Stapled hemorrhoidopexy carries a significantly higher incidence of recurrences and additional operations compared with conventional surgery. It is the patient's choice whether to accept a higher recurrence rate to take advantage of the short-term benefits of stapler procedure.Arch Surg. 2009 ;144:266-72

There is a "post-PPH syndrome" relating to postoperative morbidities. The most disturbing morbidity Is lasting perineal pain of unexplained etiology demanding challenging management. Persistent bleeding from hemorrhoidal disease distal to the staple line requires further management and raises the question as to the use of PPH as a permanent remedial procedure. Techniques in Coloproctology, 2009.

Isolated use of Doppler-guided haemorrhoidal artery ligation (DGHAL) fails for advanced haemorrhoids.

It has to be supplemented with Suture haemorrhoidopexy  or mucopexy by rectoanal repair which result in haemorrhoidal lifting and fixation. Colorectal Dis. 2008 Nov 14.

Other News

A posterior perineal support device  bring about sig nificant improvement in the symptoms of patients with anal fissures. There may also be secondary benefits of a reduction in the symptoms of constipation.

Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. Altered rectal distensibility was associated with rectal urgency and/or increased stool frequency.J Gastrointest Surg. 2009 Dec;

Use of Jet stream for anal cleaning could cause anal fissure-A bidet-toilet is an integration of a toilet and a bidet, whereby a nozzle is attached to an existing toilet for cleaning the anus and perianal region. A series of patients having anterior fissure-in-ano caused by water stream of the bidet-toilet have been noted in a study.Colorectal Disease

Transcutaneous needle-free injection of botulinum toxin into the external anal sphincter is  introduced as a safe new treatment of chronic idiopathic constipation and anal fissure in children. A second injection may be required in 20% of patients. J. Pediatr Surg. 2009 Sep;