Ponad 7000 publikacji medycznych!
Statystyki za 2021 rok:
odsłony: 8 805 378
Artykuły w Czytelni Medycznej o SARS-CoV-2/Covid-19

Poniżej zamieściliśmy fragment artykułu. Informacja nt. dostępu do pełnej treści artykułu
© Borgis - Nowa Medycyna 2/2016, s. 61-76 | DOI: 10.5604/17312485.1209445
*Aneta Obcowska1, Małgorzata Kołodziejczak2
Haemorrhoids – current view on aetiology, pathogenesis and methods of treatment. A review of literature
Choroba hemoroidalna – współczesne poglądy na temat etiopatogenezy oraz metod leczenia. Przegląd piśmiennictwa
1Department of General and Oncological Surgery with the Subunit of Vascular Surgery, Lord’s Transfiguration Hospital, Warsaw
Head of Department: Professor Mariusz Frączek, MD, PhD
2Warsaw Proctology Centre, Saint Elizabeth’s Hospital, Mokotów Medical Centre
Head of Centre: Associate Professor Małgorzata Kołodziejczak, PhD
Streszczenie
Choroba hemoroidalna jest najbardziej rozpowszechnioną chorobą proktologiczną. W artykule omówiono współczesne poglądy na temat etiopatogenezy, klasyfikacji i leczenia choroby hemoroidalnej. Etiopatogeneza choroby hemoroidalnej jest wieloczynnikowa i nie jest do końca poznana. Opublikowane w ostatnich latach badania dotyczące tego tematu sięgają do zmian na poziomie molekularnym i wśród nieprawidłowości wymieniają m.in. obniżony stosunek kolagenów typu I/III, w porównaniu z pacjentami bez choroby hemoroidalnej, co sprzyja zmniejszeniu sprężystości tkanki splotów hemoroidalnych. Pomimo dużego rozwoju diagnostyki proktologicznej, nadal podstawową metodą rozpoznania choroby hemoroidalnej jest wywiad i badanie proktologiczne. Z nowości klinicznych na uwagę zasługuje opublikowana w 2015 roku przez autorów z Włoch klasyfikacja opierająca się na ocenie każdego guzka krwawniczego oddzielnie – Single Pile Hemorrhoid Classification (SPHC) oraz skala oceny nasilenia dolegliwości choroby hemoroidalnej, korelująca z oceną jakości życia u pacjentów. Nowości w terapii hemoroidów polegają w większości na modyfikacji stosowanych dotychczas metod. Jedną z ostatnio proponowanych modyfikacji technicznych jest jednoczasowe założenie 2-3 gumowych podwiązek na jeden hemoroid. Modyfikacja ta według autorów zmniejsza odsetek nawrotów, krwawienia i wypadania hemoroidów w III°. Z kolei przedstawiona technika skleroterapii podczas fiberokolonoskopii poza możliwością jednoczasowego zdiagnozowania i usunięcia innych patologii, charakteryzuje się większym bezpieczeństwem iniekcji. Spośród metod klasycznego wycięcia hemoroidów nadal najczęściej wykonywaną procedurą jest operacja Milligana-Morgana. Według aktualnego piśmiennictwa operacje klasyczne z użyciem zaawansowanych urządzeń elektrochirurgicznych, jak LigaSure, nóż harmoniczny, charakteryzują się mniejszymi dolegliwościami bólowymi w przebiegu pooperacyjnym niż operacje wykonane przy użyciu koagulacji monopolarnej.
Summary
Haemorrhoids are the most prevalent proctologic disease. In this article we discuss the current view on its etiology, pathogenesis, classification and treatment of hemorrhoids. The etiopathogenesis of haemorrhoids is multifactorial and not fully understood. Recent publications on this topic reach a molecular level, pointing to a decreased ratio between collagen type I/III in comparison to patients without the disease, which promotes a decrease in haemorrhoid tissue elasticity. Despite the recent advancements in diagnostic methods, the mainstay is still patient history and physical examination, including per rectum examination. Worth noting is a classification published in 2015 by Italian authors, based on an individual assessment of each haemorrhoid, the Single Pile Haemorrhoid Classification (SPHC), and haemorrhoidal disease severity scale correlating with the patients’ quality of life. The innovations in the treatment of haemorrhoids are mostly modifications of the well-established methods. A recently proposed modification is binding one haemorrhoid with 2-3 bands simultaneously, thus decreasing recurrence rates, bleeding and degree III prolapses according to its authors. Also the proposed technique of sclerotherapy during fiber optic colonoscopy is characterized by higher safety of injections, while also offering the opportunity for diagnosis as well as treatment of other conditions. Among conventional surgical haemorrhoidectomy methods, the most commonly used technique is the Milligan-Morgan procedure. According to the literature, the use of advanced surgical equipment in conventional haemorrhoid surgeries like electrocautery with LigaSure or harmonic scalpel, is associated with less pain post-op than with the use of monopolar coagulation.



