Novel “endoloop and hemoclips” technique for mucosal prolapse causing efferent loop syndrome

Hemorrhoidal Laser procedure (HeLP) and Hemorrrrhoidal Laser procedure + mucopexy (HeLPexx) and other Emerging Technologies

Reviews on Recent Clinical Trials ◽

10.2174/1574887115666200406120245 ◽

2020 ◽

Vol 15 ◽

Author(s):

Paolo Giamundo

Keyword(s):

Laser Treatment ◽

Dentate Line ◽

Mucosal Prolapse ◽

Daily Activities ◽

Common Goal ◽

Superior Rectal Artery ◽

Doppler Probe ◽

The Common ◽

Probe Set

Background: Minimally-invasive treatments for hemorrhoids should be encouraged as they cause low morbidity, reasonable discomfort and quicker return to work. According to the “vascular theory” hemorrhoidal disease is mainly caused by blood overflow into hemorrhoidal plexus deriving from the superior hemorrhoidal arteries. Introduction: Many different procedures have been described in the literature with the common goal of reducing the blood flow into the hemorrhoidal piles. ‘HeLP’ (Hemorrhoids Laser Procedure) is a novel form of dearterialization to treat patients suffering from symptomatic hemorrhoids. Methods: The procedure consists of the closure of the terminal branches of the superior rectal artery approximately 2-3 cm above the dentate line by means of laser shots originated by a diode laser platform. The arteries, at that level, have variable location and distribution. Therefore, a doppler probe set at the frequency of 20MHz helps identifying the arteries that would be missed otherwise. The laser beam is well tolerated by patients. For this reason, anesthesia is not required in most cases and the procedure allows a quick return to daily activities. In case of concomitant severe mucosal prolapse, the laser treatment can be combined with suture mucopexy. Three to six running sutures allow a complete lifting of hemorrhoidal piles, securing long-term resolution of symptoms. Results and Conclusions: ‘HeLP’ is indicated in patients with symptomatic hemorrhoids where conservative treatment failed and when mucosal prolapse is scarce or not symptomatic. The addition of mucopexy to laser treatment (HeLPexx) contributes to overall resolution of symptoms when mucosal prolapse is an issue, Emborrhoid is another novel, ‘hi-tech’ form of selective dearterialization used in selected case of hemorrhoids where main symptom is bleeding. It is generally used in cases where surgery is contraindicated due to severe concomitant diseases.

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Gastroduodenal Mucosal Prolapse

American Journal of Roentgenology ◽

10.2214/ajr.178.5.1781292 ◽

2002 ◽

Vol 178 (5) ◽

pp. 1292-1293 ◽

Cited By ~ 1

Author(s):

Yvonne W. Lui ◽

Emil J. Balthazar

Keyword(s):

Mucosal Prolapse

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Polypoid mucosal prolapse in a pelvic ileal reservoir.

Gut ◽

10.1136/gut.35.11.1668 ◽

1994 ◽

Vol 35 (11) ◽

pp. 1668-1669 ◽

Cited By ~ 15

Author(s):

J M Blazeby ◽

P Durdey ◽

B F Warren

Keyword(s):

Mucosal Prolapse ◽

Ileal Reservoir

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Management of patients with rectocele, multiple pelvic floor dysfunctions and obstructed defecation syndrome

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032012000200008 ◽

2012 ◽

Vol 49 (2) ◽

pp. 135-142 ◽

Cited By ~ 12

Author(s):

Sthela Maria Murad-Regadas ◽

Francisco Sergio P. Regadas ◽

Lusmar Veras Rodrigues ◽

Graziela Olivia da Silva Fernandes ◽

Guilherme Buchen ◽

...

Keyword(s):

Obstructed Defecation ◽

Mucosal Prolapse ◽

Clinical Treatment ◽

Group Iii ◽

Treatment Groups ◽

Obstructed Defecation Syndrome ◽

Group I ◽

Grade Ii ◽

Group Ii ◽

Grade Iii

CONTEXT: Management of patients with obstructed defecation syndrome is still controversial. OBJECTIVE: To analyze the efficacy of clinical, clinical treatment followed by biofeedback, and surgical treatment in patients with obstructed defecation, rectocele and multiple dysfunctions evaluated with echodefecography. METHODS: The study included 103 females aged 26-84 years with obstructed defecation, grade-II/III rectocele and multiple dysfunctions on echodefecography. Patients were distributed into three treatment groups and constipation scores were assigned. Group I: 34 (33%) patients with significant improvement of symptoms through clinical management only. Group II: 14 (14%) with improvement through clinical treatment plus biofeedback. Group III: 55 (53%) referred to surgery due to treatment failure. RESULTS: Group I: 20 (59%) patients had grade-II rectocele, 14 (41%) grade-III. Obstructed defecation syndrome was associated with intussusception (41%), mucosal prolapse (41%), anismus (29%), enterocele (9%) or 2 dysfunctions (23%). The average constipation score decreased significantly from 11 to 5. Group II: 11 (79%) grade-II rectocele, 3 (21%) grade-III, associated with intussusception (7%), mucosal prolapse (43%), anismus (71%) or 2 dysfunctions (29%). There was significant decrease in constipation score from 13 to 6. Group III: 8 (15%) grade-II rectocele, 47 (85%) grade-III, associated with intussusception (42%), mucosal prolapse (40%) or 2 dysfunctions (32%). The constipation score remained unchanged despite clinical treatment and biofeedback. Twenty-three underwent surgery had a significantly decrease in constipation score from 12 to 4. The remaining 32 (31%) patients which 22 refused surgery, 6 had low anal pressure and 4 had slow transit. CONCLUSIONS: Approximately 50% of patients with obstructed defecation, rectocele and multiple dysfunctions presented a satisfactory response to clinical treatment and/or biofeedback. Surgical repair was mainly required in patients with grade-III rectocele whose constipation scores remained high despite all efforts.

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Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

The Scientific World JOURNAL ◽

10.1100/2012/324040 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Piotr Walega ◽

Michal Romaniszyn ◽

Jakub Kenig ◽

Roman Herman ◽

Wojciech Nowak

Keyword(s):

Safety Assessment ◽

Mucosal Prolapse ◽

Hemorrhoidal Disease ◽

Functional Evaluation ◽

Artery Ligation ◽

Major Complications ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Invasive Method ◽

Grade Iii

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD).Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure.Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR.Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

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