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Local excision versus thrombectomy in thrombosed external hemorrhoids: a multicenter, prospective, observational
Ali Yalcinkaya1, Ahmet Yalcinkaya2,3, Semra Demirli Atici4
1Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey. aliyalcink@gmail.com.
BMC Surgery
|August 10, 2023
Summary
Thrombectomy offers better outcomes for thrombosed external hemorrhoids than local excision, especially for patients with constipation or travel history. This in-office procedure shows improved success and quality of life.
Area of Science:
- Colorectal Surgery
- Hemorrhoidal Disease Management
- Minimally Invasive Procedures
Background:
- Current guidelines for thrombosed external hemorrhoids (TEH) lack robust evidence, relying on expert opinion.
- A comparative analysis of local excision (LE) and thrombectomy is needed to guide procedural treatment.
- Investigating factors influencing treatment success and patient outcomes is crucial for optimizing TEH management.
Purpose of the Study:
- To compare the efficacy and outcomes of local excision (LE) versus thrombectomy for treating thrombosed external hemorrhoids (TEH).
- To identify demographic and clinical factors associated with treatment success for both procedures.
- To evaluate the impact of LE and thrombectomy on patient-reported outcomes, including symptom scores and quality of life.
Main Methods:
- A multicenter, prospective, observational study involving 96 patients with TEH.
- Patients were treated with either local excision (LE) (n=58) or thrombectomy (n=38).
- Follow-up included assessments at 1 week, 1, 3, and 6 months, utilizing Hemorrhoidal Disease Symptom Score (HDSS), Short Health Scale (SHS), and Wexner fecal incontinence score.
Main Results:
- Thrombectomy demonstrated a higher success rate (86.8%) compared to LE (67.2%), though not statistically significant (p=0.054).
- Constipation and travel history were linked to lower success rates with LE.
- While both methods improved HDSS, SHS, and Wexner scores, thrombectomy showed significantly better SHS and Wexner scores at 6 months and all follow-up points, respectively.
Conclusions:
- In-office thrombectomy may offer superior short-term outcomes, including relative success, recurrence rates, and quality of life, compared to local excision for TEH.
- LE may be less effective in patients with constipation and a history of travel.
- Thrombectomy presents a particularly advantageous option for specific patient subsets with TEH, warranting further investigation.
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