Department of Surgery, Republican Vilnius University Hospital, Vilnius, Lithuania.
Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
Colorectal Dis. 2024 Oct;26(10):1797-1804. doi: 10.1111/codi.17140. Epub 2024 Aug 21.
There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids.
The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp.
The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I-IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids - with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary.
Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed.
痔的治疗尚无普遍接受的共识，因此世界各地的治疗方法都是个体化的。本研究旨在评估全球外科医生治疗痔的方法。
国际大学直肠和结肠外科医生协会（ISUCRS）的研究小组制定了一份自愿的、匿名的问卷，评估外科医生的经验、手术量和痔的治疗方法。该 44 个多项选择问卷可通过 ISUCRS 电子邮件数据库和 Viber 和 WhatsApp 等社交媒体平台使用一个月。
该调查由来自 103 个国家的 1005 名外科医生完成；931 名（92.6%）处于活跃实践中，819 名（81.5%）年龄在 30 至 60 岁之间，822 名（81.8%）为男性。详细的病史（92.9%）、会阴检查（91.2%）和直肠指检（91.1%）是最常见的评估方法。对于内痔，924 名（91.9%）参与者将其分级为 I-IV 级，痔的严重程度是决定治疗方法的最重要因素（76.3%）。最常见的非手术/保守治疗方法包括增加每日纤维摄入量（86.9%）、增加饮水量（82.7%）和正常化排便习惯/如厕训练（74.4%）。对于症状性第一度（92.5%）、第二度（72.4%）和第三度（47.3%）痔，保守治疗是首选治疗方法；然而，对于症状性第四度痔，手术是首选治疗方法（77.6%）。橡皮圈套扎是第一度（50.7%）和第二度（47.2%）痔的二线治疗方法，而手术是第三度（82.9%）和第四度（16.7%）症状性痔的二线治疗方法。橡皮圈套扎由 645 名（64.2%）参与者在办公室进行。对于内痔（87.1%）和外痔（89.7%），最常见的手术方法是痔切除术——716 名（71.2%）参与者切除 1、2 或 3 个痔区。
尽管痔的治疗尚无全球共识，但世界各地不同文化、资源、手术量和经验的外科医生之间存在许多相似的实践。通过进一步的研究，可能会制定出共识声明。
