, and lasting 30 min, at 30 min before lumbar anesthesia, immediately after lumbar anesthesia and 6 h after surgery, respectively. No EA intervention was performed in the group D. The postoperative urination smoothness score in each group was observed 24 h after surgery. The first urination time, first urination volume, urine residual volume after first urination were recorded, and incidence of indwelling catheterization, postoperative visual analogue scale (VAS) score, number of remedial analgesia, and the incidence of postoperative nausea and vomiting were observed in each group. RESULTS: In the groups A, B and C, the postoperative urination smoothness scores were superior to the group D (P<0.05), and the time of first urination was earlier than the group D (P<0.05). In the group C, the time of first urination was earlier than the group A and the group B (P<0.05), the first urination volume was higher than the group D (P<0.05), and the urine residual volume after first urination was lower than the group D (P<0.05). There was no significant difference in the incidence of indwelling catheterization and postoperative nausea and vomiting among the 4 groups (P>0.05). The VAS scores of the group A, B and C were lower than that in the group D (P<0.05), and the number of remedial analgesia cases was lower than that in the group D (P<0.05). CONCLUSION EA intervention could promote the recovery of urination function and relieve postoperative pain in patients with mixed hemorrhoids surgery. Early postoperative EA intervention is more conducive to the recovery of urination function.
Humans ; Electroacupuncture ; Hemorrhoids/surgery* ; Urination ; Postoperative Nausea and Vomiting ; Acupuncture Points

Hemorrhoids/surgery* ; Humans ; Lasers ; Ligation

Background: Laser hemorrhoidoplasty (LHP) is a treatment for symptomatic internal hemorrhoids. Nevertheless, there are disparities in the technique employed, including combining it with pedicle ligation. We aimed to investigate if short-term clinical outcomes were different between patients undergoing LHP with and without pedicle. Methods: Patients who underwent LHP from a prospective registry of 3 centers were identified. Demographics, severity, symptoms, operative technique, post-operative pain, complications, and recurrence were investigated. Sub-investigation of patients with simultaneous pedicle ligation, and without, was performed. Statistical analysis was done using the χ2 test. P values <0.05 were noted as statistically significant. Results: One hundred and two patients (59.8% male) of a mean age of 45 years were assessed. Most (62.7%) had 3rd degree hemorrhoids. Median operative time was 24 minutes (10-60 minutes) minutes. Post-operative length of stay was 26 hours (2-168 hours) hours. Median pain score 24 hours post-operatively was 0/10. The general complication percentage was 26.5%, but majority complications were self-limiting. The most common complication was post-operative swelling (16 patients; 15.7%). Post-operative bleeding was seen in 9 patients (8.8%) at a median of 7 (1-14) days, 3 of whom needed operation and readmission. Then 4 patients (3.9%) had moderate-to-severe pain (pain score of more than 5/10), 2 patients (2.0%) developed ulceration and 3 patients (2.9%) had recurrence, were treated conservatively. Patients with pedicle ligation had a higher complication (33.3% vs. 14.8%; p=0.08), mainly bleeding and swelling but not statistically significant. Conclusions LHP demonstrates good short-term outcomes with minimal complication and recurrence incidences. Supplementary ligation of pedicles does not provide additional benefits, and in fact, may worsen outcomes.
Hemorrhoids

Anal Canal ; Endoscopy ; Hemorrhoids/therapy* ; Humans ; Ligation ; Sclerotherapy ; Treatment Outcome

Hemorrhoids ; Humans ; Male ; Mucous Membrane

Prolapsed hemorrhoids is a common clinical disease, and severe symptoms can significantly affect work and life. The transanal stapler has the advantages of simple operation and less trauma in treating prolapsed hemorrhoids. Its clinical efficacy is closely related to the selection of indications, the standardization of surgical operations, and the prevention and treatment of complications. In current clinical practice, there is no consensus on the treatment of prolapsed hemorrhoids with transanal stapler. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the indications, contraindications, operating specifications and perioperative management of prolapsed hemorrhoids. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Anal Canal/surgery* ; China ; Consensus ; Hemorrhoidectomy/methods* ; Hemorrhoids/surgery* ; Humans ; Surgical Stapling/methods* ; Treatment Outcome

Adolescent ; Anemia, Iron-Deficiency ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Hemorrhoids ; Humans ; Klippel-Trenaunay-Weber Syndrome ; Male ; Polyps ; Port-Wine Stain ; Vascular Malformations

Hidradenoma papilliferum is a rare benign cystic tumor that originates from apocrine glands or anogenital mammary glands. Here, we describe 2 cases of hidradenoma papilliferum of the anus. Two female patients aged 39 and 35 presented with perianal masses with hemorrhoids. The patients underwent hemorrhoidectomy and excision of the lesion. Histopathology confirmed the masses as hidradenoma papilliferum. The postoperative course was uneventful for both patients, and there were no recurrences after 18 and 12 months of follow-up, respectively. Proctologists should consider hidradenoma papilliferum in their differential diagnosis of benign anal tumors. Surgical excision is necessary for diagnosis and treatment of hidradenoma papilliferum.
Acrospiroma ; Anal Canal ; Apocrine Glands ; Diagnosis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Mammary Glands, Human ; Recurrence

PURPOSE: Nonsurgical treatment of hemorrhoidal disease (HD) includes medical and instrumental techniques. We aimed to compare the efficacy of the most frequently used nonsurgical strategies, either alone or in combination, applied in an ambulatory setting.METHODS: Patients who received nonsurgical treatment for HD by proctology appointment at the Gastroenterology Department of Braga Hospital were evaluated. Isolated rubber band ligation (RBL) and a combination of RBL with a micronized purified flavonoid fraction (MPFF) were the 2 most frequently used strategies. Symptoms of HD (bleeding, pruritus, pain at rest, pain at defecation and prolapse) were assessed at days 0, 7, and 28 by using a severity grading scale (0 to 4/5). A Global Symptom score was constructed to assess the overall severity and compare the overall improvements of the HD symptoms between the 2 most frequently used strategies.RESULTS: Nineteen patients underwent the combined treatment (RBL + MPFF group) and 25 the RBL treatment (RBL group). A comparison of the 2 treatment groups showed significant improvements in the combined treatment group in terms of bleeding at days 7 (P = 0.001) and 28 (P = 0.002) and in the pruritus intensity during the first week (P < 0.001). A trend toward clinical benefit was also verified in the combined treatment group for all other HD symptoms (pain at rest, pain at defecation and prolapse).CONCLUSION: A combined treatment approach with MPFF and RBL significantly reduced the intensity of bleeding during the first month and the pruritus during the first week.
Cohort Studies ; Colorectal Surgery ; Defecation ; Flavonoids ; Gastroenterology ; Hemorrhage ; Hemorrhoids ; Humans ; Ligation ; Pruritus ; Rubber