Masao Kunimoto

Distal Hemorrhoidectomy With ALTA Injection: A New Method for Hemorrhoid Surgery

Aluminum potassium sulfate and tannic acid injection (ALTA) is a useful and less-invasive treatment for internal hemorrhoids. However, it is not a treatment option for external hemorrhoidal diseases, including mixed hemorrhoids. Distal hemorrhoidectomy with ALTA injection involves surgical resection of external piles, followed by injection therapy on internal piles. We report technical details and the short-term results of this procedure in patients with mixed hemorrhoids. Seventy-two patients with mixed hemorrhoids treated between 2010 and 2011 were included. The main outcome measures were the short-term response and complication rates. At 28 days after surgery, the disappearance rate of prolapse was 100%. Three patients (4%) had postoperative complications, all minor in nature. No prolapse recurrence was observed within a median follow-up period of 6 months. Distal hemorrhoidectomy with ALTA injection appears to be a promising treatment option for patients with mixed hemorrhoids.

Efficacy of Lubiprostone in Chronic Constipation: Clinical and WorkProductivity Outcomes

Objective: Chronic constipation is a common health problem that significantly affects the quality of life of patients and results in high economic burden. This clinical study was performed to assess the efficacy of lubiprostone in the treatment of chronic constipation using a validated constipation scoring system and the work productivity and activity impairment questionnaire. Methods: We prospectively enrolled 35 patients who received lubiprostone. All the patients had chronic constipation as defined by the Rome III criteria. The patients were treated orally with a 24-μg lubiprostone capsule twice a day. Changes in the scores before and 2 weeks after the beginning of administration were recorded and analyzed. Results: Of the 35 patients, 28 completed the study and were included in the efficacy analysis. The total constipation scoring system score was significantly improved from 11.3 ± 4.8 at baseline to 8.0 ± 4.0 after 2 weeks. Although the work activity subscale did not show a significant improvement, such an improvement was statistically significant in the case of non-work-related activities. Conclusion: Our results demonstrate that lubiprostone is effective in improving many chronic constipationrelated symptoms as well as the quality of life in patients with chronic constipation.