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Belgian consensus guideline on the management of hemorrhoidal disease

Journal Volume 84 - 2021
Issue Fasc.1 - Expert Point of View
Author(s) H. De Schepper 1, G. Coremans 2, M.A. Denis 3, P. Dewint 1 4, M. Duinslaeger 5, I. Gijsen 6, P. Haers 7, N. Komen 8, C. Remue 9, P. Roelandt 2, M. Somers 1, M. Surmont 10, D. Van de Putte 11, S. Van den Broeck 8, C. Van Kemseke 12, D. De Looze 13
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Affiliations:
(1) Department of Gastroenterology & Hepatology, University Hospital Antwerp, Belgium
(2) Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
(3) Department of Gastroenterology & Hepatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
(4) Department of Gastroenterology and Hepatology, Maria Middelares Hospital, Ghent, Belgium
(5) Department of Abdominal Surgery, University Hospital Brussels, Brussels, Belgium
(6) Department of Gastroenterology and Hepatology, Noorderhart Hospital, Overpelt, Belgium
(7) Department of Abdominal Surgery, Heilig Hart Leuven Hospital, Leuven, Belgium
(8) Department of Abdominal Surgery, University Hospital Antwerp, Antwerp, Belgium
(9) Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
(10) Department of Gastroenterology and Hepatology, University Hospital Brussels, Brussels, Belgium
(11) Department of Abdominal Surgery, University Hospital Ghent, Ghent, Belgium
(12) Department of Gastroenterology and Hepatology, University Hospital Liege, Liege, Belgium
(13) Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium

Introduction: Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking.

Methods: A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020.

Results: Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids.

Conclusions: The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.

Keywords: bleeding, external hemorrhoids, hemorrhoidal disease, internal hemorrhoids, prolapse, thrombosis.

© Acta Gastro-Enterologica Belgica.
PMID 33639701