title: Impact of less invasive treatments including sclerotherapy with a new agent and hemorrhoidopexy for prolapsing internal hemorrhoids.
abstract: Conventional hemorrhoidectomy is applied for the treatment of prolapsing internal hemorrhoids. Recently, less-invasive treatments such as sclerotherapy using aluminum potassium sulphate/tannic acid (ALTA) and a procedure for prolapse and hemorrhoids (PPH) have been introduced. We compared the results of sclerotherapy with ALTA and an improved type of PPH03 with those of hemorrhoidectomy. Between January 2006 and March 2009, we performed hemorrhoidectomy in 464 patients, ALTA in 940 patients, and PPH in 148 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. The volume of ALTA injected into a hemorrhoid was 7.3 ± 2.2 (mean ± SD) mL. The duration of the operation was significantly shorter in ALTA (13 ± 2 minutes) than in hemorrhoidectomy (43 ± 5 minutes) or PPH (32 ± 12 minutes). Postoperative pain, requiring intravenous pain medications, occurred in 65 cases (14%) in hemorrhoidectomy, in 16 cases (1.7%) in ALTA, and in 1 case (0.7%) in PPH. The disappearance rates of prolapse were 100% in hemorrhoidectomy, 96% in ALTA, and 98.6% in PPH. ALTA can be performed on an outpatient basis without any severe pain or complication, and PPH is a useful alternative treatment with less pain. Less-invasive treatments are beneficial when performed with care to avoid complications.
authors: 1 Department of Surgery, Kyoto Japan Post Hospital, Kyoto, Japan.
authors: Yukihiko
authors: Y
authors: Tokunaga
authors: Hirokazu
authors: H
authors: Sasaki
mesh_terms: D000534:Alum Compounds / Q000627:therapeutic use; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000145:classification / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy; D011391:Prolapse; D015911:Sclerotherapy / Q000379:methods*; D013634:Tannins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000534:Alum Compounds; D013634:Tannins; C041524:aluminum sulfate
references: Surg Innov. 2011 Sep;18(3):241-7
references: 21737467
references: Dis Colon Rectum. 2007 Jun;50(6):878-92
references: 17380367
references: Tech Coloproctol. 2006 Mar;10(1):43-6
references: 16528484
references: Colorectal Dis. 2002 Sep;4(5):367-370
references: 12780584
references: Dis Colon Rectum. 1998 Feb;41(2):159-64
references: 9556238
references: Ann Chir. 1996;50(8):589-92
references: 9035429
references: Tech Coloproctol. 2002 Sep;6(2):83-8
references: 12402051
references: Dis Colon Rectum. 2002 Feb;45(2):268-70
references: 11852343
references: Dis Colon Rectum. 2003 May;46(5):573-6
references: 12792430