Medical and surgical therapy of thrombosed external hemorrhoids

Background and Purpose: Thrombosed external hemorrhoid (TEH) is probably the most frequent anorectal emergency. It causes pain that brings the patient to his/her physician or to the emergency room. Treatment may be medical, but also surgical. The aim of this study was to determine differences between surgical and medical (nonsurgical) therapy of TEH. Patients and Methods: All patients with TEH, who had surgical or nonsurgical treatment in 2005, were examined retrospectively. Surgical therapy: excision in local anesthesia, healing by secondary intention. Nonsurgical therapy: local treatment with steroid ointment and/or analgesics (nonsteroidal antirheumatics). In 2006 and 2007, the patients received a questionnaire, containing questions regarding recurrent disease and operations, actual anorectal symptoms, contentment of the patient with the treatment that was performed for TEH in 2005. Results: In 2005, 142 patients (72 males, 70 females, median age 49 years) were treated for TEH. 86 patients underwent nonsurgical treatment, 56 were operated on. Recurrence: nonsurgical group 14 (12.5%), surgical group three (5.4%). Complication: abscess after operation one (1.8%). Follow up rate and time: nonsurgical group: 63.4%, 22 months, surgical group 73.2%, 16 months. Actual anorectal complaints: after nonsurgical treatment, patients complained more (not significantly) about wet anus, skin tags, bleeding and pain than patients after surgery. More patients from the surgical group would prefer to have the same treatment for TEH again (if necessary) as compared to patients from the nonsurgical group (87,8% vs. 63%). Conclusion: Surgical and nonsurgical treatment for TEH is effective and shows a low recurrence and complication rate. Although patients' contentment with the treatment performed was higher in the surgical group, there were no differences between the groups regarding anorectal complaints at follow up. © 2009 Urban & Vogel.