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Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study.

Gebbensleben O, Hilger Y, Rohde H - Clin Exp Gastroenterol (2009)

Bottom Line: Follow-up information was collected six months after admission by questionnaire.Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as "healed" or "ameliorated", and 61.1% (44/72, 95% CI: 49.6-72.6) found our management policy as "valuable to test" or "impracticable". 13.9% (10/72, 95% CI: 5.7-22.1) of patients suspected to have recurrences. 4.2% did not know.Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22).

View Article: PubMed Central - PubMed

Affiliation: Park-Klinik Berlin-Weissensee, Berlin, Germany;

ABSTRACT

Background: It is unknown whether surgery is the gold standard for therapy of thrombosed external hemorrhoids (TEH).

Methods: A prospective cohort study of 72 adults with TEH was conducted: no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation. Follow-up information was collected six months after admission by questionnaire.

Results: Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as "healed" or "ameliorated", and 61.1% (44/72, 95% CI: 49.6-72.6) found our management policy as "valuable to test" or "impracticable". 13.9% (10/72, 95% CI: 5.7-22.1) of patients suspected to have recurrences. 4.2% did not know. Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22).

Conclusions: The dictum that surgery is the gold standard for therapy for TEH should be checked by randomized controlled trials.

No MeSH data available.


Related in: MedlinePlus

All six photos are taken from the same patient. In three-day intervals, they show the healing of a perforated and bleeding single thrombosed external hemorrhoid within nine days of a patient who consequently complied to our strict conservative management policy. A) Day 0: The patient is in knee–chest position, head left. Right-lateral of the anus parts of the uninflamed external hemorrhoidal plexus are protruding. Left-lateral there is edematous tissue with a dark spot (nonperforated thrombosed external hemorrhoid) with a subcutaneous clot. B) Day 3: Perforation and anal bleeding occurred in between. Right-lateral of the anus parts of an unaltered external hemorrhoidal plexus are seen. Left-lateral redness and edema of inflamed anal skin perforated by two black clots. C) Day 6: The right-lateral parts of the external hemorrhoidal plexus remain unchanged. The left-lateral clots are still at same position. D) Day 6: Both clots were taken out. A gaping lesion remains at former perforation site. E) Day 9: A 2–4 mm healing lesion is seen at former perforation site. At right-lateral, unchanged parts of the external hemorrhoidal plexus. F) Day 32: At follow-up four weeks later, the left-lateral perforation can hardly be seen. At right-lateral, the uninflamed subcutaneous external hemorrhoidal plexus appears unchanged.
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f1-ceg-2-069: All six photos are taken from the same patient. In three-day intervals, they show the healing of a perforated and bleeding single thrombosed external hemorrhoid within nine days of a patient who consequently complied to our strict conservative management policy. A) Day 0: The patient is in knee–chest position, head left. Right-lateral of the anus parts of the uninflamed external hemorrhoidal plexus are protruding. Left-lateral there is edematous tissue with a dark spot (nonperforated thrombosed external hemorrhoid) with a subcutaneous clot. B) Day 3: Perforation and anal bleeding occurred in between. Right-lateral of the anus parts of an unaltered external hemorrhoidal plexus are seen. Left-lateral redness and edema of inflamed anal skin perforated by two black clots. C) Day 6: The right-lateral parts of the external hemorrhoidal plexus remain unchanged. The left-lateral clots are still at same position. D) Day 6: Both clots were taken out. A gaping lesion remains at former perforation site. E) Day 9: A 2–4 mm healing lesion is seen at former perforation site. At right-lateral, unchanged parts of the external hemorrhoidal plexus. F) Day 32: At follow-up four weeks later, the left-lateral perforation can hardly be seen. At right-lateral, the uninflamed subcutaneous external hemorrhoidal plexus appears unchanged.

Mentions: Two patients called on us in the first two weeks after admission because of healing problems: a 32-year-old man was dissatisfied with prolonged healing, but we persuaded him into continuing therapy. A 73-year-old lady was seen repeatedly because of recurrent anal bleeding because of TEH. She was happy with our treatment policy because she escaped surgery (Figures 1A–F).


Do we at all need surgery to treat thrombosed external hemorrhoids? Results of a prospective cohort study.

