Hemorrhoids pp 471-483 | Cite as

Literature Data on the Hemorrhoidal Disease Management

  • Ronnie MathewEmail author
  • Lionel Chen
  • Mark Wong
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)


Hemorrhoids are very common, with large proportion being asymptomatic and not requiring treatment. Wide variety of management options is available for those requiring or seeking treatment for symptom control. Comprehensive evidence relating to efficacies of multitude of treatment modalities are varied and can be lacking at times, and long-term results are limited. However, results from several meta-analysis and large multicenter randomized controlled trials in recent past could help as a guide in providing a pragmatic management algorithm for various stages of hemorrhoidal disease. The aim of this chapter is to present a comprehensive review of various treatment interventions and related evidence for management of hemorrhoidal disease.

In general, conservative management can be offered to all patients and may be adequate enough for grade I hemorrhoids. Grade II would likely benefit from a course of rubber band ligation (RBL) with the provision for a repeat RBL if required. Failure of treatment/refractory symptoms may justify interventions with hemorrhoidal dearterialization techniques. Grade III and IV hemorrhoids will most likely benefit from conventional excisional hemorrhoidectomy, which despite its main drawback of postoperative pain, has benefits from proven long-term effectiveness and low recurrence rates. Stapled hemorrhoidectomy (SH) may be considered as a possible option in select cases of circumferential prolapsed hemorrhoids. The main benefit of SH is lower postoperative pain but is a less preferred approach due to higher long-term recurrence rate. The newer energy-based excision hemorrhoidal techniques using bipolar and ultrasonic scalpel has equivalent efficacy compared to conventional excisional hemorrhoidectomy; however, increased equipment costs and lack of long-term efficacy data limits their recommendation and widespread adoption.


  1. Ahmad A, Kant R, Gupta A (2013) Comparative analysis of Doppler guided hemorrhoidal artery ligation (DG-HAL) & infrared coagulation (IRC) in management of hemorrhoids. Indian J Surg 75(4):274–277CrossRefPubMedGoogle Scholar
  2. Ala S, Saeedi M, Eshghi F (2008) Topical metronidazole can reduce pain after surgery and pain on defecation in postoperative hemorrhoidectomy. Dis Colon Rectum 51:235–238CrossRefPubMedGoogle Scholar
  3. Alonso-Coello P, Guyatt G, Heels-Ansdell D et al (2005) Laxatives for the treatment of hemorrhoids. Cochrane Database Syst Rev 4:CD004649Google Scholar
  4. Alonso-Coello P, Mills E, Heels-Ansdell D et al (2006a) Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol 101(1):181–188CrossRefPubMedGoogle Scholar
  5. Alonso-Coello P, Zhou Q, Martinez-Zapata MJ et al (2006b) Meta-analysis of flavonoids for the treatment of haemorrhoids. Br J Surg 93:909–920CrossRefPubMedGoogle Scholar
  6. Amoli HA, Notash AY, Shahandashti FJ, Kenari AY, Ashraf H (2011) A randomized, prospective, double-blind, placebo-controlled trial of the effect of topical diltiazem on posthaemorrhoidectomy pain. Color Dis 13:328–332. Scholar
  7. Ba-bai-ke-re MM, Huang HG, Re WN et al (2011) How we can improve patients’ comfort after Milligan-Morgan open haemorrhoidectomy. World J Gastroenterol 17:1448–1456CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bhatti MI, Sajid MS, Baig MK (2016) Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg 40(6):1509–1519CrossRefPubMedGoogle Scholar
