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Hemorrhoids

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Practices of Anorectal Surgery
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Abstract

The most reliable hypothesis for the occurrence of hemorrhoids is considered to be the sliding theory that the hemorrhoids occur due to having supporting muscular fiber tissue of hemorrhoidal plexus get worse or loss of elasticity from the tearing. Internal hemorrhoids can be classified into 1 to 4 grades by the degree of prolapse. The most common symptoms of patients with hemorrhoids are bleeding and prolapse. Treatment of hemorrhoids is based on the degree of prolapse, severity of symptom, and appearance of the hemorrhoids. The key factors of conservative treatment for hemorrhoids are the dietary habits and lifestyle change. In order to improve symptoms of hemorrhoids, there are many commercial topical agents such as cream, lotion, suppository, and local anesthesia. One of the commonly used invasive procedures is rubber band ligation. Excisional hemorrhoidectomy is an outstanding treatment for 3- to 4-degree hemorrhoids compared to the nonoperative treatment. Postoperative pain is one of the main reasons patients hesitate to take surgery of the hemorrhoids. Surgeon should be also aware of the other postoperative complications and, especially, the possibility of inflammatory changes in the operated area if there is urinary retention or fever.

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References

  1. Thomson WHF. The nature of hemorrhoids. Br J Surg. 1975;62:542–52.

    Article  CAS  Google Scholar 

  2. Haas PA, Fox TA Jr, Haas GP. The pathogenesis of hemorrhoids. Dis Colon Rectum. 1984;27:442–50.

    Article  CAS  Google Scholar 

  3. Banov L, Knoepp LF, Erdman LH, Alia RT. Management of hemorrhoidal disease. J S C Med Assoc. 1985;81:398.

    PubMed  Google Scholar 

  4. Harish K, Harikumar R, Sunilkumar K, Thomas V. Videoanoscopy: useful technique in the evaluation of hemorrhoids. J Gastroenterol Hepatol. 2008;23:e312–7.

    Article  Google Scholar 

  5. Gralnek IM, Ron-Tal Fisher O, Holub JL, Eisen GM. The role of colonoscopy in evaluating hematochezia: a population-based study in a large consortium of endoscopy practices. Gastrointest Endosc. 2013;77:410–8.

    Article  Google Scholar 

  6. Johannsson HO, Graf W, Pahlman L. Bowel habits in hemorrhoid patients and normal subjects. Am J Gastroenterol. 2005;100:401–6.

    Article  Google Scholar 

  7. Garg P, Singh P. Adequate dietary fiber supplement along with TONE concept can helf avoid surgery in most patients with advanced hemorrhoids. Minerva Gastroenterol Dietol. 2017;63:92–6.

    PubMed  Google Scholar 

  8. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ, et al. Meta-analysis of flavonoids for the treatment of hemorrhoids. Br J Surg. 2006;93:909–20.

    Article  CAS  Google Scholar 

  9. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities: a meta-analysis. Dis Colon Rectum. 1995;38:687–94.

    Article  CAS  Google Scholar 

  10. Law WL, Chu KW. Triple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection. Dis Colon Rectum. 1999;42(3):363–6.

    Article  CAS  Google Scholar 

  11. Bayer I, Myslovaty B, Picovsky BM. Rubber band ligation of hemorrhoids. Convenient and economic treatment. J Clin Gastroenterol. 1996;23(1):50–2.

    Article  CAS  Google Scholar 

  12. Khubchandani IT. A randomized comparison of single and multiple rubber band ligations. Dis Colon Rectum. 1983;26(11):705–8.

    Article  CAS  Google Scholar 

  13. Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum. 2004;47:1364–70.

    Article  CAS  Google Scholar 

  14. El Nakeeb AM, Fikry AA, Omar WH, et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200cases. World J Gastroenterol. 2008;14:6525–30.

    Article  Google Scholar 

  15. Khoury GA, Lake SP, Lewis MC, Lewis AA. A randomized trial to compare single with multiple phenol injection treatment for haemorrhoids. Br J Surg. 1985;72(9):741–2.

    Article  CAS  Google Scholar 

  16. Yano T, Nogaki T, Asano M, Tanaka S, Kawakami K, Matsuda Y. Outcomes of case-matched injection sclerotherapy with a new agent for hemorrhoids in patients treated with or without blood thinners. Surg Today. 2013;43:854–8.

    Article  CAS  Google Scholar 

  17. Miyamoto H, Hada T, Ishiyama G, Ono Y, Watanabe H. Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher grades II and III hemorrhoids: results from a multi-center study. World J Hempatol. 2016;8:844–9.

