• endoscopic hemostasis
• hemorrhoidectomy
• post-hemorrhoidectomy bleeding (PHB)

• anticoagulants
• hemorrhoidectomy
• humans
• platelet inhibitor
• warfarin

• Humans
• Male
• Hemorrhoidectomy/adverse effects
• Retrospective Studies
• Hemorrhage
• Anticoagulants/adverse effects
• Warfarin/therapeutic use
• Platelet Aggregation Inhibitors

• acute hemorrhagic rectal ulcer
• lowers gastrointestinal bleeding
• rectal ulcer
• vaseline gauze

• Humans
• Female
• Aged
• Aged, 80 and over
• Rectum
• Ulcer/therapy
• Rectal Diseases/complications
• Rectal Diseases/therapy
• Rectal Diseases/diagnosis
• Retrospective Studies
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Acute Disease
• Colonic Diseases/complications

• BANANA-Clip
• Delayed bleeding
• Hemorrhoids
• Pathologic constriction
• Rubber band ligation
• Vascular system injuries

• Comorbidities
• Complications
• Hemorrhoidal
• Postoperative
• Retrospective

The effectiveness of hemorrhoidal artery ligation supplementation in reducing the incidence of post laser hemorrhoidoplasty bleeding has not been investigated.

This was a double-blind, randomized controlled trial comparing post-operative bleeding incidence in patients undergoing laser hemorrhoidoplasty (LHP) only versus LHP with hemorrhoidal artery ligation (HAL). Outcome measures included post-operative bleeding and its severity (i.e. verbal rating scale and Clavien-Dindo classification), presence of perianal swelling and pain score (visual analog score) at 1-day, 1-week and 6-weeks post-operatively. Statistical tests were performed and a value of P < 0.05 was considered significant.

Seventy-six patients were randomized. There was no difference in median operating time. The bleeding incidence was highest at 1-week post-operatively (17.1%), and decreased to 1.3% at 6-weeks. There was no significant difference in bleeding incidence between both groups at any of the measured timepoints (P > 0.05). Severity of bleeding and incidence of post-operative perianal swelling were similar in both groups (P > 0.05). There was no difference in median pain scores.

Supplementation of HAL to LHP does not reduce the post-operative bleeding incidence. LHP is sufficient as a stand-alone procedure for treating haemorrhoids.

Trial registration: National Registration Number is NMRR-15-1112-24065 (IIR). The trial start date was 1st January 2015 with the ClinicalTrials.gov identifier and registration number as NCT04667169.

• Colorectal surgery
• Hemorrhoidal artery ligation
• Hemorrhoidectomy
• Hemorrhoids
• Laser hemorrhoidoplasty

Symptomatic haemorrhoids are a common anorectal disorder. The aim of the study was to investigate whether the omission of tamponade dressings after haemorrhoidectomy reduces postoperative pain without increasing the risk of severe bleeding.

This was an open-label, randomized clinical trial conducted at 14 German hospitals. All patients with third- or fourth-degree haemorrhoids undergoing haemorrhoidectomy were considered eligible for selection in the intervention (no dressing) or control group (tamponade applied). Two co-primary outcomes were analysed by testing hierarchically ordered hypotheses. First, maximum pain intensity within 48 h after surgery was compared between the groups (superiority). This was followed by an analysis of severe bleeding complications, defined as any bleeding requiring surgical re-intervention within 7 days (non-inferiority). Secondary outcomes included health-related quality of life, patient satisfaction, haemoglobin levels, and adverse events.

Out of 950 patients screened, 754 were randomized and 725 received intervention (366 patients in the intervention and 359 patients in the control group). In the group with tamponade dressings, median pain intensity on the 0 to 10 scale was 6 (interquartile range (i.q.r.) 4–7). Patients without tamponade dressings reported significantly less pain (median 5 (i.q.r. 3–7), P < 0.001). In each group, five patients (1.4 per cent) experienced severe bleeding. The absolute difference for the severe bleeding rate was −0.03 per cent with the 90 per cent confidence interval ranging from −1.47 per cent to +1.41 per cent, in line with the non-inferiority aim. No significant between-group difference was found for secondary outcomes.

