Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management - 05/04/24
, Amine Alam, Anne L. Rentien, Giorgio La Greca, Joshua Co, Elise Pommaret, Amélie Barré, Stéphane Kegne, Hélène Beaussier, Lucas Spindler, Vincent de ParadesHighlights |
• | Prolapse, bleeding and pain are the main manifestations of hemorrhoidal disease. |
• | Acceptance of a hemorrhoidal surgical procedure is limited by the fear of postoperative consequences despite better effectiveness than medico-instrumental treatments and ultimately better satisfaction. |
• | Apart from the classic prolapse score (cut-off at 2), age (>44years), the presence of hypertrophic anal skin tags, the Bristol score (cut-off at 5), the bleeding score (cut-off to 5), severe impact on quality of life, active smoking, and reading during bowel movements were significantly associated with surgical decision-making. |
• | An application, available via this link (risk-chirurgical.streamlit.app/) or via the QR-Code below, has been developed based on the previously identified factors making it possible to calculate the level of risk of hemorrhoidal surgery for each patient and which will be validated in a second study |
Summary |
Introduction |
There are very few French studies on hemorrhoidal disease and its management.
Patients and methods |
Prospective single-center study from July to December 2021 including 472 patients.
Results |
Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%),±instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P=0.002 and P≤0.0001, respectively), but improvement was more marked in the surgery group with a better rate of “very good satisfaction” (73% vs. 54%, P=0.003). Factors associated with likelihood of surgical treatment were: age>44years, hypertrophic perianal skin tags, high scores (Bristol>5, bleeding>5, prolapse>2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery.
Conclusion |
Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.
Le texte complet de cet article est disponible en PDF.Keywords : Hemorrhoidal disease, Goligher Prolapse Score, Paris Bleeding Score, Symptoms, Surgery
Plan
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