Hemorrhoids

ABSTRACT

Hemorrhoids are normal vascular structures underlying the distal rectal mucosa and anoderm. Symptomatic hemorrhoidal tissues located above the dentate line are referred to as internal hemorrhoids and produce bleeding and prolapse. Thrombosis in external hemorrhoids results in painful swelling. Symptomatic internal hemorrhoids that fail bowel management programs may be amenable to in-office treatment with rubber band ligation or infrared coagulation. Internal hemorrhoids that fail to respond to these measures or complex internal and external hemorrhoidal disease may require a surgical hemorrhoidectomy, either open or closed. A stapled hemorrhoidopexy treats symptomatic internal hemorrhoids and should be employed with care and only after thorough training of the surgeon because of the risk of rare, severe complications. The choice of procedure should be based on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon.

KEYWORDS

Hemorrhoids - thrombosed external hemorrhoids - internal hemorrhoids - rectal bleeding - stapled hemorrhoidopexy

REFERENCES

• 1 Thomson W H. The nature of haemorrhoids.  Br J Surg. 1975;  62 542-552
• 2 Banov Jr L, Knoepp Jr L F, Erdman L H, Alia R T. Management of hemorrhoidal disease.  J S C Med Assoc. 1985;  81 398-401
• 3 Alonso-Coello P, Mills E, Heels-Ansdell D et al.. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis.  Am J Gastroenterol. 2006;  101 181-188
• 4 Bleday R, Pena J P, Rothenberger D A, Goldberg S M, Buls J G. Symptomatic hemorrhoids: current incidence and complications of operative therapy.  Dis Colon Rectum. 1992;  35 477-481
• 5 Sardinha T C, Corman M L. Hemorrhoids.  Surg Clin North Am. 2002;  82 1153-1167
• 6 Armstrong D N. Multiple hemorrhoidal ligation: a prospective, randomized trial evaluating a new technique.  Dis Colon Rectum. 2003;  46 179-186
• 7 Poon G P, Chu K W, Lau W Y et al.. Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial.  Dis Colon Rectum. 1986;  29 836-838
• 8 Peng B C, Jayne D G, Ho Y H. Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles.  Dis Colon Rectum. 2003;  46 291-297 discussion 296-297
• 9 Guy R J, Seow-Choen F. Septic complications after treatment of haemorrhoids.  Br J Surg. 2003;  90 147-156
• 10 McCloud J M, Jameson J S, Scott A N. Life-threatening sepsis following treatment for haemorrhoids: a systematic review.  Colorectal Dis. 2006;  8 748-755
• 11 Steinberg D M, Liegois H, Alexander-Williams J. Long term review of the results of rubber band ligation of haemorrhoids.  Br J Surg. 1975;  62 144-146
• 12 Wrobleski D E, Corman M L, Veidenheimer M C, Coller J A. Long-term evaluation of rubber ring ligation in hemorrhoidal disease.  Dis Colon Rectum. 1980;  23 478-482
• 13 Huber Jr P, Gregorcyk S. Anorectal disease.  Curr Treat Options Gastroenterol. 2000;  3 229-242
• 14 Adami B, Eckardt V F, Suermann R B, Karbach U, Ewe K. Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy.  Dis Colon Rectum. 1981;  24 373-374
• 15 Walker A J, Leicester R J, Nicholls R J, Mann C V. A prospective study of infrared coagulation, injection and rubber band ligation in the treatment of haemorrhoids.  Int J Colorectal Dis. 1990;  5 113-116
• 16 Dennison A, Whiston R J, Rooney S, Chadderton R D, Wherry D C, Morris D L. A randomized comparison of infrared photocoagulation with bipolar diathermy for the outpatient treatment of hemorrhoids.  Dis Colon Rectum. 1990;  33 32-34
• 17 Johanson J F, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy.  Am J Gastroenterol. 1992;  87 1600-1606
• 18 MacRae H, Temple L K, McLeod R S. A meta-analysis of hemorrhoidal treatments.  Semin Colon Rectal Surg. 2002;  13 77-83
• 19 Marques C F, Nahas S C, Nahas C S, Sobrado Jr C W, Habr-Gama A, Kiss D R. Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial.  Tech Coloproctol. 2006;  10 312-317
