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

There are still controversies as to the location of ligating the inferior mesenteric artery and the central lymph node dissection during rectal cancer surgery. The reason is that the level of evidence in this area is low. Existing studies are mostly retrospective, analyses or small-sample randomized controlled trials. These results showed no significant differences between high-ligation and low-ligation, in terms of anastomotic leakage and other short-term postoperative complications. Low-ligation seems better for the recovery of postoperative genitourinary function. Due to the low rate of central lymph node metastasis and many other confounding factors that affect the survival rate, it is difficult to conclude the survival benefits of ligation site or central node dissection. It is necessary to carry out some targeted, well-designed, large-scale randomized controlled trials to explain the related issues of inferior mesenteric artery ligation site and extent of central lymphadenectomy.
Humans ; Laparoscopy/methods* ; Ligation/methods* ; Lymph Node Excision/methods* ; Mesenteric Artery, Inferior/surgery* ; Mesentery ; Rectal Neoplasms ; Rectum/surgery* ; Retrospective Studies

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can speed up the regeneration of future liver remnant (FLR) in short period of time, and offer a chance for surgical resection for patients without sufficient FLR. However, ALPPS still remains controversy due to its high perioperative morbidity and mortality, as well as the uncertain long-term oncological benefits. How to solve these problems is the key to ensure the safety of surgery.This article focus on the indication selection, liver function reserve evaluation and timing to perform the second stage surgery, surgical mode evolution and comparison with portal venous embolization/portal venous ligation+two-stage hepatectomy.
Embolization, Therapeutic ; Hepatectomy/methods* ; Humans ; Ligation ; Liver/surgery* ; Liver Neoplasms/surgery* ; Liver Regeneration ; Portal Vein/surgery* ; Treatment Outcome

Polyurethane foam (PU foam) is a new material which is being used in producing both macro-anatomical and micro-anatomical specimens. PU foam is simple to use, without need for special equipment. The present study was carried out to evaluate morphology of coronary sinus and its tributaries. During the study, we encountered few problems in carrying out injections. Coronary sinus and its tributaries were difficult to cannulate since the coronary sinus lacks a vascular stem, around which ligature can be tied before injection so that the cannula can be held in place. In contrast, in majority of the organs it is easy to inject since they possess tubular vascular stem to hold the cannula in place. A new device was developed which could be used to cannulate coronary sinus orifice to inject the casting media. The second problem we faced was saponification of adipose tissue. This made corrosion of the soft tissue difficult. Hence in this study, we describe the device we have developed to place in the coronary sinus orifice, and how saponified adipose tissue was taken care during the actual maceration step.
Adipose Tissue ; Catheters ; Coronary Sinus ; Coronary Vessels ; Corrosion ; Ligation ; Methods ; Polyurethanes

PURPOSE: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. METHODS: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. RESULTS: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. CONCLUSION The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.
Adult ; Embolization, Therapeutic ; methods ; Factor VII ; administration & dosage ; Female ; Fractures, Bone ; complications ; therapy ; Hemostasis, Surgical ; Humans ; Iliac Artery ; surgery ; Injury Severity Score ; Ligation ; Male ; Middle Aged ; Multiple Trauma ; complications ; therapy ; Pelvic Bones ; injuries ; Prognosis ; Recombinant Proteins ; administration & dosage ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; prevention & control ; Young Adult

Hanging is the most common method of suicide in Malaysia. However, hanging in combination with suicidal ligature strangulation is uncommon. The victim is a 31-year-old man, with no previous medical or psychiatric disorders. He accomplished self-strangulation using a shoelace and hanging himself with a High-Definition Multimedia Interface cable. Three loops of a shoelace ligature were present around the neck. A single knot was present on the front, and a double knot at the back of the neck. Internal examination of the neck revealed small bilateral hemorrhages of the sternocleidomastoid muscles. No laryngeal cartilage or hyoid bone fractures were observed. No other evidence of injury was noted other than moderate pulmonary edema. The post-mortem toxicology results were negative. The cause of death was ascertained as neck compression due to ligatures. Scene assessment and post-mortem findings concur with suicide. This report describes an unusual case of suicidal ligature strangulation, in combination with hanging using two different ligatures.
Adult ; Cause of Death ; Hemorrhage ; Humans ; Hyoid Bone ; Laryngeal Cartilages ; Ligation ; Malaysia ; Methods ; Multimedia ; Muscles ; Neck ; Pulmonary Edema ; Suicide ; Toxicology

