Hemorrhoidectomy: Does Age Make a Difference?

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BACKGROUND: Grade II and III hemorrhoids often require a multimodal approach that may ultimately culminate to surgical resection. Age and overall medical conditioning around the time of diagnosis can often impact the decision.

OBJECTIVE: The objective of this study was to evaluate patients with a diagnosis of symptomatic grade II or grade III hemorrhoids and determine progression to hemorrhoidectomy based on age and the time interval between diagnosis and surgical intervention.

DESIGN: A retrospective cohort study.

SETTINGS: Group practice at a single institution.

PATIENTS: Patients age 18-75 with grade II or grade III internal hemorrhoids between 2015 and 2020 were included. Patients with thrombosed hemorrhoids or surgical contraindications to hemorrhoidectomy were excluded. A total of 961 patients met inclusion criteria for Grade II (n = 442) and III (n = 519) hemorrhoids.

INTERVENTION: Treatments included hemorrhoidectomy, in-office procedures, and/or medical management.

MAIN OUTCOME MEASURES: Baseline demographics, treatment choices and time to hemorrhoidectomy (if applicable) were stratified and analyzed based on hemorrhoid grade (grade II and III) and age groupings that were pre-determined by the authors (18-30, 31-50, and 51-75).

RESULTS: Patients with Grade III vs Grade II hemorrhoids were more likely to choose hemorrhoidectomy as the initial treatment management (27.6% vs 4.1%). Patients in age groups 18-30 and 30-50 were more likely to choose hemorrhoidectomy as the initial treatment management compared to ages 51-75 years old (23.5% and 22% vs 12.8%). In patients who were initially treated with medical management or office-based procedures and then progressed to hemorrhoidectomy, no significant differences in length of time to hemorrhoidectomy were noted based on hemorrhoid grade or age.

LIMITATIONS: Data only looks at age groups and their treatment selection. Personal biases of surgeon and patient may alter results.

CONCLUSION: Our study shows that the younger population tend to seek hemorrhoidectomy first over the older population. See Video Abstract.




Medicine and Health Sciences




Department of Surgery, Fellows and Residents, Department of Surgery Faculty, Department of Surgery Residents, Network Office of Research and Innovation

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