The practice of inserting tamponade dressings after haemorrhoidectomy correlates with increased postoperative pain and does not provide benefits in terms of reduced postoperative bleeding.

DRKS00011590

• Bandages/adverse effects
• Hemorrhoidectomy/adverse effects
• Hemorrhoids/surgery
• Humans
• Pain, Postoperative/etiology
• Pain, Postoperative/prevention & control
• Quality of Life

• Helios Center for Research and Innovation

This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy.

This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes.

All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups.

The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

• Complication
• Elderly
• Hemorrhoids
• LigaSure hemorrhoidectomy

• Ferguson
• Ligasure
• bleeding
• complications
• hemorrhoid
• hemorrhoidectomy

• anticoagulant drugs
• antiplatelet drugs
• antithrombotic therapy
• proctological surgery
• secondary bleeding

Symptomatic hemorrhoids are one of the most common anorectal disorders. Many surgeons use tamponades after open hemorrhoidectomy to manage postoperative bleeding. The question of whether a tamponade is necessary and beneficial after hemorrhoidectomy has not yet been conclusively answered. A previously conducted single-center pilot trial included 100 patients after Milligan–Morgan hemorrhoidectomy. The data indicated that insertion of an anal tamponade after hemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. The findings of this pilot trial are now to be verified by means of a multicenter randomized clinical study called NoTamp.

We plan to include 953 patients after Milligan-Morgan or Parks hemorrhoidectomy in the NoTamp study. The aim is to demonstrate that using no tamponade dressing after open hemorrhoidectomy is not inferior to using tamponades with respect to postoperative bleeding, and that the patients report less pain. Primary endpoints of the trial are the maximum postoperative pain within 48 h and the incidence of severe postoperative bleeding that requires surgical revision within 7 days after the surgical procedure. Secondary endpoints of the study are the use of analgesics in the postoperative course, the lowest hemoglobin documented within 7 days, quality of life and patient satisfaction. Safety analysis includes all adverse and serious adverse events in relation to the study treatment. Further information can be found in the registration at the German Registry of Clinical Studies (DRKS00011590) and on the study webpage (https://notamp.de/en-GB/trial/main/setLocale/en_GB/). The study is financed by the HELIOS research funding.

The study received full ethics committee approval. The first patient was enrolled on 3 May 2017. This trial will finally answer the question whether the insertion of a tamponade after open hemorrhoidectomy is necessary and beneficial.

German Clinical Trials Register (Deutsches Register Klinischer Studien (DRKS), DRKS00011590. Registered on 12 April 2017.

• Anal tampon
• Hemorrhoidectomy
• Hemorrhoids
• Postoperative bleeding
• Postoperative pain
• Tamponade

• Delayed post-hemorrhoidectomy bleeding
• Ferguson procedure
• Hemorrhoidectomy
• LigaSure procedure
• Risk factors

• Female
• Hemorrhage/etiology
• Hemorrhoidectomy/adverse effects
• Humans
• Ligation
• Male
• Middle Aged
• Postoperative Complications/etiology
• Risk Factors

Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation.

During a 53-month period (February 2009–July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery.

During the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455–3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study’s 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049).

These preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.

• Anticoagulation
• Hemorrhoids
• Postoperative hemorrhage
• THD
• Transanal hemorrhoidal dearterialization

• anorectal surgery
• complications
• hemorrhage
• pelvic sepsis
• urinary retention

• Austria
• Evidence-Based Medicine
• Female
• Hemorrhoids/diagnosis
• Hemorrhoids/therapy
• Humans
• Practice Guidelines as Topic
• Pregnancy
• Pregnancy Complications/diagnosis
• Pregnancy Complications/therapy
• Recurrence

• Epinephrine/administration & dosage
• Epinephrine/therapeutic use
• Gastrointestinal Hemorrhage/therapy
• Hemorrhoids/surgery
• Hemostatic Techniques
• Humans
• Lidocaine/administration & dosage
• Lidocaine/therapeutic use
• Male
• Middle Aged
• Postoperative Complications/therapy
• Rectum
• Time Factors

• Catheterization
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hemorrhoids/surgery
• Humans
• Postoperative Complications/etiology
• Postoperative Complications/therapy
• Rectum
• Time Factors
• Treatment Outcome