Hemorrhoidal disease: Epidemiological study and analysis of predictive factors for surgical management

Abstract

Introduction

There are very few French studies on hemorrhoidal disease and its management.

Patients and methods

Prospective single-center study from July to December 2021 including 472 patients.

Results

Bleeding, prolapse and pain were the main reasons for consultation. Treatment modalities were medical (44%), ± instrumental (72%), and surgical (17%). After treatment, the bleeding score and prolapse score decreased significantly (P = 0.002 and P ≤ 0.0001, respectively), but improvement was more marked in the surgery group with a better rate of “very good satisfaction” (73% vs. 54%, P = 0.003). Factors associated with likelihood of surgical treatment were: age > 44 years, hypertrophic perianal skin tags, high scores (Bristol > 5, bleeding > 5, prolapse > 2), severe impact on quality of life, smoking and reading during bowel movements. We have developed an online application, which aims to assess the risk of requiring hemorrhoidal surgery.

Conclusion

Less than 20% of patients who present with hemorrhoidal disease require surgical treatment, but it is associated with better effectiveness despite more complex postoperative consequences that sometimes motivate patient refusal. We have highlighted factors associated with surgical management, which can guide the practitioner in their therapeutic choices.