The real clinical practice of surgery for hemorrhoidal disease

AIM: to estimate the actual clinical practice of hemorrhoidal disease treatment among Russian doctors.

PATIENTS AND METHODS: the questionnaire with detailed questions on the management of patients with haemorrhoids in the perioperative period was distributed electronically through the ProctoWeb educational project and by the authors from 12.01.2024 to 30.06.2024. The study included responses from coloproctologists or surgeons who perform open hemorrhoidectomy.

RESULTS: seventy-eight responses were obtained and 84.6% of participants were coloproctologists in private (53.8%) or city hospitals (24.4%). More than a half (56.4%) of respondents prescribe preoperative analgesia (Phlebotonics (38.5%), NSAIDs (28.2%) and Metronidazole (12.8%)). Monopolar or bipolar electrocoagulation is most often used for both skin dissection and vascular coagulation with setting of instrument’s power of 20–40 Watt on the COVIDIEN FORCE TRIAD energy platform by a half of participants. The majority (82.0%) don’t use additional coagulation, 64.1% don’t insert a swab into the anal canal after hemorrhoidectomy. 75.6% of respondents routinely prescribe postoperative anesthesia (NSAIDs (98.7%), local anesthetics (60.3%), phlebotonics (53.8%), paracetamol (41.0%)).67.9% of respondents prescribe analgesics according to their own standard regimen, 44.9% of respondents apply a multimodal analgesia. 78.2% of respondents initially prescribe non-opioid drugs prior to prescribing opioids, 19.2% of participants prescribe opioid analgesics as planned postoperative pain management. The indication pain level for prescribing tramadol for more than 40% of respondents is 6–7 points according to VAS, and for most of others — 8 points. Less than 15% of respondents usually prescribe tramadol before the discharge. There were no significant differences in the perioperative management tactics between doctors from private, city and regional hospitals.

CONCLUSION: we have described the actual clinical practice of open hemorrhoidectomy in Russia. Most doctors adhere to current trends in the perioperative management of patients with haemorrhoids, however, some statements still remain controversial regarding the feasibility and safety.

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