Gebbensleben O, Hilger Y, Rohde H - Clin Exp Gastroenterol (2009)

All six photos are taken from the same patient. In three-day intervals, they show the healing of a perforated and bleeding single thrombosed external hemorrhoid within nine days of a patient who consequently complied to our strict conservative management policy. A) Day 0: The patient is in knee–chest position, head left. Right-lateral of the anus parts of the uninflamed external hemorrhoidal plexus are protruding. Left-lateral there is edematous tissue with a dark spot (nonperforated thrombosed external hemorrhoid) with a subcutaneous clot. B) Day 3: Perforation and anal bleeding occurred in between. Right-lateral of the anus parts of an unaltered external hemorrhoidal plexus are seen. Left-lateral redness and edema of inflamed anal skin perforated by two black clots. C) Day 6: The right-lateral parts of the external hemorrhoidal plexus remain unchanged. The left-lateral clots are still at same position. D) Day 6: Both clots were taken out. A gaping lesion remains at former perforation site. E) Day 9: A 2–4 mm healing lesion is seen at former perforation site. At right-lateral, unchanged parts of the external hemorrhoidal plexus. F) Day 32: At follow-up four weeks later, the left-lateral perforation can hardly be seen. At right-lateral, the uninflamed subcutaneous external hemorrhoidal plexus appears unchanged.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3108631&req=5

f1-ceg-2-069: All six photos are taken from the same patient. In three-day intervals, they show the healing of a perforated and bleeding single thrombosed external hemorrhoid within nine days of a patient who consequently complied to our strict conservative management policy. A) Day 0: The patient is in knee–chest position, head left. Right-lateral of the anus parts of the uninflamed external hemorrhoidal plexus are protruding. Left-lateral there is edematous tissue with a dark spot (nonperforated thrombosed external hemorrhoid) with a subcutaneous clot. B) Day 3: Perforation and anal bleeding occurred in between. Right-lateral of the anus parts of an unaltered external hemorrhoidal plexus are seen. Left-lateral redness and edema of inflamed anal skin perforated by two black clots. C) Day 6: The right-lateral parts of the external hemorrhoidal plexus remain unchanged. The left-lateral clots are still at same position. D) Day 6: Both clots were taken out. A gaping lesion remains at former perforation site. E) Day 9: A 2–4 mm healing lesion is seen at former perforation site. At right-lateral, unchanged parts of the external hemorrhoidal plexus. F) Day 32: At follow-up four weeks later, the left-lateral perforation can hardly be seen. At right-lateral, the uninflamed subcutaneous external hemorrhoidal plexus appears unchanged.
Mentions: Two patients called on us in the first two weeks after admission because of healing problems: a 32-year-old man was dissatisfied with prolonged healing, but we persuaded him into continuing therapy. A 73-year-old lady was seen repeatedly because of recurrent anal bleeding because of TEH. She was happy with our treatment policy because she escaped surgery (Figures 1A–F).

Bottom Line: Follow-up information was collected six months after admission by questionnaire.Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as "healed" or "ameliorated", and 61.1% (44/72, 95% CI: 49.6-72.6) found our management policy as "valuable to test" or "impracticable". 13.9% (10/72, 95% CI: 5.7-22.1) of patients suspected to have recurrences. 4.2% did not know.Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22).

View Article: PubMed Central - PubMed

Affiliation: Park-Klinik Berlin-Weissensee, Berlin, Germany;

ABSTRACT

Background: It is unknown whether surgery is the gold standard for therapy of thrombosed external hemorrhoids (TEH).

Methods: A prospective cohort study of 72 adults with TEH was conducted: no surgery, no sitz baths but gentle dry cleaning with smooth toilet paper after defecation. Follow-up information was collected six months after admission by questionnaire.

Results: Despite our strict conservative management policy 62.5% (45/72) of patients (95% confidence interval [CI]: 51.0-74.0) described themselves as "healed" or "ameliorated", and 61.1% (44/72, 95% CI: 49.6-72.6) found our management policy as "valuable to test" or "impracticable". 13.9% (10/72, 95% CI: 5.7-22.1) of patients suspected to have recurrences. 4.2% did not know. Twenty-two of the 48 responding patients reported symptoms such as itching (18.8%), soiling (12.5%), pricking (10.4%), or a sore bottom (8.3%) once a month (59.1%, 13/22), once a week (27.3%, 6/22), or every day (13.6%, 3/22).

Conclusions: The dictum that surgery is the gold standard for therapy for TEH should be checked by randomized controlled trials.

No MeSH data available.


Related in: MedlinePlus