K K W Chan1, J D R Arthur. 1. Department of Colorectal Surgery, Aintree University Hospital, Lower Lane, Fazakerley, Liverpool, Merseyside, L9 7AL, UK. karenchan50@hotmail.com
Abstract
BACKGROUND: External haemorrhoidal thrombosis (EHT) may be managed surgically or conservatively. The optimal treatment is, however, unclear, as is the long-term outcome following treatment. METHODS: A literature search was undertaken to review and grade the evidence available for EHT management, determine the optimal management modality and assess long-term outcome after each treatment. RESULTS: Among 800 articles on haemorrhoids, only two prospective studies encompassing 248 patients and two retrospective studies of 571 patients were found. Excision significantly relieves presenting symptoms by postoperative day 4 compared with incision or topical GTN (Level IB evidence). Symptoms last over 3 weeks with conservative treatment (Level III evidence) and this period may be reduced by combining topical nifedipine and lignocaine rather than using lignocaine alone (Level IB evidence). There is no evidence regarding the optimal time for non-surgical options. CONCLUSIONS: There is a remarkable paucity of studies on EHT and few of those available provide high levels of evidence. Surgery may be superior to conservative treatment but there is no evidence regarding the optimal period of initiation of conservative management. Prospective comparative studies are needed.
BACKGROUND: External haemorrhoidal thrombosis (EHT) may be managed surgically or conservatively. The optimal treatment is, however, unclear, as is the long-term outcome following treatment. METHODS: A literature search was undertaken to review and grade the evidence available for EHT management, determine the optimal management modality and assess long-term outcome after each treatment. RESULTS: Among 800 articles on haemorrhoids, only two prospective studies encompassing 248 patients and two retrospective studies of 571 patients were found. Excision significantly relieves presenting symptoms by postoperative day 4 compared with incision or topical GTN (Level IB evidence). Symptoms last over 3 weeks with conservative treatment (Level III evidence) and this period may be reduced by combining topical nifedipine and lignocaine rather than using lignocaine alone (Level IB evidence). There is no evidence regarding the optimal time for non-surgical options. CONCLUSIONS: There is a remarkable paucity of studies on EHT and few of those available provide high levels of evidence. Surgery may be superior to conservative treatment but there is no evidence regarding the optimal period of initiation of conservative management. Prospective comparative studies are needed.
Authors: Francisco Hernández-Bernal; Georgina Castellanos-Sierra; Carmen M Valenzuela-Silva; Karem M Catasús-Álvarez; Osmany Martínez-Serrano; Odalys C Lazo-Diago; Cimara H Bermúdez-Badell; José R Causa-García; Juan E Domínguez-Suárez Journal: World J Gastroenterol Date: 2015-06-21 Impact factor: 5.742
Authors: Antonio Tarasconi; Gennaro Perrone; Justin Davies; Raul Coimbra; Ernest Moore; Francesco Azzaroli; Hariscine Abongwa; Belinda De Simone; Gaetano Gallo; Giorgio Rossi; Fikri Abu-Zidan; Vanni Agnoletti; Gianluigi de'Angelis; Nicola de'Angelis; Luca Ansaloni; Gian Luca Baiocchi; Paolo Carcoforo; Marco Ceresoli; Alain Chichom-Mefire; Salomone Di Saverio; Federica Gaiani; Mario Giuffrida; Andreas Hecker; Kenji Inaba; Michael Kelly; Andrew Kirkpatrick; Yoram Kluger; Ari Leppäniemi; Andrey Litvin; Carlos Ordoñez; Vittoria Pattonieri; Andrew Peitzman; Manos Pikoulis; Boris Sakakushev; Massimo Sartelli; Vishal Shelat; Edward Tan; Mario Testini; George Velmahos; Imtiaz Wani; Dieter Weber; Walter Biffl; Federico Coccolini; Fausto Catena Journal: World J Emerg Surg Date: 2021-09-16 Impact factor: 5.469
Authors: Francisco Hernández-Bernal; Georgina Castellanos-Sierra; Carmen M Valenzuela-Silva; Karem M Catasús-Álvarez; Roselin Valle-Cabrera; Ana Aguilera-Barreto; Pedro A López-Saura Journal: World J Gastroenterol Date: 2014-02-14 Impact factor: 5.742
Authors: Paulo Salgueiro; Ana Célia Caetano; Ana Maria Oliveira; Bruno Rosa; Miguel Mascarenhas-Saraiva; Paula Ministro; Pedro Amaro; Rogério Godinho; Rosa Coelho; Rúben Gaio; Samuel Fernandes; Vítor Fernandes; Fernando Castro-Poças Journal: GE Port J Gastroenterol Date: 2019-09-05
Authors: G Gallo; J Martellucci; A Sturiale; G Clerico; G Milito; F Marino; G Cocorullo; P Giordano; M Mistrangelo; M Trompetto Journal: Tech Coloproctol Date: 2020-01-28 Impact factor: 3.781