title: Anal cushion lifting method is a novel radical management strategy for hemorrhoids that does not involve excision or cause postoperative anal complications.
abstract: OBJECTIVE
  To describe the anal cushion lifting (ACL) method with preliminary clinical results.
  
  
  METHODS
  Between January to September 2007, 127 patients who received ACL method for hemorrhoid was investigated with informed consent. In this study, three surgeons who specialized in anorectal surgery performed the procedures. Patients with grade two or more severe hemorrhoids according to Goligher's classification were considered to be indicated for surgery. The patients were given the choice to undergo either the ACL method or the ligation and excision method. ACL method is an original technique for managing hemorrhoids without excision. After dissecting the anal cushion from the internal sphincter muscle, the anal cushion was lifted to oral side and ligated at the proper position. Clinical characteristics and outcomes of patients were recorded including complications after surgery.
  
  
  RESULTS
  A total of 127 patients were enrolled. Their median age was 42 (19-84) years, and 74.8% were female. In addition, more than 99% of the patients had grade 3 or worse hemorrhoids. The median follow-up period was 26 (0-88) mo, and the median operative time was 15 (4-30) min. After surgery, analgesics were used for a median period of three days (0-21). Pain control was achieved using extra-oral analgesic drugs, although some patients required intravenous injections of analgesic drugs. The median duration of the patients' postoperative hospital stay was 7 (2-13) d. A total of 10 complications (7.9%) occurred. Bleeding was observed in one patient and was successfully controlled with manual compression. Urinary retention occurred in 6 patients, but it disappeared spontaneously in all cases. Recurrent hemorrhoids developed in 3 patients after 36, 47, and 61 mo, respectively. No anal stenosis or persistent anal pain occurred.
  
  
  CONCLUSIONS
  We consider that the ACL method might be better than all other current methods for managing hemorrhoids.
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Gentaro
authors.initials: G
authors.lastname: Ishiyama
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nishidate
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ishiyama
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nishio
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Tarumi
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Okita
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Mizuguchi
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Mineko
authors.initials: M
authors.lastname: Fujimiya
authors.affiliation: Gentaro Ishiyama, Yuji Ishiyama, Akihiko Nishio, Ken Tarumi, Maiko Kawamura, Department of Anorectal Surgery, Sapporo Ishiyama Hospital, Sapporo, Hokkaido 064-0915, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
keywords: Anal cushion lifting method; Anal stenosis; Hemorrhoidectomy