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. 2018 May;33(5):577-588.
doi: 10.1007/s00384-018-3019-5. Epub 2018 Mar 15.

A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Robin R van Tol  1 , Marieke P A Bruijnen  1 , Jarno Melenhorst  1 , Sander M J van Kuijk  2 , Laurents P S Stassen  1 , Stéphanie O Breukink  3
Affiliations

A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Robin R van Tol et al. Int J Colorectal Dis. 2018 May.

Abstract

Purpose: In this study, we describe current practices in the management of hemorrhoidal disease in the Netherlands.

Methods: A validated online survey was performed among Dutch surgeons and residents treating hemorrhoidal disease. Contact details were retrieved from the Dutch Association for Surgery resulting in 619 contacts. Only doctors who were treating hemorrhoidal disease regularly were asked to complete the questionnaire. The following items were assessed: initial treatment, recurrence, complications, and follow-up.

Results: In total, 133 respondents completed the survey. Ninety percent of the respondents started with rubber band ligation (RBL) as the first treatment in low-grade hemorrhoidal disease. In case of recurrence, 64% of the respondents repeated RBL three times before switching to a more invasive treatment modality. In grade III hemorrhoidal disease, the respondents preferred more invasive techniques: a sutured hemorrhoidopexy was performed in 24%, Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 9%, stapled hemorrhoidopexy in 19%, and the traditional hemorrhoidectomy in 31% of the patients, respectively. The majority of the respondents (39%) reported a mild complication in 5-10% of the patients. The most reported complication was pain. Nearly all the respondents (98%) reported a major complication in less than 5% of the patients. The majority of the patients (57%) were seen in outpatient clinics 6 weeks post-treatment.

Conclusion: This Dutch survey showed areas of common practice for primary treatment of hemorrhoidal disease. However, it also demonstrated varying practices regarding recurrent hemorrhoidal disease. Practical guidelines are required to support colorectal surgeons in the Netherlands.

Keywords: Hemorrhoids; Surgical; Survey; Therapy; Treatment algorithm.

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Conflict of interest statement

The ethical committee of Maastricht University Medical Centre confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply to the abovementioned study and that an official approval of this study by the committee is not required.

Figures

Fig. 1
Fig. 1
The use of rubber band ligation (RBL), minimal invasive treatment (laser therapy or sutured hemorrhoidopexy or Doppler-guided hemorrhoidal artery ligation (DG-HAL)), or invasive treatment (stapled hemorrhoidopexy or traditional hemorrhoidectomy) for grades I–IV hemorrhoidal disease according to the Goligher classification
Fig. 2
Fig. 2
Flow diagram: initial treatment for grades I–IV hemorrhoids (RBL, rubber band ligation; minimal invasive treatment, laser therapy or sutured hemorrhoidopexy or DG-HAL; and invasive treatment, stapled hemorrhoidopexy and traditional hemorrhoidectomy)
Fig. 3
Fig. 3
The use of conservative treatment, rubber band ligation (RBL), minimal invasive treatment (laser therapy or sutured hemorrhoidopexy or DG-HAL), or invasive treatment (stapled hemorrhoidopexy or traditional hemorrhoidectomy) in recurrent grades I–IV hemorrhoidal disease according to the Goligher classification
Fig. 4
Fig. 4
Flow diagram: treatment in case of recurrent hemorrhoids for grades I–IV hemorrhoids (RBL, rubber band ligation; minimally invasive treatment: laser therapy, sutured hemorrhoidopexy, or DG-HAL; and invasive treatment, stapled hemorrhoidopexy and traditional hemorrhoidectomy)
Fig. 5
Fig. 5
Cumulative reported mild complications (Clavien-Dindo 1–2) after RBL (rubber band ligation), minimal invasive treatment (laser therapy or sutured hemorrhoidopexy or DG-HAL), and invasive treatment (stapled hemorrhoidopexy and traditional hemorrhoidectomy)
Fig. 6
Fig. 6
Cumulative reported severe complications (Clavien-Dindo 3–5) after RBL (rubber band ligation), minimal invasive treatment (laser therapy or sutured hemorrhoidopexy or DG-HAL) and invasive treatment (stapled hemorrhoidopexy or traditional hemorrhoidectomy)
Fig. 7
Fig. 7
First and second outpatient visits after initial treatment for grades I–IV hemorrhoidal disease
See this image and copyright information in PMC

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