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

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.

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…A Dutch national survey demonstrated the superiority of RBL for II-degree HD and of excisional procedures for IIIdegree HD [69].…”

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

“…Frequently used as first-line treatment [24] Not recommended under warfarin/clopidogrel (increased bleeding risk) [27] Meta-analysis shows superiority compared to sclerotherapy [28] 2nd degree Injection sclerotherapy "Easy-to-do" Feasible in outpatient clinic Short-term benefits especially for bleeding hemorrhoids Recent studies show poor longterm outcomes [31,32] Limited role in today's practice 3rd degree Open (Milligan-Morgan) hemorrhoidectomy "Easy-to-teach" procedure Good long-term results [39] Quicker compared to closed technique [42] Limited number of hemorrhoids can be resected -danger of stenosis ( < 5%) [ "urge"/"tenesmus" symptoms [77][78][79] Patient selection critical in this procedure (e.g., caution in previous urge symptoms) Placement (height and depth) of pursestring suture crucial in order to avoid potentially serious complications "Tenesmus"/"urge" symptoms can be severe, can require removal of metallic staplers 3rd degree Transanal Haemorrhoidal Dearterialisation (HAL)…”

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

“…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%). These discrepancies could reflect different health care systems, surgical preferences and companies influences strongly suggesting the urgent need for European guidelines on haemorrhoids.…”