Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey.
Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.
BMC Surg. 2023 Aug 10;23(1):228. doi: 10.1186/s12893-023-02105-4.
Available guidelines describing the procedural treatment of thrombosed external hemorrhoids (TEH) rely solely on expert opinion. We aimed to compare local excision (LE) and thrombectomy (incision) in terms of treatment success, factors affecting success, and outcomes.
This was a multicenter, prospective, observational study conducted in eight centers from September 2020 to September 2021. A total of 96 patients (58 LE, 38 thrombectomy) were included. Risk factors, demographics and clinical characteristics were recorded. Follow-up studies were scheduled for the 1 week, 1, 3 and 6 months. Surgical success was assessed at 1 month. Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale (SHS) were applied at baseline and the 6 month. Wexner fecal incontinence score was applied at all follow-up studies.
Overall mean age was 41.5 ± 12.7 years. At baseline, groups were similar with regard to demographics and disease severity (HDSS) (p > 0.05 for all). Success was relatively higher in the thrombectomy group (86.8%) compared to the LE group (67.2%) (p = 0.054). Constipation and travel history were significantly associated with lower likelihood of LE success. Symptoms during follow-up were similarly distributed in the groups. Both methods yielded significant improvements in HDSS, SHS and Wexner scores; however, SHS scores (6 months) and Wexner scores (all time points) were significantly better in the thrombectomy group.
The in-office thrombectomy procedure may have better short-term outcomes compared to LE in terms of relative success, recurrence and quality of life-despite the fact that success rates were statistically similar with the two interventions. LE may yield particularly worse results in patients with constipation and travel history; thus, thrombectomy appears to be especially advantageous in these patient subsets.
现有的描述血栓性外痔（TEH）治疗程序的指南仅依赖于专家意见。我们旨在比较局部切除（LE）和血栓切除术（切开术）在治疗成功率、影响成功率的因素和结局方面的差异。
这是一项多中心、前瞻性、观察性研究，于 2020 年 9 月至 2021 年 9 月在 8 个中心进行。共纳入 96 例患者（58 例行 LE，38 例行血栓切除术）。记录了风险因素、人口统计学和临床特征。随访研究安排在第 1 周、第 1、3 和 6 个月。在第 1 个月评估手术成功率。基线和第 6 个月时应用痔病症状评分（HDSS）和健康状况短量表（SHS）。所有随访研究均应用 Wexner 粪便失禁评分。
总体平均年龄为 41.5±12.7 岁。基线时，两组在人口统计学和疾病严重程度（HDSS）方面相似（p>0.05）。血栓切除术组的成功率相对较高（86.8%），高于 LE 组（67.2%）（p=0.054）。便秘和旅行史与 LE 成功率较低显著相关。随访期间的症状在两组中分布相似。两种方法均显著改善了 HDSS、SHS 和 Wexner 评分；然而，血栓切除术组的 SHS 评分（6 个月）和 Wexner 评分（所有时间点）显著更好。
在短期结果方面，与 LE 相比，门诊血栓切除术可能具有更高的成功率、更低的复发率和更好的生活质量，尽管两种干预措施的成功率在统计学上相似。在有便秘和旅行史的患者中，LE 的结果可能尤其较差；因此，血栓切除术在这些患者亚群中似乎具有特别的优势。
