Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3742
Peer-review started: August 14, 2019
First decision: October 14, 2019
Revised: October 21, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: November 26, 2019
Hemorrhoidal disease is the most common anorectal disorder. Hemorrhoids can be classified as external or internal, according to their relation to the dentate line. Generally, low-grade internal hemorrhoids are effectively treated conservatively, by non-operative measures, while high-grade internal hemorrhoids warrant procedural intervention.
This study is in addition to highlighting areas of equipoise that will benefit from future research.
In this study, the authors aimed to determine the application of clinical practice guidelines for the current management of hemorrhoids and colorectal surgeon consensus in Australia and New Zealand.
By using 17 guideline-based hypothetical clinical scenarios, an online survey was distributed to 206 colorectal surgeons in Australia and New Zealand.
Eight-two respondents to 17 guideline-based scenarios, nine reached consensus, of which only 1 disagreed with the guidelines. It was based on low quality evidence for the management of acutely thrombosed external hemorrhoids. There were 8 scenarios which showed community equipoise. These topics were based on low and moderate levels of evidence. And they included the initial management of grade I internal hemorrhoids, grade III internal hemorrhoids when initial management had failed and the patient had recognised risks factors for septic complications. Finally, the decision-making when considering patient preferences, including a prompt return to work, or minimal post-operative pain.
There are many areas of community equipoise which would benefit from further research.