ABSTRACT
BACKGROUND:
New concepts in the management of haemorrhoidal
disease have recently rekindled interest in this common
pathology. General and subspecialist colorectal
surgeons were surveyed to assess their impact on the current management of haemorrhoids.
METHODS:
A
questionnaire was sent to all members of the
Association of Coloproctology of
Great Britain and
Ireland (ACPGBI) and the
Association of
Surgeons of
Great Britain and
Ireland (ASGBI). Regarding indications for
surgery, surgical
techniques, day case haemorrhoidectomy (DCH) and postoperative
treatment regimens. ASGBI members were asked to
state their subspecialist interest and estimated
time devoted to colorectal practice.
RESULTS:
There were 406 (71%) ACPGBI
respondents and 483 (68%) ASGBI
respondents. Eighty-four (12%) ASGBI
respondents performed no elective
colorectal surgery. One hundred and ninety-nine (35%) of ACPGBI
respondents saw between 6 and 10 new haemorrhoid
patients per week whereas three hundred (42%) of ASGBI
respondents saw between 1 and 5 per week. Non-operative management included routine advice on fluid and
diet by the majority of
surgeons, with banding carried out in 79% (ACPGBI) and 75% (ASGBI) and
injection sclerotherapy in 61% (ACPGBI) and 56% (ASGBI). The Milligan Morgan haemorrhoidectomy was performed in 265 (46%; ACPGBI) and 336 (47%; ASGBI). ACPGBI members used Submucosal
diathermy (148, 26%vs 67, 9%; ASGBI (P < 0.01; chi2 test with Yates correction)) and stapled anoplasty (61, 11%vs 14, 2%; ASGBI (P < 0.01; chi2 test with Yates correction)) more often. DCH was performed in 117 (20%; ACPGBI) and in 48 (7%; ASGBI)(P < 0.01; chi2 test with Yates correction).
CONCLUSIONS:
In this sample of
surgeons, operative management varies according to
specialist interest. There was a trend towards day case haemorrhoidectomy. Whilst more
surgeons have accepted the use of postoperative
techniques to reduce
pain, only a small minority have, as yet, adopted new surgical
techniques such as stapling.
