A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Robin R Van Tol,Laurents P S Stassen,Marieke P A Bruijnen,Stéphanie O Breukink,Sander M J Van Kuijk,Jarno Melenhorst

doi:10.1007/s00384-018-3019-5

Abstract

PurposeIn this study, we describe current practices in the management of hemorrhoidal disease in the Netherlands.MethodsA validated online survey was performed among Dutch surgeons and residents treating hemorrhoidal disease. Contact details were retrieved from the Dutch Association for Surgery resulting in 619 contacts. Only doctors who were treating hemorrhoidal disease regularly were asked to complete the questionnaire. The following items were assessed: initial treatment, recurrence, complications, and follow-up.ResultsIn total, 133 respondents completed the survey. Ninety percent of the respondents started with rubber band ligation (RBL) as the first treatment in low-grade hemorrhoidal disease. In case of recurrence, 64% of the respondents repeated RBL three times before switching to a more invasive treatment modality. In grade III hemorrhoidal disease, the respondents preferred more invasive techniques: a sutured hemorrhoidopexy was performed in 24%, Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 9%, stapled hemorrhoidopexy in 19%, and the traditional hemorrhoidectomy in 31% of the patients, respectively. The majority of the respondents (39%) reported a mild complication in 5–10% of the patients. The most reported complication was pain. Nearly all the respondents (98%) reported a major complication in less than 5% of the patients. The majority of the patients (57%) were seen in outpatient clinics 6 weeks post-treatment.ConclusionThis Dutch survey showed areas of common practice for primary treatment of hemorrhoidal disease. However, it also demonstrated varying practices regarding recurrent hemorrhoidal disease. Practical guidelines are required to support colorectal surgeons in the Netherlands.

Highlights

Hemorrhoidal disease is a common pathology with prevalence rates of up to 44% within the general population [1,2,3]
Grades I and II hemorrhoidal disease were mostly treated conservatively or with rubber band ligation (RBL) according to the respondents
In a recent RCT, comparing RBL with hemorrhoidal artery ligation (HAL) in 370 patients with grades II and III hemorrhoidal disease, they showed that HAL resulted in fewer recurrences

Summary

Introduction

Hemorrhoidal disease is a common pathology with prevalence rates of up to 44% within the general population [1,2,3]. Hemorrhoids are usually classified by their location and by the presence and severity of prolapse. Initial treatment of grades I–II hemorrhoidal disease is quite uniform. Conservative treatment including diet, lifestyle changes, and application of topical ointments is mostly offered as a first step [5,6,7]. In case of persistent symptoms, patients are usually treated with rubber band ligation (RBL) [8]. It is still unclear what the best treatment modality is in case of recurrence after several failed RBL attempts

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