• 20 Perrotti P, Antropoli C, Molino D, De Stefano G, Antropoli M. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine.  Dis Colon Rectum. 2001;  44 405-409
• 21 Jongen J, Bach S, Stubinger S H, Bock J U. Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients.  Dis Colon Rectum. 2003;  46 1226-1231
• 22 Cavcic J, Turcic J, Martinac P, Mestrovic T, Mladina R, Pezerovic-Panijan R. Comparison of topically applied 0.2% glyceryl trinitrate ointment, incision and excision in the treatment of perianal thrombosis.  Dig Liver Dis. 2001;  33 335-340
• 23 Ferguson J AHJ. Closed hemorrhoidectomy.  Dis Colon Rectum. 1959;  2 176-179
• 24 Milligan E TMC, Jones L E. Surgical anatomy of the anal canal and the operative treatment of haemorrhoids.  Lancet. 1937;  2 119-124
• 25 Hayssen T K, Luchtefeld M A, Senagore A J. Limited hemorrhoidectomy: results and long-term follow-up.  Dis Colon Rectum. 1999;  42 909-914 discussion 914-905
• 26 Guenin M O, Rosenthal R, Kern B, Peterli R, von Flue M, Ackermann C. Ferguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson's hemorrhoidectomy.  Dis Colon Rectum. 2005;  48 1523-1527
• 27 Ho Y H, Seow-Choen F, Tan M, Leong A F. Randomized controlled trial of open and closed haemorrhoidectomy.  Br J Surg. 1997;  84 1729-1730
• 28 Carapeti E A, Kamm M A, McDonald P J, Chadwick S J, Phillips R K. Randomized trial of open versus closed day-case haemorrhoidectomy.  Br J Surg. 1999;  86 612-613
• 29 Arbman G, Krook H, Haapaniemi S. Closed vs. open hemorrhoidectomy-is there any difference?.  Dis Colon Rectum. 2000;  43 31-34
• 30 Gencosmanoglu R, Sad O, Koc D, Inceoglu R. Hemorrhoidectomy: open or closed technique? A prospective, randomized clinical trial.  Dis Colon Rectum. 2002;  45 70-75
• 31 You S Y, Kim S H, Chung C S, Lee D K. Open vs. closed hemorrhoidectomy.  Dis Colon Rectum. 2005;  48 108-113
• 32 Basdanis G, Papadopoulos V N, Michalopoulos A, Apostolidis S, Harlaftis N. Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles.  Surg Endosc. 2005;  19 235-239
• 33 Franklin E J, Seetharam S, Lowney J, Horgan P G. Randomized, clinical trial of Ligasure vs conventional diathermy in hemorrhoidectomy.  Dis Colon Rectum. 2003;  46 1380-1383
• 34 Chung Y C, Wu H J. Clinical experience of sutureless closed hemorrhoidectomy with LigaSure.  Dis Colon Rectum. 2003;  46 87-92
• 35 Palazzo F F, Francis D L, Clifton M A. Randomized clinical trial of Ligasure versus open haemorrhoidectomy.  Br J Surg. 2002;  89 154-157
• 36 Bailey H R, Ferguson J A. Prevention of urinary retention by fluid restriction following anorectal operations.  Dis Colon Rectum. 1976;  19 250-252
• 37 Hoff S D, Bailey H R, Butts D R et al.. Ambulatory surgical hemorrhoidectomy-a solution to postoperative urinary retention?.  Dis Colon Rectum. 1994;  37 1242-1244
• 38 Zaheer S, Reilly W T, Pemberton J H, Ilstrup D. Urinary retention after operations for benign anorectal diseases.  Dis Colon Rectum. 1998;  41 696-704
• 39 Chen H H, Wang J Y, Changchien C R et al.. Risk factors associated with posthemorrhoidectomy secondary hemorrhage: a single-institution prospective study of 4,880 consecutive closed hemorrhoidectomies.  Dis Colon Rectum. 2002;  45 1096-1099
• 40 Corman M. Colon and Rectal Surgery. 5th ed. Philadelphia; Lippincott Williams & Wilkins 2005
• 41 Christensen M A, Pitsch Jr R M, Cali R L, Blatchford G J, Thorson A G. “House” advancement pedicle flap for anal stenosis.  Dis Colon Rectum. 1992;  35 201-203
• 42 Carapeti E A, Kamm M A, McDonald P J, Phillips R K. Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy.  Lancet. 1998;  351 169-172
• 43 Nicholson T J, Armstrong D. Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing.  Dis Colon Rectum. 2004;  47 711-716
