Literature Data on the Hemorrhoidal Disease Management

Living reference work entry
Part of the Coloproctology book series (COLOPROCT)

Abstract

Hemorrhoids are very common, with large proportion being asymptomatic and not requiring treatment. Wide variety of management options is available for those requiring or seeking treatment for symptom control. Comprehensive evidence relating to efficacies of multitude of treatment modalities are varied and can be lacking at times, and long-term results are limited. However, results from several meta-analysis and large multicenter randomized controlled trials in recent past could help as a guide in providing a pragmatic management algorithm for various stages of hemorrhoidal disease. The aim of this chapter is to present a comprehensive review of various treatment interventions and related evidence for management of hemorrhoidal disease.

In general, conservative management can be offered to all patients and may be adequate enough for grade I hemorrhoids. Grade II would likely benefit from a course of rubber band ligation (RBL) with the provision for a repeat RBL if required. Failure of treatment/refractory symptoms may justify interventions with hemorrhoidal dearterialization techniques. Grade III and IV hemorrhoids will most likely benefit from conventional excisional hemorrhoidectomy, which despite its main drawback of postoperative pain, has benefits from proven long-term effectiveness and low recurrence rates. Stapled hemorrhoidectomy (SH) may be considered as a possible option in select cases of circumferential prolapsed hemorrhoids. The main benefit of SH is lower postoperative pain but is a less preferred approach due to higher long-term recurrence rate. The newer energy-based excision hemorrhoidal techniques using bipolar and ultrasonic scalpel has equivalent efficacy compared to conventional excisional hemorrhoidectomy; however, increased equipment costs and lack of long-term efficacy data limits their recommendation and widespread adoption.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgerySingapore General HospitalSingaporeSingapore
  2. 2.Department of General SurgerySingapore General HospitalSingaporeSingapore
  3. 3.Colorectal Clinical AssociatesSingaporeSingapore

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