EP802 - Practical Cost Savings Using Monsel’s Solution for Hemostasis in Office-Based Anorectal Procedures

Monday, May 11, 2026

10:31 AM - 10:36 AM ET

ePoster Presenter(s)

Grace C. Chang, DO

Colorectal Surgery Fellow
Rutgers Health/ RWJBarnabas Health
Rutgers Health/ RWJBarnabas Health
Morristown, NJ, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Lindsay Weil, MD

Colon & Rectal Surgery Fellow
Rutgers Robert Wood Johnson
Cranford, New Jersey, United States

Disclosure information not submitted.
Sophia Zigouras, DO, MS, RD

Colon & Rectal Surgery Fellow
Rutgers Robert Wood Johnson
Rutgers RWJ
Jersey City, NJ, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Suraj Alva, M.D.

Program Director
RWJ Colon and Rectal Surgery Fellowship, RWJ-BH
Summit, New Jersey, United States

Disclosure information not submitted.

Author(s)

Kirsten Bass Wilkins, MD FACS FASCRS (she/her/hers)

Associate Program Director Colorectal Fellowship
Rutgers-Robert Wood Johnson
Plainfield, New Jersey, United States

Disclosure information not submitted.
JN

Joseph R. Notaro, MD,FACS,FASCRS

Staff Attending,RWJ Colon & Rectal Fellowship
RWJ-BH
Warren, New Jersey, United States

Disclosure information not submitted.
CB

Chinn T. Bertram, M.D.

Staff Attending
RWJ Colon and Rectal Surgery Fellowship, RWJ-BH
Westfield, New Jersey, United States

Disclosure information not submitted.
AA

Analena Alcabes, MD

Colorectal Surgeon
Atlantic Health
New York, New York, United States

Disclosure information not submitted.
BK

Benjamin Kuritzkes, M.D.

Staff Attending
RWJ Colon and Rectal Surgery Fellowship, RWJ-BH
Summit, New Jersey, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Grace C. Chang, DO: This individual has no financial relationships with ineligible companies.

Sophia Zigouras, DO, MS: This individual has no financial relationships with ineligible companies.

Purpose/Background: Achieving effective hemostasis is essential for minor anorectal procedures performed in the office setting. Conventional agents such as Surgicel are effective but costly, increasing the expense of otherwise low-resource interventions. Monsel's solution (ferric subsulfate) is a well-established, inexpensive hemostatic agent widely used in gynecology and dermatology but underutilized in colorectal practice. This project describes office experience using Monsel's solution for hemostasis in common office-based anorectal procedures and evaluates its safety, practicality, and cost efficiency compared with Surgicel.

Methods/Interventions: Monsel's solution was applied to achieve hemostasis during routine office-based anorectal procedures, including external hemorrhoid excision, internal hemorrhoid treatment (rubber band ligation or sclerotherapy), anal skin tag or condyloma excision, abscess incision and drainage, and anorectal biopsy. The solution was applied directly to bleeding sites with a cotton-tipped applicator until hemostasis was achieved. Observations included ease of application, bleeding control, and patient tolerance. Product cost was obtained from institutional supply data: Monsel's solution ($15.66 per use) and Surgicel ($134.35 per use). No formal data collection or identifiable patient information was used; this report reflects practical clinical experience.

Results/Outcomes: Monsel's solution consistently achieved rapid and durable hemostasis across multiple office-based procedures without postoperative bleeding, tissue irritation, or patient discomfort. Substitution of Monsel's for Surgicel resulted in an average per-case savings of $118.69. Based on modeled case volumes, projected annual savings were:

• 50 cases/year: $5,934

• 100 cases/year: $11,868

• 250 cases/year: $29,670

No adverse outcomes were observed, and the agent was well tolerated by patients. Application was straightforward, required minimal material, and integrated seamlessly into standard office workflow.

Conclusion/Discussion: Anecdotal office experience demonstrates that Monsel's solution is a safe, effective, and cost-efficient hemostatic alternative to Surgicel for in-office anorectal procedures. Substituting Monsel's for Surgicel can yield annual savings of $5,900-$29,700, depending on practice volume. Its broad applicability and ease of use support its wider adoption in outpatient colorectal practices seeking to optimize both cost efficiency and quality patient care.