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Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand

BACKGROUND: Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the peri...

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Autores principales: Fowler, George E, Siddiqui, Javariah, Zahid, Assad, Young, Christopher John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887603/
https://www.ncbi.nlm.nih.gov/pubmed/31799299
http://dx.doi.org/10.12998/wjcc.v7.i22.3742
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author Fowler, George E
Siddiqui, Javariah
Zahid, Assad
Young, Christopher John
author_facet Fowler, George E
Siddiqui, Javariah
Zahid, Assad
Young, Christopher John
author_sort Fowler, George E
collection PubMed
description BACKGROUND: Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean, or they cause significant discomfort. Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse, as described by Goligher. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention. AIM: To determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand. METHODS: An online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios. RESULTS: There were 82 respondents (40%) to 17 guideline-based scenarios. Nine (53%) reached consensus, of which only 1 (6%) disagreed with the guidelines. This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise (47%) and they were equally divided for agreeing or disagreeing with the guidelines. These topics were based on low and moderate levels of evidence. They included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications; and finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain. CONCLUSION: Although there are areas of consensus in the management of hemorrhoids, there are many areas of community equipoise which would benefit from further research.
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spelling pubmed-68876032019-12-03 Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand Fowler, George E Siddiqui, Javariah Zahid, Assad Young, Christopher John World J Clin Cases Observational Study BACKGROUND: Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. External hemorrhoids originate below the dentate line and are managed conservatively unless the patient cannot keep the perianal region clean, or they cause significant discomfort. Internal hemorrhoids originate above the dentate line and can be managed according to the graded degree of prolapse, as described by Goligher. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention. AIM: To determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand. METHODS: An online survey was distributed to 206 colorectal surgeons in Australia and New Zealand using 17 guideline-based hypothetical clinical scenarios. RESULTS: There were 82 respondents (40%) to 17 guideline-based scenarios. Nine (53%) reached consensus, of which only 1 (6%) disagreed with the guidelines. This was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise (47%) and they were equally divided for agreeing or disagreeing with the guidelines. These topics were based on low and moderate levels of evidence. They included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications; and finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain. CONCLUSION: Although there are areas of consensus in the management of hemorrhoids, there are many areas of community equipoise which would benefit from further research. Baishideng Publishing Group Inc 2019-11-26 2019-11-26 /pmc/articles/PMC6887603/ /pubmed/31799299 http://dx.doi.org/10.12998/wjcc.v7.i22.3742 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Observational Study
Fowler, George E
Siddiqui, Javariah
Zahid, Assad
Young, Christopher John
Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title_full Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title_fullStr Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title_full_unstemmed Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title_short Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
title_sort treatment of hemorrhoids: a survey of surgical practice in australia and new zealand
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6887603/
https://www.ncbi.nlm.nih.gov/pubmed/31799299
http://dx.doi.org/10.12998/wjcc.v7.i22.3742
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