• Hemorrhoids
• Milligan–Morgan hemorrhoidectomy (MMH)
• Polidocanol foam sclerotherapy
• Postoperative complications
• Rubber band ligation

• Humans
• Hemorrhoids/therapy
• Hemorrhoids/surgery
• Retrospective Studies
• Male
• Female
• Sclerotherapy/methods
• Ligation/methods
• Middle Aged
• Hemorrhoidectomy/methods
• Hemorrhoidectomy/adverse effects
• Polidocanol/therapeutic use
• Polidocanol/administration & dosage
• Adult
• Recurrence
• Treatment Outcome
• Sclerosing Solutions/therapeutic use
• Patient Satisfaction
• Combined Modality Therapy
• Aged
• Severity of Illness Index
• Postoperative Complications/epidemiology

• Humans
• Hemorrhoidectomy/adverse effects
• Hemorrhoidectomy/methods
• Hemorrhoids/surgery
• Fecal Incontinence/epidemiology
• Fecal Incontinence/etiology
• Surgical Stapling/adverse effects
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Prevalence

• Hemorrhoidal artery ligation and mucopexy
• Hemorrhoidopexy
• Hemorrhoids
• Laser hemorrhoidoplasty
• Stapled hemorrhoidopexy

• Hemorrhoids
• Overview
• Stapled hemorrhoidopexy
• Systematic reviews

• Humans
• Hemorrhoids/surgery
• Female
• Ligation/methods
• Male
• Surgical Stapling/methods
• Middle Aged
• Adult
• Patient Satisfaction
• Hemorrhoidectomy/methods
• Hemorrhoidectomy/adverse effects
• Recurrence
• Quality of Life
• Treatment Outcome
• Operative Time
• Severity of Illness Index
• Anal Canal/surgery
• Pain, Postoperative/etiology
• Pain, Postoperative/epidemiology

• Comorbidities
• Complications
• Hemorrhoidal
• Postoperative
• Retrospective

Stapled haemorrhoidopexy (SH) has resulted in a unique collection of procedural complications with postoperative mucocele a particularly rare example. This study is designed to comprehensively describe the characteristics of rectal mucocele and discuss its pathogenesis following SH surgery.

A database of patients presenting with a rectal mucocele following an SH procedure was established and studied retrospectively.

Seven patients (5 males; median age 32 years, range 20–75 years) were identified. All patients complained of variable anal discomfort with 5/7 presenting with inconstant anal pain, 2 with de novo evacuatory difficulty. These cases appeared at a median time of 6 months (range 2–84 months) after SH surgery.

Rectal Mucocele develops when mucosal fragments become embedded and isolated under the mucosa. It is a preventable complication of SH surgery by ensuring correct purse string placement prior to stapled haemorrhoid excision.

The online version contains supplementary material available at 10.1186/s12893-022-01744-3.

Background

Surgical removal of hemorrhoids is the gold-standard treatment for symptomatic grade III and IV hemorrhoid disease. There are numerous ways the hemorrhoidectomy surgical procedure is done but the most effective and least painful way is still to be elucidated.

Objective

To compare the outcomes of ENSEAL® (Ethicon, Inc., Raritan, USA) versus gold standard Milligan-Morgan hemorrhoidectomy in patients presenting with grade-III and IV hemorrhoids

Materials and methods

After ethical approval, the Randomized Controlled Trial was conducted at the Department of Surgery, Unit III, Lahore General Hospital, Lahore, Pakistan, between January 2020 and January 2022. In this study, 140 patients who met the inclusion criteria were recruited after informed consent. Patients were split randomly into two equal groups using a lottery technique. In group A, hemorrhoidectomy was carried out with ENSEAL®, whereas in group B, open hemorrhoidectomy was performed by the Milligan-Morgan method. the surgery duration and blood loss were noted. After the operation, patients were transferred to and discharged from the post-anesthesia recovery room. Patients were further followed up for pain scores after 24 hours. Data was analyzed by using Statistical Package for Social Sciences (SPSS) v25 (IBM Corp., Armonk, USA). Data was categorized for age, gender, body mass index (BMI), degree of hemorrhoids, and duration of hemorrhoids. A p-value <0.05 was considered significant.