Introduction
Haemorrhoids are the most common proctologic pathology in western countries, accounting for nearly half of the hospitalization cases in colorectal surgery units (1). It amounts to a social problem, as its symptoms frequently affect young, professionally active people, with some studies indicating as much as 5% of adult population to suffer from the problem (2). Approximately, 40% of patients with pathologically enlarged haemorrhoid plexus are symptomatic.
Haemorrhoidal disease is considered the most common reason for bleeding upon defecation, with bleeding also being its most common symptom (3-5). Other manifestations include itching and prolapsed haemorrhoids. Pain is not a pathognomic presentation of this disease, and only occurs in the case of thrombosed prolapsed haemorrhoids. It may also be associated with the swelling of anoderm, rich in distended, inflamed, and thrombosed venous plexus.
Etiopathogenesis
The etiopathogenesis of haemorrhoids remains unclear, yet it is certainly a multi-factor one. The theories on the development of haemorrhoidal disease so far have accounted for the following factors: hyperplasia or increased pressure of the internal anal sphincter (6), excessive dilation of the arteriovenous connections in the haemorrhoidal tissue (7), and age-related deterioration of the anchoring connective tissue system (8, 9).
The current theories on the etiopathogenesis of haemorrhoidal disease
The studies published over the recent years concerning the etiopathogenesis of haemorrhoidal disease have reached as deep as the molecular level. The disorders that have been discussed have included a decrease in type I/III collagen ratio in patients with haemorrhoidal disease as compared to patients without the disease, facilitating reduced tissue elasticity in the haemorrhoidal plexus (10, 11). This is a theory documented in a study published in 2015, where collagen I/III ratio in a group of 57 patients with grade III or IV haemorrhoidal disease was compared against samples collected from human cadavers without haemorrhoidal disease. Another report consistent with this theory has demonstrated the presence of fibrosis in dysplastic smooth muscle fibres in the muscular layer and the submucosa, correlating with symptoms of rectal bleeding and prolapsed haemorrhoids (12). Other theories aimed at explaining the development of haemorrhoidal disease on the molecular layer are concerned with a high level of metalloproteinase VII (13) in the blood serum, as well as with vascular proliferation manifesting with increased expression in endoglin (CD105) (14).
Classification
The most popular classification of haemorrhoids is one created by Goligher, based on the assessment of the degree of external haemorrhoid prolapse (15). Other classifications may also be found in literature, yet the majority of them have not been commonly used (16-18).
The newly-proposed classification for haemorrhoidal disease – Single Pile Haemorrhoid Classification (SPHC)
Single Pile Haemorrhoid Classification (SPHC) published in 2015 by Italian authors, based on an individual assessment of every haemorrhoid pile certainly deserves attention. It comprises the assessment of several morphological features of a haemorrhoid pile, including its location (on the face of a clock), Goligher’s classification, and identification of features other than prolapse, characteristic for the severity of haemorrhoidal disease (tab. 1) (19).
Tab. 1. Features assessed according to SPHC
Number of pathological piles – NAssessment of internal pileAssessment of external pile
Goligher’s grade I-IV Fibrous inelastic pile – FCongestion of external pile – ESkin tags – S
Example: 3IIIFE7–IIIFE11–II3 stands for the presence of 3 piles:
– one grade III pile at 7 o’clock, with visibly fibrous, inelastic internal pile (F) and congested external pile (E),
– one grade III pile at 11 o’clock, with visibly fibrous, inelastic internal pile (F) and congested external pile (E),
– one grade II pile at 3 o’clock.
The advocates of this classification have stressed its greater accuracy in determining disease advancement possible due to describing and highlighting characteristics other than just the prolapse. It is also useful for the assessment of surgical outcome. Nonetheless, it also seems to be quite complex, hence its application in the colorectal surgeon’s daily practice may initially be more challenging.
Symptom-based severity score f or haemorrhoidal disease
Another study by other authors, published in 2015, presented a scale for the assessment of haemorrhoidal disease severity, correlated with the assessment of the patient’s quality of life. Surprisingly, the authors cite bleeding to be poorly correlated with deteriorated quality of life. In its opening part, the questionnaire asks the physician whether the patient suffers from rectal bleeding and whether any other reasons potentially underlying the reported symptoms have been considered and ruled out. It is only when both questions have been answered affirmatively that the questionnaire is addressed at the patient. Interestingly, the applied point score is not proportionate to the frequency with which the symptoms occur, and varies depending on their character (tab. 2) (20).
Tab. 2. Scale assessment of the severity of symptoms of haemorrhoidal disease. Based on (20)
Have you considered or ruled out other pathologies?
Does your patient suffer from rectal bleeding?
Fill in the questionnaire only when the answers to the questions above are affirmative.
Please answer the questions below as concerns your symptoms over the last month.
