History of research of hemorrhoids is a history of one great mistake        

                         History of treatment of hemorrhoids is history of needless invasive treatment.

Ligation under vision of hemorrhoidial cushions for therapy of bleeding hemorrhoids.

Bronstein M, Issa N, Gutman M, Neufeld D

Tech Coloproctol. 2008 Jun 10

Department of Surgery "A", "Meir" Medical Center, 59 Tchernichovsky St., Kfar Saba, 44281, Israel.

Ligation under vision (LUV) is a simple method for the surgical treatment of hemorrhoids . In this study, we evaluated the results of our initial experience with the procedure in terms of postoperative pain, patients' final satisfaction and complications. We reviewed a group of patients who had undergone suture ligation of symptomatic hemorrhoids of grade II and III. This was performed with the hemorrhoids under direct vision and without the use of any ancillary instrumentation such as a Doppler sensor. All interventions were performed in the day-care surgical unit using general or regional anaesthesia. Surgical outcome and degree of postoperative pain were determined from outpatient clinic follow-up and individual phone interviews. A total of 32 patients (19 men and 13 women) with a mean age of 59 years had undergone LUV. There were 23 patients (72%) with grade II and 9 patients (28%) with grade III haemorrhoids. The indication for the surgery was bleeding in 19 patients (59%), prolapse in 6 (19%) and both in 7 (22%). A previous rubber band ligation had been carried out in 17 patients (53%). On average, the surgery took 22 min. All patients were discharged on the same day. Four %patients (12%) suffered only mild postoperative pain, 14 (44%) suffered from moderate pain and another 14 (44%) had severe pain. At follow-up (median 21 months, range 9-33 months), 28 %patients (87.5%) were completely asymptomatic at the time of the phone interview. The final result was assessed as excellent by 19 patients (60%), successful by 10 (31%), and unsuccessful by 3 (9%). All patients had complete functional recovery and there were no major surgical complications. Our data show that LUV of symptomatic hemorrhoids is a simple and safe procedure. It can be performed as effective isolated surgery for symptomatic hemorrhoids and as an additional procedure in the treatment of complex peri anal pathology.

Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures.

Pescatory M, Gagliary G. Tech Coloproctol. 2008 Mar, 12(1): 7-19 Epub 2008 May 30

Coloproctology Unit, Ars Medica Hospital, Rome, Italy. ucpclub@virgilio.it

Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctolgia,  total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented.