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Thrombosed external hemorrhoids during pregnancy: surgery versus conservative treatment

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Abstract

The management of thrombosed external hemorrhoids (TEH) during pregnancy is still under debate because of the fear of potential adverse effects on the fetus. This study aims to compare efficacy and safety of conservative versus surgical treatment of acute TEH in pregnant women. Furthermore, the outcome of two different surgical approaches was evaluated. This is a prospective observational study including a sub-analysis on two randomized groups of pregnant women affected by TEH. The primary outcome measured was the impact of conservative and surgical treatment defined in terms of VAS, clinical patient grading assessment scale (CPGAS) and the SF-12 questionnaire. In a randomized sub-analysis of the surgical treatment, the outcome of local excision (LE) versus thrombectomy (TE) was compared. Fifty-three patients entered the study. Twenty-six patients had conservative treatment and 22 underwent surgery. Within the surgical group, 8 were randomized for TE and 14 for LE. VAS, SF-12 and CPGAS improved in both groups after 3 and 10 days from the treatment. However, physical (PCS) and mental health (MCS) domains of the SF-12 and CPGAS showed a significant difference in favor of surgery on the 10th day (PCS: p < 0.002 and MCS: p = 0.03; CPGAS: p = 0.002). The surgical group showed an earlier significant reduction of pain on the 3rd day (p = 0.0004). In the surgical group, randomization was halted due to ethical concerns arising from a notable difference in the primary end point between subgroups during interim analysis. Specifically, the re-thrombosis rate was 38% (3/8) after TE and 7% (1/14) after LE. No complications occurred for either mothers or fetuses. Both surgical and conservative treatments are safe and effective. However, surgery allows a faster relief of anal pain. Thrombectomy is associated with higher risk of re-thrombosis when compared to local excision (clinicaltrials.gov ID number NCT04588467).

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Abbreviations

TEH:

Thrombosis of the external hemorrhoids

TE:

Thrombectomy

LE:

Local excision

QoL:

Quality of life

CPGAS:

Clinical Patient Grading Assessment Scale

IQR:

Interquartile ranges

VAS:

Visual analog scale

PCS:

Physical component summary

MCS:

Mental component summary

References

  1. Mirhaidari SJ, Porter JA, Slezak FA (2016) Thrombosed external hemorrhoids in pregnancy: a retrospective review of outcomes. Int J Colorectal Dis 31(8):1557–1559

    Article  PubMed  Google Scholar 

  2. Picciariello A et al (2022) Management and treatment of external hemorrhoidal thrombosis. Front Surg 9:898850

    Article  PubMed  PubMed Central  Google Scholar 

  3. Poskus T et al (2014) Haemorrhoids and anal fissures during pregnancy and after childbirth: a prospective cohort study. BJOG 121(13):1666–1671

    Article  CAS  PubMed  Google Scholar 

  4. Gallo G, Sacco R, Sammarco G (2018) Epidemiology of hemorrhoidal disease. In: Ratto C, Parello A, Litta F (eds) Hemorrhoids. Springer International Publishing, Cham, pp 3–7

    Chapter  Google Scholar 

  5. Buzinskiene D, Sabonyte-Balsaitiene Z, Poskus T (2022) Perianal diseases in pregnancy and after childbirth: frequency, risk factors, impact on women’s quality of life and treatment methods. Front Surg 9:788823

    Article  PubMed  PubMed Central  Google Scholar 

  6. Picciariello A et al (2021) Classifications and clinical assessment of haemorrhoids: the proctologist’s corner. Rev Recent Clin Trials 16(1):10–16

    PubMed  Google Scholar 

  7. Gallo G et al (2018) Efficacy of mesoglycan in pain control after excisional hemorrhoidectomy: a pilot comparative prospective multicenter study. Gastroenterol Res Pract 2018:6423895

    Article  PubMed  PubMed Central  Google Scholar 

  8. Medich DS, Fazio VW (1995) Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Surg Clin North Am 75(1):77–88

    Article  CAS  PubMed  Google Scholar 

  9. Greenspon J et al (2004) Thrombosed external hemorrhoids: outcome after conservative or surgical management. Dis Colon Rectum 47(9):1493–1498

    Article  PubMed  Google Scholar 

  10. van Tol RR et al (2020) European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis 22(6):650–662

    Article  PubMed  Google Scholar 

  11. Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    Article  PubMed  Google Scholar 

