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Evidence-based practice in haemorrhoidectomy
1Department of Surgery, St Mark's Hospital, Harrow, UK.
Summary
Haemorrhoidectomy is the most effective treatment for prolapsing haemorrhoids, with no clear evidence favoring one surgical technique over another. With proper care, it can be safely performed as day surgery.
Area of Science:
- Colorectal Surgery
- Gastroenterology
Background:
- Haemorrhoidectomy offers long-term efficacy for haemorrhoids but can cause pain and complications.
- Current literature review and best practice guidelines for surgical haemorrhoid treatment are needed.
Purpose of the Study:
- To review the literature on surgical treatments for haemorrhoids.
- To describe best practices in haemorrhoidectomy.
Main Methods:
- Medline search conducted for clinical trials comparing surgical haemorrhoid treatments.
- Keywords used: haemorrhoids, haemorrhoidectomy.
Main Results:
- Many studies had small sample sizes and short follow-up periods.
- Open and closed haemorrhoidectomy techniques are comparable; laser haemorrhoidectomy lacks evidence.
- Preoperative lactulose and postoperative metronidazole are supported by trials.
Conclusions:
- Haemorrhoidectomy is the most effective treatment for prolapsing haemorrhoids.
- Little evidence supports one surgical technique over another.
- Haemorrhoidectomy can be performed as day surgery with attention to pain management.