SymptomScore
How severe/persistent is the itching or irritation?0 – not at all/no symptoms
1 – mild/does not bother me
2 –
3 – moderately severe
4 –
5 – very severe
0
0
0
0
4
4
How severe is the pain/discomfort when relaxing?0 – not at all/no symptoms
1 – mild/does not bother me
2 –
3 – moderately severe
4 –
5 – very severe
0
0
0
3
3
3
How severe is pain/discomfort when defecating?0 – not at all/no symptoms
1 – mild/does not bother me
2 –
3 – moderately severe
4 –
5 – very severe
0
0
0
0
3
3
How often do you notice a prolapsed haemorrhoid pile?0 – never
1 – less often than once a month
2 – more often than once month
3 – more often than once a week
4 – every day
0
0
0
0
4
Final score: 0-14 points
As the questionnaire may be repeated, it allows the physician to assess the therapeutic outcome and the potential progress of the disease, hence it may find wider application among colorectal surgeons.
Diagnostics
Regardless of the substantial advancements in diagnostic methods, patient history and physical examination remain the mainstay of haemorrhoidal disease diagnosis. When taking patient history, it is crucial to cover questions concerning the presence of contributing factors such as constipation, wrong dietary choices, and sedentary lifestyle alongside the ones regarding the symptoms as such.
Physical examination includes abdominal examination, inspection of the perineum, digital rectal examination, and anoscopy. In patients over 50 years old reporting rectal bleeding, as well as in every patient reporting any other alarming symptoms raising the suspicion of cancer or IDB a colonoscopy must be performed. For patients who are not in the group at greater risk from colorectal cancer, flexible fiberosigmoidoscopy (FFS) is recommended.
Even though in most cases of non-prolapsed haemorrhoids elevated maximum resting anal pressure is revealed, anorectal manometry is not commonly employed. This test is recommended to facilitate a better planning of surgery in patients with recurring haemorrhoids, incontinence, and decreased sphincter tone suggested by the examining colorectal surgeon.
Treatment
Conservative treatment
Aside from several specific situations, conservative treatment remains the initial stage in the management of haemorrhoidal disease. It encompasses the right nutrition to prevent constipation, including fibre supplements, as well as oral medication and topical anti-inflammatory agents and myorelaxants.
There have been multiple reports confirming the beneficial effect of dietary fiber administered at a dosage of 20-30 g/d. The advantages have been listed to include decreased bleeding and itchiness (21, 22). Stool-softeners, e.g. paraffin-based agents, may also be used as an adjuvant.
Among the orally administered medications, at present flavonoids are the most commonly used. They are agents with anti-oxidant, anti-inflammatory, anti-allergic and vasodilating properties. Their mechanism of action consists in inhibiting enzymes such as hyaluronidase, elastase and collagenase which cause increased pericapillar permeability. A meta-analysis of numerous studies has determined the effectiveness of flavonoids for the suppression of bleeding and haemorrhoidal prolapsing (23-26). In the periods of acute symptomacity, when there is severe pain caused by the spasm of the internal anal sphincter, in the course of strangulated and thrombosed prolapsed haemorrhoids, substances that reduce the tone of the internal sphincter are applied (pharmacological sphincterotomy). As recently as several years ago, 0.5% nitroglycerin ointment was commonly ordered, yet owing to its side-effects (headaches) it is now only sporadically used. Currently, 0.3% nifedipine ointment is in use, being also very effective for relieving post-operative pain (28). In our practice, we have found 2% dilitiazem ointment to be effective, administered b.i.d rectally for a period of several weeks. Similarly to nifedipine, this is also an agent that reduces sphincter tone, thus providing analgesic effect in the post-operative course following haemorrhoidectomy. Transient chemical denervation of the internal sphincter may also be produced with botulinum toxin, a method that has been available for many years, currently regaining its popularity (29).
Corticosteroid ointments of anti-inflammatory and anti-itch properties are also still in use in conservative treatment of haemorrhoidal disease, however when applied on a long-term basis (for many weeks), they are believed to have a thinning effect on the mucosa, thus putting it at an increased risk of damage.
Streptokinase administered in the form of intrarectal suppositories (2000 000IU) has been found to be effective in management of prolapsed haemorrhoids. THERESA-2 and THERESA-4 studies demonstrated streptokinase administered for 5 days to reduce pain and bleeding accompanying prolapsed and strangulated haemorrhoids in a statistically significant manner. The above mentioned study found the therapy to be more effective than 25 mg Hydrocortisone suppositories, without causing any significant adverse effects (30, 31).
For their drying effect, zinc oxide ointments still tend to be used, as well as topical analgesics .
Another method used adjunctively to relieve haemorrhoidal pain are warm sitz baths (hip baths), with warm water sitz baths being equally effective to herbal ones (e.g. chamomile) (32) in our practice.
Instrumental methods
The majority of currently used instrumental methods have been known for years, some have had a historic impact.