    Article  Google Scholar 

  18. Guy RJ, Seow-Choen F. Septic complications after treatment of haemorrhoids. Br J Surg. 2003;90:147–56.

    Article  CAS  Google Scholar 

  19. Admi B, Eckardt VF, Suermann RB, Karbach U, Ewe K. Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy. Dis Colon Rectum. 1981;24:373–4.

    Article  Google Scholar 

  20. Linares Santiago E, Gomez Parra M, Mendoza Olivares FJ, Pellicer Bautista FJ, Herrerias Gutierrez JM. Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation. Rev Es Enferm Dig. 2001;93:238–47.

    CAS  Google Scholar 

  21. Ahmad A, Kant R, Gupta A. Comparative analysis of Doppler guided hemorrhoidal artery ligation (DG-HAL) & infrared coagulation (IRC) in management of hemorrhoids. Ind J Surg. 2013;75:274–72.

    Google Scholar 

  22. Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery. 1971;70(3):480–4.

    CAS  PubMed  Google Scholar 

  23. Milligan ET, Morgan CN. Surgical anatomy of the anal canal and the operative treatment of hemorrhoids. Lancet. 1937;2:119–24.

    Google Scholar 

  24. Ruiz-Moreno F. Hemorrhoidectomy–how I do it: semiclosed technique. Dis Colon Rectum. 1977;20(3):177–82.

    Article  CAS  Google Scholar 

  25. Ho YH, Seow-Choen F, Tan M, Leong AF. Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg. 1997;84(12):1729–30.

    Article  CAS  Google Scholar 

  26. Gencosmanoglu R, Sad O, Koc D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial. Dis Colon Rectum. 2002;45(1):70–5.

    Article  Google Scholar 

  27. Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg. 2016;40:1509–19.

    Article  Google Scholar 

  28. Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2015;25:106–10.

    Article  Google Scholar 

  29. Mushaya CD, Caleo PJ, Bartlett L, Buettner PG, Ho YH. Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol. 2014;18:1009–16.

    Article  CAS  Google Scholar 

  30. Tsunoda A, Sada H, Sugimoto T, et al. Randomized controlled trial of bipolar diathermy vs ultrasonic scalpel for closed hemorrhoidectomy. World J Gastrointesti Surg. 2011;3:147–52.

    Article  Google Scholar 

  31. Longo A. Treatment of haemorrhoidal disease by reduction for mucosa and haemorrhoidal prolapse with a circular stapling device: a new procedure-6th World Congress of Endoscopic Surgery. Mundozzi Editore. 1998. p. 777–84.

    Google Scholar 

  32. Lin HC, He QL, Ren DL, Peng H, Xie SK, Su D, et al. Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids. Surg Today. 2012;42(9):868–75.

    Article  Google Scholar 

  33. Lin HC, Ren DL, He QL, Peng H, Xie SK, Su D, et al. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol. 2012;16:337–43.

    Article  Google Scholar 

  34. Jeong H, Hwang S, Ryu KO, Lim J, Kim HT, Yu HM, et al. Early experience with a partial stapled hemorrhoidopexy for treating patients with grades III-IV prolapsing hemorrhoids. Ann Coloproctol. 2017;33:28–34.

    Article  Google Scholar 

  35. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg. 2008;95(2):147–60.

    Article  Google Scholar 

  36. Watson AJ, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A, Norrie J, Bruhn H, Cook JA, eTHoS Study Group. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet. 2016;388:2375–85.

    Article  Google Scholar 

  37. van Wensen RJ, van Leuken MH, Bosscha K. Pelvic sepsis after stapled hemorrhoidopexy. World J Gastroenterol. 2008;14(38):5924–6.

    Article  Google Scholar 

  38. Faucheron JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg. 2012;99:746–53.

    Article  Google Scholar 

  39. Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, Bonatti H. The vascular nature of hemorrhoids. J Gastrointest Surg. 2006;10:1044–50.

    Article  Google Scholar 

  40. Kalafateli M, Triantos CK, Nikolopoulou V, Burroughs A. Non-variceal gastrointestinal bleeding in patients with liver cirrhosis: a review. Dig Dis Sci. 2012;57:2743–54.

    Article  CAS  Google Scholar 

  41. Emile SH, Youssef M, Elfeki H, Thabet W, El-Hamed TM, Farid M. Literature review of the role of lateral internal sphincterotomy (LIS) when combined with excisional hemorrhoidectomy. Int J Color Dis. 2016;31:1261–72.

