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Samalavicius NE, Gupta RK, Nunoo-Mensah J, Fortunato R, Lohsiriwat V, Khanal B, Kumar A, Sah B, Cerkauskaite D, Dulskas A. Global treatment of haemorrhoids-A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons. Colorectal Dis 2024. [PMID: 39169548 DOI: 10.1111/codi.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/13/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
AIM There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. METHODS The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. RESULTS The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I-IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids - with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. CONCLUSION Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed.
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Affiliation(s)
- Narimantas E Samalavicius
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Hila, Medical Diagnostics and Treatment Center, Vilnius, Lithuania
| | - Rakesh Kumar Gupta
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Joseph Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK
- Cleveland Clinic, London, UK
| | - Richard Fortunato
- Department of Colorectal Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Varut Lohsiriwat
- Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bhawani Khanal
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhijeet Kumar
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bikash Sah
- Department of Surgery, Gastrointestinal Unit, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dovile Cerkauskaite
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
- SMK, University of Applied Social Sciences, Vilnius, Lithuania
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Jongen J, Petersen S, Kleijnen J. Guideline on haemorrhoids: AGREE-II-Criteria can be applied in different ways? ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:375. [PMID: 37675323 PMCID: PMC10477629 DOI: 10.21037/atm-23-1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Johannes Jongen
- Proctological Office Kiel/Department of Proctological Surgery, Park-Klinik, Kiel, Germany
| | - Sven Petersen
- Department of General & Visceral Surgery, Asklepios Hospital Altona, Hamburg, Germany
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Christodoulou P, Baloyiannis I, Perivoliotis K, Symeonidis D, Tzovaras G. The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis. Tech Coloproctol 2023; 27:103-115. [PMID: 36371772 DOI: 10.1007/s10151-022-02730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD). METHODS This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. RESULTS Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8-26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5-12.5%), thrombosis (2.2%, 95% CI 0.4-4.8%), and pain (1.6%, 95% CI 0.2-3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3-3.4%) and 4.8% (95% CI 1.2-8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7-96.6%) and 95% (95% CI 89.8-100%), correspondingly. Overall CoE was "Very Low". CONCLUSIONS Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.
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Affiliation(s)
| | | | | | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa, Greece
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