The non-surgical management for hemorrhoidal disease. A systematic review

Abstract

IntroductionRationale. The non-surgical treatments for hemorrhoids include rubber band ligation (RBL), injection sclerotherapy (IS), infrared coagulation (IRC), anal stretch, cryosurgery, laser hemorroidectomy. These treatments are usually performed in outpatient clinics without anesthesia, so reducing the costs related to hospital stay, operation-theatre and anesthesia; moreover, these techniques are time-saving and allow preserving patients' working days. These procedures have found a large use in patients suffering bleeding and prolapse caused by early hemorrhoidal stages that did not found an improvement with conservative therapy.Objectives. The aim of this review is to provide a framework to select the best procedure for different patients in order to minimize complications and to obtain the cure for this widespread social problem. Among the treatments RBL, IS and IRC are the most utilized and were analyzed. It was analyzed: 1) Does these procedures help? 2) What are the common harms? 3) What are the rare harms? 4) How many are the recurrences? MethodsThis systematic review was undertaken in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (2).Eligibility criteria. Studies on patient complaining of bleeding or prolapse due to hemorroidal disease managed with RBL, IS and IRC were collected. The hemorroidal degrees and the presence of bleeding or prolapses were analyzed. The well-defined treatment modality and the symptoms resolution as outcome measures were The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC

The use of sclerotherapy with polidocanol foam in the treatment of second‐degree haemorrhoidal disease – a video vignette

“…Depending on its severity, HD can be effectively treated with medical and office‐based procedures such as rubber‐band ligation or sclerotherapy or various surgical approaches . Sclerotherapy has been described for treating Grade I–III HD .…”

“…The injection of a sclerosing agent such as polidocanol provokes an inflammatory reaction with subsequent necrosis, fibrosis and fixation of the haemorrhoidal tissue. The success rate of sclerotherapy varies depending on the definition of success, the type of sclerosing agent injected and the degree of HD .…”

First aid toolkit for anal fistulas, a detailed treatise for trainees – a video vignette (ESCP Trainee Video)

“…Depending on its severity, HD can be effectively treated with medical and office-based procedures such as rubber-band ligation or sclerotherapy [1] or various surgical approaches [2]. Sclerotherapy has been described for treating Grade I-III HD [3].…”

“…Methods to find the internal opening are discussed and proper seton placement will be shown. Different operative techniques such as fistulotomy, ligation of the intersphincteric fistula tract and advancement flap repair [1] will be briefly discussed.…”

Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson�s disease: case report

“…Early symptoms are frequently absent so that acute abdominal pain may be the only presenting symptom of mesenteric ischemia (16).…”