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INTRODUCTION:Hemorrhoidal disease is a common condition, affecting about 80% of all Americans at some point in their life. There are two types of hemorrhoids: internal and external hemorrhoids. The internal hemorrhoids are further classified into four grades depending on their presentation. The HETTM Bipolar Ligator System is a nonsurgical safe and easy procedure that uses sterile, single-use bipolar forceps with a tapered tubular configuration for the treatment internal hemorrhoids. This study evaluated the efficacy and safety of the HETTM Bipolar Ligator System for the treatment of grade I and grade II hemorrhoids with the potential idea to improve overall patient care.METHODS:Primary goal was to evaluate the efficacy and safety of the HETTM Bipolar Ligator System for the treatment of grade I and grade II hemorrhoids. Using a chart review, all of the patients who had received elective treatment for grade I or grade II internal hemorrhoids with the HETTM Bipolar Ligator System from April 2013 to November 2016 in our community hospital. A total of 100 patients were studied for treatment with the HETTMsystem.RESULTS:Total of 100 patients received treatment with the HETTM system, 39 patients were male, and 61 were female. The mean age of the patients was 59 years. 27% of the patients complained of mild bleeding, 49% of moderate bleeding and 24% of severe bleeding. 31% of the patients complained of daily bleeding, 53% complained of bleeding at least once a week and 16% complained of bleeding less than once a week. 37% of patients had grade I hemorrhoids while 63% had grade II hemorrhoids. Only 11% of the patients reported pain at levels 1–2 (out of 5) immediately after the procedure, and in 15% of the patients, mild bleeding was observed. After the six-month follow-up period (Figure 3), 96% of the patients had a resolution of bleeding (primary goal). Lastly, all of the patients reported a high level of satisfaction with the procedure.CONCLUSION:All other hemorrhoidal treatments including rubber band ligation, sclerotherapy, bipolar diathermy, cryotherapy and laser photocoagulation were associated with complications such as postoperative pain and bleeding or required multiple treatments to provide relief. The HETTM ligation device is a novel treatment option for symptomatic grade I and grade II hemorrhoids. It is simple, cost effective, safe and highly effective in resolving bleeding hemorrhoids in a single non-surgical ambulatory setting.Table 1.Demographic, clinic and hemorrhoids’ characteristics dataTable 2.Comparison of different endoscopic modalities for the treatment of hemorrhoids

Everyone has hemorrhoids. They are a normal part of our bodies: Hemorrhoids are simply cushions of veins along the top and bottom of the anal canal.They never get any credit, says Ask a Doctor columnist Dr. Trisha Pasricha (@trishapasrichamd), but have you ever wondered how your body knows the difference between gas, solid or liquid?Scientists think it’s those sensitive hemorrhoids. But those veins can become engorged, and the tissue holding them in their rightful place can weaken. When this happens, we notice our hemorrhoids, and that’s when we call them a problem.

This is a narrative medicine piece that reflects on my interaction with an LGBTQ patient seeking asylum at the US-Mexican border during my time volunteering as a family physician with an NGO there. The piece tells her narrative and outlines her struggle to get health care. It ultimately calls for the re-examination of services available to this vulnerable population in the midst of our country’s ongoing immigration crisis. It highlights the role that family physicians like myself can have in providing care to this community.

Two commonly performed surgical interventions are available for severe (grade II–IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery. The eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II–IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723. Between Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference −0·073 (95% CI −0·140 to −0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group. 24 (7%) of 338 participants who received stapled haemorrhoidopexy and 33 (9%) of 352 participants who received traditional excisional surgery had serious adverse events. As part of a tailored management plan for haemorrhoids, traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice. National Institute for Health Research Health Technology Assessment programme.

Background: Haemorrhoids are usually managed by open haemorrhoidectomy which is associated with postoperative pain, prolong hospital stay, longer convalescence and late return to normal activities. Stapled haemorrhoidopexy is a newer alternative for the treatment of haemorrhoid. The present study was designed to evaluate this technique in terms of duration of surgery & hospital stay, complications, convalescence, time return to normal activities, cost effectiveness and patient’s satisfaction. Materials and methods: One hundred and sixty patients of either sex who fulfilled the criteria were included in this study. More than 90% of the patients were in grade 3 & 4. All data were prospectively collected and examined. The patients were evaluated in terms of demographic properties, complaints on admission and postoperative complication. Results: 69.4% were male and 30.6% were female. Mean age was 40.93 years. Grade 3 haemorrhoid was present in 73.75% cases, Grade 4 was 18.12% cases, Grade 1 and Grade 2 were in 8.13% cases. The mean duration of surgery was 30 minutes. The mean duration of hospitalization was 36 hours. Intraoperative bleeding was observed in 9.38% patients. Reactionary haemorrhage was seen in 3.75% patients. Postoperative mild pain in 3.12% patients and residual prolapse in 1.25% cases. Conclusion: Stapled haemorrhoidopexy is safer alternative to open haemorrhoidotectomy with many short and long term benefits. J Bangladesh Coll Phys Surg 2020; 38(3): 126-134

Hemorrhoids are common diseases of the anorectal system and are usually accompanied by vascular proliferation and edema. Curcumin is a natural molecule with potential anti-inflammatory, antitumor and antioxidant effects. This study aimed to explore the effect and molecular mechanism of curcumin in alleviating angiogenesis in rat hemorrhoids. A rat model of hemorrhoids was established via glacial acetic acid induction. Human venous endothelial cells were collected to perform cell experiments. The rats received curcumin at 25, 50, or 100 mg/kg/d. The rats were scored for perianal symptoms and inflammation levels, and the expression of angiogenesis-related factors was evaluated by immunofluorescence. Bioinformatics analysis, dual-luciferase, RT‒qPCR and Western blotting were used to verify the molecular mechanism of curcumin in the treatment of hemorrhoids. This study demonstrates that curcumin inhibited angiogenesis in endothelial cells and relieved the symptoms of hemorrhoids in rats. Notably, the expression of miR-190a-5p was significantly downregulated in hemorrhoids, whereas curcumin promoted the expression of miR-190a-5p. The results also revealed that miR-190a-5p could inhibit angiogenesis and inflammation in endothelial cells by targeting TGFBR2, thereby alleviating the development of hemorrhoids. Mechanistically, curcumin inhibits the expression of TGFBR2 by upregulating miR-190a-5p, effectively blocking the angiogenesis ability of endothelial cells and thereby attenuating the progression and development of hemorrhoids in rats. Curcumin effectively inhibits angiogenesis in endothelial cells and relieves inflammation and the progression of hemorrhoids by regulating the miR-190a-5p/TGFBR2 molecular pathway.