Fowler GE, Siddiqui J, Zahid A, Young CJ. Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand. World J Clin Cases 2019; 7(22): 3742-3750 [PMID: 31799299 DOI: 10.12998/wjcc.v7.i22.3742]
Corresponding Author of This Article
Christopher John Young, FACS, MBBS, Professor, Department of Colorectal Surgery, Head of Department, Royal Prince Alfred Hospital Medical Centre, Suite G07, 100 Carillon Avenue, Newtown 2042, NSW, Australia. cyoungnsw@aol.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2019; 7(22): 3742-3750 Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3742
Treatment of hemorrhoids: A survey of surgical practice in Australia and New Zealand
George E Fowler, Javariah Siddiqui, Assad Zahid, Christopher John Young
George E Fowler, Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, United Kingdom
Javariah Siddiqui, Assad Zahid, Christopher John Young, Department of Colorectal Surgery, Royal Prince Alfred Hospital, Newtown 2042, NSW, Australia
Author contributions: Fowler GE, Zahid A and Young CJ designed the research, Fowler GE, Siddiqui J and Young CJ analysed the data, Fowler GE, Siddiqui J, Zahid A and Young CJ wrote the paper.
Institutional review board statement: All specimens from the patients were obtained after their informed consent and ethical permission was obtained for participation in the study.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christopher John Young, FACS, MBBS, Professor, Department of Colorectal Surgery, Head of Department, Royal Prince Alfred Hospital Medical Centre, Suite G07, 100 Carillon Avenue, Newtown 2042, NSW, Australia. cyoungnsw@aol.com
Telephone: +61-2-95190064 Fax: +61-1300-078746
Received: August 14, 2019 Peer-review started: August 14, 2019 First decision: October 14, 2019 Revised: October 21, 2019 Accepted: October 30, 2019 Article in press: October 30, 2019 Published online: November 26, 2019 Processing time: 103 Days and 11.1 Hours
ARTICLE HIGHLIGHTS
Research background
Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention.
Research motivation
This study is in addition to highlighting areas of equipoise that will benefit from future research.
Research objectives
In this study, the authors aimed to determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.
Research methods
By using 17 guideline-based hypothetical clinical scenarios, an online survey was distributed to 206 colorectal surgeons in Australia and New Zealand.
Research results
Eight-two respondents to 17 guideline-based scenarios, nine reached consensus, of which only 1 disagreed with the guidelines. It was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise. These topics were based on low and moderate levels of evidence. And they included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications. Finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain.
Research conclusions
There are many areas of community equipoise which would benefit from further research.