    Article  Google Scholar 

  42. Siddiqui MR, Abraham-Igwe C, Shangumanandan A, Grassi V, Swift I, Abulafi AM. A literature review on the role of chemical sphincterotomy after Milligan-Morgan hemorrhoidectomy. Int J Color Dis. 2011;26:685–92.

    Article  Google Scholar 

  43. Gorfine SR, Onel E, Patou G, Krivokapic ZV. Bupivacaine extended-release liposome injection for prolonged postsurgical analgesia in patients undergoing hemorrhoidectomy: a multicenter, randomized, double-blind, placebo-controlled trial. Dis Colon Rectum. 2011;54:1552–9.

    Article  Google Scholar 

  44. Haas E, Onel E, Miller H, Ragupathi M, White PF. A double-blind, randomized, active-controlled study for post-hemorrhoidectomy pain management with liposome bupivacaine, a novel local analgesic formulation. Am Surg. 2012;78:574–81.

    Google Scholar 

  45. Sugimoto T, Tsunoda A, Kano N, Kashiwagura Y, Hirose K, Sasaki T. A randomized, prospective, double-blind, placebo-controlled trial of the effect of diltiazem gel on pain after hemorrhoidectomy. World J Surg. 2013;37:2454–7.

    Article  Google Scholar 

  46. Amoli HA, Notash AY, Shahandashti FJ, Kenari AY, Ashraf H. A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Color Dis. 2011;13:328–32.

    Article  CAS  Google Scholar 

  47. Liu JW, Lin CC, Kiu KT, Wang CY, Tam KW. Effect of glyceryl trinitrate ointment on pain control after hemorrhoidectomy: a meta-analysis of randomized controlled trials. World J Surg. 2016;40:215–24.

    Article  Google Scholar 

  48. Wanis KN, Emmerton-Coughlin HM, Coughlin S, Foley N, Vinden C. Systemic metronidazole may not reduce posthemorrhoidectomy pain: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2017;60:446–55.

    Article  Google Scholar 

  49. Vinson-Bonnet B, Higuero T, Faucheron JL, Senejoux A, Pigot F, Siproudhis L. Ambulatory haemorrhoidal surgery: systematic literature review and qualitative analysis. Int J Color Dis. 2015;30:437–45.

    Article  CAS  Google Scholar 

  50. Toyonaga T, Matsushima M, Sogawa N, Jiang SF, Matsumura N, Shimojima Y, Tanaka Y, Suzuki K, Masuda J, Tanaka M. Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Color Dis. 2006;21:676–82.

    Article  Google Scholar 

  51. Stelzner F. Hemorrhoidectomy–a simple operation? Incontinence, stenosis, fistula, infection and fatalities. Chirurg. 1992;63(4):316–26.

    CAS  PubMed  Google Scholar 

  52. Sayfan J. Complications of Milligan-Morgan hemorrhoidectomy. Dig Surg. 2001;18(2):131–3.

    Article  CAS  Google Scholar 

  53. Wronski K. Etiology of thrombosed external hemorrhoids. Postepy Hig Med Dosw (Online). 2012;66:41–4.

    Google Scholar 

  54. Greenspon J, Williams SB, Uoung HA, Orkin BA. Thrombosed external hemorrhoids. Outcome after conservative or surgical management. Dis Colon Rectum. 2004;47:1493–8.

    Article  Google Scholar 

  55. Bernstein WC. What are hemorrhoids and what is their relationship to the portal venous system? Dis Colon Rectum. 1983;26:829–34.

    Article  CAS  Google Scholar 

  56. Quijano CE, Abalos E. Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium. Cochrane Database Syst Rev. 2005;(3):CD004077.

    Google Scholar 

  57. Cracco N, Zinicola R. Is haemorrhoidectomy in inflammatory bowel disease harmful? An old dogma re-examined. Color Dis. 2014;16:516–9.

    Article  CAS  Google Scholar 

  58. D’Ugo S, Stasi E, Gaspari AL, Sileri P. Hemorrhoids and anal fissures in inflammatory bowel disease. Minerva Gastroenterol Dietol. 2015;61:223–33.

    PubMed  Google Scholar 

  59. Morandi E, Merlini D, Salvaggio A, Foschi D, Trabucchi E. Prospective study of healing time after hemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection. Dis Colon Rectum. 1999;42:1140–4.

    Article  CAS  Google Scholar 

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Jeong, G.Y. (2019). Hemorrhoids. In: Lee, D. (eds) Practices of Anorectal Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-1447-6_5

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  • DOI: https://doi.org/10.1007/978-981-13-1447-6_5

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