  9. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992) Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 35(5):477–481CrossRefPubMedGoogle Scholar
  10. Brown S, Tiernan J, Biggs K et al (2016a) The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess 20:88CrossRefGoogle Scholar
  11. Brown S, Tiernan J, Biggs K, Hind D, Shephard N, Bradburn M, Wailoo A, Alshreef A, Swaby L, Watson A, Radley S, Jones O, Skaife P, Agarwal A, Giordano P, Lamah M, Cartmell M, Davies J, Faiz O, Nugent K, Clarke A, MacDonald A, Conaghan P, Ziprin P, Makhija R (2016b) The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess 20(88):1–150CrossRefPubMedPubMedCentralGoogle Scholar
  12. Buchmann P, Seefeld U (1989) Rubber band ligation for piles can be disastrous in HIV-positive patients. Int J Color Dis 4:57–58CrossRefGoogle Scholar
  13. Carapeti EA, Kamm MA, McDonald PJ (1998) Double-blind randomised controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy. Lancet 351:169–172CrossRefPubMedGoogle Scholar
  14. Cerera N, Liolitsa D, Iype S et al (2012) Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 8:CD004322Google Scholar
  15. Ceulemans R, Creve U, Van Hee R, Martens C, Wuyts FL (2000) Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations. Eur J Surg 166(10):808–812.; discussion 813. Scholar
  16. Chen HL, Woo XB, Cui J, Chen CQ, Peng JS (2014) Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 24:285–289CrossRefPubMedGoogle Scholar
  17. Cheng FC, Shum DW, Ong GB (1981) The treatment of second degree haemorrhoids by injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy: a prospective clinical trial. Aust N Z J Surg 51:458–462. Scholar
  18. Clark CG, Giles GR, Goligher JC (1967) Results of conservative management of internal haemorrhoids. Br Med J 2:12–14CrossRefPubMedPubMedCentralGoogle Scholar
  19. De Nardi P, Capretti G, Corsaro A, Staudacher C (2014) A prospective, randomized trial comparing the short- and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum 57(3):348–353CrossRefPubMedGoogle Scholar
  20. Denoya PI, Fakhoury M, Chang K, Fakhoury J, Bergamaschi R (2013) Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial. Color Dis 15(10):1281–1288CrossRefGoogle Scholar
  21. Dimitroulopoulos D, Tsamakidis K, Xinopoulos D, Karaitianos I, Fotopoulou A, Paraskevas E (2005) Prospective, randomized, controlled, observer-blinded trial of combined infrared photocoagulation and micronized purified flavonoid fraction versus each alone for the treatment of hemorrhoidal disease. Clin Ther 27(6):746–754CrossRefPubMedGoogle Scholar
  22. Elmér SE, Nygren JO, Lenander CE (2013) A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 56(4):484–490CrossRefPubMedGoogle Scholar
  23. Erzurumlu K, Karabulut K, Özbalcı GS, Tarım İA, Lap G, Güngör B (2017) The Whitehead operation procedure: is it a useful technique? Turk J Surg 33(3):190–194CrossRefPubMedPubMedCentralGoogle Scholar
  24. Espinosa DJ (2000) Analytical review of multicenter studies with polycresulene for hemorrhoidal pathologies. Acta Gastroenterol Latinoam 30:177–186PubMedGoogle Scholar
  25. Eu KW, Seow-Choen F, Goh HS (1994) Comparison of emergency and elective haemorrhoidectomy. Br J Surg 81:308–310. Scholar
  26. Ganio E, Altomare DF, Milito G, Gabrielli F, Canuti S (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94:1033–1037. Scholar
  27. Giordano P, Gravante G, Sorge R, Ovens L, Nastro P (2009a) Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 144:266–272CrossRefPubMedGoogle Scholar
  28. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009b) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52(9):1665–1671CrossRefPubMedGoogle Scholar