Powyżej zamieściliśmy fragment artykułu, do którego możesz uzyskać pełny dostęp.
Mam kod dostępu
  • Aby uzyskać płatny dostęp do pełnej treści powyższego artykułu albo wszystkich artykułów (w zależności od wybranej opcji), należy wprowadzić kod.
  • Wprowadzając kod, akceptują Państwo treść Regulaminu oraz potwierdzają zapoznanie się z nim.
  • Aby kupić kod proszę skorzystać z jednej z poniższych opcji.

Opcja #1

24

Wybieram
  • dostęp do tego artykułu
  • dostęp na 7 dni

uzyskany kod musi być wprowadzony na stronie artykułu, do którego został wykupiony

Opcja #2

59

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 30 dni
  • najpopularniejsza opcja

Opcja #3

119

Wybieram
  • dostęp do tego i pozostałych ponad 7000 artykułów
  • dostęp na 90 dni
  • oszczędzasz 28 zł
Piśmiennictwo
1. Bernal J, Enguix M, Lopez Garcia J et al.: Rubber-band ligation for hemorrhoids in a Colorectal Unit: a prospective study. Rev Españ Enferm Dig 2005; 97: 38-45. 2. Sneider EB, Maykel JA: Diagnosis and management of symptomatic hemorrhoids. Surg Clin North Am 2010; 90: 17. 3. Gralnek IM, Ron-Tal Fisher O, Holub JL, Eisen GM: The role of colonoscopy in evaluating hematochezia: a population based study in a large consortium of endoscopy practices. Gastrointest Endosc 2013; 77: 410-418. 4. Nikpour S, Ali Asgari A: Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol 2008; 14: 6536-6540. 5. Wong RF, Khosla R, Moore JH, Kuwada SK: Consider colonoscopy for young patients with hematochezia. J Fam Pract 2004; 53: 879-884. 6. Miles WE: Observations upon internal piles. Surg Gynecol Obstet 1919; 29: 497. 7. Thomson WH: The nature of haemorrhoids. Br J Surg 1975; 62: 542. 8. Haas PA, Fox TA Jr, Haas GP: The pathogenesis of hemorrhoids. Dis Colon Rectum 1984; 27: 442. 9. Arabi Y, Alexander-Williams J, Keighley MR: Anal pressures in hemorrhoids and anal fissure. Am J Surg 1977; 134: 608. 10. Nasseri YY, Krott E, Van Groningen KM et al.: Abnormalities in collagen composition may contribute to the pathogenesis of hemorrhoids: morphometric analysis Tech Coloproctol 2015; 19: 83-87. 11. Willis S, Junge K, Ebrahimi R et al.: Haemorrhoids – a collagen disease? Colorectal Dis 2010; 12: 1249-1253. 12. Li H-L, Jing F-Y, Ma L-L et al.: Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease. Drug Design, Development and Therapy 2015; 9: 4649-4656. 13. Kisli E, Kemik A, Sümer A, Kemik Ö: Matrix metalloproteinases in pathogenesis of hemorrhoidal disease. Am Surg. 2013 Nov; 79(11): 1181-1184. 14. Chung YC, Hou YC, Pan AC: Endoglin (CD105) expression in the development of haemorrhoids. Eur J Clin Invest 2004; 34(2): 107-112. 15. Goligher JC, Duthie HL, Nixon HH: Surgery of the anus, rectum and colon. Vol. 5. Baillière Tindall, London 1984: 98-149. 16. Lunniss PJ, Mann CV: Classification of internal haemorrhoids: a discussion paper. Colorectal Dis 2004; 6: 226-232. 17. Gaj F, Trecca A: New “PATE 2006” system for classifying hemorrhoidal disease: advantages resulting from revision of “PATE 2000 Sorrento”. Chir Ital 2007; 59: 521-526. 18. Wijffels NA, Collinson R, Cunningham C, Lindsey I: What is the natural history of internal rectal prolapse? Colorectal Dis 2010; 12: 822-830. 