The non-surgical management for hemorrhoidal disease. A systematic review

Gianfranco Cocorullo, Gaspare Gulotta, Giuseppe Salamone, Roberta Tutino, Leo Licari, Raspanti, Fontana, Gallo, Orlando, Nicolò Falco, Gianfranco Cocorullo, Trompetto, Roberta Tutino, Trompetto, Leo Licari, Gregorio Scerrino, Gulotta, Salamone, Trompetto, Cristina RaspantiGiuseppina Orlando, Nicolo' Falco, Tommaso Fontana

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)

Abstract

The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC). We performed a systematic review in order to evaluate: do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are? A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS. In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%. IV degree prolapse should have a more invasive treatment. The commonest complications are bleeding and pain (8-80%). IRC related improvement is 78%, 51% and 22% for I, II and III degree. Post-operative pain occurs in 15- 100% and post-operative bleeding ranges from 15% to 44%. Recurrence rate is 13% at a three months follow-up. IS brings to the resolution of prolapse in 90%-100% of II degree and allows good results for III degree even if reported only by case series. The post-procedural pain is 36%-49%. Bleeding is a very rare harm. Even if not definitive, these treatments could be an alternative for mild symptomatic patients after a clear explanation of recurrence rates and possible complications.
Original languageEnglish
Pages (from-to)5-14
Number of pages10
JournalIL GIORNALE DI CHIRURGIA
Volume38
Publication statusPublished - 2017

All Science Journal Classification (ASJC) codes

  • Surgery

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