Use of flavonoids mixture (diosmin, troxerutin, rutin, hesperidin, quercetin) is a safe and effective mean of managing bleeding from hemorrhoidal disease and minimal adverse events are reported.

Myoxinol is a complex of oligopeptides obtained from the seeds of Hibiscus esculentus used in cosmetic as natural alternative to botulin toxin. The aim of the study was to evaluate the safety and effectiveness of local myoxinol for the treatment of acute anal fissure. All the consecutive patients with acute fissure treated from January to June 2014 underwent 30 days of topical treatment (twice/day) with a mioxinol based ointment. Pain, symptomatic relief, fissure healing and re-epithelization, 1-year recurrence rate, subjective satisfaction and need for further treatments were evaluated. During the study period 157 patients were eligible for data analysis (91 males: 58%; mean age 38 years: range 17-83). Median anal pain score was 7.1 pre-treatment and 1.7 and 0.9 after 30 days and 12 months from treatment, respectively (p: 0.0001). After the treatment period complete healing was achieved in 103 patients (65.5%), relevant improvement in 31 (20%) and no improvement in 21 patients (13.5%). Overall efficacy rate was 85.5%. A significant difference was reported considering patients with pre-treatment VAS between 1-5 and 6-10 (p: 0.004). Twenty-nine patients (18.5%) required further treatments. Hydrolyzed Hibiscus esculentus extract was proven to be an effective and well-tolerated topical treatment for acute fissure, with a high healing rate, a significant reduction of pain and a low 1-year recurrence rate.

The treatment of hemorrhoidal disease using stapled anopexy (SA) is still burdened by a high incidence of recurrence. Probably this condition is secondary to inadequate removal of the prolapsed tissue due to the reduced capacity of resection from the adopted device. In order to limit the incidence of failures by providing a removal of a greater amount of prolapsed tissue was considered the opportunity to use the STARR technique even in the presence of haemorrhoidal disease not burdened by symptoms of obstructed defecation. We evaluated the early and at a distance results of 285 patients who had undergone in 2007-2011 surgical resection with trans-anal circular stapler for symptomatic III-IV degree haemorrhoids without obstructed defecation disorders. 237 patients were subjected to SA, while in the remaining 48, since on intervention prolapse committed the CAD more than half of the device, we performed a STARR. adopted the Chi square test (C) considering significant p-values less than 0.05. The anamnestic preoperative evaluation allowed to put the correct indication for surgical treatment in 80% of patients. Mean operative times, hospital stay, incidence of early and more important complications, the symptomatic recurrence of disease (5%) were not dissimilar in the two groups under consideration. Conversely (p < 0.05) the relief of residual asymptomatic disease (24 vs. 10%) was significant . The overall satisfaction was significantly higher in the ST group (73.5 vs 58.6%). The STARR in case of massive prolapse who express themselves with only haemorrhoidal disease is a safe technique, able to optimize the long-term effectiveness of trans-anal resection surgery, limiting the incidence of symptomatic recurrences. The information offered to the patient at the time of the consent to surgery must be extensive and detailed, always considering the possibility of adopting the two techniques alternately and that, at completion of the intervention, could be necessary also the removal of persistent skin tags.

Purpose: Post-operative stenosis following SA is a rare complication, however it can be strongly disabling and require further treatments. Objective of the study is to identify risk factors and procedures of treatment of stenosis after Stapled Anopexy. Methods: 237 patients subjected to surgical resection with circular stapler for symptomatic III-IV-degree haemorrhoids without obstructed defecation disorders. 225 cases (95%) respected the planned follow-up conduced for one year after surgery. Results: Stenosis was noticed in 23 patients (10.2%), 7 of which (3,1%) complained about "difficult evacuation". All patients reported symptomatology appearance within 60 days from surgery. Previous rubber band ligation was referred from 7 patients (30,43%) and painful post-operative course (VAS >6) was referred from 11 (47,82%) of the 23 that developed a stenosis. These values appear statistically significant with p<0.05. Previous anal surgery and number of stitches applied during surgical procedure do not appear statistically significant. Symptomatic stenosis was subjected to cycles of outpatient progressive dilatation with remission of troubles in six cases. A woman, did not get any advantage, was been subjected to surgical operation, removing the stapled line and performing a new handmade sutura. Conclusions: The stenosis that complicate Stapled Anopexy are high anal stenosis or low rectal stenosis and they are precocious, reported within 60 days from surgery. If intense post-operative pain occurs (VAS >6), this appears to be related to development of a symptomatic stenosis. Surgery is avoidable in most cases and conservative treatment, as outpatient dilatations, has to be carried out.