‘Bumps down under:’ hemorrhoids, skin tags and all things perianal

Abstract

Purpose of reviewThere continues to be a concentrated effort to improve treatment options readily available for some of the most common perianal diseases: hemorrhoids, anal fissure and anal fistula. The emphasis remains on therapies that definitively address the underlying pathology yet minimize pain and risk of incontinence, have a short recovery period, and are cost-effective. In this analysis, recent developments in the literature are reviewed. Recent findingsTreatment of early stage hemorrhoidal disease remains the same. For grades II-IV disease, hemorrhoidal vessel ligation/obliteration with laser or bipolar energy are reported. For more advanced diseases, modifying the technique for hemorrhoidectomy to improve postoperative complications and pain is described. For anal fissure, a stepwise method continues to be the mainstay of treatment (initiating with vasodilators, followed by botox, and ultimately sphincterotomy), which decreases the risk of incontinence with proper patient selection and technique. Management of anal fistula continues to be challenging, balancing cure vs. risk of harm. Recent developments include modifications to ligation of intersphincteric fistula tract procedure and use of laser to obliterate the tract. SummaryAdvancements in managing benign anorectal disease are ongoing. Several reports are novel, whereas others involve enhancing well-established treatment options by either operative technique or patient selection.

Simultaneous treatment for anal fissure and hemorrhoids

“…According to various data, combined diseases of rectum are present in 20-30% of patients who come to a proctologist, with a stable trend towards an increase in their number [4,8,10]. Diagnosis and selection of treatment methods for combined diseases of the rectum represent a complex and still not fully understood problem [1,4,6].…”

“…Hemorrhoids and anal fissure occupy the first and the third places, respectively, in terms of frequency of occurrence among proctological diseases. According to various literary sources, the combination of chronic hemorrhoids with anal fissure is present in 55-70% of patients [1,7].…”

“…When using surgical treatment for combined diseases of the rectum, the doctor always faces the question of whether to divide the surgical intervention into two sequential stages or to perform a simultaneous surgical intervention for the combined pathology, and in which cases one or the other should be done [1,11].…”

Comparison of external treatment of Acupuncture and moxibustion and intervention of Chinese and Western Medicine on postoperative pain of hemorrhoids: A systematic review and meta-analysis

“…Studies have also shown[2] that sugar can reduce hemorrhoid edema and inflammation. Surgery[3][4] was the main treatment[5][6], but there were more complications such as pain[7], edema, constipation and itching, which affected the quality of life and recovery. This paper focuses on postoperative pain as a complication of systematic discussion.…”