19. Elbetti C, Giani I, Novelli E et al.: The single pile classification: a new tool for the classification of haemorrhoidal disease and the comparison of treatment results. Updates Surg 2015; 67: 421-426. 20. Pucher PH, Qurashi M, Howell A-M et al.: Development and validation of a symptom-based severity score for haemorrhoidal disease: the Sodergren score. The Association of Coloproctology of Great Britain and Ireland. Colorectal Disease 2015; 17: 612-618. 21. Rivadeneira DE, Steele SR, Ternent C et al.: Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54: 1059. 22. Alonso-Coello P, Guyatt G, Heels-Andsell D et al.: Fiber for the treatment of hamorrhoidal complications: a systematic review and metanalysis. Am J Gastroenterol 2006; 101: 181-188. 23. Perera N, Liolitsa D, Iype S et al.: Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 2012 Aug 15; 8: CD004322. 24. Meyer OC: Safety and security of Daflon 500 mg in venous insufficiency and in hemorrhoidal disease. Angiology 1994; 45: 579. 25. Godeberge P: Daflon 500 mg in the treatment of hemorrhoidal disease: a demonstrated efficacy in comparison with placebo. Angiology 1994; 45: 574. 26. Buckshee K, Takkar D, Aggarwal N: Micronized flavonoid therapy in internal hemorrhoids of pregnancy. Int J Gynaecol Obstet 1997; 57: 145. 27. Misra MC, Parshad R: Randomized clinical trial of micronized flavonoids in the early control of bleeding from acute internal haemorrhoids. Br J Surg 2000; 87: 868. 28. Perrotti P, Antropoli C, Molino D et al.: Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum 2001; 44: 405. 29. Patti R, Arcara M, Bonventre S et al.: Randomized clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external haemorrhoids. Br J Surg 2008; 95: 1339. 30. Hernandez-Bernal F, Valenzuela-Silva CM, Quintero-Tabıo L et al.; THERESA-2 Group of Investigators: Recombinant streptokinase suppositories in the treatment of acute haemorrhoidal disease. Multicentre randomized double-blind placebo-controlled trial (THERESA-2). Colorectal Disease 2013. The Association of Coloproctology of Great Britain and Ireland 15: 1423-1428. 31. Hernández-Bernal F, Castellanos-Sierra G, Valenzuela-Silva CM et al.: Recombinant streptokinase vs hydrocortisone suppositories in acute hemorrhoids: A randomized controlled trial. World J Gastroenterol 2015 June 21; 21(23): 7305-7312. 32. Shafik A: Role of warm-water bath in anorectal conditions. The “thermosphincteric reflex”. J Clin Gastroenterol 1993; 16(4): 304. 33. Placer C, Enriquez Navascuès JM, Lizarazu A, Borda N: Ligaduras múltiples verticales: un nuevo enfoque en el tratamiento de la enfermedad hemorroidal grado III. Cirugía Española 2012; 90(10): 656-659. 34. Nelson RS, Ewing BM, Ternent C et al.: Risk of late bleeding following hemorrhoidal banding in patients on antithrombotic prophylaxis. Am J Surg 2008; 196: 994. 35. Iyer VS, Shrier I, Gordon PH: Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 2004; 47: 1364. 36. Lu LY, Zhu Y, Sun Q: A retrospective analysis of short and long term efficacy of RBL for hemorrhoids. European Review for Medical and Pharmacological Sciences 2013; 17: 2827-2830. 37. Moser K-H, Mosch Ch, Walgenbach M et al.: Efficacy and safety of sclerotherapy with polidocanol foam in comparison with fluid sclerosant in the treatment of first-grade haemorrhoidal disease: a randomised, controlled, single-blind, multicentre trial. Int J Colorectal Dis 2013; 28: 1439-1447. 