  29. Gravié JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242(1):29–35CrossRefPubMedPubMedCentralGoogle Scholar
  30. Gupta PJ (2003) Infrared coagulation versus rubber band ligation in early stage hemorrhoids. Braz J Med Biol Res 36(10):1433–1439CrossRefPubMedGoogle Scholar
  31. Ho YH, Buettner PG (2007) Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol 11:135–143CrossRefPubMedGoogle Scholar
  32. Ho YH, Foo CL, Seow-Choen F et al (1995) Prospective randomized controlled trial of a micronized flavonoid fraction to reduce bleeding after haemorrhoidectomy. Br J Surg 82:1034–1035CrossRefPubMedGoogle Scholar
  33. Hoff SD, Bailey HR, Butts DR et al (1994) Ambulatory surgical hemorrhoidectomy – a solution to postoperative urinary retention? Dis Colon Rectum 37(12):1242–1244CrossRefPubMedGoogle Scholar
  34. Ibanez L, Ballarin E, Vidal X et al (2000) Agranulocytosis associated with calcium dobesilate clinical course and risk estimation with the case-control and the case-population approaches. Eur J Clin Pharmacol 56:763–767CrossRefPubMedGoogle Scholar
  35. Iyer VS, Shrier I, Gordon PH (2004) Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 47:1364–1370CrossRefPubMedGoogle Scholar
  36. Jayaraman S, Colquhoun PH, Malthaner RA (2006) Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 4:CD005393Google Scholar
  37. Johanson JF, Sonnenberg A (1990) The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 98(2):380–386CrossRefPubMedGoogle Scholar
  38. Kanellos I, Goulimaris I, Vakalis I et al (2000) Long-term evaluation of sclerotherapy for haemorrhoids. A prospective study. Int J Surg Investig 2:295–298PubMedGoogle Scholar
  39. Karanlik H, Akturk R, Camlica H, Asoglu O (2009) The effect of glyceryl trinitrate ointment on posthemorrhoidectomy pain and wound healing: results of a randomized, double-blind, placebo-controlled study. Dis Colon Rectum 52:280–285. Scholar
  40. Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12:876–878CrossRefPubMedGoogle Scholar
  41. Khubchandani IT (1983) A randomized comparison of single and multiple rubber band ligations. Dis Colon Rectum 26:705–708CrossRefPubMedGoogle Scholar
  42. La Torre F, Nicolai AP (2004) Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical trial. Dis Colon Rectum 47:704–710CrossRefPubMedGoogle Scholar
  43. Lan P, Wu X, Zhou X, Wang J, Zhang L (2006) The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Color Dis 21:172–178CrossRefGoogle Scholar
  44. Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G (2009) Stapled haemorrhoidopexy compared to Milligan–Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Color Dis 24:335–344CrossRefGoogle Scholar
  45. Lee KC, Chen HH, Chung KC, Hu WH, Chang CL, Lin SE et al (2013) Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure™ hemorrhoidectomy for symptomatic hemorrhoids in adults. Int J Surg 11:914–918CrossRefPubMedGoogle Scholar
  46. Lehur PA, Didnée AS, Faucheron JL, Meurette G, Zerbib P, Siproudhis L, Vinson-Bonnet B, Dubois A, Casa C, Hardouin JB, Durand-Zaleski I, LigaLongo Study Group (2016) Cost-effectiveness of new surgical treatments for hemorrhoidal disease: a multicentre randomized controlled trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy. Ann Surg 264:710–716CrossRefPubMedGoogle Scholar
  47. London NJ, Bramley PD, Windle R (1987) Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial. Br Med J (Clin Res Ed) 295:363–364. Scholar
  48. Lumb KJ, Colquhoun PH, Malthaner R, Jayaraman S (2006) Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev 4:CD005393. Scholar
