Ambulatory Surgery for Perianal Disease

The gold standard in the diagnosis and treatment of proctological diseases is the exploration of the anal canal and distal rectum under anaesthesia (EUA), routinely performed as day case surgery. In selected cases it can be conducted as an outpatient exploration (OE) during a specialist surgical consultation. In the outpatient setting it is possible and safe to perform rubber band ligation, sclerotherapy and infrared coagulation for the treatment of haemorrhoidal disease, excision and incision of thrombosed external haemorrhoids, abscess drainage, setonage and fistulotomy also in case of perianal Crohn’s disease, anal warts and skin tags removal. In terms of patients’ satisfaction and success rate OE is comparable to EUA. All procedures can be performed under local anaesthesia. Pain control after the procedure is provided by oral pain killers.

Incidence of Recurrent High-Grade Anal Dysplasia in HIV-1-Infected Men and Women Following Infrared Coagulation Ablation: A Retrospective Cohort Study

This single-center, retrospective cohort study sought to estimate the cumulative incidence in HIV-1-infected patients of biopsy-proven high-grade anal intraepithelial neoplasia (HGAIN) recurrence after infrared coagulation (IRC) treatment. The study was based on data from a prospectively compiled database of 665 HIV-1-infected outpatients who attended a hospital Clinical Proctology/HIV Unit between January 2012 and December 2015. Patient records were checked to see which ones had received IRC treatment but later experienced a recurrence of HGAIN. Cytology samples were also checked for the presence of human papilloma virus (HPV). A total of 81 of the 665 patients (12%, 95%CI: 10–15%), of whom 65 were men and 16 women, were diagnosed with HGAIN and again treated with IRC. Of these 81, 20 (25%) experienced recurrent HGAIN, this incidence being true of both men (16/65, 95%CI: 19–57%) and women (4/16, 95%CI: 10–50%). The median time to recurrence was 6 (2–19) months overall, 6 (2–19) months in men, and 4 (2–6) months in women. HPV infection was detected in all patients except two, with HPV-16 being the most common genotype. This rate of incidence of recurrent HGAIN following IRC treatment is consistent with other reports and highlights the importance of continued post-treatment surveillance, particularly in the first year.

Treatment Options for Chronic Hemorrhoids

The paper provides an overview of various treatment options for chronic hemorrhoids based on current national and international recommendations. The publication describes the basic principles of effective conservative therapy of the disease. Methods of minimally invasive treatment options for chronic hemorrhoids are given in details: sclerotherapy, infrared coagulation, latex ligation; advantages and disadvantages of each of these methods are highlighted. Literature data indicate that surgical removal of hemorrhoids remains an effective method of treatment for patients with hemorrhoids stage III IV, who underwent unsuccessful minimally invasive procedures. The characteristics of possible complications after hemorrhoidectomy and the frequency of their occurrence are also given. The authors analyze results of using stapler hemorrhoidopexy and the technique of Doppler-controlled ligation of hemorrhoidal arteries. Despite the variety of techniques, it remains relevant to search for further treatment options for chronic hemorrhoids in order to choose an effective individual treatment tactics for each patient, taking into account various manifestations of hemorrhoidal disease.

COMPARATIVE CLINICAL STUDY OF APAMARGAKSHARATAILA INJECTION AND INFRARED COAGULATION IN THE MANAGEMENT OF ARSHA (1ST AND 2ND DEGREE HEMORRHOIDS)

Introduction: In anorectal disorders, incidences of hemorrhoids and fissures are increasing in Indian population due to western lifestyle. Many surgical methods are available to cure anorectal disorders, but now a days, demand for Ayurveda and herbal preparation is increasing in society. Materials and Methods: In this study, ApamargaKsharaTaila Injection submucosal Route (Group A) and infrared coagulation (Group B) procedure were administered for the management of internal hemorrhoid (Arsha). This study was an open labelled, prospective, interventional study, in which patients of hemorrhoids [n=30(15eachgroup)] were selected from OPD of Institutional hospital. ApamargaKsharaTaila Injection application submucosally on internal hemorrhoids and IRC was applied at the base of hemorrhoids. In all the two groups, the patients were assessed every week for 4 weeks and were followed up for another 4 weeks for relief in signs and symptoms. Results: Obtained results were analyzed and encouraging results were observed after completion of the treatment. Conclusion: The study concluded that ApamargaKshara-Taila Injection is the most effective treatment for the management of internal hemorrhoid of 1st and 2nd de-gree in comparison to IRC procedure. Keywords: ApamargaKshartaila, Arsha, Ayurveda, hemorrhoids