  12. Picciariello A et al (2019) Post-operative clinical, manometric, and defecographic findings in patients undergoing unsuccessful STARR operation for obstructed defecation. Int J Colorectal Dis 34(5):837–842

    Article  CAS  PubMed  Google Scholar 

  13. Heckert J et al (2016) Gastric electric stimulation for refractory gastroparesis: a prospective analysis of 151 patients at a single center. Dig Dis Sci 61(1):168–175

    Article  PubMed  Google Scholar 

  14. Abramowitz L, Batallan A (2003) Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum. Gynecol Obstet Fertil 31(6):546–549

    Article  CAS  PubMed  Google Scholar 

  15. Abramowitz L et al (2002) Anal fissure and thrombosed external hemorrhoids before and after delivery. Dis Colon Rectum 45(5):650–655

    Article  PubMed  Google Scholar 

  16. Staroselsky A et al (2008) Hemorrhoids in pregnancy. Can Fam Physician 54(2):189–190

    PubMed  PubMed Central  Google Scholar 

  17. Pata F et al (2021) Anatomy, physiology and pathophysiology of haemorrhoids. Rev Recent Clin Trials 16(1):75–80

    Article  CAS  PubMed  Google Scholar 

  18. Vohra S et al (2009) The effectiveness of Proctofoam-HC for treatment of hemorrhoids in late pregnancy. J Obstet Gynaecol Can 31(7):654–659

    Article  PubMed  Google Scholar 

  19. Ebrahimi N et al (2011) The fetal safety of hydrocortisone-pramoxine (Proctofoam-HC) for the treatment of hemorrhoids in late pregnancy. J Obstet Gynaecol Can 33(2):153–158

    Article  PubMed  Google Scholar 

  20. Dietrich CS 3rd, Hill CC, Hueman M (2008) Surgical diseases presenting in pregnancy. Surg Clin North Am 88(2):403–419

    Article  PubMed  Google Scholar 

  21. Titapant V et al (2001) Trihydroxyethylrutosides in the treatment of hemorrhoids of pregnancy: a double-blind placebo-controlled trial. J Med Assoc Thai 84(10):1395–1400

    CAS  PubMed  Google Scholar 

  22. Wijayanegara H et al (1992) A clinical trial of hydroxyethylrutosides in the treatment of haemorrhoids of pregnancy. J Int Med Res 20(1):54–60

    Article  CAS  PubMed  Google Scholar 

  23. Saleeby RG Jr et al (1991) Hemorrhoidectomy during pregnancy: risk or relief? Dis Colon Rectum 34(3):260–261

    Article  PubMed  Google Scholar 

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Funding

This research is a part of research project “Development of new reconstructive procedures for colorectal and anal canal surgery” assigned to the Clinic of Colorectal and Minimally Invasive Surgery by the Sechenov First Moscow State Medical University.

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Authors and Affiliations

  1. Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia

    Yuliia Medkova, Inna Tulina & Petr Tsarkov

  2. Department of Hearth Rhythm Disorders, Federal State Budget Organization “National Medical Research Center of Cardiology” of the Ministry of Healthcare of the Russian Federation, Moscow, Russia

    Ivan Novikov

  3. Snegirev Clinic of Obstetrics and Gynecology, Sechenov First Moscow State Medical University, Moscow, Russia

    Andrey Nikonov, Anatoliy Ischenko & Leonid Aleksandrov

  4. Department of Precision and Regenerative Medicine and Ionian Area and Inter-Department Research Center for Pelvic Floor Disease (CIRPAP), University “Aldo Moro” of Bari, Piazza G. Cesare, Bari, Italy

    Donato F. Altomare & Agnese Dezi

  5. Department of Experimental Medicine, University of Salento, Lecce, Italy

    Arcangelo Picciariello

Authors
  1. Yuliia Medkova
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  2. Inna Tulina
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  3. Ivan Novikov
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  4. Andrey Nikonov
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  5. Anatoliy Ischenko
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  6. Leonid Aleksandrov
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  7. Donato F. Altomare
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  8. Agnese Dezi
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  9. Arcangelo Picciariello
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  10. Petr Tsarkov
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Correspondence to Arcangelo Picciariello.

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All authors declare no conflict of interest with regard to this work. No off-label or unapproved drugs or products and previously copyrighted materials were used.

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Medkova, Y., Tulina, I., Novikov, I. et al. Thrombosed external hemorrhoids during pregnancy: surgery versus conservative treatment. Updates Surg 76, 539–545 (2024). https://doi.org/10.1007/s13304-023-01741-y

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