  49. MacRae HM, McLeod RS (1995) Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum 38:687–694CrossRefPubMedGoogle Scholar
  50. Mann CV (2002) Injection sclerotherapy. In: Mann CV (ed) The surgical management of haemorrhoids. Springer, LondonCrossRefGoogle Scholar
  51. Marques CFS, Nahas SC, Nahas CSR, Sobrado CW Jr, Habr-Gama A et al (2006) Early results of the treatment of internal hemorrhoid disease by infrared coagulation and elastic banding: a prospective randomized cross-over trial. Tech Coloproctol 10(4):312–317CrossRefPubMedGoogle Scholar
  52. Mastakov MY, Buettner PG, Ho YH (2008) Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure™ for haemorrhoids. Tech Coloproctol 12:229–239CrossRefPubMedPubMedCentralGoogle Scholar
  53. Menteş BB, Görgül A, Tatlicioğlu E et al (2001) Efficacy of calcium dobesilate in treating acute attacks of hemorrhoidal disease. Dis Colon Rectum 44:1489–1495CrossRefPubMedGoogle Scholar
  54. Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM (2010) Haemorrhoidectomy with Ligasure vs conventional excisional techniques: meta-analysis of randomized controlled trials. Color Dis 12:85–93CrossRefGoogle Scholar
  55. Miller CE, Amaral JF (1994) Harmonic scalpel – pros and cons! Fertil Steril 62:1094–1095CrossRefPubMedGoogle Scholar
  56. Milligan ETC, Naunton Morgan C, Jones LE et al (1937) Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet 2:1119–1124. Scholar
  57. Morandi E, Merlini D, Salvaggio A, Foschi D, Trabucchi E (1999) Prospective study of healing time after hemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection. Dis Colon Rectum 42(9):1140–1144CrossRefPubMedGoogle Scholar
  58. Mukhashavria GA, Qarabaki MA (2011) Circumferential excisional hemorrhoidectomy for extensive acute thrombosis: a 14-year experience. Dis Colon Rectum 54:1162–1169CrossRefPubMedGoogle Scholar
  59. Mushaya CD, Caleo PJ, Bartlett L, Buettner PG, Ho YH (2014) Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol 18:1009–1116CrossRefPubMedGoogle Scholar
  60. Nicholson TJ, Armstrong D (2004) Topical metronidazole (10 percent) decreases posthemorrhoidectomy pain and improves healing. Dis Colon Rectum 47:711–716CrossRefPubMedGoogle Scholar
  61. Nienhuijs S, de Hingh I (2009) Conventional versus LigaSure hemorrhoidectomy for patients with symptomatic hemorrhoids. Cochrane Database Syst Rev 1:CD006761. Scholar
  62. Nienhuijs SW, de Hingh IH (2010) Pain after conventional versus Ligasure haemorrhoidectomy. A meta-analysis. Int J Surg 8:269–273CrossRefPubMedGoogle Scholar
  63. Nisar PJ, Acheson AG, Neal KR, Scholefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47:1837–1845CrossRefPubMedGoogle Scholar
  64. Nyström P-O, Qvist N, Raahave D et al (2010) Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg 97:167–176. Scholar
  65. Poskus T, Buzinskien D, Drasutiene G, Samalavicius NE, Barkus A, Barisauskiene A, Tutkuviene J, Sakalauskaite I, Drasutis J, Jasulaitis A, Jakaitiene A (2014) Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG 121:1666–1672. Scholar
  66. Riss S, Weiser FA, Riss T, Schwameis K, Mittlböck M, Stift A (2011) Haemorrhoids and quality of life. Color Dis 13:e48–e52.–1318.2010.02480.xCrossRefGoogle Scholar
  67. Rowsell M, Bello M, Hemingway DM (2000) Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355:779–781. Scholar
  68. Scaglia M, Delaini GG, Destefano I et al (2001) Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome. Dis Colon Rectum 44:401–404CrossRefPubMedGoogle Scholar
  69. Senapati A, Nicholls RJ (1988) A randomised trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids. Int J Color Dis 3:124–126CrossRefGoogle Scholar
