Recent advances in the management of hemorrhoids

Hemorrhoids are considered one of the most common anorectal diseases with a prevalence of 4.4% up to 36.4% of the general population, and a peak incidence between 45 and 65 years. Hemorrhoidal disease presents with a prolapsed lump, painless bleeding, discomfort, discharge, hygiene problems, soiling, and pruritus. Sliding anal canal lining theory is the most accepted theory as a cause of hemorrhoidal disease; however, it is also associated with hyper-vascularity, and, recently, with several enzymes or mediators involved in the disintegration of the tissues supporting the anal cushions, such as matrix metalloproteinase. A comprehensive search in published English-language literature till 2013 involving hemorrhoids was performed to construct this review article, which discusses advances in the management of hemorrhoids. This includes conservative treatment(life style modification, oral medications, and topical treatment), office procedures(rubber band ligation, injection sclerotherapy, infrared and radiofrequency coagulation, bipolar diathermy and direct-current electrotherapy, cryosurgery, and laser therapy), as well as surgical procedures including diathermy hemorrhoidectomy, Liga Sure hemorrhoidectomy, Harmonic scalpel hemorrhoidectomy, hemorrhoidal artery ligation, stapled hemorrhoidopexy(SH), and double SH. Results, merits and demerits of the different modalities of treatment of hemorrhoids are presented, in addition to the cost of the recent innovations.

Stapled haemorrhoidopexy—Complications and patient satisfaction

Background: Surgical haemorrhoidectomy is recognised as an effective but often painful intervention for haemorrhoids. Performed in a district hospital setting, this survey studied the success rates of stapled haemorrhoidopexy (SH) technique according to reported symptoms and patient satisfaction, post operatively. Methods: A cohort of 108 patients admitted for cir- cular stapled procedure at Inverclyde Royal Hospital between June 2006 and December 2011 gave their consent to be interviewed over the telephone after their procedure. 101 out of the 108 patients responded. Assessment of patient satisfaction was made on the basis of pre operative symptoms, postoperative results and complications. Results: Preoperatively, all patients had Grade lll or lV haemorrhoids complicated by haemorrhage. 33% of patients reported associated pain, and 25% complained of anal leakage. Mean follow up time was 23.8 months (7 - 38 months). Overall reported complication rate was 17%, with 9% reporting short term bleeding, 4% reporting shortlived post-operative pain and 3% with recurrence of prolapsed haemorrhoids. 88% of patients were happy with results, with 87% of patients happy to recommend the procedure to others. Conclusion: Stapled anopexy is a relatively new procedure. It has been found to be a successful and well-tolerated procedure for prolapsing haemorrhoids in this district general setting. It has a low recurrence rate, low incidence of post operative pain and a high level of patient satisfaction. However, there are associated complications and it has a steep training curve.