Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades II and III hemorrhoids: Results from a multicenter study

Abstract

AIM:To show that aluminum potassium sulfate and tannic acid (ALTA) sclerotherapy has a high success rate for Grade Ⅱ and Ⅲ hemorrhoids. METHODS:This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015. The objective of this study was to assess the efficacy of this treatment for Grades Ⅱ and Ⅲ hemorrhoids. Preoperative and postoperative symptoms, complications and success rate were all assessed retrospectively. Follow-up consisted of a simple questionnaire, physical examination and an anoscopy. Patients were followed-up at one day, one week, two weeks, one month, one year, two years, three years, four years and five years after the ALTA sclerotherapy. RESULTS:One hundred and sixty-nine patients were diagnosed with Grade Ⅱ hemorrhoids and 435 patients were diagnosed with Grade Ⅲ hemorrhoids. The one year, three year and five year cumulative success rates of ALTA sclerotherapy for Grades Ⅱ and Ⅲ hemo- Retrospective Study 845July 18, 2016|Volume 8|Issue 20| WJH|www.wjgnet.com Miyamoto H et al . ALTA sclerotherapy for Grade Ⅱ and Ⅲ hemorrhoids rrhoids were 95.9% and 93.1%; 89.3% and 83.7%; and 89.3% and 78.2%, respectively. No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between Grades Ⅱ and Ⅲ hemorrhoids (P = 0.09). There were forty-seven post-operative complications (low grade fever; anal pain; urinary retention; rectal ulcer; and others). No serious or life-threatening complications occurred and all cases improved through conservative treatment. At univariate analysis there were no predictive factors of failure. CONCLUSION:ALTA sclerotherapy has had a high success rate for Grade Ⅱ and Ⅲ hemorrhoids during five years of post-operative treatment. However, additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.

Gluteal-fold flap repair of rectovaginal fistula caused by aluminum potassium sulfate hydrate-tannic acid injection for internal hemorrhoids: a case report

“…Patients usually experience little postoperative pain and no serious complications, and they report high satisfaction. ALTA therapy can be performed for patients suffering from Goligher's grade II and III hemorrhoids in an outpatient setting [3].…”

“…ALTA therapy combines aluminum potassium sulfate and tannic acid; the former induces an inflammatory reaction, resulting in strong, local fibrosis, while the latter has a strong astringent effect on tissue, promoting protein coagulation and the contraction of blood vessels while reducing exudation into the tissue from the inflammatory reaction [ 1 , 2 ]. ALTA sclerotherapy is popular as a comparatively simple, minimally invasive treatment for symptomatic internal hemorrhoids in outpatient clinics in Japan [ 3 – 5 ]. The symptoms of concern vanish practically on the first post-operative day.…”

“…ALTA therapy is effective for shrinking and hardening the hemorrhoids in order to eliminate prolapse and bleeding. Reported post-operative complications have included a slight fever, ischuria, anal pain, and rectal ulcer, most of which improved through conservative treatment [ 3 – 5 ]. However, in rare cases, RVF has been reported following ALTA therapy.…”

Laparoscopic low anterior resection for rectal cancer after Whitehead's hemorrhoidectomy: A case report

“…However, surgical treatment is required for most advanced stages, such as grade III or IV, and bleeding. Several other methods of surgical treatment for hemorrhoids—that is, other than Whitehead's hemorrhoidectomy—are found in the literature and include Milligan–Morgan hemorrhoidectomy, stapled hemorrhoidopexy, and trans‐anal hemorrhoidal dearterialization .…”

Anal Sphincter Function After Hemorrhoidectomy

“…При 1-2-й стадии рекомендуется проведения консервативной терапии, направленной на нормализацию деятельности желудочно-кишечного тракта и профилактику запоров [11], купирование воспаления, ликвидацию кровотечения и устранение болевого синдрома [12]. При отсутствии эффекта от консервативной терапии возможно применение малоинвазивных методик.…”