Results

140 patients were included in this study. Group A patients underwent ENSEAL® hemorrhoidectomy, and group B was formed from those who underwent the Milligan-Morgan procedure. In group A, there were 41 (58.5%) males and 29 (41.4%) females, while in group B, there were 43 (61.4%) males and 27 (38.5%) females. The mean age of group A patients was 49.97 ± 7.36 years and 43.2 ± 8.01 years in group B. In group A, the mean operative time was 20.87 ± 3.05 min, while 27.10 ± 3.42 min in group B, which is statistically significant with a p-value of <0.001. In group A, mean blood loss was 9.79 ± 2.87 ml, while 13.36 ± 3.73 ml in group B, which is statistically significant with a p-value of <0.001. In group A, the mean pain score was 2.7 ± 1.08, while 3.34 ± 1.16 in group B, which is statistically significant with a p-value of <0.001.

Conclusion

When considering the length of the procedure and blood loss, ENSEAL® hemorrhoidectomy has been determined to be an effective treatment that the patients tolerated well. Therefore, ENSEAL® hemorrhoidectomy can be a safe and efficient alternative to conventional treatment for hemorrhoids that are causing symptoms.

• anatomical variations
• clinical anatomy
• forensic clinical anatomy
• iatrogenic lesions
• individual anatomy
• medical liability
• medical malpractice
• medical responsibility
• post-mortem imaging

The aim of this study was to compare a modified ligation procedure versus stapled haemorrhoidectomy (SH) in patients with symptomatic haemorrhoids.

This randomized trial included patients with symptomatic haemorrhoids treated in Shanghai from May 2018 to September 2021. Eligible patients were randomly 1:1 assigned the modified ligation procedure for prolapsed haemorrhoids (MLPPH) and SH groups. The primary outcome was the assessment of efficacy at 6 months after the intervention. The operating time, incidence of complications, clinical effectiveness (pain, Wexner incontinence, haemorrhoid symptom severity (HSS) scores, and 6-month cure rate) were collected, and quality-adjusted life years (QALYs) were adopted as indicator for the cost-effectiveness analysis (CEA).

Out of 187 patients screened, 133 patients were randomized (67 for MLPPH and 66 for SH). One patient in the MLPPH group was excluded, and two patients were lost to follow-up. The mean operating time was longer in MLPPH than in SH (57.42 min versus 30.68 min; P < 0.001). The median pain score was higher in SH than in MLPPH at postoperative day 3 (P = 0.018), day 7(P = 0.013), and day 14 (P = 0.003). The median Wexner incontinence score was higher in SH than in MLPPH at postoperative month 1 (P = 0.036) and month 3 (P = 0.035), but was similar in the two groups at month 6. In addition, the median HSS score was lower in MLPPH than in SH 6 months after surgery (P = 0.003). The 6-month cure rate was higher in MLPPH than in SH (P = 0.003). CEA showed lower mean costs in MLPPH than in SH (EUR 1080.24 versus EUR 1657.97; P < 0.001) but there was no significant difference in effectiveness (P = 0.181). However, MLPPH was cost-effective (incremental cost-effectiveness ratio, −120 656.19 EUR/QALYs).

MLPPH was documented as a longer but cost-effective procedure, it provided lower short-term pain, and Wexner and HSS scores.

Registration number: Chinese Clinical Trial Registry ChiCTR1800015928 (http://www.chictr.org.cn/searchproj.aspx).

• China
• Hemorrhoidectomy/adverse effects
• Hemorrhoids/surgery
• Humans
• Ligation/methods
• Pain

• Shanghai Municipal Health Commission