Literature Review on Outpatient Treatments for Hemorrhoids
The chapter focuses on literature review on outpatient treatments for hemorrhoids, involving medical management, and above all office-based procedures, for symptomatic low-grade internal hemorrhoids according to the Goligher’s classification.
A wide range of options are available, and the choice is based on several aspects that may depend on surgeon preference and experience, equipment availability, patient medical comorbidities, and patient preference. Correction of lifestyle and dietary habits are the initial preventive measures. Conservative approaches are recommended initially for patients with low-grade disease and in particular for pregnant, immunocompromised, in coagulation disorders, cirrhosis, and Crohn’s disease. Medical management for symptomatic hemorrhoids can be distinguished in oral and topical treatment; however, there are no evidence showing their benefit for prevention or long-term treatment of hemorrhoid disease.
Nonoperative treatments are generally done in the office or endoscopy suite, without the need for anesthesia or preparation of the patient and they have the advantage that patients resume normal activities after treatment. These techniques do not have effect on any external hemorrhoid, and rubber band ligation (RBL) is currently the most widespread outpatient treatment. Complications are usually minor with range from 3% to 8%, and banding has the best outcome with first- and second-degree hemorrhoids, with 70–90% success after one treatment.
Other office-based procedures include injection sclerotherapy with a high degree of initial success in decreasing bleeding and pain and infrared photocoagulation, bipolar diathermy, and direct current electrotherapy. All these techniques have success rates inferior to RBL in randomized studies.
Hemorrhoidal artery ligation
Hemorrhoid laser procedure
Rubber band ligation
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