Scientific Papers

The Treatment of Haemorrhoids. Guidelines of the Italian Society of Colorectal Surgery (www.SICCR.org)
Authors: Donato F. Altomare, Antonietta Roveran, Giuseppe Pecorella, Fabio Gaj, Ezio Stortini
Source: Dis. Colon Rectum, 2006 May

THE TREATMENT OF HAEMORRHOIDS

Guidelines of the Italian Society of Colorectal Surgery (www.SICCR.org) Donato F Altomare(1), Antonietta Roveran(2), Giuseppe Pecorella(3), Fabio Gaj(4), Ezio Stortini(5).
(1) UCP Bari-Dipart. Emergenza e Trapianti d’organo, Università di Bari, (2) Divisione di Chirurgia d’Urgenza, Osp. Camillo Forlanini, Roma, (3) Università di Catania, (4) Clinica Chirurgica Università di Roma “La Sapienza”, (5) Unità di Coloproctologia di Chianciano

The choice of the best surgical technique must always be based not only on the surgeon’s personal experience but above all on the scientific evidence supporting the superiority of one surgical technique compared with another. The results of surgical treatment of haemorrhoids can be assessed on the basis of its effect on various parameters, namely postoperative pain, time taken to return to normal working and relational activities, hospital stay, the incidence of early and late complications, aesthetic and functional results, the incidence of recurrence and finally, its cost. Thus, any comparison of different techniques must take into account all these factors.

These guidelines aim to offer some therapeutic decision-making support based on the best scientific evidence available at the time; in other words they are to be taken as advisory rather than prescriptive rules. Therefore, they are not static but dynamic, susceptible to continual variations in concomitance with the introduction of new techniques and the accumulation of scientific evidence of their validity. The proposed guidelines are based essentially on close analysis of the international literature carried out by MedLine searches using the keywords: Haemorrhoids in association with haemorrhoidectomy, long term results, Randomized controlled trials, stapler.

The levels of scientific evidence of any therapeutic choice, and hence the degree of recommendation of the given technique, were indicated in 19921 and have already been accepted by various important scientific societies (ASCRS).