Hemorrhoidectomy: Does Age Make a Difference?

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.