Guidelines for the treatment of hemorrhoids (short report)

Abstract

Hemorrhoids are a common medical problem that is often considered as benign. The French Society of Colo-Proctology (Société nationale française de colo-proctologie [SNFCP]) recently revised its recommendations for the management of hemorrhoids (last issued in 2001), based on the literature and consensual expert opinion. We present a short report of these recommendations. Briefly, medical treatment, including dietary fiber, should always be proposed in first intention and instrumental treatment only if medical treatment fails, except in grade ≥III prolapse. Surgery should be the last resort, and the patient well informed of the surgical alternatives, including the possibility of elective ambulatory surgery, if appropriate. Postoperative pain should be prevented by the systematic implementation of a pudendal block and multimodal use of analgesics.

Hemorrhoidal disease and chronic venous insufficiency: Concomitance or coincidence; results of the CHORUS study (Chronic venous and HemORrhoidal diseases evalUation and Scientific research)

“…Nonsurgical approaches are preferred for lower grade hemorrhoids because of the physiologic importance of the hemorrhoid cushions and potential self‐limiting nature of many hemorrhoid symptoms . When conservative therapy fails, clinical practice guidelines recommend office‐based procedures such as banding, sclerotherapy, and infrared coagulation for Grade I to III hemorrhoids .…”

“…Nonsurgical approaches are preferred for lower grade hemorrhoids because of the physiologic importance of the hemorrhoid cushions and potential self-limiting nature of many hemorrhoid symptoms. 12,17,20,21 When conservative therapy fails, clinical practice guidelines recommend office-based procedures such as banding, sclerotherapy, and infrared coagulation for Grade I to III hemorrhoids. 20,22 Surgical options such as hemorrhoidectomy, stapled hemorrhoidopexy, or hemorrhoidal artery ligation may be the initial step in patients with Grade III or IV hemorrhoids or in those who are refractory to or cannot tolerate office procedures.…”

“…12,17,20,21 When conservative therapy fails, clinical practice guidelines recommend office-based procedures such as banding, sclerotherapy, and infrared coagulation for Grade I to III hemorrhoids. 20,22 Surgical options such as hemorrhoidectomy, stapled hemorrhoidopexy, or hemorrhoidal artery ligation may be the initial step in patients with Grade III or IV hemorrhoids or in those who are refractory to or cannot tolerate office procedures. 20,22 However, conservative therapy can still play a role, creating favorable conditions for a smooth postoperative recovery.…”

Surgical management of haemorrhoids: an Italian survey of over 32 000 patients over 17 years

“…In fact, the reported long-term outcome in terms of recurrences after these operations widely varies from 9.5% in large case series [26] to 30% in RCT [11]. The results of this survey indicate that today haemorrhoids management in Italy is aligned to the recently published Italian position paper 27 and to most of the international guidelines [6][7][8][9]27]. However, the pattern of surgical choice for haemorrhoid Grade III in Italy differs substantially from the one recently reported in a Dutch survey [28], where traditional haemorrhoidectomy was performed in 31% of the cases (instead of 70%), non DGHAL with mucopexy in 24% of the cases (instead of 2.5%), DGHAL with mucopexy in 9% of the cases (instead of 24%) and PPH in 19% of the cases (instead of 5%).…”

Towards a core outcome set for hemorrhoidal disease—a systematic review of outcomes reported in literature

“…The most widely accepted classification is Golighers’ classification [2]. There is considerable variation in the way that HD is managed due to the lack of strong recommendations in treatment guidelines [3, 4]. Basic treatment of HD consists of diet, lifestyle changes, and application of topical ointments [5].…”