Abstract
Background
Aluminum potassium sulfate and tannic acid (ALTA) is an effective sclerosing agent for the treatment of internal hemorrhoids. ALTA therapy with rectal mucopexy (AM) is a new approach for treating hemorrhoidal prolapse. This study investigated the midterm outcomes of AM surgery in patients with hemorrhoids.
Methods
Patients with grade III hemorrhoids who underwent AM surgery were enrolled in this retrospective analysis of prospectively collected data from a single institution. Cumulative success rates, postoperative symptoms, including pain scores, analgesic requirements, and postoperative complications, and patient satisfaction were assessed.
Results
The median number of ALTA injection procedures was 3 (range 1–4), and the median total injection dose was 19 mL (range 7–32 mL). The median number of mucopexy procedures was 2 (range 1–4). The median postoperative pain score (0 = no pain at all, 10 = worst pain imaginable) at rest or during defecation were ≤2. The total dose of analgesics administered during the first two weeks after surgery was 1 (range 0–25). Six patients (5.3%) showed postoperative complications: five showed Clavien–Dindo (C-D) grade I and one showed C-D grade IIIa complications. Cumulative success rates at one, three, and five years were 96.5%, 85.3%, and 85.3%, respectively. Patient satisfaction scores, which were assessed using a 10-point scale, were ≥9 at each postoperative year.
Conclusions
AM surgery is an effective non-excisional surgery with satisfactory mid-term results for grade III hemorrhoids, and is associated with lower complication rates, postoperative analgesic requirements, and higher patient satisfaction.
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References
Jayaraman S, Colquhoun PH, Malthaner RA (2006) Stapled versus conventional surgery for hemmorhoids. Cochrane Database Syst Rev 8(4):CD005393
Takano M, Iwadare J, Ohba H et al (2006) Sclerosing therapy of internal hemorrhoids with novel sclerosing agent. Comparison with ligation and excision. Int J Colorecatal Dis 21:44–51
Takamura H, Inatsugu H, Yoshikawa S, Masuda T (2001) Treatment of internal hemorrhoids with Xiaozhiling injection. J Jpn Soc Coloproctol 54:910–914
Yano T, Yano K (2015) Comparison of injection sclerotherapy between 5% phenol in almond oil and aluminum potassium sulfate and tannic acid for grade 3 hemorrhoids. Ann Coloproctol 31:103–105
Miyamoto H, Hada T, Ishiyama G, Ono Y, Watanabe H (2016) Aluminum potassium sulfate and tannic acid sclerotherapy for Golighter grades II and III hemorrhoids: results from a multicenter study. World J Hepatol 8:844–849
Dal Monte PP, Tagariello C, Sarago M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338
Takada S, Tsunoda A, Takahashi T, Kusanagi H (2022) Early postoperative outcomes of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids. Ann Coloproctol 38:290–296
Rockwood TH, Church JM, Fleshman JW et al (1999) Patient and surgeon ranking of the severity of symptoms assicuated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum 42:1525–1532
Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152:2399–2404
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Elmér SE, Nygren JO, Lenander CE (2013) A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 56:484–490
Ono T, Goto K, Takagi S, Iwasaki S, Komatsu H (2005) Screlosing effect of OC-108, a novel agent for hemorrhoids, is associated with granulomatous inflammation induced by aluminum. J Pharmacol Sci 99:353–363
Ono T, Nakagawa H, Fukunari A, Hashimoto T, Komatsu H (2006) Hemostatic action of OC-108, a novel agent for hemorrhoids, is associated with regional blood flow arrest induced by acute inflammation. J Pharmacol Sci 102:314–320
Patel J, McKechnie T, Wu K et al (2023) HEmoRhoidal disease management with Band ligation versus polidocanol Sclerotherapy: a systematic review and meta-analysis (the HerBS Review). Int J Colorectal Dis 38(1):112. https://doi.org/10.1007/s00384-023-04394-w
Thomson WH (1975) The nature and cause of hemorrhoids. Proc R Soc Med 68:574–575
Hachiro Y, Kunimoto M, Abe T, Kitada M, Ebisawa Y (2011) Aluminum potassium sulfate and tannic acid (ALTA) injection as the mainstay of treatment for internal hemorrhoids. Surg Today 41:806–809
Abe T, Kunimoto M, Hachiro Y, Ohara K, Inagaki M (2022) Long-term outcomes of aluminum potassium sulfate and tannic acid sclerotherapy for prolapsed hemorrhoids: a single-center, observational study. Dis Colon Rectum 65:271–275
Gupta PJ, Kalaskar S, Taori S, Heda PS (2011) Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids. Tech Coloproctol 15:439–444
Aigner F, Kronberger I, Oberwalder M et al (2016) Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of grade III haemorrhoids: a prospective randomized controlled trial. Colorectal Dis 18:710–716
Basile M, Di Resta V, Ranieri E (2016) Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up. Tech Coloproctol 20:353–359
Kato N, Kato K, Hosoi Y (2015) The combined effect of Otsuji-to with aluminum potassium sulfate and tannic acid therapy. J Jpn Soc Coloproctol 68:147–150
De Nardi P, Capretti G, Corsaro A, Staudacher C (2014) A prospective, randomized trial comparing the short- and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum 57:348–353
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This study was approved by the Ethics Committee of Kameda Medical Center (approval no. 23-026).
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Tsunoda, A., Kusanagi, H. Mid-term outcome of a novel nonexcisional technique using aluminum potassium sulfate and tannic acid sclerotherapy with mucopexy on patients with grade III hemorrhoids. Tech Coloproctol 27, 1335–1343 (2023). https://doi.org/10.1007/s10151-023-02863-6
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DOI: https://doi.org/10.1007/s10151-023-02863-6