Is haemorrhoidectomy in inflammatory bowel disease harmful? An old dogma re‐examined

Cracco, N.; Zinicola, R.

doi:10.1111/codi.12555

Cited by 27 publications

(23 citation statements)

References 21 publications

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“…D'Ugo et al [152] suggested that first-line management should be medical therapy, considering that a spontaneous healing is possible. Despite the higher risk of complications in patients with IBD [153], in non-responding patients, the surgical options on a highly selective basis can be considered with acceptable results [154]…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

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

et al. 2020

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Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication. The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE. These guidelines are inclusive and not prescriptive. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.

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Section: Inflammatory Bowel Diseasementioning

confidence: 99%

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

et al. 2020

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“…Cracco and Zinicola recently examined the literature on hemorrhoidal treatment in patients with inflammatory bowel disease. 7 In 11 retrospective studies with a total of 135 patients, there was a higher rate of complications in Crohn's patients (17%) than those with ulcerative colitis (5.5%).…”

Section: Hemorrhoidectomy In the Presence Of Crohn's Diseasementioning

confidence: 99%

Management of Complex Anorectal and Perianal Crohn's Disease

Bolshinsky

Church

2019

Clinics in Colon and Rectal Surgery

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Perianal symptoms occur in up to 50% of patients with Crohn's disease in other parts of the gastrointestinal tract, and in 5% of patients it is the first manifestation of the disease. The perianal area is often under stress in patients with Crohn's disease, because of the diarrhea, and the fecal urgency, frequency, and incontinence caused by proximal disease. Symptomatic perianal disease can therefore be due to the effects of the stress on an otherwise normal anus, or the result of Crohn's disease in the low rectum and/or perianal tissues themselves. This key distinction should drive the investigation and management of anal and perianal symptoms in patients with Crohn's disease. In this review, the evaluation and management of the various manifestations of Crohn's disease in the perineum and perianal tissues will be described.

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“…However, this practice is influenced by data from the 1970s and 1980s, well before medical treatment included biological therapy [4,5]. While the safety of excisional haemorrhoidectomy is being revisited in CD [6], the situation in UC remains largely unstudied, despite an estimated incidence of bleeding haemorrhoids in UC patients of 7% [1,4,[6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…A recent review of the literature reported that the incidence of complications after haemorrhoidectomy was higher in CD (17.1%) than in patients with UC (5.5%). The authors proposed that minimally invasive surgical techniques, such as transanal haemorrhoidal dearterialization, and better luminal disease control with the use of biological agents may account for the lower complication rates observed in IBD in recent years [6]. However, the authors did not mention an appropriate surgical management in the presence of IPAA.…”

Section: Introductionmentioning

confidence: 99%

Excisional haemorrhoidectomy: is it safe in patients with an ileal pouch–anal anastomosis?

et al. 2020

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Aim Excisional haemorrhoidectomy in patients with ulcerative colitis (UC), especially those undergoing an ileal pouch-anal anastomosis (IPAA), remains controversial. The aim of our study was to determine the safety of excisional haemorrhoidectomy in UC patients with and without an IPAA. Method A retrospective review of all adult UC patients undergoing excisional haemorrhoidectomy between 1 January 1995 and 1 January 2019 at a tertiary inflammatory bowel disease referral centre was performed. Data collected included patient demographics, clinical characteristics of UC, prior surgical intervention for UC (colectomy, IPAA) and complications after haemorrhoidectomy. Results Forty-one adult patients [50% male; median age 52 (range 25-79) years] with UC underwent excisional haemorrhoidectomy between 1 January 1995 and 1 January 2019. The majority (n = 23) had not previously undergone surgery for UC. However, eight had already undergone construction of an IPAA at the time of haemorrhoidectomy, seven had IPAA at the time of haemorrhoidectomy and three had an IPAA constructed subsequent to haemorrhoidectomy. Two (4.9%) patients need to go back to theatre for postoperative bleeding. There were no further 30-day complications or long-term nonhealing of the surgical site. There were no pouch complications in those who had haemorrhoidectomy at the time of IPAA construction or in the presence of an IPAA. Conclusion Our data suggest that excisional haemorrhoidectomy may be performed safely in carefully selected UC patients with symptomatic haemorrhoids with or without IPAA and even at the time of IPAA construction.

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Is haemorrhoidectomy in inflammatory bowel disease harmful? An old dogma re‐examined

Abstract: There is great variation in the incidence of complications reported after haemorrhoidectomy or removal of skin tags in patients with IBD and it is not possible to draw a firm conclusion. Nevertheless the incidence of complications is high in patients with CD.

Cited by 27 publications

References 21 publications

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

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

Management of Complex Anorectal and Perianal Crohn's Disease

Excisional haemorrhoidectomy: is it safe in patients with an ileal pouch–anal anastomosis?

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