  70. Shafik A (1993) Role of warm-waterbath in anorectal conditions. The “thermosphincteric reflex”. J Clin Gastroenterol 16:304–308CrossRefPubMedGoogle Scholar
  71. Shafik A (2009) Surgical anatomy of hemorrhoids. Surgical treatment of hemorrhoids. Springer, London, pp 7–13CrossRefGoogle Scholar
  72. Shanmugam V, Hakeem A, Campbell KL, Rabindranath KS, Steele RJC, Thaha MA, Loudon MA (2005) Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev 1:CD005034. Scholar
  73. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 95:147–160CrossRefPubMedGoogle Scholar
  74. Simillis C, Thoukididou SN, Slesser AAP, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102:1603–1618CrossRefPubMedGoogle Scholar
  75. Solorio-López S, Palomares-Chacón UR, Guerrero-Tarín JE (2015) Efficacy of metronidazole versus placebo in pain control after hemorrhoidectomy. Results of a controlled clinical trial. Rev Esp Enferm Dig 107:681–685CrossRefPubMedGoogle Scholar
  76. Tan EK, Cornish J, Darzi AW, Papagrigoriadis S, Tekkis PP (2007) Meta-analysis of short-term outcomes of randomized controlled trials of LigaSure™ vs conventional hemorrhoidectomy. Arch Surg 142:1209–1218CrossRefPubMedGoogle Scholar
  77. Tejirian T, Abbas MA (2005) Sitz bath: where is the evidence? Scientific basis of a common practice. Dis Colon Rectum 48:2336–2340CrossRefPubMedGoogle Scholar
  78. Templeton JL, Spence RA, Kennedy TL, Parks TG, Mackenzie G, Hanna WA (1983) Comparison of infrared coagulation and rubber band ligation for first and second degree haemorrhoids: a randomised prospective clinical trial. Br Med J (Clin Res Ed) 286:1387–1389. Scholar
  79. Thaha MA, Campbell KL, Kazmi SA et al (2009) Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut 58:668–678. Scholar
  80. Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62(7):542–552CrossRefPubMedGoogle Scholar
  81. Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892CrossRefPubMedGoogle Scholar
  82. Tjandra JJ, Tan JJY, Lim JF et al (2006) Rectogesic (glyceryltrinitrate 0.2%) ointment relieves symptoms of haemorrhoids associated with high resting anal canal pressures. Color Dis 9:457–463CrossRefGoogle Scholar
  83. Watson AJ, Hudson J, Wood J, Kilonzo M, Brown S, McDonald A, Norrie J, Bruhn H, Cook JA, eTHoS Study Group (2016) Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 388:2375–2385CrossRefPubMedPubMedCentralGoogle Scholar
  84. Watson AJ, Cook J, Hudson J, Kilonzo M, Wood J, Bruhn H, Brown S, Buckley B, Curran F, Jayne D, Loudon M, Rajagopal R, McDonald A, Norrie J (2017) A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: the eTHoS study. Health Technol Assess 21(70):1–224CrossRefPubMedPubMedCentralGoogle Scholar
  85. Wexner SD, Smithy WB, Milsom JW, Dailey TH (1986) The surgical management of anorectal diseases in AIDS and pre-AIDS patients. Dis Colon Rectum 29(11):719–723CrossRefPubMedGoogle Scholar
  86. Wolff BG, Culp CE (1988) The whitehead hemorrhoidectomy. An unjustly maligned procedure. Dis Colon Rectum 31:587–590CrossRefPubMedGoogle Scholar
  87. Yang J, Cui PJ, Han HZ, Tong DN (2013) Meta-analysis of stapled hemorrhoidopexy vs LigaSure™ hemorrhoidectomy. World J Gastroenterol 19:4799–5807CrossRefPubMedPubMedCentralGoogle Scholar
  88. Zapater P, Horga JF, García A (2003) Risk of drug-induced agranulocytosis: the case of calcium dobesilate. Eur J Clin Pharmacol 58:767–772CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgerySingapore General HospitalSingaporeSingapore
  2. 2.Department of General SurgerySingapore General HospitalSingaporeSingapore
  3. 3.Colorectal Clinical AssociatesSingaporeSingapore

Personalised recommendations