38. Hachiro Y, Kunimoto M, Abe T et al.: Aluminum potassium sulfate and tannic acid (ALTA) injection as the mainstay of treatment for internal hemorrhoids. Surg Today 2011; 41: 806-809. 39. Kaidar-Person O, Person B, Wexner SD: Hemorrhoidal disease: A comprehensive review. J Am Coll Surg 2007; 204: 102-117. 40. Graham-Stewart CW: Injection treatment of haemorrhoids. Br Med J 1962; 1: 213. 41. Santos G, Novell JR, Khoury G et al.: Long-term results of large-dose, single-session phenol injection sclerotherapy for hemorrhoids. Dis Colon Rectum 1993; 36: 958-961. 42. Kaman L, Aggarwal S, Kumar R et al.: Necrotizing fascitis after injection sclerotherapy for hemorrhoids: report of a case. Dis Colon Rectum 1999; 42: 419. 43. Barwell J, Watkins RM, Lloyd-Davies E, Wilkins DC: Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case. Dis Colon Rectum 1999; 42: 421. 44. Schulte T, Fändrich F, Kahlke V: Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Colorectal Dis 2008; 23: 725. 45. Sim A, Murie J, Mackenzie I: Three year follow-up study on the treatment of first and second degree hemorrhoids by sclerosant injection or rubber band ligation. Surg Gynecol Obstet 1983; 157: 534-536. 46. Takano M, Iwadare J, Ohba H et al.: Sclerosing therapy of internal haemorrhoids with a novel sclerosing agent. Comparison with ligation and excision. Int J Colorectal Dis 2006; 21: 44-51. 47. Zhang T, Xu L-J, Xiang J et al.: Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods, feasibility and efficacy. World J Gastrointest Endosc 2015 Dec 25; 7(19): 1334-1340. 48. Singal R, Gupta S, Dalal AK et al.: An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital. Journal of Medicine and Life 2013; 6(3): 302-306. 49. Crea N, Pata G, Lippa M et al.: Hemorrhoidal laser procedure: short- and long-term results from a prospective study. The American Journal of Surgery 2014; 208: 21-25. 50. Duben J, Hnatek L, Dudesek B et al.: Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a new minimally invasive method for haemorrhoidal disease treatment. Early results of a pilot study. Videosurgery Miniinv 2013; 8(1): 43-48. 51. Bleday R, Pena JP, Rothenberger DA et al.: Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992; 35(5): 477-481. 52. Wesarachawit W, Pattana-arun J: Antibiotics and early post operative complications of closed hemorrhoidectomy: a retrospective matched pair study. J Med Assoc Thai 2007; 90: 1828. 53. Joshi GP, Neugebauer EA, PROSPECT Collaboration: Evidence-based management of pain after haemorrhoidectomy surgery. Br J Surg 2010; 97: 1155. 54. You SY, Kim SH, Chung CS, Lee DK: Open vs. closed hemorrhoidectomy. Dis Colon Rectum 2005; 48: 108. 55. Mirzaei R, Mahjoubi B, Kadivar M et al.: Anal sphincter injuries during hemorrhoidectomy: a multi center study. Acta Med Iran 2012; 50(9): 632-634. 56. Nyström PO, Qvist N, Raahave D et al.: Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg 2010; 97: 167. 57. Jayaraman S, Colquhoun PH, Malthaner RA: Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 2006; 18: 4. 58. Giordano P, Gravante G, Sorge R et al.: Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 2009; 144: 266. 