Digestive surgery service including surgical management of gastrointestinal disease and digestive cancers are experiencing the impact of COVID-19 pandemic. Therefore it is necessary to formulate recommendation for digestives surgery service, as guidelines to engage in case-by-case assessment of particular patients with digestive diseases. We are aware that the knowledge and science of COVID-19 are still evolving, with new progression every day. This recommendation reflect actual condition and are subject for future adjustment in the future.

Background The 1st, 2nd and small 3rd degree hemorrhoids are non-operatively treated by using anti-inflammatory and plebotonic medicines, high fiber diet and changing lifestyle. Graptophyllum pictum (L.) Griff (GP) is potential to be a hemorrhoid medicine (anti-inflammatory and plebotonic medicine) since its anti-inflammatory effect may be related to antioxidant property. ObjectiveTo elaborate the anti-inflammatory and anti-oxidant effect of GP on experimental hemorrhoid in male Wistar rats. MethodsA Randomized Controlled Trial Post-test only design in hemorrhoid-like rats using croton oil induced into the anus for 30 seconds each day for 3 consecutive days. 14 Wistar rats were randomly allocated into 2 groups. Group 1 got normal saline solution, while group 2 treated with GPE 100mg/Kg bw for 5 consecutive days. On the 9th experimental day, the blood was drawn for Elisa examination of COX-2 and SOD levels. As COX-2 and SOD normally distributed, pool t-test and product moment correlation was used for statistical analysis. Results All of Wistar rats were still alive. COX-2 levels (ng/ml) in the GPE group was 266.28±158.47, was significantly lower compared to control (595.21±68.92) (p=0.000). Serum SOD levels (ng/ml) in the GPE was 77.00±11.0, and was significantly higher than the control 28.00±4.00 (p=0.02). Correlation between COX-2 and SOD serum level was significantly strong negative correlation (p=0,000 and r=-0.842) Conclusions GPE at a dose of 100 mg/kg bw has antioxidant and anti-inflammatory effects on artificial hemorrhoids through decreased COX-2 levels, and elevated SOD levels. There is a strong negative correlation between SOD and COX-2 serum level.  KeywordsGraptophyllum pictum, hemorrhoids, Croton oil, COX-2, SOD.

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Hemorrhoids are a common anorectal disease and are often found in clinical practice. Patients mostly come with a complaint of anal bleeding or prolapsing mass. Grade III and IV prolapsing hemorrhoids are distinguished from grade II by the fact that grade II prolapse only during defecation and returns simultaneously after defecation and usually does not cause complaint. Prolapsing hemorrhoids should be differentiated from prolapsing rectal polyps, small rectal prolapse, anorectal tumors, hypertrophy of the anal papilla, and condylomas. Nowadays, the management of prolapsing hemorrhoids varies. Medical therapy is rarely used alone, it is used to improve the effect of surgical therapy. The surgical gold standard for prolapsing hemorrhoids is excision surgery (hemorrhoidectomy) with or without suturing. However, since it comes with pain complaints, non-excision surgery is now offered. Non-excision surgery is divided into two types—stapled hemorrhoidopexy and hemorrhoidal artery ligation and rectoanal repair. Each method of surgery has its own advantages and disadvantages. This chapter review discusses the anatomy, pathophysiology, diagnosis, and management of prolapsing hemorrhoids.