Diverticular bleeding accounts for approximately 26%–40% of the cases of lower gastrointestinal bleeding. Rupture of the vasa recta at the neck or dome of the diverticula can be the cause of this bleeding. Colonoscopy aids in not only the diagnosis but also the treatment of diverticular bleeding after a steady bowel preparation. Endoscopic hemostasis involves several methods, such as injection/thermal contact therapy, clipping, endoscopic band ligation (EBL), hemostatic powder, and over-the-scope clips. Each endoscopic method can provide a secure initial hemostasis. With regard to the clinical outcomes after an endoscopic treatment, the methods reportedly have no significant differences in the initial hemostasis and early recurring bleeding; however, EBL might prevent the need for transcatheter arterial embolization or surgery. In contrast, the long-term outcomes of the endoscopic treatments, such as a late bleeding and recurrent bleeding at 1 and 2 years, are not well known for diverticular bleeding. With regard to a cure for diverticular bleeding, there should be an improvement in both the endoscopic methods and the multilateral perspectives, such as diet, medicines, interventional approaches, and surgery.
Colon ; Colonoscopy ; Diagnosis ; Diet ; Diverticulum ; Hemorrhage ; Hemostasis ; Hemostasis, Endoscopic ; Ligation ; Methods ; Neck ; Rupture

PURPOSE: The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. MATERIALS AND METHODS: This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. RESULTS: The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien–Dindo classification grade ≥II) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. CONCLUSIONS: Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.
Anastomotic Leak ; Classification ; Constriction, Pathologic ; Dilatation ; Esophagus ; Gastrectomy ; Head ; Humans ; Incidence ; Laparoscopy ; Ligation ; Methods ; Mortality ; Postoperative Complications ; Retrospective Studies ; Sutures

The ligation of dorsal venous complex (DVC) is a very important procedure during laparoscopic radical prostatectomy (LRP). Inaccurate DVC ligation may lead to severe bleeding or postoperative incontinence. We, therefore, designed the DVC pretightening technique to facilitate this procedure. The 32 involved patients with localized prostate cancer underwent LRP between July 2017 and October 2018. All of the patients received DVC pretightening technique. A laparoscopic intestinal clamp was used to narrow and strain DVC. The needle passage was limited between the bone and clamp. The ligation time, DVC-related blood loss, and continence data were recorded. The ligation of DVC in 32 patients was performed with DVC pretightening technique. Every suture was completed with one attempt. The mean ligation time was 2.7 ± 1.0 min. The DVC-related blood loss was 2.0 ± 1.3 ml. The 3-month continence rate was 81.3% (26/32). Positive margin rate was 9.4% (3/32). In conclusion, the DVC pretightening technique simplified the ligation of DVC during LRP. It is a safe and reliable technique. However, large-sample randomized controlled trials are still required to confirm the advantage of the new method in improving mean ligation time, DVC-related blood loss, continence rate, and positive margin rate.
Blood Loss, Surgical/prevention & control* ; Humans ; Laparoscopy/methods* ; Ligation/methods* ; Male ; Operative Time ; Prostate/surgery* ; Prostatectomy/methods* ; Treatment Outcome ; Veins/surgery*

ObjectiveTo compare the clinical effects and postoperative complications of microsurgical subinguinal varicocelectomy (MSV) with or without delivery of the testis and ligation of gubernacular veins in the treatment of varicocele.

METHODSWe retrospectively analyzed the clinical data about 163 varicocele patients treated by MSV, 40 with (group A) and the other 123 without delivery of the testis and ligation of gubernacular veins (group B). We compared the operation time, postoperative complications, rate of recurrence, and semen parameters before and at 3 months after surgery between the two groups of patients.

RESULTSThe operation time was significantly longer in group A than in B (［81.1 ± 20.0］ vs ［62.3 ± 9.6］ min, P = 0.041). Sperm concentration, total sperm count per ejaculate, sperm viability, and the percentage of progressively motile sperm were significantly improved in both groups at 3 months after MSV as compared with the baseline (P < 0.05). There were no statistically significant differences in the above semen parameters between the two groups of patients with grade Ⅲ varicocele before and after surgery (P < 0.05). Scrotal edema developed in 5 cases in group A and wound infection in 2 cases in group B after MSV, but no postoperative testicular atrophy or recurrence was observed in either of the two groups.

CONCLUSIONSMSV with delivery of the testis and ligation of gubernacular veins showed no advantages over that without in reducing varicocele recurrence and improving semen parameters, but rather involved longer operation time and a higher incidence rate of postoperative complications.

Edema ; etiology ; Humans ; Ligation ; Male ; Microsurgery ; adverse effects ; methods ; Operative Time ; Postoperative Complications ; etiology ; Recurrence ; Retrospective Studies ; Semen ; Semen Analysis ; Sperm Count ; Spermatozoa ; Testis ; Treatment Outcome ; Varicocele ; surgery ; Vascular Surgical Procedures ; adverse effects ; methods ; Veins ; surgery