59. Thaha MA, Irvine LA, Steele RJ, Campbell KL: Postdefaecation pain syndrome after circular stapled anopexy is abolished by oral nifedipine. Br J Surg 2005; 92: 208. 60. Wong LY, Jiang JK, Chang SC: Rectal perforation: a life-threatening complications of stapled haemorrhoidectomy: report of a case. Dis Colon Rectum 2003; 46: 116-117. 61. Cheetham MJ, Mortensen NJ, Nystrom PO: Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 2000; 356: 730-733. 62. Pessaux P, Lermite E, Tuech JJ: Pelvic sepsis after stapled haemorrhoidectomy. J Am Coll Surg 2004; 199: 824-825. 63. Cirocco WC: Life-threatening sepsis and mortality following stapled haemorrhoidectopexy. Surgery 2008; 143: 824-829. 64. NICE – National Institute for Health and Clinical Excellence: Stapled haemorrhoidopexy for the treatments of haemorrhoids. Nice technology appraisal guidance 128, 2010. 65. Corsale I, Rigutini M, Francioli N et al.: Stapled anopexy and STARR in surgical treatment of haemorrhoidal disease. Updates Surg 2014; 66: 217-222. 66. Naldini G, Martellucci J, Rea R et al.: Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus. Int J Colorectal Dis 2014; 29: 623-629. 67. Pucher PH, Sodergren MH, Lord AC et al.: Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 2013; 15: 284. 68. Elmèr SE, Nygren JO, Lenander CE: A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 2013; 56(4): 484-490. 69. Simillis C, Thoukididou SN, Slesser AA et al.: Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 2015; 102: 1603. 70. Silverman R, Bendick PJ, Wasvary HJ: A randomized, prospective, double-blind, placebo-controlled trial of the effect of a calcium channel blocker ointment on pain after hemorrhoidectomy. Dis Colon Rectum 2005; 48: 1913. 71. Mari FS, Nigri G, Dall’Oglio A et al.: Topical glyceryl trinitrate ointment for pain related to anal hypertonia after stapled hemorrhoidopexy: a randomized controlled trial. Dis Colon Rectum 2013; 56(6): 768-773. 72. Ala S, Saeedi M, Eshghi F, Mirzabeygi P: Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 2008; 51: 235. 73. Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE et al.: Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Rev Esp Enferm Dig (Madrid) 2015; 107(11): 681-685. 74. Faucheron JL, Voirin D, Abba J: Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 2012; 99: 746. 75. Yang J, Cui PJ, Han HZ, Tong DN: Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy. World J Gastroenterol 2013; 19: 4799. 76. Allan A, Samad AJ, Mellon A, Marshall T: Prospective randomised study of urgent haemorrhoidectomy compared with non-operative treatment in the management of prolapsed thrombosed internal haemorrhoids. Colorectal Dis 2006; 8: 41-45. 77. Hardy A, Cohen CRG: The acute management of haemorrhoids Ann R Coll Surg Engl 2014; 96: 508-511.
otrzymano: 2016-06-01
zaakceptowano do druku: 2016-06-15

Adres do korespondencji:
*Aneta Obcowska
Oddział Chirurgii Ogólnej i Onkologicznej z Pododdziałem Chirurgii Naczyniowej Szpital Praski p.w. Przemienienia Pańskiego Sp. z o.o.
Aleja Solidarności 67
03-401 Warszawa
tel. +48 (22) 555-10-80
e-mail: aneta_w@poczta.onet.pl

Nowa Medycyna 2/2016
Strona internetowa czasopisma Nowa Medycyna