• 44 Balfour L, Stojkovic S G, Botterill I D, Burke D A, Finan P J, Sagar P M. A randomized, double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy.  Dis Colon Rectum. 2002;  45 1186-1190 discussion 1190-1181
• 45 Huang D Y, Yoon S G, Kim H S, Lee J K, Kim K Y. Effect of 0.2 percent glyceryl trinitrate ointment on woulnd healing after hemorrhoidectomy: results of a randomized, prospective, double-blind, placebo-controlled trial.  Dis Colon Rectum. 2003;  46 950-954
• 46 Wasvary H J, Hain J, Mosed-Vogel M, Bendick P, Barkel D C, Klein S N. Randomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy.  Dis Colon Rectum. 2001;  44 1069-1073
• 47 Silverman R, Bendick P J, Wasvary H J. A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy.  Dis Colon Rectum. 2005;  48 1913-1916
• 48 Chiu J H, Chen W S, Chen C H et al.. Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy: prospective, randomized, controlled trial.  Dis Colon Rectum. 1999;  42 180-185
• 49 Allegra G. Experiences with mechanical staplers: hemorrhoidectomy using a circular stapler.  G Chir. 1990;  11 95-97
• 50 Longo A. Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with a circular suturing device: a new procedure. Paper presented in: Proceedings of the 6th World Congress of Endoscopic Surgery and 6th International Congress of European Association for Endoscopic Surgery June 3-6, 1998 Rome;
• 51 Longo A. Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures.  Dis Colon Rectum. 2002;  45 571-572 , author reply 572
• 52 Correa-Rovelo J M, Tellez O, Obregon L et al.. Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: a need for preservation of squamous epithelium.  Dis Colon Rectum. 2003;  46 955-962
• 53 Senagore A J, Singer M, Abcarian H et al.. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results.  , [erratum appears in Dis Colon Rectum. 2005;48:400] Dis Colon Rectum. 2004;  47 1824-1836
• 54 Oughriss M, Yver R, Faucheron J L. Complications of stapled hemorrhoidectomy: a French multicentric study.  Gastroenterol Clin Biol. 2005;  29 429-433
• 55 Pernice L M, Bartalucci B, Bencini L, Borri A, Catarzi S, Kroning K. Early and late (ten years) experience with circular stapler hemorrhoidectomy.  Dis Colon Rectum. 2001;  44 836-841
• 56 Hetzer F H, Demartines N, Handschin A E, Clavien P A. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial.  Arch Surg. 2002;  137 337-340
• 57 Kairaluoma M, Nuorva K, Kellokumpu I. Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome.  Dis Colon Rectum. 2003;  46 93-99
• 58 Ho Y H, Cheong W K, Tsang C et al.. Stapled hemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months.  Dis Colon Rectum. 2000;  43 1666-1675
• 59 Cheetham M J, Cohen C R, Kamm M A, Phillips R K. A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up.  Dis Colon Rectum. 2003;  46 491-497
• 60 Brusciano L, Ayabaca S M, Pescatori M et al.. Reinterventions after complicated or failed stapled hemorrhoidopexy.  Dis Colon Rectum. 2004;  47 1846-1851
• 61 Cheetham M J, Mortensen N J, Nystrom P O, Kamm M A, Phillips R K. Persistent pain and faecal urgency after stapled haemorrhoidectomy.  Lancet. 2000;  356 730-733
• 62 Bufo A, Galasse S, Amoroso M. Recurrent severe postoperative bleeding after stapled hemorrhoidopexy requiring emergency laparotomy.  Tech Coloproctol. 2006;  10 62-63
• 63 Angelone G, Giardiello C, Prota C. Bleeding after stapled haemorhoidopexy using PPH 03 instrument.  ANZ J Surg. 2006;  76 672-673
• 64 Madoff R D, Fleshman J W. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids.  Gastroenterology. 2004;  126 1463-1473
• 65 Eu K W, Teoh T A, Seow-Choen F, Goh H S. Anal stricture following haemorrhoidectomy: early diagnosis and treatment.  Aust N Z J Surg. 1995;  65 101-103
• 66 Ortiz H, Marzo J, Armendariz P. Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy.  Br J Surg. 2002;  89 1376-1381